With thoughtful integration into general practices, clinical pharmacists can benefit PCNs in multiple ways – and the opportunities are only increasing. PCN clinical director Dr Stefan Waldendorf shares his personal perspective.

When our PCN came into existence, we realised that the one immediate benefit to general practices would be the free additional workforce through the additional roles reimbursement scheme (ARRS).

The first professionals who came to mind were clinical pharmacists. But where could we find one? In the school playground, as it turned out. 

Phil, one of the dads I knew, was a pharmacist in a community pharmacy. So, we had a chat about this new thing – primary care networks – and me being the (involuntary) clinical director looking for someone to work as a clinical pharmacist in a GP practice.

To my surprise, he himself was interested, feeing dissatisfied with working for a pharmacy chain and having to move around to different pharmacies all the time.

And that’s where it started. 

The integration journey

Integrating clinical pharmacists into four practices was not a straightforward journey. In the beginning, we had no clear plan for how to make the best use of our new assets. The general idea was to deploy one pharmacist in each practice. Though recruiting further pharmacists was no easy task, one of the practices had a pharmacist already, and we were lucky to be able to recruit two more over the next few months. 

All needed to undertake CPPE training to work in primary care, which required supervision and support. Different practices had different ideas about how to use their new pharmacist, and the PCN wanted to be supportive.

Phil started to do the PCN DES-required structured medication reviews (SMRs), had telephone clinics to answer medication-related problems and supported the GPs. He was also an important part of our weekly care home MDTs.

When the covid pandemic hit, our PCN set up a covid vaccination hub. We managed to achieve this within a fortnight, and Phil brilliantly handled the complex vaccination ordering, storage and stock keeping requirements for us.

After life returned to a degree of normality, Phil undertook his independent prescriber qualification. His supervision and weekly tutorials turned out to be a bilateral learning experience; we discussed clinical cases and prescribing guidelines. We worked particularly on areas of long-term conditions, such as cardiovascular disease and hypertension, so he would be able to take over our hypertension and statin clinics.

Over time, the PCN pharmacist team has grown through the addition of four pharmacy technicians. Phil was instrumental in setting up their work roles and identifying areas where they would be most efficient. He also became the team leader for the other pharmacists. They work closely together, have regular meetings, and a very supportive WhatsApp group.

Phil now runs his own hypertension clinics and probably knows more about cholesterol and lipid-lowering medications than any of our clinicians. He deals with some of our 'difficult' patients who are on controlled drugs and need closer management. He is still part of our weekly Care Home MDT and has an excellent knowledge of our residents. The pharmacy team deals with all medication requests from our eight care homes. 

The other part of his work is the support for the PCN, which has grown now to a fully-fledged organisation, employing our staff directly through our own company. We ran a hugely successful series of menopause webinars, with sessions run by clinicians, physiotherapists, and Phil talking about HRT.

We also received funding to run Wellbeing Patient Group sessions for patients at risk of cardiovascular disease, and again Phil ran some sessions for this. He has become an integral part in reviewing the clinical aspects of all PCN projects.

What contributes to success

Looking back over the past few years, I think there are a few key elements that made the role of the clinical pharmacist in our PCN a success. 

Firstly, and probably most importantly, is the support and training. We have been a training practice for some years, and the ethos of training is ingrained in our practice. It takes effort and time, review of portfolios and supervised sessions. But it does pay off, and we now benefit from their knowledge and skills. 

For our PCN, the model of a pharmacist being embedded in one practice worked brilliantly as well. They are a part of the team, clinicians know how to use them and they are embedded in the clinical workflows. But, at the same time, it is important to have the wider scope of PCN work, to understand PCN DES requirements (such as the SMRs) and to empower them to play a part in PCN project work. 

Working towards the transition to neighbourhood healthcare more changes for our ARRS team and the clinical pharmacists lie ahead. We are planning to set up a Neighbourhood Hub at some stage, and there might be the possibility for more direct patient contact in pharmacy clinics or further group-based prevention work. 

It can certainly be said, that with a strong ARRS team, including clinical pharmacists, we feel much better prepared to face any challenges thrown at our PCN in the uncertain future of the NHS.

Dr Stefan Waldendorf is a principal GP and clinical director for Newport & Central PCN.