How we improved medicines management processes in Somerset primary care

Established in 2016, Symphony Healthcare Services is an at-scale primary care provider based in Somerset. Owned by Yeovil District Hospital NHS Foundation Trust, it is a provider of NHS services to around 82,000 patients.

In 2016, pharmacists were employed to undertake medicines reconciliation and medication reviews within GP practices, and — within a year —pharmacy technicians were employed to help undertake medicines reconciliation, answer prescription queries from patients and healthcare professionals, synchronise medication regimes and liaise with care homes, as well as manage safety alerts, formularies and audits.

Practice-based pharmacists were then able to undertake electronic ‘AskMyGP’ queries, patient medication reviews, opioid reduction, hypertension monitoring and anticoagulant switches, in addition to management of complex medicines reconciliation and queries passed on from the technician team.

However, in 2017, most GP practices did not have dedicated personnel to process repeat prescription requests. Instead, these requests were processed by receptionists in between their other duties, often with minimal training or experience. This led to patient safety concerns.

In July 2018, we developed and introduced a medicines management hub dedicated to processing repeat prescription requests, and a new role of prescription clerk was created to work with the practice teams. Prescription clerks ensure patients are up to date with reviews and blood tests, and are able to answer queries from patients and healthcare professionals. Working under the direct supervision of a pharmacy technician, they respond quickly to most enquiries, or refer to practice pharmacists based in the GP surgeries. This approach saves a substantial amount of GP time; working within a resilient team allows for peer support and enables cover for annual leave and sickness.

While each having their own roles, the prescription clerks, pharmacy technicians and pharmacists integrate to ensure safe and efficient outcomes for patients across the practice network. Medicines management pharmacy technicians are pivotal to the team, acting as a bridge between the prescription clerks and practice pharmacists.

Two small rural practices situated five miles apart in Somerton and Ilchester were identified for initial rollout. This allowed us to address some logistical issues while working at small scale, such as:

• How to manage paper repeat prescription requests handed in to each surgery;
• How to ensure printed prescriptions are at the correct site for collection, or delivered to the appropriate pharmacy for dispensing;
• How to efficiently switch between separate surgeries’ patient records;
• How much prescription clerk time is needed;
• How much time in the day to be available for telephone requests and queries.

The hub can be contacted directly at any time of the working day (08.30–17:00), with either a prescription clerk or pharmacy technician available to respond to questions and quickly solve most problems without the need to contact the GP.

After three months, two more surgeries were added to the hub, bringing the total to four practices with a patient population of 18,000. This provided efficiencies and resilience in staffing and processing, as well as increased quality and safety of prescribing for our patients. In January 2020, the prescription clerk team from another surgery was integrated into the existing team, bringing the total patient population served to 35,000 across five sites.

Advantages to utilising the hub approach include:

• Increased patient safety through embedding safe processes for repeat prescription ordering;
• Efficiencies in staff cost and resilience, patient safety and satisfaction;
• Improved recruitment and retention of staff owing to co-location, enabling peer support;
• Increased adherence to the local formulary, leading to improvement in cost-effective prescribing and formulary management, increased patient safety and waste reduction;
• Receptionists’ time is released;
• Medication queries from patients and community pharmacies are responded to in a timely manner;
• GP time is saved through a reduction in medication queries;
• A change in culture from working under the supervision of a pharmacy technician, and with access to a pharmacist independent prescriber, which streamlines repeat prescription processing for both service users and providers.

The change to the way prescriptions are processed has demonstrated a saving in reception/admin staff of 120 hours/week (3.2 hours whole time equivalent) and in GP time when signing prescriptions. By auditing prescription signing, a saving of one minute per prescription was demonstrated, as all queries should have been resolved before the prescription is sent for signing. This represents a saving of 43 hours/week across the practices served by the hub.

The hub has improved communications with community pharmacy and other healthcare professionals through a dedicated ‘priority’ phone line, which avoids the need to queue.

A reduction in the number of community pharmacy queries was observed, likely owing to increased efficiencies within the systems. An average of 42 calls are taken each week, and this number increases whenever a practice has a backlog of prescriptions to be signed. Dealing with these queries directly saves around 1.5 hours of reception time and around 4 hours of GP time each week.

As our organisation continues to develop and more GP practices join the portfolio, there are plans to set up two further ‘branch hubs’ from July 2021 to serve practices in separate localities.

Kate Jones, lead pharmacist, Symphony Healthcare Services; Helen Belben, lead medicines management technician, Symphony Healthcare Services.