How a £600 laptop helped us to integrate with our local general practice

Computer connections

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Around 30 years ago, I worked as a community pharmacist and prescribing advisor in Sheffield, and my GP colleague would often say (and still says): “Why can’t I simply diagnose what’s wrong and then send the patient to you to prescribe and supply the treatment?” And in 2008, another GP from the practice next to one of my pharmacies told me he wanted to leave, but the practice risked closure as a result. When my long-time GP friend heard my growing concerns, he said: “Why doesn’t Myers Enterprises Inc. take over the practice?”

So, I became an executive partner at the general practice. And in July 2018, with the support of the National Pharmacy Association (NPA), we published a 65-page report on our community pharmacy’s partnership with the practice, in which any patient who can be managed in the pharmacy is referred there.

The model provides around eight times more clinical pharmacy support to patients than standard care, and at a fraction of the cost of employing our own general practice pharmacist. This model — in which practice and pharmacy act as a single entity with a unity of purpose — will be the future of community pharmacy’s integration into primary care. It is immediately available, scalable and cost-effective, and can save primary care from the manpower crisis it currently faces.

Pharmacy and practice working as one

Our integrated care approach started to develop when SystmOne first introduced its mobile records access, which allowed GPs to access clinical records during home visits. The community pharmacy bought a SystmOne laptop, which we discovered could use the Pharmacy N3 connection to communicate directly with the clinical system.

We can now send messages and have access to the appointments book, which allows us to easily share tasks and workload between the practice and pharmacy team. Access to hospital discharge and pathology information allows us to take corrective action, in real time, often when problems with medication arise after patients have been discharged from hospital.

We also routinely pre-screen prescription requests and again, in real time, take corrective action in response to drug availability problems, cost-effectiveness issues, and concerns for drug safety or medical appropriateness. We can also dose-titrate, de-prescribe, prescribe, and order and interpret biochemical tests. Our pharmacy consulting room is an extension of the general practice, and practice and pharmacy teams can share their wealth of knowledge of the patients.

Delivering the model where you are

A laptop, including all software requirements, costs around £584; all pharmacies in England could deploy this model for a minimum capital investment from the Department of Health and Social Care of around £6.7m. We use existing community pharmacy consulting room facilities, so in our experience, in the short-term, there are no other infrastructure costs for the community pharmacy. We do not consider it necessary for practices and community pharmacies to engage in any type of legal or structural integration, as we have, in order to deliver our model of seamless integrated care.

Other financial considerations, such as costs for training, indemnity and employment of community pharmacy staff, sit within the community pharmacy, but these must be recognised as delivery costs in any agreement.

Our report calls for the NPA and other national pharmacy bodies to work with the British Medical Association to develop template agreements to facilitate a national roll-out of this type of model. However, there is no reason why local NHS bodies, clinical commissioning groups, area teams, integrated care systems, or sustainability and transformation plans cannot immediately engage with the community pharmacy network, and why local pharmaceutical committees and/or the national bodies should not develop their own local versions of our work.

Facilitators to a national roll-out include the development of appropriate national template agreements between practices and community pharmacies, on issues such as the boundaries around liability for professional indemnity; information governance, including data sharing, data security and data quality; and delivery costs for community pharmacy.

Why we need to roll out nationwide

Large-scale deployment of this model will bring immediate and significant benefits. When we initiated the partnership, one of the GP partners, in an unsolicited comment, claimed that the approach had saved her up to two hours per day, from day one. Across all 7,000 practices in England, this alone could save over £500m of GP time every year. Our report describes how we believe eight hours of dedicated community pharmacy support each week could save 15m–18m appointments per year for practices in England. Nationwide deployment would eventually deliver billions of pounds of efficiency savings and provide huge benefits in safety and quality of care.

In 2016, described pharmacists as “one of the most underutilised professional resources in the system” and demanded that we must bring “their considerable skills in to play more fully” — we can achieve this with our model. And in light of these facts, the model deserves further investment for much wider deployment.

Garry Myers is executive partner, Jaunty Springs Medical Practice; practising community pharmacist, Sheffield and North Derbyshire.

Readers' comments (2)

  • Thank you for this piece Garry.

    We have tried to develop something similar for a pharmacy local to us however were under the impression that a lot would need to be done in terms of governance and ethics.

    Two key issues that we were concerned with were:

    1) The amount of workload associated with gaining consent to access patient records; I believe community pharmacies would need to gain consent each time they access records for the tasks you have mentioned above, just like they would do with summary care records - patients must also be informed what exactly the pharmacy can see when they're using SystmOne.

    2) Unfair advantage to the community pharmacy linked to the GP practice compared to other pharmacies in the local area - the initiative above can be seen of the community pharmacy having a "blank cheque" to issue scripts in their favour. Also if prescribers are working within the community pharmacy then this will bring about the issue of dispensing medicines that they may have prescribed themselves.

    How have you managed to overcome these issues?

    Atif Saddiq, Clinical Pharmacist in General Practice

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  • Thanks very much for your comments Atif

    1) In our experience this isn't a problem since electronic records can be shared with other clinicians if this is for the purposes of caring for the patient. Secondly consent prior to any form of intervention made in the Pharmacy at the request of the patient or practice (i.e. when they are physically present) is easily obtained anyway and finally all patients in our experience expect and indeed are extremely grateful for our ability to access the information. I might add that since this type of link is easily available now and at nominal cost all Pharmacies should be considering such an approach in collaboration with practices in order to better uphold the interests of the patients we serve.
    2) There is nothing to prevent Pharmacies in any area all investing in laptops to avoid such unfair advantage is there? If patients choose one Pharmacy over any other because they get seamless integrated care through such means that should encourage others to follow suit should it not? (remember how Pharmacy medicines delivery started). The blank cheque issue is a complete fallacy, usually spread by individuals with antipathy around Community Pharmacy delivery of enhanced Clinical services. Read our report...we are actually one of the top 25% of practices in terms of cost. Knowledge of procurement issues (including cost) in real time, we have proven, has real advantages for patients, practices and the NHS. Also, as you know, actions taken on clinical systems are time, date & name stamped...so whatever is done, is done under significant external scrutiny, and any prescribing decisions taken must be always be justifiable clinically. On your last point where we do prescribe & supply this is quite rare....and is permitted in any case where patients treatment would be "delayed" otherwise. Furthermore prescribing rights allow other treatment decisions to be taken linked to Pharmaceutical care of the patient when a prescription isn't then required...such as dose titration or de-prescribing etc. I've personally no doubt that changes to Pharmacy supervision and the Pharmacy contract funding mechanism (which has traditionally been one of the key issues around prescribing and dispensing) will render this issue obsolete in the near future anyway.
    Finally our report does call for national bodies to work together to develop the template agreements necessary to facilitate Community Pharmacies adopting the type of integrated care model in collaboration with Practices that we described in our report.

    I hope that helps answer your queries

    Garry Myers

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