Clinical Pharmacist

Clinical Pharmacist

Questions?

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Clinical Pharmacists

"Clinical pharmacists work in primary care as part of a multidisciplinary team in a patient facing role to clinically assess and treat patients using expert knowledge of medicines for specific disease areas."

Source: HEE's Role Overview

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What are they?

What benefits can they bring?

What is their scope of practice?

Is funding available for them?

Are there any case studies?

What characteristics, training / qualifications, and competencies should they have?

Are there any requirements to receive ARRS funding?

What employment routes are there?

Any example job descriptions?

Any sample interview questions?

What clinical supervision do they need?

What should practice induction include?

What ongoing support is available?

What are clinical pharmacists?

Clinical pharmacists are primary care health professionals, who work in a patient-facing role as part of a multidisciplinary team (MDT) to clinically assess and treat patients using their specialised knowledge of medicines. They are responsible for medicines optimisation within their respective primary care network (PCN) and conduct clinical medication reviews for patients with complex polypharmacy, especially the elderly, care home residents, or individuals with multiple co-morbidities.

If not already able to prescribe, clinical pharmacists can achieve an independent prescribing qualification following completion of the Centre for Pharmacy Postgraduate Education’s (CPPE) 18-month pathway (completing this or an equivalent, approved course is necessary for clinical pharmacists receiving funding through the Additional Roles Reimbursement Scheme (ARRS)).

For more information:

HEE's Clinical Pharmacist Role Overview

Provided by HEE, this page offers a succinct look at the education and training requirements, skills and competencies, and work activities of clinical pharmacists.

To read it, please Training for pharmacists | Health Education England (hee.nhs.uk)

ARRS Minimum Role Requirements

This appendix, from the Clinical Pharmacist DES Contract, clarifies the minimum requirements for clinical pharmacists receiving funding through the ARRS.

To read it, please NHS England Report Template 7 – no photo on cover.

(Appendix B1)

What benefits can clinical pharmacists bring?

Clinical pharmacists can help to ease the workload of and release time for GPs — as a case study provided by NSHEI suggests, the inclusion of a clinical pharmacist in an MDT can reduce the patient need for GP appointments to a significant degree (by 30% in the case of Wallingbrook Health Group, Devon). By extension, clinical pharmacists can help to decrease prescription error rates and medication-related, non-elective hospital admissions.

In short, clinical pharmacists can help to improve not only the quality of care provided to practice’s service-users, but also the efficiency and well-being of other members of staff.

Please read NHSEI Devon Case Study and Clinical pharmacists in general practice: a necessity not a luxury? below, for more information.

NHSEI Devon Case Study

Hosted by NHSEI, this case study examines the highly positive impact a clinical pharmacist had on practices in Devon.

To read it, please click here.

Clinical pharmacists in general practice: a necessity not a luxury?

From the British Journal of General Practice (February 2018), this article is linked to from Dorset Training Hub’s website.

To read it, please bjgpfeb-2018-68-667-85.pdf (nih.gov)

What is their scope of practice?

Clinical pharmacists are qualified to carry out the following activities, as part of their scope of practice:

  • Collaborate with care homes to provide support on medicines-related issues
  • Conduct clinical switching protocols and alternative prescribing policies
  • Conduct evidence-based Medicines and Best Practice reviews
  • Conduct structured medication reviews
  • Domiciliary reviews
  • Educate other members of their MDT and patients on the use of specific medicines
  • Manage polypharmacy and co-morbidity complexities
  • Provide high-risk medicines monitoring
  • Provide medicines information and advice to other members of their MDT, patients, and the general public
  • Provide medicines reconciliation, supporting safe transfers of care
  • Provide prescribing and clinic management (e.g., Minor Ailments Clinics)
  • Treat patients with complex long-term conditions, like “difficult” hypertension

Please note that this is not an exhaustive list, however.

For more information on the scope of practice of this profession, please consult the Dorset Training Hub’s page on clinical pharmacists.

Dorset Training Hub's Clinical Pharmacist Page

Kindly provided by Dorset Training Hub, this page signposts to several useful documents exploring the role of clinical pharmacists.

To read it, please click here.

Is funding available for them?

The PCN DES clarifies the annual maximum reimbursable amount per role.

Pharmacists must be employed for at least 0.5WTE under the terms of the DES.

