Primary Care Pharmacy November 1999 Vol 1 No 1 p6-7
A week in the life of a primary care group pharmacist
By Susan Lunec PhD, MRPharmS
Seven days with PACT data analysis, group protocols, officers meetings, practice reports and the prescribing work group
In October, 1998, I began working with seven, and later all 12, medical practices that were due, in April, 1999, to become one of the new primary care groups. I am also a visiting lecturer for the postgraduate diploma in community clinical pharmacy at Aston university. Last October the, "shadow" primary care group had not formed and consequently there was no headquarters. In order to have a local base, I was given a desk within the pharmacy of the local hospital where the chief pharmacist had recognised the potential value to the trust of working closely with a member of the primary care team. The benefits to primary care were obvious in that a degree of influence on prescribing in the trust could be brought to bear. Neither party was really aware of how successful this arrangement was to turn out to be. |
Susan Lunec with a practice nurse |
Monday
I have a practice meeting on Thursday so I need to analyse the PACT data and prepare a report. The PCG prescribing group on which I serve is currently working on a cardiovascular formulary so it will be data from this chapter that I present to the practice.
One of the first tasks that the primary care group board set the prescribing group was to produce a formulary. We argued strongly that the formulary should be more than just a list of drugs and consequently have found ourselves preparing therapeutic guidelines in addition to making cost–effective drug choices. Much of this work falls to me, including the liaison with the local hospital specialists. Since I am based at the hospital this task is not too difficult and a bonus is that the hospital clinical pharmacists work closely with me, resulting in our guidelines being very similar.
I am getting along fine with the PACT data analysis when I receive a copy of a letter sent to the PCG office by a general medical practitioner. It is a letter from a hospital directorate requesting the GP to prescribe a drug outside of its licence and in a manner cautioned against in the data sheet. This is not the hospital where I am based so I have to make many telephone calls to track down the responsible person. I eventually speak to the manager of the directorate who requests that I fax my concerns to her immediately so she can raise them at the directorate meeting that afternoon.
I need to research this before putting it in writing so I check the Drug and Therapeutics Bulletin, Merec Bulletin, National Prescribing Centre publications and various other publications - (I have access to the drug information centre) - and finally contact the manufacturer. Now I have all the information I need and the fax is sent. I copy this to the PCG chief officer, the chairman and the prescribing lead as well as the health authority pharmaceutical adviser. I go back to working on my practice report in the afternoon.
Tuesday
I have a meeting with some practice nurses to finalise the PCG group protocol for the supply and administration of travel vaccines. I have been extremely impressed by the dedication and efficiency of this group and we are justifiably proud of our protocol, which, when approved by the PCG board, will be used by all the practices. At lunch time I participate in the hospital pharmacy journal club giving the primary care perspective.
In the afternoon I go to the university and discuss how to incorporate the most recent changes to PACT data and current prescribing issues into the diploma assignments.
Wednesday
I have a meeting with the PCG officers to discuss the practice budgets. The hospital directorate letter from Monday is a hot topic and the chairman decides to write expressing our concerns. We advise the GPs not to comply with the directorate request for the time being.
The local hospital drug and therapeutics committee meeting is at lunch time and the PCG cardiovascular formulary and guidelines are being presented. These have been produced in collaboration with the cardiologist, the medical directorate and the clinical pharmacists from the hospital where I am based.
Although the members of the hospital drug and therapeutics committee can also see the benefits of standardising drug choice across primary and secondary care, they do have some concerns about the emergence of the PCGs. How can one trust comply with, perhaps, three or four different PCG formularies? This is a very valid concern and raises the question of whether a county–wide formulary should be produced. If this approach is taken then the formulary will need to be carefully presented to practices to gain their approval and cooperation. A county–wide antibiotic policy, produced by the local microbiologists in conjunction with GPs and pharmacists, is already well on the way. The plan is to use the county PCG pharmacists to promote the formulary to the doctors rather than to post a copy to them with a covering letter. Perhaps the antibiotic policy could be the pilot for a county formulary.
Thursday
I finish the practice report only minutes before leaving for the meeting with the doctors. I draw attention to the PCG prescribing newsletter and we discuss the issues. We move on to cardiovascular issues but there have been so many changes recently that the doctors decide to arrange a longer meeting for a later date. I rush over to another practice to meet a local community pharmacist to discuss her wound management formulary with a representative of the district nurses. We stop to chat to the local pharmaceutical committee representative on the prescribing working group on the way out. She gives me a few patient names where the prescribing is far from rational and I make a note to follow these up when I am in the practices. She has discussed some of the formulary choices with the LPC and feeds back their comments informally. The community pharmacists appreciate being kept informed by receiving the PCG and prescribing newsletters and a promise of a copy of the formulary when it is completed.
Friday
I ring round a few practices and pharmacies to check that the change to salbutamol CFC-free inhalers is running smoothly. We worked out a protocol with the local pharmacists, asthma nurses, GPs and the hospital pharmacists and presented it at a multidisciplinary meeting. There are no problems as yet so perhaps the same approach will be taken for the change to steroid CFC-free inhalers.
I attend the lunch-time meeting for GPs at the postgraduate centre where I can mingle with the doctors and remind them of my presence. I may also have an opportunity to speak to the specialist who is presenting. I chat with the drug company representatives and make an appointment to see them at a later date.
The prescribing working group meets next week so I need to start to prepare all the papers, notes and the agenda and check that I have followed up all the issues from the last meeting. A few minutes filing and looking through journals leaves just enough time to discuss discharge letters with the medical directorate clinical pharmacist before we go home for the weekend. Since we work in the same office this is easy and we can relax and have a cup of tea at the same time.
Susan Lunec works with Redditch primary care group