Pharmacy
Primary care pharmacy in Wales
The pharmacy profession makes a significant and unique contribution to the healthcare of the people of Wales. Pharmacists are experts in medicines and their use. Medicines are used in all care settings and are the most common intervention in healthcare to prevent, treat or manage many illnesses or conditions.
‘Your care, your medicines’ calls for further focus on the role of pharmacy in primary care. There is increasing recognition of the benefits of extended clinical roles for pharmacists and medicines management roles for pharmacy technicians. More recently, there have been significant developments and activity to increase the number of clinical pharmacists working within general practices and primary care clusters, as well as community pharmacists to provide a greater range of clinically-focused services.
Current roles within primary care pharmacy include:
Adapted from: Models of care for pharmacy within primary care clusters (Wales)
Clinical Pharmacists in General Practice and Primary Care Clusters
Clinical pharmacists (Advanced practice pharmacists) contribute to clinical work related to medicines in GP practices. They have in-depth knowledge of diseases and medicines. They can work either in a specialist clinical area or have a more generic role, addressing a range of medicines-related issues within the practices. As part of the GP practice team, clinical pharmacists provide specialist advice for patients particularly the elderly, those taking multiple medicines (polypharmacy), and those with multiple conditions. Through taking responsibility for patients with long-term conditions, clinical pharmacists can free up GPs for other appointments and so help to reduce the numbers of people presenting at A&E departments.
Clinical pharmacists can proactively help identify and manage “at risk” patients in relation to the safe use of their medicines.
They can also support patients to manage their own health, offering support through e.g. advice and social prescribing. Pharmacist independent prescribers have an additional Non-Medical Prescriber (NMP) qualification and may prescribe independently for any condition within their clinical competence.
The Welsh Government’s plan for a primary care service for Wales up to March 2018 clearly sets out the intention to see more pharmacists working in clinical roles in GP practices. Since the launch of the plan there has been a significant increase in the number of pharmacists working in these patient-facing roles.
These posts operate at either GP practice level or at cluster (sometimes known as network) level, depending upon local circumstances, to deal with the many medicines-related issues and problems that arise in primary care.
Practice Based Clinical Pharmacists work as part of the GP practice team, in line with the practices’ priorities. They can release clinical capacity and give improved direction and guidance on prudent evidence based medicine. Usually employed by the GP Practice / health board or a community pharmacist contracted for practice based work.
What can pharmacists in General Practices do?
Cluster Clinical Pharmacists work as part of a multi-disciplinary team across a cluster of GP practices Employed by the Health Board on behalf of the cluster to achieve primary care cluster priorities. May also provide support to the cluster in relation to prescribing trends and analysis depending on cluster priorities.
Community Pharmacists
Community pharmacists are easily accessible with over 700 community pharmacies in Wales located where people live, shop and work. They are highly trained health care professionals whom patients can access without appointment, often in extended hours.
The Community Pharmacy Contractual Framework focuses on the range of services that pharmacists provide for patients within a community. These are divided into three levels; essential, advanced and enhanced.
Essential services e.g. clinically checking and reviewing the appropriateness of prescribed medicines, dispensing medicines, repeat dispensing, signposting, self-care, and advice on medicines.
Advanced services may provide e.g. Medicines Use Reviews (MURs), and Discharge Medicines Reviews (DMRs).
Enhanced services may provide additional services commissioned by the Health Board or GP practice e.g. ‘triage and treat’, common ailments and smoking cessation services.
(Article on community pharmacy under development)
Primary Care Pharmacists / Prescribing Advisors
Work closely with GP practices to the Health Board’s priorities. May provide support to practices and primary care clusters through prescribing data and analysis and facilitation of service development relating to medicines management across all professions. Employed by the Health Board.
Primary Care Pharmacy Technicians
Undertake the technical aspects of medicines management e.g. checking inhaler technique, synchronising medicines, reviewing repeat prescribing and are often involved with prescribing audits within GP Practices. These roles are developing rapidly and in some areas pharmacy technicians are taking on prescribing data analysis roles but would not undertake clinical reviews. Employed by the Health Board.