Time may not heal all wounds, but it helps optimise their treatment. Particularly in today’s healthcare service, where patients often present with multiple long-term conditions and psychosocial issues.
However, frustration over the time that pharmacists are being given to carry out structured medication reviews (SMRs) in GP practices was laid bare at the recent Clinical Pharmacy Congress, held in London in May 2022.
Following a talk by Tony Avery, the national clinical director for prescribing in England, looking at the implications of the recent overprescribing review, GP pharmacists in the audience explained to him that they were not being given enough time to carry out their vital work with patients.
One pharmacist said she had heard from some of her primary care network (PCN) pharmacists that they were not allowed to book appointments for longer than ten minutes to carry out an SMR. Another said: “We do have a lack of understanding among our GPs about what an SMR is”, before adding that recently introduced financial incentives for PCNs to carry out more SMRs were not helping.
These incentives — worth around £16,400 for the average PCN — were introduced in April 2022, and it is worrying that they may already be leading to compromises in quality over quantity in terms of the care provided, as this pharmacist suggested.
GPs themselves struggle with ten minute appointments. The Royal College of General Practitioners is calling for 15-minute appointments as a minimum, and a British Medical Journal article from 2019 that looked into this concluded: “Very few GPs feel as though they can comfortably do a good job and provide holistic care in a 10-minute appointment.”
This is understandable. Often, it can take a minute or more just for a patient to walk from the waiting room — add in a discussion about various long-term conditions and personal experiences with treatment, and it can take a very long time to get to the root of the problem and talk through a solution.
An SMR is meant to be a comprehensive review that takes all the conditions, treatments, concerns and expectations of patients into account. Research shows that patients value not being rushed and being treated holistically, and that is what an SMR should offer, particularly when dealing with medications that have a strong potential for dependence, such as opioids or antidepressants. As Avery said in response to the pharmacists raising concerns: “It’s not going to be a structured medication review in ten minutes”.
Avery promised to look into the concerns raised by pharmacists, and we look forward to what action is taken as a result. There are ways that SMRs could be made shorter — for instance, a lot of time can be taken up with digging back through the patient’s records and medical history to find out why and how a medication was first prescribed. If a pharmacy technician was given this task to do before the appointment, and the patient was asked to reflect on their current treatment before the appointment by the GP practice, that would help immensely with keeping to time. In addition, better supervision and support from GPs would help inexperienced pharmacists conduct reviews more quickly over time.
However, let’s be clear: good care will always take time. Rushed SMRs are the worst of both worlds — bad for patients and stressful for pharmacists. PJ