Evolution of the pharmacist role in primary care by Mo Harb, Consultant Pharmacist.

May 01st 2018

With the ever-increasing potential for additional qualifications, the role of pharmacists in primary care has significantly changed. From being restricted to dispensing medications and conducting level 1 medication reviews, it has now become possible to, to some extent, mimic General Practitioners, where prescriptions can be issued on a clinical basis, rather than medication compliance.

Originally, in primary care, the role of the pharmacist was that of supplementary prescribing, implementing an agreed patient-specific clinical management plan, and having involvement in QOF (Quality Outcome Framework) and QUIPP (Quality, Innovation, Productivity and Prevention). QOF, as part of the General Medical Services contract, is a voluntary reward and incentive programme whereby, upon reaching specific targets concerning the improvement of primary care delivery, the Practice is rewarded monetarily. Moreover, QUIPP is a CCG initiative aimed at developing a cost effective ideology to prescribing in primary care.

The evolution of pharmacist competencies has resulted in their ability to, not only provide medicines optimisation consultation sessions, ensuring both clinical and cost effective prescribing, but also, with level 7 training, to prescribe independently from other prescribers. This transformation has ultimately resulted in time and monetary savings, enabling GPs to carry out more advanced consultations and simultaneously reduce pressures. A particularly efficient use of independent pharmacist prescribers can be found with regards to repeat prescribing. Audits have revealed that an average of three hours of GP time can be saved daily in practices where independent prescribing pharmacists are responsible for medication, blood test and high-risk drug monitoring.

Independent pharmacist prescribers can conduct both level 2 and 3 medication reviews for long-term conditions including asthma and hypertension, unlike community pharmacists who are restricted to level 1. Level 2 consists of treatment reviews, while level 3 reviews concern clinical outputs, prescribing and de-prescribing. Both levels require thorough diagnostic and examination training by the pharmacists together with being aware of, and following NICE guidelines.

Budget and temporal pressures on General Practices has necessitated the involvement of pharmacist prescribers in minor illness clinics, examining, diagnosing and prescribing for minor illnesses. These include but are by no means limited to, chest infections, skin infections, urinary tract infections, nausea and vomiting.

Ultimately, it is becoming an understatement to claim that these developments in the role of pharmacists are positively impacting prescribing in primary care.