Further to last week’s urgent guidance by the Pharmacists’ Defence Association (PDA) which highlighted concerns after a number of critical incidences, we felt it was timely to provide some context to this and offer some practical advice. A key theme outlined by the PDA announcement is the notions of ‘competency’ and ‘scope of practice’— two topics that Soar Beyond has been actively promoting for many years.
Let’s reflect on the journey of the GP Clinical Pharmacist role to date and how it is that we arrived here.
In 2015, due to a workforce crisis in general practice and oversupply of pharmacists, NHS England (NHSE) pump-primed a pilot of subsidised GP Clinical Pharmacist roles, which comprised staggered funding for the pharmacist over a three-year period. Soar Beyond was a Wave 1 provider of these services across ten practices in NW London.
Following a further seven waves of this NHSE funding, the GP Clinical Pharmacist could be deemed to ‘have proven itself as a valuable and indispensable role in GP Practice with nearly 500 roles created through that programme. Testament to this was the January 2019 announcement in the NHS Long Term Plan of 70% (recurrent) funding for every single GP Practice to have access to this role through the newly formed Primary Care Networks (PCNs). By 2024, the goal is that every PCN will have 5 pharmacists.
Both these NHSE programmes have invested heavily in the role through partial funding and a national pathway of training and development including an expectation that pharmacists quickly acquire their independent prescribing qualification (usually within the first nine months).
This rapid growth in responsibility and clinical decision-making constantly highlighted the need for the clinical pharmacist to be adequately supported and consciously aware of what activities they have the competence to undertake — ‘conscious incompetence’ as Maslow defined it.
The PCN Pharmacist role is even more stretched at ratios of 1 pharmacist for every 30–50,000 patients; it is common for pharmacists to secure coveted roles in general practice, only to have to meet wholly unrealistic expectations from GPs. Often, we hear of pharmacists feeling pressurised to undertake roles without sufficient training, patient information or safety-netting in place. It is important that pharmacists feel empowered to communicate what roles they can, and cannot, take on.
During our involvement in the Wave 1 provision of GP pharmacists, we were quick to recognise some of the challenges facing both practices and the pharmacists themselves, and these challenges still persist, some four years later.
Despite the valid concerns raised by the PDA (and unhelpfully, sensationalised in the mainstream press), the GP Clinical Pharmacist role is here to stay. All GP pharmacists should ensure they have adequate professional indemnity insurance in place for their current skills and tasks as well as continuing to reflect the growth in their scope of competence.
Since the GP Pharmacist is still a relatively new role and many practices are still inexperienced in understanding and utilising their skills, their continued success will require:
After three years of substantial funding and branding of the value of the GP Pharmacist role, we feel it would be a travesty if a culture of defensive practice was to now pervade the profession. In order to build GP confidence and pharmacist competence and to avoid limiting the potential value that clinical pharmacists bring (as the only medicines experts in primary care), it continues to be important that pharmacists have evidence of their proficiency and for practices to be supportive of their journey and safe growth.
For the past (nearly) 13 years, Soar Beyond has been delivering clinical pharmacist services in general practice and has created two key services designed to help to fulfill the potential of the GP Pharmacist to improve patient care, reduce GP workload and improve patient safety. Both these services are underpinned by self-assessment of competencies and evidencing improvement in the scope of practice – these include resources such as our proprietary circles of competence interactive tool which identifies current competence and prioritises development in line with practice needs; this helps to manage expectations.
The SMART platform
The online SMART platform enables GPs to work with and support practice pharmacists to demonstrate their competencies, track KPIs and measure impact on workload and patient care. The SMART platform is designed to enhance the safety and efficiency of medicines-related processes in practice and is now being deployed by PCNs in England as well as for the national GP Pharmacist Programme across Northern Ireland (360 GP Pharmacists). The SMART platform has a suite of implementation resources to standardise care and is also accompanied by Accelerator coaching and senior pharmacist sessions to reduce the effort required by GPs.