 

Pharmacists receiving funding through the Additional Roles Reimbursement Scheme (ARRS) must complete the 18-month Centre for Pharmacy Postgraduate Education (CPPE) Primary Care Pharmacy Education Pathway (PCPEP) unless they are exempt.  For further details of the pathway including exemptions please see below and also Primary care pharmacy education pathway : CPPE.   Pharmacists employed through the ARRS will need to complete their Independent Prescribing certificate at the end of the PCPEP.

 

Pharmacists must deliver the key responsibilities that are outlined in the DES.

 

There is currently no funding for pharmacists who are not employed under the terms of the PCN DES (ARRS)

Pharmacist Funding Supporting Doc

Are there any case studies?

NHSEI is able to provide a couple of case studies, focused on clinical pharmacists located in Devon and Norwich, and the valuable contributions they made to their respective practices.

For more:

NHSEI Devon Case Study

Hosted by NHSEI, this case study examines the highly positive impact a clinical pharmacist had on practices in Devon.

To read it, please click here.

NHSEI Norwich Case Study

Hosted by NHSEI, this case study examines the beneficial impact a clinical pharmacist had on practices in Norwich.

To read it, please click here.

What characteristics, training / qualifications, and competencies should they have?

Please find information on what you should look out for when employing a clinical pharmacist below:

Personal Characteristics

Clinical pharmacists should have personal characteristics that are in keeping with the Standards for pharmacy professionals provided by the General Pharmaceutical Council, with the most recent standards being published in May 2017. They outline what is expected from pharmacy professionals, and serve as a reflection of how pharmacy professionals view themselves and their colleagues.

In short, clinical pharmacists should adhere to these nine standards:

  • Provide person-centred care
  • Work in partnership with others
  • Communicate effectively
  • Maintain, develop and use their professional knowledge and skills
  • Use professional judgement
  • Behave in a professional manner
  • Respect and maintain patient confidentiality and privacy
  • Speak up when they have concerns or when things go wrong
  • Demonstrate leadership

To read the Standards themselves, which include a breakdown, please Standards for pharmacy professionals | General Pharmaceutical Council (pharmacyregulation.org)

Training and Qualifications

All pharmacists must be registered with the General Pharmaceutical Council (GPhC) and will need to revalidate with them each year.   To be registered with the GPhC, pharmacists must have completed a GPhC-accredited or approved degree (in the UK this is now a 4-year Masters degree [MPharm] but previously was a 3-year Bachelors degree [BPharm]).  Pharmacists will then undertake a Foundation Year training programme (formerly pre-registration year) which will be signed off by a tutor and undertake a registration exam.  It is to be noted that some pharmacists will have completed their degree outside of the UK but all will have undertaken registration by the GPhC).

 

To be employed in primary care and for the PCN to receive funding from the Additional Roles Reimbursement Scheme (ARRS), there are additional criteria that pharmacists must meet – See appendix B of the PCN DES.

Are there any requirements to receive ARRS funding?

Pharmacists receiving funding through the Additional Roles Reimbursement Scheme (ARRS) must complete the 18-month Centre for Pharmacy Postgraduate Education (CPPE) Primary Care Pharmacy Education Pathway (PCPEP) unless they are exempt.  For further details of the pathway including exemptions please see below link also Primary care pharmacy education pathway : CPPE.   Pharmacists employed through the ARRS will need to complete their Independent Prescribing certificate at the end of the PCPEP.

 

A clinical pharmacist employed under the ARRS scheme must be employed for at least 0.5 WTE.

 

Pharmacists must deliver the key responsibilities that are outlined in the DES:

 

Where a PCN employs or engages one or more Clinical Pharmacists under  the Additional Roles Reimbursement Scheme, the PCN must ensure that each Clinical Pharmacist has the following key responsibilities in relation to  delivering health services:

