The Importance of Conscious Competence and the GP Clinical Pharmacist

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.

How the GP pharmacist role has evolved

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).

The challenges GP pharmacists have faced

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.

Practice Challenges

  1. Not understanding the GP Pharmacist role and how best to utilise the skill-mix within the practice
  2. Not being able to assess competence and confidence of pharmacists and identify how best to deploy and support
  3.  Not being able to provide adequate support and supervision to accelerate pharmacist development and integration

Pharmacist Challenges

  1. Not understanding general practice and how to utilise own skills to add most value and impact
  2. Not being able to self-assess competence and manage expectations from GPs regarding clinical workload 
  3. Not being confident to push back when asked to deliver something which is outside of competence and confidence 

What next for GP Pharmacists?

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:

  • The practice and PCN understanding what the pharmacist’s current competencies are (this will depend on the individual professional background, experience, and personality)
  • Clarity about what the PCN and practices need from their pharmacist role and whether that is achievable within the individuals existing skillset
  • The GP Pharmacist being adequately supported, developed, nurtured, and trained to reach their full capability and make maximum impact on patient care and workload

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.

How can we help you to support your GP Pharmacists?

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.

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