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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR79

Pharmacists shadowing GPs and practice members

By Sivashanthi Balachandran and Imogen Savage*

Introduction Patients, doctors, pharmacists and the health authority could all benefit from the provision of prescribing advice by a community pharmacist.1 Outcomes include cheaper therapeutic equivalents, increased use of generic medication, and reduced risk of adverse drug reactions and interactions. However, pharmacists who are not normally able to leave their pharmacies during business hours may think they cannot take on this type of work.
This study, which was funded by Enfield and Haringey local pharmaceutical committee, gave community pharmacists the chance to visit their local surgery and shadow the general practitioner and other members of the practice. The main aims were:

  • To provide a greater insight into the operational aspects of a general medical practice
  • To help pharmacists understand the steps leading to treatment decisions
  • To allow pharmacists to see how collaborative working could benefit patients

Method Fourteen pharmacists and nine GPs took part in the project. Each pharmacist spent a minimum of half to one full day at the surgery, sitting in on consultations (with the patient's consent) and spending time with the receptionist, practice manager and the practice nurse. To evaluate the scheme, semi-structured face-to-face or telephone interviews were conducted with the participants, before and after each visit to the practice. Pharmacists and GPs were questioned on the visit and were asked to comment on the extended role of the pharmacist.

Focal points

  • By shadowing the GPs, the pharmacists were now made more aware of the diagnostic procedures and the detailed steps involved in making treatment decisions
  • Eighty-six per cent of the pharmacists learned of the many other facilities available to the patient through the practice
  • The pharmacists identified areas where they could help nurses, receptionists and the GPs to ensure a smoother delivery of quality care to the patients
  • Both pharmacists and the GPs felt that the study would contribute to improving their existing communication level

Results and discussion The pharmacists identified the following specific opportunities after their visit:

During practice visits, the pharmacists witnessed extensive patient consultations and observed the large number of referrals that GPs made. Eighty-six per cent had discussed prescribing with the GP, and 71 per cent felt that they were more aware of the decision-making process. Eighty-six per cent of the pharmacists were made more aware of the facilities the surgery provided. This allowed them to help patients gain access to specialist services.
The vast majority of pharmacists (79 per cent) and all but one GP welcomed pharmacists' involvement in reporting serious adverse drug reactions to GPs.
All the pharmacists were very keen to provide screening services and other extended roles. Eight of the nine GPs felt the same.
Both pharmacists and GPs believed that there should be protocols/guidelines on when to refer patients to GPs, and the kind of advice to give.
The GPs and the pharmacists both felt that the study would contribute to improving their existing communication level, thereby ensuring better patient care.

Conclusion Both pharmacists and the GP practices benefited from this pilot work-shadowing scheme. The pharmacists identified specific areas where they could help nurses, receptionists and GPs to ensure a smoother delivery of quality care to patients.
The formation of primary care groups emphasises that teamwork is the key factor in the overall success of the patient's well being, with a greater need for collaboration between all health professionals. If pharmacy is to genuinely move forward, more community pharmacists should be given the opportunity to spend time in their local GP practice.
Future research could evaluate the effects of giving quality time to pharmacists and GPs to enable them to discuss practical ways of achieving better integration of pharmacy and GP services.

References

1. Corbett J. The provision of prescribing advice by community pharmacists. Pharm J 1995;255:555-7.