Pharmacists working in primary care networks (PCNs) will be expected to play a vital role in reviewing the medication of millions of patients with long-term conditions, under radical proposals to improve the care provided in the community published by NHS England.
The draft plans, published on 23 December 2019, will ask networks of GP practices to use “a variety of tools” to identify eligible patients for a structured medication review (SMR) and suggested eight patient groups that should be considered for SMRs from April 2020.
The groups include people: who have diagnosed with frailty; living in care homes; with complex polypharmacy; with multiple long-term conditions and/or with high numbers of prescribed addictive pain management medication.
NHS England said it would not provide an estimate for the number of patients eligible to receive an SMR, as this will be a local decision made by PCNs, but currently around 10 million patients have two or more long-term conditions, and a Health Foundation report published in July 2019 found the current number of people living in care homes was approximately 274,000.
The consultation document notes that SMRs can be carried out by clinical pharmacists, GPs and advanced nurse practitioners.
However, both GPs and pharmacists have expressed concerns about workload, with GP pharmacists saying the “sheer number of patients” needing SMRs could result in reviews that are “strictly efficient rather than being thorough”.
The draft service specifications for the network contract direct enhanced service details the replacement for medicines use reviews, currently carried out in community pharmacy, as specified in the community pharmacy contractual framework for 2019/2020 to 2023/2024.
The document said that although further recruitment decisions will depend on the network’s priorities, “an average PCN could — indicatively — engage around 3.0 whole-time equivalent (WTE) clinical pharmacists, 1.5 WTE social prescribing link workers, 0.5 WTE physiotherapists and 0.5 WTE physician associates from April 2020”.
The document said that pharmacists will be “key in delivering SMRs, and given this degree of existing capacity and expertise, we believe it is reasonable to expect the new national SMR service requirements to be delivered in full from April 2020”.
PCNs were given £38,000 in 2019/2020 to hire one dedicated pharmacist for each PCN.
Amira Shaikh, deputy lead clinical pharmacist at the Islington GP Group, said: “I envisage, due to the sheer number of patients we would expect to manage, we would prioritise being (strictly) efficient rather than being thorough, so most medication reviews carried out will be with little or no patient involvement, and, potentially, medicines rarely being optimised.”
Robin Conibere, a practice pharmacist at the Beacon Medical Group in Devon, said on Twitter that although it is “hard to judge the scale” of SMRs, “this could easily be a huge task for PCN pharmacist[s] if they aren’t doing anything else to help workload”.
“Those three pharmacists per PCN from April 2020 are going to be busy,” he added.
Richard Vautrey, chair of the British Medical Association’s GP committee, which is negotiating the service specifications, said he has heard concerns raised by GPs “in recent weeks about these draft specifications, the workload implications and the need for a qualified workforce to deliver them, loud and clear”.
The Royal Pharmaceutical Society also said it was consulting with members on the specifications “and will produce a response at the end of the consultation period”.
The consultation is open until 15 January 2020.