Pharmacists thriving in general practice

GPs, patients and pharmacists are all reporting positive outcomes from a Canberra trial

The Pharmacist within General Practice Pilot Program has been run by Capital Health Network (CHN), the ACT’s primary health network, since February this year.

CHN Chief Executive Gaylene Coulton says the program, which was originally 12 months long, has been extended due to its popularity.

“The feedback received to date has been positive from the GPs, consumers, and certainly from the pharmacists involved in the trial. Based on recommendations from the Project Governance Committee, we are extending it for another 12 months.

“The original plan was to extend the trial to more practices, but instead we are looking to evaluate the pilot over an extended period of time for the current three practices.”

Evaluation will be looking at the viability of the model and the benefits for those involved.

Coulton says CHN is hoping that “through the undertaking of this pilot there will be a well-articulated place for pharmacists within the general practice team”.

One of three pharmacists involved in the program, Anne Develin works within the National Health Co-operative, a “multidisciplinary practice” that has eight clinics across the state.

Develin is enjoying her time as part of the trial, which she is involved with two days a week, spending the rest of her working week in community pharmacy.

“I’m enjoying spending quality time with patients, assisting them with their medications, and providing quality care and specialised services such as smoking cessation,” Develin tells AJP.

“Actually having time with patients allows me to have a conversation to identify any medication problems, such as dosage issues. In a busy pharmacy there’s not always time to identify [these problems]. So that’s been really valuable for the patients and professionally rewarding for myself.

“The key difference is that I have time to spend with [the patients], whereas in community pharmacy, it’s such a busy environment that it’s hard to find the time.”

Develin says that contributing to continuity of care has been a highlight, particularly for older patients on several medicines who have been discharged from hospital.

“Changes to medicines and dosages often occur in hospital, and the transition back to the community can be a time of confusion for the patient and prescribers. Having a pharmacist at hand within general practice assists the prescriber and the dispensing community pharmacist to ensure changes are implemented and any issues identified,” she explains.

GPs and other health professionals within the practice have been “quite supportive”, says Develin, and she has been able to provide education session and coaching on medicines to both doctors and their patients.

There may be something of a “turf war” brewing, with concern that pharmacists in general practice are duplicating the role of community pharmacy.

However Develin is adamant that the two roles can coexist not only harmoniously, but to each other’s benefit.

“During the Pilot there’s been a lot of communication with community pharmacy. I see there’s a great deal of potential for ‘collaborative medication management’ between the two.

“I believe that there is much to be gained by embracing the concept of pharmacists working in general practice – it’s a great opportunity for pharmacist skills to be better utilised across the healthcare settings, which will no doubt benefit patients in the long run,” she says.

Dr Joe Oguns, who also works at the National Health Co-op as a GP, says having Develin as a colleague has enhanced the role of pharmacists within the team.

He says patients have approached him after seeing Develin saying, “I actually now know what this medication is for even though I’ve been on it for years” or, “the pharmacist told me about different options for smoking cessation than I didn’t even know about”.

“As a result of having a pharmacist within the practice, not only are interactions smoother with [Develin] but other pharmacists are also now seen as a key part of the team,” says Dr Oguns.

“The GPs with whom I have worked now better understand the value and skills of the pharmacy profession, be it in community or hospital settings,” Develin adds.

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  1. Debbie Rigby

    Anne makes some good points on the benefits of pharmacists in general practice for patients, GPs and community pharmacists. These comments are based on experience. The greater understanding by GPs and consumers of pharmacists’ knowledge and skills will benefit the profession as a whole.

  2. Sounds promising

  3. Anne Develin

    There are many benefits to having pharmacists working more broadly across the health sector – with a major one being the potential for improving medication adherence for people with chronic health conditions. The stats are quite alarming – some studies showing overall adherence rates at only 50%. The potential to work in general practice alongside community and hospital pharmacy to improve medication & health literacy, and to enhance self-care, are major benefits for patients, and hugely rewarding for health professionals. A great spin-off too is the potential to raise the profile of pharmacy as a profession and community pharmacy as a health destination.

  4. SPG

    It is good to see that GPs and patients are reporting positive outcomes when a pharmacist is able to spend more time with patients. However, this article still raises concerns about the potential for duplication of services if pharmacists were publicly funded to work in GP practices. There is no clear difference between the services mentioned in this article and those that are already and could be provided in a community pharmacy. What is the difference between the services described in this article and a MedsCheck/HMR? The article also mentions counselling for smoking cessation. Furthermore, the PSA still has not provided evidence of the necessity for a pharmacist to be co-located in a GP practice rather than a community pharmacy. On the contrary we contend that it is better for a community pharmacy to take on this role as only a community pharmacy can be involved in all 9 steps of the medication management pathway (as outlined in Stowasser et al. 2004, 294 and endorsed by the PSA). Today’s article in AJP mentions how busy pharmacies are but if community pharmacy had more funding we could employ another pharmacist to further develop these services (that we already perform). Why not use the Pharmacy Trial Program money from 6CPA to trial this in community pharmacies? This would be a great opportunity for pharmacies that are already patient focused to improve health outcomes for patients and strengthen collaboration with local GPs. Please read our submission to the PSA regarding the importance of collaborating with community pharmacy on this issue.