  1. work as part of a multi-disciplinary team in a patient facing role to clinically  assess and treat patients using their expert knowledge of medicines for specific disease areas;
  2. be a prescriber, or completing training to become prescribers, and work with and alongside the general practice team;
  3. be responsible for the care management of patients with chronic diseases and undertake clinical medication reviews to proactively manage people with complex polypharmacy, especially the elderly, people in care homes, those with multiple co-morbidities (in particular frailty, COPD and asthma) and people with learning disabilities or autism (through STOMP – Stop Over Medication Programme);
  4. provide specialist expertise in the use of medicines whilst helping to address both the public health and social care needs of patients at the PCN’s practice(s) and to help in tackling inequalities;
  5. provide leadership on person-centred medicines optimisation (including ensuring prescribers in the practice conserve antibiotics in line with local antimicrobial stewardship guidance) and quality improvement, whilst contributing to the quality and outcomes framework and enhanced services;
  6. through structured medication reviews, support patients to take their medications to get the best from them, reduce waste and promote self[1]care;
  7. have a leadership role in supporting further integration of general practice with the wider healthcare teams (including community and hospital pharmacy) to help improve patient outcomes, ensure better access to healthcare and help manage general practice workload;
  8. develop relationships and work closely with other pharmacy professionals across PCNs and the wider health and social care system;
  9. take a central role in the clinical aspects of shared care protocols, clinical research with medicines, liaison with specialist pharmacists (including mental health and reduction of inappropriate antipsychotic use in people with learning difficulties), liaison with community pharmacists and anticoagulation; and
  10. be part of a professional clinical network and have access to appropriate clinical supervision. Appropriate clinical supervision means:
    1. each clinical pharmacist must receive a minimum of one supervision session per month by a senior clinical pharmacist
    2. the senior clinical pharmacist must receive a minimum of one supervision session every three months by a GP clinical supervisor
    3. each clinical pharmacist will have access to an assigned GP clinical supervisor for support and development; and
    4. a ratio of one senior clinical pharmacist to no more than five junior clinical pharmacists, with appropriate peer support and supervision in place.

To read the full annex, please consult ARRS Minimum Role Requirements below.

ARRS Minimum Role Requirements

This appendix, from the Clinical Pharmacist DES Contract, clarifies the minimum requirements for clinical pharmacists receiving funding through the ARRS.

To read it, please click here.

BNSSG-Pharmacist-Opps-Funding-v1.2

What employment routes are there?

Clinical Pharmacists can be employed under the ARRS scheme – see ‘Requirements to receive ARRS funding’ and ‘Is funding available for them?’ sections for further details of the requirements under the DES.

 

Clinical Pharmacists can be employed directly by the GP practice but would not qualify for any ARRS funding.  They won’t have access to the Primary Care Pharmacy Education Pathway (PCPEP) but there is other training available.

Any example job descriptions?

NSHEI have developed a job description, in addition to a recruitment pack — these are both available on the FutureNHS site. Accessing the site requires you to create an account; once done, you can visit the role selection page to find the resources in question (click here to jump to the role selection page — remember, you will need to be logged in to access it).

Alternatively, you can download HealthWest’s job description by clicking here.

The Primary Care Pharmacy Association (PCPA) have also kindly provided several example job descriptions, for various bands of working, on their site, accessible via the button below.

Any sample interview questions?

The Primary Care Pharmacy Association (PCPA) kindly provides sample interview questions for clinical pharmacists on their website, accessible via the button below. The sample interview questions themselves are at the bottom of the page.

What clinical supervision do they need?

When employed in primary care under the Additional Roles Reimbursement Scheme (ARRS), clinical pharmacists must be part of a professional clinical network and receive clinical supervision. Specifically, they must have:

  • A minimum of one supervision session per month, delivered by a senior clinical pharmacist
  • Senior pharmacists should receive a minimum of one supervision session every three months, delivered by a GP clinical supervisor
  • All pharmacy professionals must have access to an assigned GP clinical supervisor, whom can provide support and development
  • There should be a ratio of one senior clinical pharmacist to five clinical pharmacists — and in all cases, appropriate peer support and supervision must be in place for each pharmacist

Sourced from:

ARRS Minimum Role Requirements

This appendix, from the Clinical Pharmacist DES Contract, clarifies the minimum requirements for clinical pharmacists receiving funding through the ARRS.

To read it, please click here.

The Centre for Pharmacy Postgraduate Education (CPPE) offers training to become a clinical supervisor for individuals supervising pharmacy professionals on the CPPE Primary Care Pharmacy Education Pathway. This is a half-day workshop generally, but it can be completed by attending two webinars.

Interested individuals can apply for a space via the CPPE website, Primary care pharmacy education pathway : CPPE. If you are not a pharmacy professional, you will need to create an account on the site before you are able to book a place.

For more:

Primary Care Pharmacy Education Pathway

This page, produced by the Centre for Pharmacy Postgraduate Education (CPPE), elaborates on the clinical supervision requirements for clinical pharmacists working in primary care.

