Job responsibilities
The Role of the Pharmacy Technician at Firth Park Surgery needs to be registered with the GPHC. Experience of working in primary care and EMIS are desirable but training will be provided for the right candidate.
The Pharmacy Technician (PT) occupies an important role to assist patients, doctors and administrative staff in providing an efficient, effective and safe prescribing system. This is facilitated in a number of different ways.
Prescribing needs to be:
Safe
Evidence-based
Cost Effective
Clinical Oversight
As the PT is a non-prescriber, all prescription issue responsibility resides with the prescriber (usually a GP) who signs a particular prescription. The PT is to be supported and trained by the GP Prescribing Lead. This is currently Dr Corker.
Medicines Reconciliation
The PT will review clinic letters and hospital discharge summaries for changes to medication, either new medication added, or medication discontinued. If this is unclear, the hospital may need to be contacted for clarification, via letter or phone call.
It is also expected that any monitoring requirements arising from a secondary care letter (e.g. blood tests) will be noted and actioned by the PT, either by notifying a clinician or directly arranging an appointment. A number of medications have shared-care protocols outlining monitoring requirements, but any new shared-care arrangement should be agreed by a GP familiar with the shared care protocol in question. Read codes are often used to add a patient to a particular monitoring register.
In more general terms, it is good practice to ensure that a patients prescription quantities are aligned at either 28 or 56 days. A small number of patients have a 7-day NOMAD arrangement, which is usually expressed as 4x weekly batches on repeat dispensing.
Medication Reviews and Chronic Disease Reviews
Patients on repeat medication will have a global medication review date, which ideally should match their birthday month (or 6 months later) each year. If a patient requests a medication that is not on their repeat prescription, other their medication review date has expired, the request becomes a query to be passed to a doctor or the PT for review.
Medications not on repeat this is often for a short-term item such as analgesia, or a cream that the
patient may have been given recently. If, from reviewing the clinical record, it seems reasonable for a further quantity to be issued, then the PT may forward the request to a GP for signing, at the discretion of the GP. If, however, this is an item not issued before, or not for a long time, or the indication is unclear, then the PT should pass the request directly to the on-call doctor to review.
Expired Medication Review Date in this situation the PT should review the clinical record to
consider whether a patient has any outstanding monitoring needs, such as a chronic disease review appointment or a blood test. If the patient appears to have had the appropriate monitoring, then the PT is permitted to move the medication review date forward to an appropriate future date, ideally linking with the patients birthday month or 6 months later. If there are outstanding
monitoring requirements, then the PT should help arrange the necessary appointments, either by directly booking appointments or liaising with administrative/reception staff to achieve this.
If it is unclear whether a patient needs to be seen for a review, the PT is expected to ask a GP to review the notes. Patients needing a review may still have their medication issued, but the medication review date should not be amended.
Where patients have received several notifications to attend for review and have failed to do so, it is reasonable to halve their medication quantities as a further prompt to attend.
Specific Chronic Disease Monitoring Requirements
The medical year runs from 1st April to the following 31st March, in line with requirements of the QOF (Quality & Outcomes Framework)
Each patient should be considered individually, depending on their complexity, vulnerability, and age. However, in general terms, typical monitoring requirements would be:
Asthma an annual practice nurse appointment. Patients on high steroid (step 4) regimes should be seen 6 monthly. Patients whose treatment has been changed should be reviewed 2-3 months later.
COPD an annual appointment for spirometry and review with practice nurse
CHD/Angina annual blood tests (HbA1c, UE/LFT/Lipids) plus practice nurse review
Stroke/TIA annual blood test (HbA1c, UE/LFT/Lipids) plus BP check/smoking status
Diabetes Annual UE/LFT/Lipids, plus HbA1c 6-12 monthly depending on treatment
BP and foot check with health care assistant
Practice nurse review twice a year unless diet controlled, when annual may suffice.
Type 1 diabetes is usually managed by hospital clinic results may be visible on ICE system, or in clinic letters
Hypothyroidism annual TFT check, with TFT 3 months after any dose change
Depression GP review of medication 6 monthly, or 3 months after medication change
Severe Mental Health (Schizophrenia, Bipolar, Psychosis) annual GP review, plus annual blood test (HbA1c, lipids), plus BP, BMI, smoking/alcohol status (by GP or HCA)
Rheumatoid Arthritis annual GP review, plus 3 monthly DMARDs blood test if prescribed under a Shared Care Protocol
Prostate Cancer Hormone treatment (Prostap injections) 3 monthly practice nurse appt for injection, plus PSA blood test 6 monthly.
Eczema/Psoriasis usually an annual GP review unless unstable disease
Atrial Fibrillation most warfarin patients seen by HCA for monitoring. DOAC patients need FBC/UE blood test 6 monthly. Annual patients should have a pulse rate and BP recorded annually.
Housebound patients on any chronic disease register should be under the care of local district nurses, and a referral letter faxed to them if outstanding monitoring needed.
Clinical Audit
The PT will also offer valuable assistance in reviewing prescribing practice and effecting change via clinical audit. In conjunction with the prescribing lead GP, suitable areas for audit will be identified, and a data search performed. The PT will be trained in devising and running audit searches on the EMIS clinical system.
Topics for audit should include areas where safety is paramount, where monitoring is required, where there is clear best practice to be adhered to, and where prescribing could be more cost effective. The PT should be able to generate and send mail-merge letters to facilitate changes to prescribing.
There are tools available to help direct such audit ideas, including resources such as the online Open Prescribing website database (https://openprescribing.net) as well as local Sheffield CCG data.
CAS Alerts
The PT will be responsible for actioning alerts from the MHRA or other relevant bodies and updating the excel sheet located on the L DRIVE.
Total Triage
The PT will be assisting the GPs on call with any medication-related queries on the day by accessing the Accurex requests under the prescribing section which will be allocated to the team.
Training
The PT would need to be happy to enrol on the the CPPE pharmacy education pathway or have already completed this.