Structured Support for Clinical Pharmacists

Case Study of a PCN Soar Beyond has been commissioned directly by to support with Pharmacist.

Situation: Three practices in Didcot joined to form Didcot Primary Care Network with a patient population of over 43,000. Despite the practices being local to each other, each practice had different population needs. Although they had good informal relationships, they had no previous experience of working together in an organised way.

The practices all had:

• similar issues regarding workload and capacity
• a good mix of healthcare professionals and a desire to work closely to make the PCN structure successful for their staff and patients
• a clear rationale for investing in a pharmacist with the funding available; however,
  • none of the practices had any previous experience of working with a pharmacist other than CCG practice-based pharmacists
  • there were concerns that the PCN’s lack of experience and knowledge of background, skills, and training of a clinical pharmacist could lead to common pitfalls they were hearing from other PCNs and they didn’t want to recruit the wrong candidate for their PCN needs.

Task: The PCN needed to recruit and employ an effective pharmacist who could hit the ground running and start prescribing, running medication reviews, and delivering the income generation and clinical requirements of the directed enhanced service in an equitable way across the three practices. PCN staff sought external expertise from Soar Beyond, to accelerate the process and guide them.

Action: Soar Beyond ran a facilitated diagnostic session in July 2019 with participation across the three practices. This session helped staff to:

• understand what the practice pharmacist can do and how they would add value
• collate the needs of the individual and collective practices, and manage practice expectations
• identify the specific skillset of the clinical pharmacist they wanted to recruit. Staff decided that the candidate needed the leadership skills to work autonomously so that they would require less intensive support.

The PCN therefore sought a more senior pharmacist with an existing independent prescriber qualification and relevant experience to support and drive the PCN agenda, even though this would require additional ‘top-up funding’ by the practices. Staff outsourced the recruitment and support to Soar Beyond to ensure they would find the right candidate.

Soar Beyond supported the practice by:

• advertising to attract a clinical pharmacist with the right skillset, as well as screening and testing candidates for fit with the defined criteria
• designing and leading a rigorous needs-based interview with GP participation
• helping the PCN to sell the role to potential pharmacist candidates
• supporting the PCN to employ and agree suitable terms and conditions.

Result: After a thorough screening and interview process, a suitably experienced candidate was interviewed in September 2019 with an offer made to start work in January 2020. The delay in start date was due to a lengthy notice period, which is typical for skilled professionals—something that should be considered when beginning recruitment.

The benefits for the PCN, practices, and pharmacist included:

• clarity of expectations and deliverables among practice staff
• a clear and structured 90-day induction plan with agreed KPIs aligned to the PCN’s needs and priorities, such as streamlining the repeat prescribing process across practices
• a structured development plan aligned to PCN’s goals and to the pharmacist’s existing competencies
• a supported pharmacist, without the practice being overburdened, who is well placed to upskill the remainder of the clinical and non-clinical team members
• access to the Soar Beyond SMART platform, which includes a suite of online resource, toolkits, and other implementation resources to enable the pharmacists to roll out new processes efficiently and effectively, without having to ’reinvent the wheel’.

The PCN has commissioned additional senior pharmacist support from Soar Beyond to provide regular coaching calls to ensure development and progress is kept on track through KPI reporting and deployment of milestones.

Conclusion: Although the whole process took 6 months, this was accelerated using external support and expertise, and prevented Didcot PCN encountering common pitfalls experienced by other PCNs, such as taking on inadequately experienced pharmacists or those that require significant support and supervision.

• ‘Working through the recruitment and induction process with the support of Soar Beyond has been strategically invaluable in terms of aligning my vision and values with those of the PCN Clinical Director and member practices. In my experience so far, this very alignment is crucial in effectively delivering the PCN Pharmacist role at scale.’ Ziad A Laklouk; PCN Pharmacist, Didcot PCN

Summary

• Practice overwhelmed with prescription burden
• Unmanageable workload -> no GP capacity to support pharmacists
• Understood their own limitation and sought support from Soar Beyond
• With support from a senior pharmacist and the SMART platform the practice has achieved a 50% reduction in prescription workload

Situation

Practice based in North London (11,000 list size) faced similar problems to many -workforce crisis, with the lack of GPs and nurses, and an increase in workload due to the growing demands of the population. The practice was overwhelmed with the prescription workload and decided to take on and eventually increase the pharmacist capacity within the practice to manage this. The practice went from 0.8 WTE to 2 (made up of three pharmacists) and although the process was refined, and the pharmacists led on the prescription process the workload was still unmanageable. The GPs recognised there was a mix of capability and competence between the pharmacists, and a lack of capacity from themselves to provide adequate support to train and upskill the pharmacists. There was also a sense of the pharmacists taking too long – ‘GPs used to do this much faster’ creating anxiety and dissatisfaction within the team. The practice commissioned Soar Beyond to provide them with support and structure through the SMART platform and additional supervision support through a senior Soar Beyond pharmacist.

TASK:   

Review individual pharmacist competence and create a development plan for each of them in line with the practice needs.

Review prescription process and implement systematic change across the practice to improve workload

ACTION:

1. Base line competency assessment completed for each pharmacist focused on practice needs around prescription management
2. Detailed plan created to address prescription workload through a system review with the SMART 4D repeat prescribing toolkit
3. Incorporated proactive medication review and QOF reviews to process to identify patients who would be suitable for eRD
4. Clarity of roles and accountabilities across the practice for each step of the prescribing process
5. Half day support through a senior pharmacist to support and mentor the pharmacists and to provide a focused checkpoint on progress on development plans and prescribing process

RESULT:

• All pharmacists are clear on their deliverables for the practice with a clear development plan in place
• Standardised process implemented across the practice to manage the repeat prescribing process which included clarity of roles across the practice for each step of the process.
• All the pharmacists feel supported and valued due to the impact they have made on the prescribing process

The coordinated approach of developing the pharmacists and empowering them to take on the repeat prescribing process with a dedicated approach to medication review has led to a 50% reduction in prescription workload

“Soar Beyond have been providing senior pharmacist support for the past 18 months here at Honeypot, supporting the pharmacists with development planning and providing structure to the repeat prescribing process through the SMART platform. This has really helped us during the COVID crisis, as we have further monitored and refined the repeat prescribing process creating a rapid response to switching to eRD which is showing from initial figures to have reduced our prescription workload by 50%.”

Ksharma Katkaria Clinical Pharmacist Honey Pot Surgery