Technician support puts PCT ahead
| When GPs understand the broad benefits
of medicines management they are likely to take note. Debbie
Andalo meets a technician who is providing that input |
Debbie Andalo is a freelance journalist
|
Pharmacy technician Chrystal Wheatley has spent the last
year visiting GP practices helping them to
improve medicines management and make them realise that it is more than
just saving money. “A lot of GPs say that medicines management
is just penny pinching and us telling them to prescribe cheaper drugs.
But I think we stop money being wasted when there is no reason for it
to be wasted,” said Mrs Wheatley.
“Some GPs have been reluctant for me to go in because they don’t
see how I can help them with their prescribing. But once they can see
the evidence of what I have been doing, they see the benefit.”
Community technician able to recommend medicines reviews |
Mrs Wheatley is employed by Wakefield West Primary Care
Trust in Yorkshire to visit its 18 practices and focus on the “good housekeeping” elements
of medicines management. Working to agreed protocols with the GPs, her
work has included looking at dose optimisation, and scrutinising patient
records to improve drug synchronisation so that different medicines are
prescribed for the same number of days to prevent multiple trips to the
pharmacy.
Another task has been to check that prescribing guidelines are met where
agreed branded, rather than generic, drugs are selected.
PCT assistant director of medicines management Louise Jackson said: “We
decided to employ a technician in this role rather than a pharmacist
because it is a model we knew was being used elsewhere. We also believed
that there were some tasks that a technician, working to protocols, had
the clinical knowledge and expertise to perform without the support of
a community pharmacist. But the decision wasn’t only made on the
grounds of skill mix – we couldn’t afford to have lots of
pharmacists doing this work.”
The pharmacy technician has also been employed to carry out prescribing
audits that have included looking at COX-2 selective inhibitors in patients
who have rheumatoid arthritis. She is not allowed to change prescribing
decisions, but is expected to alert GPs to any problems she spots.
Mrs Jackson added: “She does have some clinical knowledge so she
can alert the GP to something she has spotted in the audit and ask them
to take it forward. She works to strict protocols to which the practice
and the GPs have signed up, and is aware of confidentiality issues, because
she has access to patient records.”
The technician has, from September, had back-up support from two practice
pharmacists. Before then she was expected to approach the PCT’s
two assistant directors of medicines management for advice. Mrs Jackson
said: “Having worked in the past in community pharmacy Chrystal
has a real understanding of where her limits lie and when to ask for
help.”
Mrs Wheatley agreed and added: “A lot of the work I do doesn’t
need to be done by a pharmacist, but I know when I have reached a point
that I have to stop and ask advice.”
The extended role of the pharmacy technician in West Wakefield brings
great job satisfaction. Mrs. Wheatley admitted: “I spent eight
years working in the community before I took on this new role, but I
think there is only so much you can do there. When I first looked at
the specification for the medicines management job I thought I couldn’t
do all that, but once I had broken it all down I realised that I was
capable. I am still under supervision in my new role but the work is
more varied and more rewarding — I feel I am achieving more than
just counting out pills and putting them into bottles. If other technicians
have the opportunity to do this I would definitely tell them to go for
it.”
One of her projects during her first year has been to look at optimising
dosage for statins — which has saved money. She has also helped
to reduce the number of patients over-ordering. She said: “What
patients sometimes do is get a two-month supply of drugs every month
because they don’t understand how the repeat prescription system
works. But this is also a compliance issue — are they taking their
medication as prescribed or not noticing that they have lots of other
tablets?”
When these cases have come to light she has alerted the GP and recommended
a medicine review. She has also looked at modified release dosing: “I
discovered that some patients, who were on 12-hours-a-day modified release
preparations were taking a tablet only once a day. In other cases patients
who should have been taking tablets once a day were in fact taking medication
twice a day. Sometimes it was the patient who was responsible for the
mistake but I don’t want to blame anybody for this because it’s
such a complex issue.”
GPs, according to Mrs Jackson, have welcomed the initiative and its benefits.
She said: “This is a very simple change that can be made which
can improve efficiencies. The practices are extremely busy places and
although the GPs think that a lot of the medicines management initiatives
we are trying to do are a good idea they don’t have the time. What
we have done is given them an extra resource within their practice. At
the same time we have addressed the problem which pharmacy technicians
sometimes face in the community when they are aware of an issue within
a practice but don’t have the time or the authority to deal with
it or to get systems changed.”
The Wakefield scheme has been praised by Darren Leech, president of the
Association of Pharmacy Technicians UK. He said: “Pharmacy technicians
are traditionally practical people and they are well placed to transfer
in growing numbers to primary care. This isn’t a common role for
technicians but it is one which is growing. What is interesting in Wakefield
is the degree of autonomy the technician has and I am also pleased to
see that she is dealing with more qualitative issues. I think, as PCTs
evolve, they will be looking for people with a range of skills to take
on new work — it seems that Wakefield is well ahead of the game.” |
