Making the best of the grey areas

29 June 2017

Helen Kilminster was no stranger to general practice when she took up her role with the Whiteacres Medical Centre in Malvern, south Worcestershire.

Before the pilot programme started, she had worked in local practices for the GP federation, Stay Well Healthcare, supporting practices to deliver the CCG’s medicines optimisation service.

In her varied clinics she helps patients with long-term medicines management issues, with most of those she sees having chronic conditions. Kilminster also sees some patients for acute conditions – such as colds and rashes – and those recently discharged from hospital.

“Using my advanced clinical practice skills, I am able to conduct a basic holistic health assessment of the patient and refer on to the duty doctor for any grey areas or to confirm next steps for management of patients,” she explains.

While she suspects that it will be difficult to provide evidence for her direct impact on GP workload, Kilminster says that the partners are now finishing their working day on time and the appointment book is more manageable as the high-pressure additional appointment slots are not being filled.

“I’m not sure if I’m able to make a dent in the GP workload for appointments, being here only three days a week, but patient access to appointments is good and the general feel on pressure for GP appointments has improved,” she says.

Kilminster is involved in delivering the local improvement schemes – including an initiative for improving the care of the frail elderly – and has helped increase the number of NHS Health Checks completed by the practice. She also supports proactive care of patients at risk of type 2 diabetes.

“In my care navigator role I am able to help some patients over the telephone and I see some carers or patients in the clinic. Signposting is a positive action and reception are brilliant at getting patients or carers to me. I think that community pharmacy has always had that signposting role. We know about the services and support available locally.”

Pharmacists, Kilminster insists, clearly have a unique skillset that means they can interpret data and provide effective clinical care as well as completing the routine prescription-related work.

However, she suggests that communications challenges could be the greatest barrier to expanding the programme.

“Some pharmacists need support and guidance on the softer skills – like effective communications and leadership. Perhaps understandably, pharmacists may not always know what to say and how to integrate themselves in to general practice. Practice managers don’t always know what to do with us and GPs don’t have the time. Pharmacists do need to understand the GP business and show how we add value by tying our work in with local improvement schemes that could provide new workstreams without much GP input.”

She does feel a need to prove herself, despite already having that relationship with the practice.

“We did have a new practice manager a few months after starting in this role so I did feel I was starting from scratch in terms of proving both that I am someone that can be trusted and that I was worth keeping in the practice.”

Kilminster is not the only pharmacist interviewed by PCC to voice frustration at the unanticipated difficulty of finding adequate indemnity cover for the expanded role she and the practice had planned.

“If there was a surprise or challenge it was finding the indemnity insurance and agreement on what it is deemed safe for you to do. That is a huge grey area with variation across the country.”

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