    • Bill

      Re: “if community
      pharmacy had more funding we could employ another pharmacist to further
      develop these services (that we already perform)”…………………….REALLY SPG? You think pharmacy owners would do that? OR would they much rather just off load the extra duties to their already over-worked existing pharmacists, without any additional remuneration, and put the extra funding in the owners pockets.

      My gut feeling tells me that the latter is a more likely scenario, especially that pharmacy profit is on the decline. So to answer your question, NO we don’t need more funding to community pharmacies, they had their chances and failed to perform. Give GPs a chance and pharmacies will just have to put up with it.

      This is a great initiative which means that pharmacist can look for work in medical centers as well, reducing demands to work in community pharmacy, which means that pharmacy owners have to raise pharmacist wages to attract pharmacist to work with them or retain their existing staff.

    • Anne Develin

      Thanks for this SPG – am very interested in your submission. I will leave the political commentary to you and others – just want to point out some of the advantages I have found working as a phst within the practice, which I am sure all are aware: (1) have access to critical information by way of patient’s full medical history/notes/blood test results etc and progress wrt chronic disease management – (2) the time available to have a quality conversation/consultation in a private area with the patient and (3) the ability to liaise in real-time with prescribers and other HCPs – these all combine to make it a lot easier to operate and achieve outcomes. Although these activities are currently possible within some community pharmacies, to some degree, in my experience pharmacists can be time-poor with limited access to patient-relevant information. On the other hand, GP pharmacists may not be fully aware of other matters eg OTC medicines being taken etc, which is why, in an imperfect world, we should work together for the benefit of the patient. Only this morning have I recommended and organised a patient to attend their regular pharmacy for a Medscheck Service, on the basis that the community pharmacist is more familiar with that person’s day-to-day medication care. But this is not always the case. The GP pharmacist is well-place to link-up care, join the dots, assist in co-ordinating services and contribute to strengthening collaboration between all pharmacists and local GPs. We are not wanting to duplicate services and most patients would not tolerate this anyway. I guess the point is that the services are not mutually exclusive – they are complementary and better serve the needs of the community.

      • Drugby

        Anne makes the points raised in many other forums by pharmacists who are working in general practice. Practice pharmacists are filling the gaps in care delivery around medication management. It is not competition, and can only improve medication management for patients, improve understanding by GPs of the knowledge and skills of all pharmacists, and increase collaboration between community pharmacies and GPs. In my experience, having access to the patient’s notes, history and test results is a big bonus. And funding more pharmacists in a community pharmacy who will not have that access is not optimal from a patient outcome viewpoint.
        In addition, some pharmacists will have a special interest and expertise in particular therapeutic areas which will enable them to focus on specific issues or diseases. Anne mentioned smoking cessation as one of her interests.
        In general, GPs have minimal awareness of CPA programs and other services delivered through community pharmacy. Practice pharmacists do know this, and, as Anne has mentioned, can refer and recommend patients towards these services.

      • Karalyn Huxhagen

        my experience is that I am able to provide more support from within the practice than I can from the community phcy hanging off the end of the phone. It is a collaboration-I refer to the appropriate pharmacist for the follow up e.g. regular BP monitoring,DAA, wound care etc. Being the person on the ground with access to the patient notes makes a considerable difference in determining and planning the health pathway for the patient. Like Anne I am respected by my peers and we work in a collaboration. The govt funding model is supposed to be about improved patient outcomes with less barriers to patient care. GPs for the most part welcome the assistance we provide and our knowledge of other programs and services avaialble to the patient.

  5. Tim Hewitt

    I think most would agree that pharmacists can have a positive impact ANYWHERE within the health ‘matrix’..

    Is there any data/research/opinion on how HMR might fit into the community/GP/Pharmacist/ matrix? would GP practices employing (assuming they actually employ) pharmacists be less inclined to then refer patients for HMR ? Should GP practice pharmacists BE HMR accredited?.. I can’t help thinking that whether they set out to or not, GP practice pharmacists will, in effect, be conducting ‘HMR’ even if they are not funded as such.. will a GP therefore, see any need for ‘real’ HMR?.. finally, do we have any idea what sort of money the PHN is paying the trial GP practice pharmacists? (sorry couldn’t help myself..)

    • Anne Develin

      Quick reply Tim – I am not HMR accredited and since the trial started I have discovered patients who could benefit from a HMR, have recommended this to their GP who has gone ahead with this service via the patient’s regular community pharmacy under the current arrangements. This has been a sensible approach, I believe, and allows for the “full HMR” to be conducted within the patient’s home. Once conducted, the practice-based pharmacist is then in a position to follow-up with the GP and patient, and reinforce messages from the community pharmacist, to ensure recommendations are appropriately considered. My experience so far leads me to believe that a GP will not necessarily be less inclined to request a HMR, and could be more inclined and assisted to better target HMRs to where they are most needed..

      • Tim Hewitt

        Anne, that’s encouraging.. but results in three pharmacists now involved in patient care!.. the more the merrier I guess.. lucky patient!

        • Anne Develin

          In many cases the GP pharmacist may not have even seen the patient, but, based on a review of their medical history, is joining the dots by identifying that the patient may benefit from a HMR, This then prompts the GP to engage the surrounding community pharmacies and their services. It is early days and important that GP pharmacists do not confuse patients or complicate care. Building relationships with local pharmacies is a critical part of the role and something I have been acutely aware of, and working on as the role evolves.

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