To read it, please Primary care pharmacy education pathway : CPPE.

What should practice induction include?

Practice induction for clinical pharmacists should include:

  • Signing them up on e-Learning for Health (e-LFH) to complete mandatory training | Please click here to access e-LFH
  • Signing them up on TeamNet, so that they can access relevant policies | Please click here to access TeamNet
  • Provide them with EMIS training, via the CCG
  • Familiarise them with the BNSSG Joint Formulary | Please click here to access it
  • Link with the CCG Medicines Optimisation Team, particularly if they should need Eclipse / Radar training
  • Provide them with Docman training

Those employed under the ARRS scheme need to apply to the CPPE Primary Care Pharmacy Education Pathway (PCPEP).  This usually requires being added to a waiting list and you will need to enrol when enrolment is open.  CPPE residential course booking.  There is an exemption process which can be worked through if the pharmacist has specific relevant prior learning.  The exemption process is available at Primary care pharmacy education pathway : CPPE.  Whilst waiting for the cohort to start pharmacists are advised to complete the Primary Care essentials e-course which is part of module 1 of the pathway – Primary care essentials e-course : CPPE

 

Those not employed under the ARRS scheme are not eligible for the PCPEP but there is some training that is recommended by CPPE available at primary care learning in the cppe portfolio_v2_october 2020.pdf.  Pharmacists who have not had any experience in primary care are advised to complete the Primary Care essentials e-course – Primary care essentials e-course : CPPE

 

It is advised that all pharmacists working in general practice should meet and shadow any current pharmacists, pharmacy technicians and prescription teams.  They should also meet with all other members of the clinical and non-clinical teams and link in with the Training Hub Pharmacy Lead as well as their PCN / practice-assigned CCG Medicines Optimisation Pharmacist.

 

Those not employed under the ARRS scheme and are going to be completing Structured Medication Reviews (SMRs) under the DES, must have the skills and knowledge required to complete these.  The DES states ‘ensure that only appropriately trained clinicians working within their sphere of competence undertake SMRs. The PCN must also ensure that these professionals undertaking SMRs have a prescribing qualification and advanced assessment and history taking skills, or be enrolled in a current training pathway to develop this qualification and skills.’  NHS England has produced guidance on SMRs – NHS England » Structured medication reviews and medicines optimisation 2021/22 and CPPE have published an exemption process – any pharmacist who is not enrolled on the PCPEP or who has not completed the PCPEP has to go through this equivalence recognition process in order to complete SMRs.

What ongoing support is available for clinical pharmacists?

The Training Hub is keen to support and develop pharmacists in general practice and the Pharmacy Lead can advise on any further support.  Work is being undertaken to look at Training Needs Analyses of individual pharmacists to support professional development plans.

 

Please contact TH email inbox for further [email protected] [email protected] and see links below for further guidance

Literature

List of CPPE resources available to non-ARRS funded Pharmacists

ARRS Minimum Role Requirements

This appendix, from the Clinical Pharmacist DES Contract, clarifies the minimum requirements for clinical pharmacists receiving funding through the ARRS.

To read it, please click here.

  • Updated ARRS Roles link to be added in according to latest information
Dorset Training Hub's Clinical Pharmacist Page

Kindly provided by Dorset Training Hub, this page signposts to several useful documents exploring the role of clinical pharmacists.

To read it, please click here.

NHSEI Devon Case Study

Hosted by NHSEI, this case study examines the highly positive impact a clinical pharmacist had on practices in Devon.

To read it, please click here.

NHSEI Norwich Case Study

Hosted by NHSEI, this case study examines the beneficial impact a clinical pharmacist had on practices in Norwich.

To read it, please click here.

Primary Care Pharmacy Education Pathway

This page, produced by the Centre for Pharmacy Postgraduate Education (CPPE), elaborates on the clinical supervision requirements for clinical pharmacists working in primary care.

To read it, please Primary care pharmacy education pathway : CPPE.

Standards for pharmacy professionals

Regulated by the General Pharmaceutical Council, these standards outline what is expected of pharmacy professionals, including clinical pharmacists.

To read them, please click here.

A/V resources
I'd like to see the clinical pharmacist

Produced by NSHEI for the NHS’ 70th anniversary in 2018, this video explores the role of a clinical pharmacist in their primary care MDT.

To watch it, please click here.

[This video was uploaded on 07.05.19.]

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