Advanced-level pharmacists specialising in general practice will complement — not replace — the existing clinical workforce

The roles and training of pharmacists have developed extensively, particularly since 2003 when they were able to become supplementary prescribers and then independent prescribers in 2006. The expertise and skills of pharmacists were also recognised in NHS England’s ‘Clinical pharmacists in general practice pilot‘ in 2015.

At the time, the benefits of ‘clinical pharmacists’ mainly centred on medicines management to free up time for GPs to focus on diagnosing and treating patients with more complex conditions.

These are no longer the prerogatives of the medical profession. Indeed, unlike a supplementary prescriber, an independent prescriber can also make a diagnosis. A diagnosis following a clinical examination undeniably marks an important evolution from the diagnosis of minor ailments that traditionally relied on a simple history taking over the counter.

Clinical examinations were commonly not included in the pharmacist foundation training, but this is now embedded in the new curriculum, with the next cohort of pharmacists graduating with prescribing rights from 2026. 

Learning how to manage patients presenting with acute conditions was the next natural step towards working at an advanced level by gaining autonomy at managing complex clinical conditions. The idea of autonomy in a clinical context can be daunting, as clinical responsibility and accountability now remain with the pharmacist.

The MSc Advanced Professional Practice with Plymouth University has given me the tools to work across the four pillars of advanced practice. It is essential to remember that this is not an abridged version of medical training.

My current medical practice nurtures a multi-professional culture, where all skills are valued. My role is complementing — not replacing — the existing clinical workforce to enhance patients’ access to healthcare. My pharmacist training and experience, combined with my new clinical examination skills and complex decision-making acumen, allow for a more comprehensive patient experience from the first diagnosis to the ongoing management. It is important not to lose sight of our identity as pharmacists because this is our unique selling point.

Working in general practice gave me the opportunity to not specialise in a specific area or disease and to gain experience in managing a diverse range of acute and long-term conditions. This has proved beneficial for the pharmacy team I work with, as they can refer more complex clinical scenarios for me to manage instead of the traditional GPs’ pathway. 

This role will sit well with the new Pharmacy First service, due to be launched on 31 January 2024, part of the delivery plan for recovering access to primary care. This is a good opportunity to work in partnership with community pharmacists and the local branch of Community Pharmacy England to help train community pharmacists and manage onward referrals to general practice. 

Moving forward, a pharmacist practising at an advanced level, specialising in general practice, will help with continuity of care, so that, as far as possible, people with long-term conditions see the same clinician each time. 

Dany Ros, trainee advanced clinical practitioner and senior clinical practice pharmacist, Pembroke House Surgery in Paignton, Devon

Last updated
Citation
The Pharmaceutical Journal, PJ, January 2024, Vol 312, No 7981;312(7981)::DOI:10.1211/PJ.2024.1.215372

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