PJ Online | MM: Practice receptionists given on-the-job training in community pharmacies

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Medicines Management
Issue no 4, p7-9
July/August 2002

Features

Practice receptionists given on-the-job training in community pharmacies

Receptionists are an underused resource when it comes to organising repeat dispensing. Pamela Grant describes how training by community pharmacists can ensure their skills are best used

Pamela Grant is now community pharmacist with Poole PCT Elderly Resource Team

Repeat prescriptions account for around 80 per cent of a GP practice's prescribing budget and yet the task is given low status in many practices. It is often seen as a repetitive task carried out with constant interruption from phones and patients.

Receptionists — who generate repeat prescriptions in most GP practices — currently receive little formal training. They may know how to operate the computer and how to produce the printed document, but they have no training on the pharmaceutical products, which is the ultimate output from the prescription.

This lack of knowledge can mean that the wrong product is chosen from computer drug listings. The wrong product may then be dispensed for the patient, only to be returned to the pharmacy later where it cannot be re-used, resulting in a charge against the practice prescribing budget and a waste of NHS resources.

Furthermore, receptionists, while generating repeat prescriptions, have access to a patient's medication history, which can give important clues to the patient's compliance with therapy. But receptionists currently have insufficient knowledge to be able to interpret such information, and are therefore unable to flag up possible problems to the prescribers, who may not be seeing the patient on a regular basis.

I had the idea of sending practice receptionists for a period of work experience in their local community pharmacy. It was proposed that practice receptionists should be released to work in community pharmacy dispensaries for short training sessions, on a regular basis, over a period of six weeks.

The PCT would fund cover for these posts in the surgeries and would pay the community pharmacists to provide training. There would be an agreed work programme, which would be standardised across all providers.

The receptionists would be assessed at the beginning and end of the course and successful candidates would receive a certificate of achievement that could be part of their personal development plans.

If the scheme were to be successful, there would have to be measurable benefits for all parties involved and these benefits would have to be presented to the management and executive boards of the PCT.

Benefits for the PCT

• Reduction in prescribing costs due to reduced wastage

• Tangible evidence of a commitment to safer work practices in the area of repeat prescribing

(This will be a Commission for Health Improvement requirement.)

• Demonstration of a willingness by the PCT to support the clinical governance agenda in which practices and pharmacies are expected to participate

• Commitment to staff development and training

• Engagement of community pharmacies in the delivery of the health care agenda for the PCT

• Improved relations with patients by demonstrating an ability to adopt innovative practice

Benefits for practices

• Increased job satisfaction for the receptionist thus improving motivation

• Reduction in workload associated with repeat prescribing

(As a result of training, receptionists would be able to adjust quantities to pack size and align quantities on scripts so patients will need to make less frequent visits to the practice.)

• A better level of service for patients (This would be as a direct result of receptionists' increased level of product knowledge, particularly in the area of non-drug prescribing.)

• Safer working practices

(Receptionists would gain an understanding of what is usual, and be able to flag up the unusual; improved product knowledge would enable them to pick out the correct product more quickly and safely.)

• Improved communication and relationships with their local community pharmacy

Benefits for pharmacies

• Improved communication channels with local GP practices in order to share information about patient compliance with medication

• Reduced work load if repeat prescription quantities can be regularised and kept to pack sizes

• An improved perception by patients of the pharmacy working in co-operation with the GP practices as part of the primary health care team

Benefits for patients

• The receptionists' practical knowledge of appliances would result in an improved level of service to patients

• Increased levels of product knowledge

(This would mean that repeat prescriptions would be produced with fewer errors, when choosing products from the computer drug file.)

• Improved communications between pharmacy and practice

(This will lead to faster resolution of problems when prescriptions seem to be "missing".)

• An increased understanding of the difficulties patients may experience with packaging of pharmaceuticals

(This would lead to a more sympathetic approach by practice receptionists to patients.)

Poole PCT practice receptionists dispensary training course

Objectives of the training course

1. To enable a receptionist to be familiar with the physical form of the medicines and appliances for which she/he is commonly generating prescriptions

2. To gain an understanding of the patient's experience in administering a therapy using these medicines and/or appliances.

3. To be able to use two key reference sources available in GP practices.

Course contents

Receptionists would expect to develop an appreciation of the following topics:

• Dispensary layout — product location — stock rotation.

