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Karen Acott: new practice partner
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In April this year, pharmacist Karen Acott became a partner
at Wallingbrook Health Centre in Chulmleigh, Devon (PJ, 17 April, p463). Five years ago
this would have been inconceivable. However, in recent years, a number
of things have happened to pave the way for her to become a practice
partner.
The turning point, in her view, was the publication of “Pharmacy
in the future”. At the time, she was working as a pharmaceutical
adviser for North Devon Primary Care Trust. “From that day on,
it has been about changing mindsets and perspectives about the roles
of pharmacists,” she says. A local pharmacy forum was created,
GPs became more open to the idea of pharmacists working within practices
on a sessional basis, and a medicines management collaborative in the
PCT was launched.
Chulmleigh is in a rural area of Devon where there are a large number
of dispensing doctors. “In rural areas it is often not viable for
a community pharmacy to operate,” says Mrs Acott. Six years ago,
Chulmleigh had a community pharmacy. But when the pharmacist retired,
a new one could not be found. The GP practice applied for the contract
and was given outline permission. The practice was planning to move to
a new building and decided that the new premises should house an on-site
pharmacy. In the meantime, the practice took over the pharmacy’s
dispensing (it already dispensed some items).
The move to the new health centre happened a year ago but the practice
was unable to recruit a pharmacist. Diana Wielink, one of the GP partners,
explains: “We advertised for a pharmacist but did not get much
interest.” It was not a position that Mrs Acott wanted. “I
didn’t want to become what was effectively a full-time community
pharmacist again. I had a much wider role at the PCT, doing project work
and undertaking reviews,” she explains. “So when one of the
practice partners asked me if I was interested in the job I made an off-the-cuff
remark that I would only come if I was made a partner.” A couple
of weeks later Mrs Acott found herself at a practice meeting discussing
the idea seriously.
Chris Bowman, senior partner, says that being a dispensing practice was
fundamental to the decision. “The initial driver was that we needed
to secure that line of revenue and bringing Karen on board supported
this. But since then it has mushroomed in terms of
potential.” He adds: “The reason for having Karen as a partner,
as opposed to a salaried employee, is that you only get drive and
enthusiasm for change when you are in the partnership. Getting this commitment
to the practice and sharing risk is key.” Dr Wielink adds: “If
you give someone this sort of
responsibility then you should acknowledge those skills and make them
a partner.” All the partners were in agreement.
“When they said ‘yes’ I was surprised,” says
Mrs Acott. “Having
a pharmacist partner is a big risk; if they had another GP it would bring
in money from the NHS that they do not get for a pharmacist. But they
felt that this short-term loss would be worth it for the longer-term
benefits.” In fact, the practice is already seeing financial benefit,
not only around medicines but also because Mrs Acott has taken on some
of the GPs’ workload,
reducing the need for the practice to employ additional GPs.
Becoming a partner was also a risk for Mrs Acott. “It was something
I had to consider
seriously. It is a long-term commitment both in joining a group of people
and in making a financial commitment. So I had to take legal advice and
speak to an accountant because as a partner you are self-employed; you
buy into your share of the partnership,” she says. “Now I
think about the greater good of the partnership, something I would not
be focusing on as an employed pharmacist,” she explains. And being
a partner gives her equal weight with the GPs in decision-making.
Roles and responsibilities
Mrs Acott’s roles can be divided into three: dispensary roles,
medicines management and clinical roles.
Her role in the practice dispensary is to ensure that it is run in a
cost-effective way and according to best practice. “I am in the
process of introducing standard operating procedures and the three technicians
will be going on a technician checking course,” she explains. The
dispensary not only supplies medicines for the 6,000 patients at the
practice but also for two other local surgeries. Before Mrs Acott started,
each prescription was checked by one of the doctors before it was given
out, something that they continue to do outside the hours that she works.
In terms of medicines management, Mrs Acott advises the practice on prescribing.
She has also started to run medication review clinics although the practice
is still fine-tuning how patients will be identified for these reviews.
Mrs Acott’s clinical work is the area that will expand most in
the future. She is currently training to be a supplementary prescriber
and expects to start prescribing in the autumn. This will be used in
chronic disease management clinics, initially for patients with epilepsy
and diabetes. A clinical role she
already has is reviewing discharge letters sent from hospitals, checking
the patients’ medication and updating their records.
“It is early days but Karen has already made a huge impact, particularly
through taking on the dispensing burden, medicines management, providing
medicines advice to patients and tackling repeat prescribing,” says
Dr Wielink.
Practice nurse Angela Kirkam says that all the nurses at the practice
have welcomed Mrs Acott’s arrival: “She is a good source
of
information for us and for patients, particularly around OTC medicines
and the North Devon formulary. She is also extremely
approachable and has fitted in well.”
What of the future? Initially, the practice hopes to open a non-contract
pharmacy to allow the sale of over-the-counter medicines. It would only
be open in the morning so that Mrs Acott would be free for her other
roles the rest of the time. “I do not want to be tied to a dispensary
bench but at the same time want to introduce self-care to the local population,” she
says. The practice also hopes to take advantage of all the new contracts:
the new GP contract, personal medical services, local pharmaceutical
services and the new pharmacy contract. Mrs Acott would like to see PMS
and LPS linked together to enable greater integration between GP surgeries
and pharmacists. The practice particularly hopes that Mrs Acott will
develop a consultancy role through which she could be contracted to provide
medicines management advice to other practices. Dr Bowman also points
out that the practice’s approach fits in with the current NHS focus
on
plurality of providers.
To a certain extent, they are all feeling their way. The practice is
in a unique position and exactly what Mrs Acott’s roles will be
has yet to be determined. “I believe there is a
future for pharmacists. But we have to be confident in charting our own
territory,
challenging existing boundaries and trying things out,” she says. “I
hope to be able to demonstrate the value of my role so that it does not
have to rely on just dispensing.” What she achieves could become
a future model for pharmacy in rural areas. |
The
Pharmaceutical Journal