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Mohammed Ahmed: helping to meet the 24-hour access
target
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Better access to health professionals is a key target in the NHS Plan.
All patients should be able to see a primary care health professional
within 24 hours and a GP within 48 hours. To help meet this 24-hour target,
and to ease the burden on GPs, a new training programme has been designed
so that other health professionals can develop the necessary skills to
become the first point of contact for patients.
The “First Contact Care” programme is being offered by the
NHS University. It leads to either a postgraduate diploma or a masters
(MSc) degree, depending on the number of modules undertaken. The course
covers how to assess and diagnosis a patient, and how to plan subsequent
treatment. This includes
referral to another professional, advising on self-care or discharging
the patient.
Pilot programmes began in September 2003 and in January 2004, with the
programme now being rolled out. So far, 146 health professionals are
taking the course in nine centres across England. Of these, three are
pharmacists. A further eight centres have recently been added; numbers
of students on these new courses have yet to be confirmed.
Pharmacists in training
In Doncaster, two pharmacists are among the first health professionals
to undertake the First Contact Care training programme. They are Mohammed
Ahmed, a primary care pharmacist employed by Doncaster West Primary
Care Trust, who works at a number of GP practices in the area, and
community pharmacist Jonathan McGill, who is an independent contractor
in Doncaster Central PCT.
Mr McGill attended a training session held by Doncaster Central PCT
at which the course was discussed. “I thought it sounded interesting
and patient-focused. I have worked in community pharmacy since I qualified
and have always enjoyed the patient contact. This was the first course
that really seemed to expand on that,” he comments. After hearing
about the course, Mr Ahmed approached Doncaster West PCT and asked if
it would put him on the course.
Students study at their own pace. On average, the diploma course takes
two years to complete and the MSc is a further year on top. But it is
possible to get credit for prior learning for up to half of the course
content. The diploma involves four modules. The first is about developing
self-awareness including recognising one’s limitations and reflecting
on practice. The second module covers the use and management of knowledge.
In module three, consultation skills and the practice of First Contact
care is covered. And module four is about demonstrating competence in
First Contact consultations. “It is in module four that we carry
out live consultations on our own, which are videoed and then
assessed,” explains Mr Ahmed. The MSc
involves two further modules on managing research and project management.
Some of the training involves structured day courses organised by the
local learning manager at the PCT. These cover the theoretical parts
of the course, including topics such as communication skills, anatomy,
research skills and consultation skills. Both pharmacists also have to
study in their own time. Mr Ahmed’s employer — the PCT — allows
him to set aside one day a week for the training. “It would have
been difficult if this day wasn’t available,” he says. Mr
McGill has to pay for a locum to cover his training time. But he believes
that the professional gain outweighs this cost. “It is something
that I really enjoy doing, although I know that financial gain is unlikely,” he
says.
It is in diagnosis that pharmacists tend to have less experience than
other health professionals. “The course arms you with a lot more
knowledge about conditions than you learn on the pharmacy degree course.
For example, you learn how to listen to chest sounds, what the noises
mean and when you need to refer,” says Mr McGill.
Both pharmacists have GP mentors. “The theory plays an important
part but the biggest element of the course is the practical experience
with your mentor,” explains Mr Ahmed. “All the practice GPs
call me to their consultations if they have a patient with an unusual
presentation or classic symptoms to help me learn the diagnosis side,” he
comments. Using the new skills
Being among the first professionals to qualify as First Contact practitioners,
it is not surprising that how the pharmacists will use their new skills
is still to be determined.
The concept obviously lends itself to out-of-hours service provision,
and both pharmacists see a role here. Mr McGill comments that since the
introduction of the new GP contract, the PCT has taken over the provision
of out-of-hours services, so there is an opportunity for it to make use
of First Contact practitioners. Mr Ahmed suggests: “First Contact
practitioners could have independent status with individual contracts
with the PCT such as for out-of-hours services.” But without independent
prescribing status this would be difficult.
Plenty of other opportunities exist. Many pharmacists working in GP surgeries
already offer medication reviews and some provide clinics for chronic
conditions. Now, as First Contact practitioners, they can manage acute
conditions, too. “Doncaster West PCT is short of eight GPs so it
could either send a First Contact practitioner to a particular practice
on a daily basis or it could suggest taking over the role of a GP at
one practice,” Mr Ahmed says. This second example would require
some input from a GP but not a full-time position.
First Contact practitioners could play a key role in the community, too. “My
pharmacy is quite a distance from a doctors’ surgery so I felt
that there was a strong argument for finding ways to improve access to
services,” says Mr McGill. The PCT agreed. “One of the problems
with centralising services at big health centres is that access is reduced.
So there is a need for pharmacies in local communities,” he explains.
A possibility he is
exploring is setting up a mini walk-in centre next to the pharmacy in
which he could work as a First Contact practitioner. “The PCT is
supportive of this idea not just because of the distance from the nearest
surgery but also because it is a deprived area.”
How the role will develop will partly depend on the prescribing status
of the practitioners. Mr Ahmed is already a supplementary prescriber
but his hope for the First Contact role is for independent prescribing
rights. At the moment, the choices for pharmacist First Contact practitioners
are to recommend OTC medicines, to use a patient group
direction or to ask a GP to sign a prescription for them. All are limiting
compared with
independent prescribing status.
As has been said for so many extended roles, community pharmacists who
train as First Contact practitioners will be held back if they do not
have access to patients’ medical records. If this and independent
prescribing status are granted then pharmacists will be able to contribute
significantly to the 24-hour access targets.
Further information is available on the NHS University website (www.nhsu.nhs.uk). |
The
Pharmaceutical Journal