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Proposals on how pharmacists can work to review the medication of millions of patients have been described as creating an “unrealistic” workload by pharmacy leaders.
The Royal Pharmaceutical Society (RPS) has urged NHS England to review its draft proposals, published for consultation on 23 December 2019, which ask pharmacists working in primary care networks (PCNs) to play a vital role in reviewing the medication of patients from eight groups.
These 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.
The document adds that all of these patient groups should be considered for a structured medication review (SMR) from April 2020.
In its response to the consultation, the RPS said the number of SMRs required “within the first year is very ambitious”.
“We strongly recommended that this is reviewed and staggered over a period, or focus on a few specific cohorts of populations within the first year, as the workforce grows and develops,” it continued, adding that it has “concerns about the workload that will be required of PCN healthcare professionals” overall in delivering the proposals.
The Society also criticised the proposals’ “little mention of working collaboratively with community pharmacy”, saying that the SMR specifications should refer to community pharmacy’s delivery of the new medicine service (NMS) and the development of medicines reconciliation services, which could further “improve patient care and optimise GP workload”.
The RPS also requested clarification on the level of experience needed for SMRs in different patient groups.
“This would help to assure patient safety, especially if we are using a new workforce or looking to develop pharmacists in a range of settings to take on new roles,” it said.
The Primary Care Pharmacy Association (PCPA) noted in its response to the proposals, that it takes at least 18 months for the “successful integration” of a new pharmacist into general practice, with an additional six months required for a prescribing qualification.
“Therefore, the expectation for PCNs to deliver such services at scale in the next few months is unrealistic,” the response said, adding that some PCN pharmacists are in their foundation year, while others are from a community or hospital background.
“It is not realistic to expect so much from these inexperienced practitioners so soon into the development of PCN workforces,” continued the response.
The PCPA’s comments also highlighted the “risk to retention and future recruitment of pharmacists if undue pressure is placed on individuals too early in their development”.
NHS England said it would not provide an estimate for the number of patients eligible to receive an SMR. Currently there are around 10 million people in England living 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 to be approximately 274,000.
A joint response to the proposals submitted by the the Pharmaceutical Services Negotiating Committee, National Pharmacy Association, Company Chemists’ Association and the Association of Independent Multiple Pharmacies said the bodies “welcome the increased focus on collaboration and integrated working across primary care”.
“We support the recognition of the importance of medication reviews and the benefit they can bring for patient care and clinical outcomes, as well as delivering NHS efficiencies,” it said.
“There may be further opportunities to achieve the aim of this specification by extending the scope of the NMS to cover all the patient groups highlighted as a priority for SMRs.”
The consultation closed on 15 January 2020.
