Podcast: Developing your role as a PCN Pharmacist
In our latest podcast, MORPh Clinical Services Director Ryan Smith and PCN Associate Director Darshan Negandhi discuss developing your role as a PCN Pharmacist. Find out what PCN Clinical Pharmacists do and how to take the journey into working in Primary Care.
How did you become a PCN pharmacist?
Darshan explains what led him to become a PCN pharmacist, having come from a community background. He appreciates the opportunity to have more say in patient healthcare and the outcome. He also enjoys putting his clinical knowledge and expertise to good use. Ryan started off as a medicines optimisation pharmacist when he qualified. When he started as a PCN pharmacist, it was an audit role. Since then, the role of the PCN pharmacist has changed and developed.
Darshan talks about the transition into the world of a PCN pharmacist. He describes it as trying to fly a plane whilst still building it. PCN employers still didn’t really know what it was all about, beyond the fact that they had funding to employ pharmacists in a PCN role. As part of the Additional Roles Reinvestment Scheme, that has expanded to other roles and professions to support the MDT. Being in a PCN role has sharpened up his knowledge, experience and clinical expertise.
Ryan found the move into PCN pharmacy to be a change of mindset. A nurse in his practice told him that pharmacists are good at drawing a line under a problem, but they’re not great at following it up. This resonated with him because in the past, you would produce an audit and show it to a clinician before stepping back. The nurse’s comment changed Ryan’s mindset.
What are the three key priorities for PCN pharmacists?
A webinar participant asked the top three key priorities for PCN pharmacists. Ryan’s main priority is adding value to the team, playing a role, integrating well and understanding how to do more in the right way in line with practice need.
Darshan asks himself how he is showing value and benefit to the practice within his role. He considers adding value to be about carrying out his ongoing tasks and remembering the cross-sector network available to him. As pharmacists, you have a duty to link in with colleagues in secondary care, community pharmacists, industry and other sectors. He regards cross-sector collaborative working as the PCN pharmacist’s greatest asset. He considers how to reduce the burden on the GP workforce by using his expertise. Darshan views it as essential to develop sufficiently to meet the needs of the community.
What fundamental changes did you make on becoming a PCN Pharmacist?
Ryan asks Darshan about the fundamental changes he made on becoming a PCN Pharmacist. Darshan explains that the main fundamental change was the way he was conducting his work. He had to be self-motivated to develop himself to meet the needs of the GPs and nurses he was working with. Implementation of clinical knowledge to make clinical judgement is important for pharmacists working in Primary Care.
Ryan regards adding value as including his contribution to structured medication reviews. Pharmacists should lead on SMRs. He believes it is important to understand the processes and systems in operation around you as a practice. It was initially difficult to understand how he would fit into the team. It was his role to helpfully intercept the paths already being walked and add value to the environment. He views it as important to decide which long-term conditions to target. His PCN drew up a collective task list and each colleague would take on particular tasks. This led to dialogue between them, thereby growing everybody’s competency through engagement.
Delegate questions
A delegate asked whether Ryan and Darshan had any advice for people who have never worked in a GP practice before. Darshan recommended making use of available networks, including the MORPh Telegram groups. This is a supportive environment that gives guidance to PCN pharmacists, enabling them to grow and develop together. It is a good platform to share resources and information using such networks.
Ryan agrees that competency starts with the self-awareness of understanding what you don’t know. He worries that the pressures and expectations placed upon them are high. Competency always needs to be at the front of your mind to ensure you are always comfortable with what you are doing. He believes it is important to reach a point where the GPs they work with couldn’t do without their PCN pharmacists because of the level of value that they add.
The different types of medication review
A delegate asks what the difference is between an SMR and a normal medication review. Darshan explains that a Structured Medication Review (SMR) is a structured, holistic, personalised review of all of the patient’s therapy. It is not restricted to a particular condition or type of drug but is instead a holistic review. This is where the skillset of communication skills and health and lifestyle coaching are important. A medication review is simply where someone is due for a review of their medication and the practitioner ensures that everything is being taken properly and there are no issues. SMRs take a lot longer, from 30 minutes to over an hour.
Darshan explains that there are two types of SMRs. A proactive SMR, looking at those individuals at highest risk due to medicines that could increase the risk of them being hospitalised. Conversely, reactive SMRs are in response to an incident involving the patient. You respond to an event that could be medication-related or a referral by a healthcare colleague.
A day in the life of a PCN Pharmacist
A delegate asks how Ryan and Darshan plan their days in practice and requests that they talk through a typical day. Ryan’s typical day is a list of tasks from the team. This may include discharge letters with a question on them, things involving medication that would usually go to the GP. He then moves onto a proactive SMR list. This allows him to triage with other people in the practice and engage with colleagues with more experience in the area of a particular illness.
Darshan would also work through tasks in the morning including medication queries and discharge summaries. He may then link in with the patient to follow up some things that come through that task list. Darshan then works through SMR appointments. Finally, he will look at medicines reconciliations, drug alerts and audits and any other areas where he can add value.
An attendee asked how to become a PCN pharmacist and Ryan pointed them towards the NHS jobs website. Further training is provided as part of the role. There is also an element of training time within the role.
PCN Pharmacists and Holistic Wellness
Concerns are raised about the absence of holistic wellness training in traditional pharmacy education. Ryan is asked to comment on how to build health coaching skills. He feels it is an unmet need. A pharmacist’s ability to coach somebody is potentially something that is developed on an individual level rather than through education. Talking is powerful and gives patients the knowledge to act to help themselves. Darshan thinks that communication is a soft skill that should be taught better because all pharmacists need to develop it.
One delegate wonders whether all clinical pharmacists should be prepared to become advanced practitioners to remain in PCNs. Ryan does not feel that any level of qualification should be forced on a person. Each person should find their own role where they are happy and confident. He does not feel that you need to be an ACP to add value. Darshan thinks that it is necessary from a career progression point of view. In the future, he would like to be a partner in a GP practice due to adding value as an ACP. Ryan believes that the main thing is to add value, in whatever role you fulfil without a label determining what you do.
Attendees ask Darshan and Ryan whether they have much interaction with secondary care and both agree that their interaction is minimal. They are also asked about the overlap between them and diabetes nurse specialists. They do not feel that there is any overlap but Darshan recommends checking in with the MORPh Diabetes Academy for further input.
Does the CPP really prepare you to be a PCN pharmacist in the real world?
A delegate asks whether the CPP completely prepares you for the real world in PCN pharmacy. Ryan doesn’t feel that it does, and recommends throwing yourself into the team and building rapport. Another delegate asks how they manage the clinical admin expectations placed upon them. Darshan responds that you set your own agenda and timetable. By speaking to reception and your supervisor, you can ensure that you are not bombarded.
Linked to this, someone asks whether there is a right and wrong in terms of expectation of clinical admin. Ryan is keen to emphasise that PCN pharmacists should not be afraid to say when they feel unable to add enough value due to processes holding them back. If you are spending too long on things that waste your clinical experience, it is your responsibility to say so.
A delegate asks Darshan why he chose PCN training prior to IP training. He explains that he wanted to up-skill himself clinically before being put under the immense pressure of an IP. He wanted to build up his competence and confidence as a PCN first. Ryan and Darshan both offer to help if anybody requires further information or assistance and recommend reaching out via LinkedIn or on the MORPh telegram groups.
