Clinical Pharmacist

PRIMARY DUTIES AND AREAS OF RESPONSIBILITY

Clinical - Long Term Conditions / Chronic

Disease Management - via pharmacist led clinics, telephone and office based notes

reviews

Undertake disease focused

medication reviews, particularly of high risk groups (elderly,renal/hepatic impairment,

patients on high-risk medicines, etc.) to improve effectiveness and safety, and

to ensure appropriate compliance with national and local guidelines.

These may be patients with

single or multiple medical problems where medicine optimisation is required

(e.g. respiratory, hypertension).

Ensure the care for patients

taking high risk drugs e.g. DMARDs, anticoagulation, are safe and appropriate.

Review the on-going need for

each medicine.

Titrate medication according to

need and guidance.

Review monitoring requirements

and arrange appropriately, ensuring recalls are placed on the IT system.

Use the opportunity to support

patients with administration of their medicines.

Telephone advice to patients

with LTCs on specific medicines management issues.

Provide health promotion where

appropriate, including flu vaccinations.

Discuss where necessary any

recommendations or concerns with Senior Clinicians or GPs. Undertake audits and

reviews of LTC groups where bulk changes are required.

Clinical - Repeat Prescribing and Medication

Reviews

Develop and quality-assure

improved, safe and efficient repeat prescribing and medication review processes

within the practice, and implement changes as required.

Undertake focused and

structured clinical medication reviews with individual patients and produce a

management plan on future prescribing and monitoring, with a focus on

maximising effectiveness and reducing harm.

Review processes will update

repeat prescribing in line with local and national policies to align to best

practice and reduce wastage.

Medication reviews will be

undertaken via clinics in the practice, domiciliary visits and in residential

and nursing homes. These may be face to face or records based reviews.

Ensure computer records are

updated and accurate, and recall / review dates are entered appropriately.

Clinical - Acute Illness Pharmacist led

clinics

Pharmacists may be involved in

clinics assessing patients who present with undifferentiated minor illness,

working within their scope of practice and limits of competence.

Undertake initial assessment of

common general practice presentations, working through differential diagnosis,

identifying potential serious disease and referring to GPs and other healthcare

professionals where appropriate.

Triaging and managing minor

illness, with particular focus on educating patients on self-care, and

signposting to minor ailment schemes, minor eye complaints service, dental

services, etc.

Telephone advice to patients

with acute illness queries.

Risk Stratification around medication harm

and avoidable hospital admissions

Review the use of medicines

most commonly associated with unplanned hospital admissions through audit and

individual patient reviews with the intent of reducing avoidable admissions.

Put in place changes to reduce

the prescribing of these medicines to highrisk patient groups

Identification of cohorts of

patients at high risk of harm from medicines through practice computer

searches. This might include risks that are patient related, medicine related,

or both.

Management of medicines at discharge from

hospital

To reconcile medicines

• following discharge from hospitals, intermediate care and into/from care homes,
• including identifying and rectifying unexplained changes and working with
• patients and community pharmacists to ensure patients receive the medicines they
• need post-discharge.

Set up and manage systems to

ensure continuity of medicines supply to high risk groups of patients (e.g.

those with medicine compliance aids or those in care homes).

Reconcile

patients computer records with discharge medication and discuss

discrepancies or concerns with hospital doctors/pharmacists

Ensure changes to discharge

medication are in concordance with national and local policies, and to ensure

optimisation of treatment and reduce inappropriate or wasteful prescribing.

Ensure instructions and

recommendations are enacted within the practice, including organising reviews,

blood test monitoring and appropriate up/down titration.

Ensure patients are informed

• and aware of any changes to their medication
• MDTs and Case Conferences
• Attend and refer patients to
• multidisciplinary case conferences where appropriate.
• Team Information, Education and Training
• Answers relevant medicines and
• prescribing related enquiries from GPs, other practice staff, other healthcare
• teams (e.g. community pharmacy) with queries about medicines.

To consider the skills of the

reception team and develop plans for training as necessary to ensure safe and

efficient prescribing processes.

Implementation of local and national

guidelines, safety alerts and formulary recommendations

Implement changes to medicines

• and prescribing that result from MHRA alerts, product withdrawal and other
• local and national guidance
• Assessing the practices compliance with NICE guidance and advise on the implementation of
• new guidance

Assist the practice in

maintaining and complying with a practice/PCN/Locality formulary.

Monitor practice prescribing

• against the local health economys RAG list / formulary and make
• recommendations to GPs for medicines that should be prescribed by hospital
• doctors (red drugs) or subject to shared care agreements (ESCAs) for amber
• drugs.

Provide newsletters or

bulletins on important prescribing messages.

Audit and Monitoring

To plan and undertake

prescribing audits to identify areas where improvement is needed, develop

action plans and implement appropriate changes.

To provide regular support and

feedback on prescribing action plans

Analyse practice complex

prescribing data to inform GPs and non-medical prescribers on their collective

and individual performance.

Analyse, interpret and present

• medicines management / prescribing data to highlight issues and risks.
• Lead on the identification,
• implementation and monitoring of medicines management targets and initiatives
• including QOF and ICB prescribing targets

Undertake specific audits on

the effectiveness of the role, and where improvements or review of service/role

are needed

Assist with the implementation

and monitoring of ICB medicines management targets and initiatives, including

the medicines management QIPP plan and national prescribing targets.

Support the implementation of

actions resulting from audit findings when necessary.

To agree all auditing and

monitoring priorities in discussion with the practice.