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How we integrate GP and pharmacy services

Our on-site pharmacy helps us provide enhanced and seamless patient care, says Dr Philip Koopowitz.

Major area of work is organising discharged patients' drugs (Image: iStock)
Major area of work is organising discharged patients' drugs (Image: iStock)

In 2009 our rural, dispensing practice at Watlington Medical Centre in King’s Lynn, Norfolk, was threatened by an application to open a pharmacy.

We were concerned that our patient care, which up to that point had been seamless, would be split between the practice and the separate pharmacy business.

After some long, hard negotiations, we secured the rights to open our own pharmacy and set about integrating it into our medical centre.

We now have an on-site pharmacy alongside the practice. Over the last three years we have ensured that our patients continued to get the seamless care that they desire.

Enhanced patient care

We have enhanced patient care through harnessing the expertise of our pharmacist Candice van der Merwe and her team. Called Watlington Pharmacy, it has direct access to the patients’ computer notes and this has ensured safer delivery of medication to our patients.

Candice can check adverse drug reaction records, as well as concurrent and past medications. Patient compliance and acceptance with their medication has been improved through this collaborative working.

Ours is a ‘hybrid’ pharmacy that dispenses to our non-dispensing patients while the dispensary supplies our dispensing patients’ medication to them.

This is a complex arrangement but from the patients’ perspective, the service is the same whether or not they are dispensing patients.

Luckily, we had previously expanded the dispensary, so there was enough room to integrate the pharmacy within it.

Integral team member

We see Candice as an integral member of our clinical team, and she assists us with advice on medications, especially paediatric dosages and the use of specials.

In addition, she has been able to highlight those patients who might have difficulties with their medications and might benefit from monitored dosage systems (MDS).

We work closely with the pharmacy to reduce potential risks associated with changes in medication.

Medication post discharge

A major area of work that Candice assists us with is organising medication for patients who have been discharged from hospital.

She liaises with the hospital and clarifies any changes that have occurred or discrepancies that might appear between the patients’ normal medication list and the hospital discharge list.

With the increasing pressure on GPs to reduce drug budget overspends, the pharmacist is ideally placed to assist the practice in bringing about changes to medications, and ensuring the smooth transition of these changes.

New Medicines Service

Candice assists patients when they are started on new medications, via the New Medicines Service

Community pharmacies can offer this service, which involves up to three appointments with the pharmacist, to patients with prescriptions for a new medicine for asthma, chronic obstructive pulmonary disease, type 2 diabetes, high blood pressure, or have been given new antiplatelet/anticoagulant therapy.

We are also able to help the pharmacy target the most appropriate patients for their medicines use reviews (MURs).

Palliative care and other services

Treatment of our palliative care patients has improved with the help of Candice’s expertise and we rely on her advice on end of life medication.

As part of our clinical team, the pharmacist provides clinical care to patients who require emergency contraception and smoking cessation advice.

This frees up the doctors’ time for other patients.

Good all round

All in all, our primary care integrated pharmacy is good for:

  • Our patients – it leads to increased compliance and acceptance of medications, improved medication monitoring and improved access to a health care professional
  • The pharmacist – she has increased clinical contact and is able to provide better patient care through access to clinical notes. This leads to improved job satisfaction.
  • The GPs – we now have an easily accessible resource for medicines management, palliative care and less discharge medication problems that we have to sort out.
  • Most of all, it is good for the whole primary care integrated team as we work together for the good of the patient.

Opt for pharmacy ownership

I believe that we should welcome pharmacies into our surgeries and the best way of doing that is for the GPs to own the pharmacy, so that the two organisations, the surgery and the pharmacy, can integrate without conflicts of interest and the NHS income from prescriptions can be recycled into patient care.

This arrangement allows pharmacists greater input into clinical care and ensures that they is part of the integrated primary care team.

Our practice and pharmacy

Location Semi-rural; practice area covers over 20 villages and nearly 260 sq km.  

List 6,500 including dispensing patients.  

GPs Training practice with four whole time equivalent doctors  

Pharmacy Team includes a pharmacist and four pharmacy assistants (including an apprentice); the dispensary has five dispensers

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