A career as a practice pharmacist

Pharmacists have been working with general medical practitioners for more than a decade, but recent changes in the structure of health care delivery, particularly the advent of primary care groups (PCGs) and their equivalents in Scotland and Wales, are creating a growing number of opportunities for pharmacists in this field

The total number of pharmacists currently working with GPs is unknown, but a survey conducted by the National Prescribing Centre (NPC) in the summer of 1999 found that over 440 professionals - mostly pharmacists - were providing prescribing support to a total of 344 PCGs in 91 health authorities. Of the 137 PCGs which, at the time of the survey, did not have prescribing support, many were actively recruiting during the autumn of last year.
Pharmacists working in practices are employed according to a variety of different working arrangements - full-time, part-time or on a sessional basis. Of the 440 professionals in the NPC survey, over 150 were working full time and more than 90 half time or more. What seems likely is that as more PCGs experience the benefits of pharmaceutical input, and PCGs merge and become larger, an increasing number of pharmacists will be employed on a permanent and full time basis.

Fast growing
Fuelled in large measure by the need to contain prescribing budgets, practice pharmacy is one of the fastest growing specialisms in the profession, if not in the whole of the National Health Service. It has been suggested that within the next five years or so, every PCG could be employing up to six pharmacists. This represents an enormous opportunity for those pharmacists with the appropriate knowledge, attitudes and skill. Indeed, skills are more important than previous background. So, whether one has worked in hospital, community or academia matters less than the motivation and ability to gain the right skills.
That practice pharmacists need sound clinical skills is obvious. But this means more than understanding how drugs work, their side effects, interactions and what they cost. Practice pharmacists need to be able to apply their clinical knowledge to individual patients and groups of patients. An ability to evaluate published evidence and health economic data is also vital - in other words, critical appraisal skills are needed. It is also necessary to have a broad understanding of primary care systems, hospital interface issues, the pharmaceutical industry and a perspective on public health, as well as skills in marketing and information technology.
But what is just as important, if not more so, is "people skills". Practice pharmacists work with multidisciplinary teams that may never have worked with a pharmacist before. Although many pharmacy colleagues have already been trail blazers in this field, practice team members may be a bit sceptical and require convincing of the value of a pharmacist's contribution. In short, it is necessary to be able to build effective and long-lasting relationships within the practice team.
Practice pharmacists also need to able to work as independent professionals and to communicate to the team with authority. They need to be assertive and good negotiators, capable of balancing the concerns of the practice with their own professional position.
Yes, it is a tall order, but most practice pharmacists will say how great are the rewards, in terms of professional satisfaction. Working as part of a multidisciplinary team, they start to see the big picture, not just a part of it. Most practice pharmacists value the fact that they have broadened their knowledge of the NHS and what other health professionals do as well as presenting a pharmacy voice at the practice level.

Activities
So, what do practice pharmacists do? They are involved in a wide range of activities, which generally fall into two broad categories - strategic and operational. At the strategic level, practice pharmacists can be involved in the planning of pharmaceutical services, medicines management, clinical guidelines, formulary development and prescribing policy across the PCG (or primary care trust).
At an operational level, pharmacists can provide prescribing support to individual practices (analysis of prescribing data, repeat prescribing protocols, management of new and/or high cost drug prescribing), run clinics (anticoagulant, analgesic and diabetic), provide pharmaceutical care to individuals in care homes and liaise with hospitals on discharge planning issues around medicines.
Those who wish to apply for one of these posts should look carefully at the job description and check exactly what the practice is looking for. This should also be discussed thoroughly at any interview to make sure that the applicants skills match as nearly as possible the job the practice wants doing. Because these posts are relatively new, there is a lot of room for innovation and professional satisfaction, but potential also for disappointment on the part of the practice if its expectations are not met.
As with any new specialism, there is currently little in the way of a career structure and an overall lack of clarity in relation to roles and professional standards. One model has been put forward and, in collaboration with the Department of Health, the NPC is working on a national initiative with the aim of defining core roles and competencies for this group of professionals. The next stage will be to develop standards for practice and link these with these continuing professional development requirements.

Training
There is no specialised training for practice pharmacists, so they need to be able to recognise their own training needs and to form their own development plans. These can then be met from the usual variety of sources - workshops, distance learning, conferences, mentoring and reading journals and books.
Professional isolation is a problem for practice pharmacists, simply because they are usually the only pharmacy voice in a multidisciplinary environment. However, as a group, they are evolving rapidly and developing an identity of their own. Two primary care pharmacists' groups - the Primary Care Pharmacists' Association (PCPA) and the Prescribing Support Pharmacists' Group (PSGP) - are now in existence and provide channels for two-way communication and sharing of ideas and information. There is also a new journal Primary Care Pharmacy.
Practice pharmacy is the fastest growing wing of the profession and is professionally rewarding for pharmacists with the right skills or the motivation and ability to develop them. Testing clinical, management and interpersonal skills to the utmost, this job currently provides a challenge like no other, and if done well, helps to raise the profile of pharmacy within the primary health care team. Moreover, practice pharmacists have the potential to be a powerful force in helping to shape the future direction of health care in general and the delivery of pharmaceutical care in particular - patients should ultimately benefit, too.