The i2i network
The i2i Network is a free training network based on the ‘insight 2 implementation’ approach, which upskills GP Pharmacists to improve their competencies in defined clinical areas. By the end of 2019, we will have trained over 1,000 pharmacists across six long-term conditions (LTCs) including type 2 diabetes, asthma, frailty, atrial fibrillation, heart failure, and psoriasis. All our LTC programmes utilise simplified change methodologies and provide a suite of implementation resources for attending pharmacists. Pharmacists demonstrate improved competence and confidence at the end of each workshop alongside an associated development plan to help address areas where they are now consciously not competent.
"We commissioned SMART for our pharmacy workforce in March 2020 recognising that we had ambitious plans to rapidly expand the workforce in the next two years and that we needed a structured framework to ensure standardised delivery of the clinical pharmacist and technician role across our 6 PCNs.
The support we commissioned, including 4D Accelerator sessions with our senior pharmacists, ensured a shared vision and agreed set of competencies as well as a delivery plan for the service. This enabled us to use the SMART platform to quickly create a map of baseline competencies and capabilities which highlighted and identified training and development needs. We now have a focused development plan and set of agreed service milestones, KPIs including DES deliverables like SMRs; best of all, we have visibility of all of these to share with our PCNs. Having expanded our team rapidly to already having 25 clinical pharmacists and 6 technicians, SMART has been vital in providing assurance to the PCNs about the quality of the pharmacy workforce and has given us all clarity of service deliverables and priorities. Because Soar Beyond also has the i2i Network, we have been delighted that we are now addressing one of our key development needs around managing frail older patients by implementing a federation-wide quality improvement (QI) initiative including training, upskilling and systematic review and management.
I feel the structure of the SMART platform and the wrap-around support of the Soar Beyond team has been instrumental in helping us to rapidly standardise and provide a quality service and would recommend this for services- both large and small."
Juliet Fletcher -Senior Meds Optimisation Pharmacist and Senior Lead Pharmacist for Sunderland GP Alliance
“We chose Soar Beyond to help us develop and implement our Pharmacy Activation Strategy because of their heritage and expertise in primary care pharmacy; they really understand the various pharmacy sectors and their relative importance for our portfolio of products. Not only have they helped us to map the entire patient journey and potential interventions, but they have supported us to identify the service and workforce development opportunities so that we have a clear short, medium, and long-term vision and matching value offer that will drive market access of our brands.”
Marketing Director, Top 10 Global Pharmaceutical Company
"Soar Beyond’s QI (Quality Improvement) pods are an innovative, interactive way of engaging an interested cohort of customers, galvanising their desire to make QI change and providing them with the structure and support to do this well. Through an expression of interest process, Soar Beyond has been facilitating these QI pods to help equip the frailty champions to drive the QI in their practices. We now have developed a frailty QI community through the pods which is really helping us to build relationships with these GP Clinical Pharmacists for us as a company and supporting patient and process QI implementation. Having the QI pods as a value offer to drive implementation has been a key part of our delivery and implementation strategy."
Hannah Harding, Senior Scientific Affairs Manager, Nutricia.
"Novo Nordisk has been working with Soar Beyond since 2016 to support NHS organisations, to optimise their pathways and clinical services, using the Soar Beyond proprietary 4D™ methodology in facilitated stakeholder meetings. This started with Soar Beyond’s consultancy and expertise in delivering 4D™ change programmes. Due to the success of this approach, we have now rolled out an intensive upskilling programme for our field based market access team, whereby they become accredited to apply the 4D™ methodology to support service optimisation. I’ve enjoyed the collaborative approach with Soar Beyond to create market access solutions to meet both our business and NHS customer needs"
Hasseena Winter, National Market Access Manager
"Having worked with Soar Beyond on a number of training and NHS partnering projects at different companies, I have found them to be very responsive to our needs and to ensure the subject matter is both relevant and informative. As they work at the cutting edge with the NHS directly, the additional offerings around tool kits to support healthcare professionals are forward thinking and absolutely in line with the NHS agenda. For example, the i2i toolkit which they have developed for our disease area focus has attracted huge interest from medicines management and primary care network pharmacists. This provides a platform on which we can act as peer level partners in the improved management of patients whilst provide us with commercial opportunities in line with this agenda. I would wholeheartedly recommend working with Shailen and his team."
Colin Smith, Head of Field Sales, Alliance Pharma