As an autonomous general practice pharmacist prescriber, I can work from any location — I can support general practice even while I am working in community pharmacy.
I didn’t imagine I would be doing this in 2017, when I earned my prescribing annotation and realised that without seeking opportunities to develop my prescribing competence, I wouldn’t make much use of it. I interviewed for many pharmacist prescriber roles in general practice, but failed to attain them — my suitability for the job was never in question, my availability was. With my commitments to community pharmacy and preregistration tutoring, I could take up a general practice role only as part of a job share.
Eventually, one interview panel offered me a different role, and I gladly accepted. My innovative role at the Broadmead Medical Centre, Bristol, is unlike any other role I have had and it deploys all available technology to take a new, flexible approach to care.
Log on and prescribe
I work for at Broadmead Medical Centre 18 hours a week, over 4 days, with at least 6 remote working hours. I log into the practice’s common clinical IT platform EMIS Web, which gives me access to patient records via Connecting Care, and enables seamless transfer of care.
We developed working protocols that accommodate my physical absence from the practice and ensure that patient care is not compromised
When working remotely, I log into the practice via the N3 Network through a secure WiFi or Ethernet connection. My laptop’s software allows me to deliver real-time care, which includes issuing electronic prescriptions, requesting and viewing test results, and communicating with other clinical and administrative colleagues. I am involved in managing long-term conditions and I can undertake telephone medication reviews when I am away from the practice. I can even remotely print prescriptions on a designated practice printer, and I sign these when I am next on site, or they are passed to a GP colleague if the patient’s demand is urgent.
Getting started in an unusual new role
I took a risk assessment before starting the new work arrangement, in which I juggle supervising the work of my community pharmacy colleagues with making decisions about patients under my care in general practice. I explored legal issues, and considered the changes we needed to make to our community pharmacy working practices to avoid patient harm or compromising our ability to provide safe, efficient services. For example, some polypharmacy and multimorbidity patient queries are just unsafe to address remotely. As a result of the assessment, we upskilled our colleagues and created clear, consistent working and task delegation practices.
I cannot understate how disruptive the change was for practice colleagues, who struggled to get used to the ‘pharmacist-working-but-not-on-site model’. I had to engineer ways of meeting agreed reasonable expectations within the constraints of the available unfamiliar technology, my own clinical competence and my time.
We developed working protocols that accommodate my physical absence from the practice and ensure that patient care is not compromised. For example, the practice team can flag up urgent tasks and create a priority list for me to view when I log in. We could not have done this without the team’s willingness to air opinions and suggestions, and contributions from the clinical lead, practice manager and senior pharmacist in designing workflow processes.
But one should bear in mind that technology is not always seamless. As with any IT-dependent working, systems can go down. And working remotely can also mean you are removed from team decision processes, although there has been a deliberate effort to include me in decisions. I value the effort my colleagues to introduce themselves on days when I am at the practice.
Making the best use of pharmacists
During a cold weather spell in early 2019, I was grateful that I could offer my remote help on a day off. I felt part of a bigger primary care network sustaining the NHS at a time of such strain. This is an example of how we can make better use of pharmacists’ clinical skills and redesign general practice’s workload to make sure primary care stays strong. With technology-enabled clinical care sharing and physical co-working, we can achieve this.
But portfolio working in pharmacy needs clearer guidance and support from regulators and NHS England; we have the technology, but it is its right and timely deployment that will arm pharmacy with the platform to shape the future of healthcare, particularly as we seek to engage effectively with primary care networks.
Ade Williams, superintendent pharmacist, Bedminster Pharmacy; pharmacist prescriber, Broadmead Medical Centre