Delivering primary care within the Hove community

At Charter Medical Centre, our team of healthcare professionals including General Practitioners (GPs), Advanced Nurse Practitioners, Practice Nurses, Pharmacists and Health Care Assistants provide general medical services to our practice population of 23 000 patients. We also provide an extended hours service – so we’re open an extra two hours in the evening, two days a week. In addition to that, we participate in many of the local enhanced services as well – such as delivery of minor operations and vaccinations.

Identifying the need to change how primary care is delivered

If you look at the number of medications reviews that land in the average GP session, this was taking up a lot of the GPs’ day. Often these do not need to be done by a GP, nor are GPs always the best skilled do them. By recognising individual skills we were able to effect appropriate use of resource. Having a qualified pharmacist – somebody that can really focus in on the medication issues as opposed to the more general care – is a good way of using that skillset and embedding that new role into the practice team.

Bringing skills together in partnership

Partnering with Here, we have benefitted from having a corporate perspective and a thought-through understanding of governance across multiple providers and employers. This covers our individual contractual obligations to each other and how we demonstrate accountability to each other. The practice has got a historical working relationship with Here (formerly BICS), going back to 2008 when they began running the original Referral Management Service for the city. More recently Here has been a facilitator in getting the pharmacy project off the ground. The contractual arrangements around collaborative working can be complex – for example around Human Resources. Here was able to step in and support the project in terms of providing the support of their HR team. They were also able to support the project with the recruitment process and contractual arrangements around collaborative working. For me, partnering with Here has been about facilitating change in a way that we would struggle to do as individual organisations.

Overcoming obstacles to reach solutions together

We as practices are used to working in isolation. There haven’t been many projects locally where a number of practices have all come together. Fortunately, our Pharmacy project bid was successful largely because of the help and support that we had from Here. They helped us with the initial preparation of the bid and then the implementation process – supporting us with recruitment, HR and the induction process to ensure that there’s continuity for the new team. Everyone’s working to the same expectations and standards.

We’re all capable of doing our own individual HR and induction programmes in our individual practices, but if you try and roll that out across several sites it becomes far more complex. There was a time where the project was at risk, and Here was able to offer us dedicated time and resources to manage recruitment and end-to-end implementation that we didn’t have the capacity for at individual sites. Having that time and resource gave us time to work out the problems we ran up against. We had the benefit of working with an organisation that enabled cross-practice working while we figured out what was needed.

Improving people’s experience of primary care

Having a mixed skillset in practices is improving the standard of patient care we can deliver. When you’ve got someone who is specifically trained, they are highly skilled to deal with particular issues – and that means patients can benefit from dedicated clinics that offer the kind of care and service that we couldn’t provide without a pharmacist.

The pharmacists have regular patient facing sessions on the phone and in clinics, but they’ve also been able to support our administrative staff and help them to develop their skills. We’ve had positive feedback not just from patients but within our team also.

Implementing a mixed skill-set approach to improve future care

This will be vital in the future sustainability of delivering general practice. I imagine that every practice will have a pharmacist in their regular team – and this project is helping us to learn and demonstrate what’s possible for that role. For example, pharmacists have professional links and are able to keep the GP up-to-speed with prescribing issues. They’re a good source of advice for GPs and for the staff behind the practice desks. Furthermore, by setting up pharmacist-led medication review clinics, it will reduce the wait time for GP appointments, freeing up GPs to have more contact with the patients and put their specific skills to best use. It will make GPs overall more accessible to patients and staff and that will be to everyone’s benefit.