• Generic and brand names for commonly prescribed medicines

• Pack sizes for commonly prescribed medicines

• Usual dosage ranges for commonly prescribed medicines

• Relationship between dosages and quantities supplied on a prescription

• Inadequacies of "as directed" as an instruction for a patient

• Uses of commonly prescribed medicines (basic information only) eg, cardiovascular medicines, respiratory medicines, GI medicines

• Pharmaceutical forms — tablets, capsules, liquids, suppositories, injections, topical creams and ointments, inhaler devices

• Insulins — knowledge of main types — fast acting, longer acting, mixed, etc.

• Diabetic appliances — blood glucose testing, needles, syringes

• Incontinence appliances — what they look like, how they are used

• Stoma appliances and allied products

• Dressings — types and pack sizes

• Monitored dosage systems — what they look like, how they are used, limitations and advantages

• Controlled drugs — what must be on a correctly handwritten prescription for drugs to be lawfully dispensed

• Drug Tariff — how to look up and find any appliance or dressing in the Drug Tariff

• British National Formulary — how to look up and find recommended dosages in the BNF and how to use this book as a source of reference

Qualification gained

There is a simple multiple choice questionnaire on product knowledge pre-course and post-course and a short evaluation form about the usefulness of the training, to be completed four weeks after the end of the course.

A certificate of achievement is issued by the PCT on successful completion of the course.

What the scheme involved

Support for the scheme was canvassed by telephone and personal visits to practice managers, and an evening meeting was held for all community pharmacists in the Poole area of Dorset in December 2001.

Each GP practice was invited to nominate any members of staff who regularly produce repeat prescriptions in the practice. Each pharmacy was invited to participate providing they had a pharmacy manager or regular long-term locum, thus maintaining continuity of contact with the same trainer.

Altogether, 21 GP practice sites, from 22 GP practices, and 21 community pharmacies, out of a total of 32 pharmacies, signed up for the scheme. If possible, each GP practice was linked to the pharmacy which nor-mally dispenses a high proportion of that practice's scripts.

The receptionist would gain a total of 36 hours work experience over a period of six weeks. He or she could choose to attend three two-hour sessions a week or two three-hour sessions. The times were mutually agreed by the practice and the pharmacy. Only one receptionist was permitted to train in any one session.

The training course ran throughout February and March 2002 and participants were visited by a PCT prescribing support technician to deal with any teething problems.

Pharmacists were given an outline syllabus to follow and were given supporting materials on stoma and inc- ontinence appliances and on insulins and their associated appliances.

An attendance register was kept and signed at the end of each training session. This document had to be submitted to qualify for payment.

What did it cost?

Each participating GP practice was paid Ł12.50 per hour to cover the cost of releasing the receptionist and each participating pharmacy was paid Ł12.50 per hour for providing the training. Total cost to the PCT for each practice-pharmacy partnership was Ł900 and, with administrative costs, the scheme cost about Ł20,000.

Evaluating outcomes

The training scheme has now finished and been evaluated. A quantitative evaluation was accomplished by asking the receptionists to sit a short product knowledge test before starting the training, and a similar test at the end of the training. Both tests were taken under examination conditions without access to any reference sources.

There was an improvement in the level of the mean test score of 8 per cent. In total, 17 receptionists showed an improvement in their test score of between 2 and 38 per cent. Four receptionists did not improve their scores, but scored highly in both tests indicating that they were less likely to benefit from the training than some of their colleagues. The choice of receptionist had been left entirely to the discretion of the practice manager.

Part of the training was aimed at improving the receptionists' ability to use two reference sources commonly found in GP practices, namely the British National Formulary and the Drug Tariff. Ability to use these reference books was tested before and after the training. There was a 9 per cent increase in the mean score. Again, 17 receptionists improved their scores by amounts ranging from 4 to 28 per cent.

A qualitative evaluation was undertaken by sending out a short questionnaire about the length and content of the training course to practice managers, receptionists and pharmacists. All 21 receptionists returned the evaluation forms, and 18 out of 21 pharmacists and 12 out of 16 practice managers replied.

All receptionists believed that the content of the training course had been appropriate, that their level of knowledge had increased and that they were able to use their increased knowledge in their day to day working. About half of them believed that the training course had been longer than necessary and the other half believed it had been about right, so this is something to consider for future courses.

Most receptionists assessed the quality of the training they received from pharmacy staff as having been very good (15 respondents) or good (5 respondents). Receptionists said that their willingness to contact their local pharmacy, when problems arose, had increased a lot.

Pharmacies believed that their relationship with their local GP practice had improved as a direct result of the training course. All 18 pharmacists who had returned evaluations said they would be willing to train another receptionist in the future, and all participating GP practices said that they would like to send other members of staff in the future.