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Supporting pharmacists in general practice

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The recent announcement from NHS England of a pilot project that will part fund the cost of employing clinical pharmacists in GP surgeries for 3 years1 has been welcomed by the professional bodies that represent pharmacists and doctors.2,3 It is part of a plan developed with the British Medical Association to alleviate GP workload pressures and make general practice a more attractive career.3 The Royal Pharmaceutical Society believes that patients in primary care should have the benefit of a pharmacist's clinical expertise similar to that currently experienced by patients in hospital.2 Interest in developing similar schemes has been expressed by other devolved health administrations.3,4

Projects to pilot the role of GP practice-based pharmacists are not new, and initiatives to embed pharmacists in GP practices date back to the 1990s. Over the years, Family Health Services Authorities, Health Authorities, Primary Care Groups and Trusts, Clinical Commissioning Groups, and Local and Regional Health Boards have developed and tested schemes to increase the number of pharmacists working in GP practices. An early proof-of-concept study assessed the effectiveness of pharmacist-led medication reviews in general practice5 and a recent systematic review highlighted pharmacist-led improvements in areas of chronic disease management and use of medicines.6 There are plenty of examples of the work that pharmacists do to improve patient care,2 but often such schemes are based on short-term funding. In some parts of the country innovative and forward-looking GP surgeries have seen the benefit and employed pharmacists directly. In other places funding has come from local NHS commissioners. However, many practice-based pharmacists work in isolation and lack a robust network for clinical supervision and peer support. Unlike hospital pharmacy that has a long-established infrastructure that trains, develops and provides clinical leadership, there is no nationally recognised career or development pathway for practice-based pharmacists.

Learning from previous initiatives of joint working should help to bypass some of the more obvious problems and pitfalls. Potential barriers to successful joint working relate to developing professional relationships, mutual trust and respect, and lack of understanding of the role of the pharmacist.7 Other, less relevant concerns have been expressed by those who believe that the project's funding should have been targeted to develop the role for community pharmacy. At a time of austerity and shrinking balance sheets in primary care, expecting practices to part fund these pilots will prove challenging, and unless the evaluation clearly demonstrates increased capacity in addition to improved patient care, the roles will disappear once the funds have been exhausted. However, the key challenge may be as much about developing and sustaining the workforce as it is about the availability of long-term funding.

What is encouraging about the pilot project from NHS England is the inclusion of a mentoring and leadership role alongside funding for a development programme for clinical pharmacists and some organisational development for GP practices. This latest initiative may go some way to break down real and perceived barriers that have often separated these two professions and allow pharmacists to further demonstrate the benefits they can bring to general practice. It remains to be seen whether this initiative will be enough to develop a sustainable model of clinical pharmacy that has taken several decades to evolve in hospital pharmacy. Three years may not be long enough.