Case study: Joy Gailer practice support pharmacist model
What motivated you to start a pharmacist support clinic in general practice?
I was motivated knowing that skilled pharmacists could offer so much more in terms of patient care alongside general practitioners. It can be a harmonious collaboration improving outcomes for patients and mutual learning for everyone. I had given the model a lot of thought and was lucky enough to come across like-minded individuals at the practice who made it happen.
The GPs at Chandler’s Hill wanted a pharmacist available to provide therapeutic support on the spot, similar to what is provided in the hospitals whereby pharmacists are part of the team and seen as integral in patient care. That is the model we are endeavouring to implement.
It’s an open door policy, where by the practice GPs, registrars, medical students and nurses can ask therapeutic related queries. The GPs also book patients in to see me for a consultation regarding their drug therapy and/or chronic condition.
The practice saw that engaging with a practice consultant pharmacist is a great quality improvement and quality assurance measure to put in place for the practice. I play a role in clinical governance around the quality use of medicines, helping to identify areas in which a clinical audit or review of practice may be worthwhile.
What services do you provide?
The practice support pharmacist model is still very much in its evolution stage.
I currently provide three sessions of four hours each month. It is anticipated that this will increase as demand for the service increases.
The appointments with patients are typically 45 minutes to 1 hour long.
The consultations are usually regarding a specific reason or condition, such as the management of and/or patient education about chronic pain or a complex cardiac condition, or to encourage a better understanding of a particular medicine which might have changed or medication regimen which might be quite complex.
The consultation might also be a follow up to a Home Medicine Review, with the GP seeking advice about changes that have been implemented.
I liaise with the relevant community pharmacist too and they know what has been discussed with the patient and can reinforce those conversations. By being onsite and having access to the full patient record, I am able to make informed, real time decisions with the GPs and patients regarding therapy. This helps to ensure a meaningful patient centred approach to care.
I also contribute to the practice’s weekly newsletter by writing a piece on a relevant therapeutic topic (often one where there may be debate or controversy), to provide a quick evidence-based update for the practice. I participate in and at times present at the practice clinical meetings and at times the partner meetings.
What would you say is critical to the success of the clinic?
The GPs in the practice identified the need for the service and what it could offer their patients. They really had an understanding of what pharmacy can offer a practice in terms of collaboration. The pharmacist needs to be able to walk in the shoes of a GP and understand what they face in their working day.
The role is unsupervised and un-mentored so if the pharmacist has experience across all/many aspects of pharmacotherapy it helps. They also should have a good understanding of general practice and a level of experience in understanding a patient’s perspective.
Being on site, within the practice, is critical to the success of the service. By being present it generates queries that would otherwise go unanswered. When I am there with an open door, I am an available resource and can answer those queries. Having access to the full patient record is a great advantage.
Excellent communication skills (written and verbal) with all practice staff, patients and their carers, allied health practitioners and medical specialists is a must.
All of these skills and insights take time to develop and attain, and I think are essential for the credibility and success of the service.
What advice would you give to other pharmacists considering a role like this?
It’s very exciting what is happening in general practice. This is just one area that is receiving the attention that it needs because it benefits the patients. I feel it is necessary to break down the silos and misunderstandings that can exist between the GP and pharmacist. We should have trusting and respectful relationships.
In this model, the GPs are handing over their patients to us. I honour and respect that. Having said that, I am proactive in my suggestions for the patients. This is an exciting model and setting the base standards and expectations is very important.