Switching from the Community to GP Pharmacist?

Original post by Claremont4ever

I wouldn't think the GPs would be happy to see an IP prescribing since most believe diagnosis and prescribing is the core role of a doctor. It seems some GPs would prefer practice pharmacists to focus purely on medication reviews and prescription cost savings via brand to generic switching rather than prescribe. When the concept of practice pharmacists (''clinical pharmacists'') was first coined, I could be wrong but I thought they were supposed to play a primary role in ensuring cost savings to the practice via brand to generic switching etc? It then evolved to include prescribing later on.

It's definitely in GPs interest for pharmacists to prescribe in the surgery. Signing off prescriptions is time consuming work, and having IPs bypass that saves a lot of time. GPs are under no threat from pharmacists, there's a large gap between the clinical skills or a GP and a pharmacist.

Reply 23

Sarah H.

10

Original post by ChillBear

It's definitely in GPs interest for pharmacists to prescribe in the surgery. Signing off prescriptions is time consuming work, and having IPs bypass that saves a lot of time. GPs are under no threat from pharmacists, there's a large gap between the clinical skills or a GP and a pharmacist.

Hi Chillbear,

Could I ask your views on the prospects for pharmacy students who will be graduating with IP qualifications in a few years time?

Do you think there will be new opportunities for them (and if so where) or will the market be saturated and the IP qualification be devalued? Will many be able to use the qualification? I ask because I know a couple of experienced iIP qualified pharmacists in Community who currently are struggling to find permanent full time positions in GP surgeries.

Regards.

Reply 24

Original post by ChillBear

It's definitely in GPs interest for pharmacists to prescribe in the surgery. Signing off prescriptions is time consuming work, and having IPs bypass that saves a lot of time. GPs are under no threat from pharmacists, there's a large gap between the clinical skills or a GP and a pharmacist.

I just like to add a bit more to this and an example I had in the surgery. When I mean signing off prescriptions is time consuming work, I mean signing off other people's prescriptions. If you're a GP and you employ non-IPs who are prescribing, you're having to make sure what they are trying to have signed off is clinically correct. It can add up to dozens of prescriptions from a single clinician, then multiply that by a few clinicians in the practice. Trying to find time to do that in between your 10 min slots and given how busy GPs are can be difficult. That's why the value of IP is so useful, you're another prescriber in the practice saving time so GPs can focus on their tasks at hand.

Now for an example I had today how there's a gap between clinical skills of a pharmacist and a GP.

I had a lady present to me due to a cardiovascular issue, the receptionists know I run hypertension clinics so they thought it'd be appropriate to book her in with me. She explained how two weeks ago on holiday she had a high pulse, feeling dizzy and vertigo. She was so bad she had to go to a hospital there where they thought she was hypovolemic so they did a saline infusion. They also did multiple blood tests, in the end they recommended she drink 2L water daily and seek advice from the GP when she came back to the UK. Two weeks later she is still feeling awful, dizzy, vertigo, lips are dry and cracked despite 2L of water daily.

I measured her BP which was normal, but she was tachycardic, as in 120+ pulse. At this stage alarm bells are ringing in my head, this may be an acute emergency and my clinical skills are at their limit, because as pharmacists we're not trained to this degree of diagnosis. I passed her onto the GP immediately.

The GP dealt with her and came up with a diagnosis of thyrotoxicosis. I asked him to explain his reasoning to me to help me learn. He first asked me what common conditions can lead to a high pulse. I told him hypovolemia, some medications, but off the top of my head I wasn't really sure. He listed some other reasons such as high thyroid levels, DVT, some adrenal conditions. He explained the blood test results from abroad were incomplete, but what he did know from the FBC and blood glucose was she wasn't diabetic, nor was it a problem with her blood count. She had no physical symptoms of DVT. Probable diagnosis was high thyroid levels, so he ordered a thyroid and renal test and initiated her on beta-blockers.

It's an example where I think GPs and pharmacists have a gap in clinical skills and where they're under no threat from IP pharmacists. I'd love for us to get to that stage of clinical diagnosis, but I appreciate there's a number of years of study and experience GPs have been doing this where we haven't.

(edited 3 years ago)

Reply 25

Original post by Sarah H.

Hi Chillbear,

Could I ask your views on the prospects for pharmacy students who will be graduating with IP qualifications in a few years time?

Do you think there will be new opportunities for them (and if so where) or will the market be saturated and the IP qualification be devalued? Will many be able to use the qualification? I ask because I know a couple of experienced iIP qualified pharmacists in Community who currently are struggling to find permanent full time positions in GP surgeries.

Regards.

Hey Sarah

I think with any substantial change to the profession like IP for all newly qualifieds there will always be a degree of apprehension. Will it devalue current IPs? Will it be dangerous to the public? Will training be adequate to support a largely young, inexperienced generation of new prescribers?

In terms of progression for the profession I agree, it makes sense that pharmacists, experts of medicines, should be able to prescribe what they work day in and day out with. What I'm afraid of is cowboy pharmacists going rogue and prescribing medication they don't have competence for. Will that be a common occurrence? Unlikely. We're reminded again and again to prescribe where we're competent in and I don't imagine community pharmacists feeling they have the diagnostic skills to go ahead and prescribe Mrs. Betty medications for an undiagnosed TIA.

So, serious, chronic conditions aside what about acute conditions like minor ailments and antibiotic prescribing? After all, it's been touted for years that this is where community pharmacists could make a big impact. It will have an impact, but I'm afraid in a not so positive way. For example, a recent article by Red Whale regarding the usage of chloramphenicol in children: https://www.gp-update.co.uk/SM4/Mutable/Uploads/pdf_file/Conjunctivitis_July_2021.pdf

"Until 2005, when chloramphenicol was made available over the counter, usage was stable.
• After 2005, chloramphenicol prescribing rates by GPs fell by 15%. However, an extra 1.1 million packets of chloramphenicol eye ointment were sold over the counter! Interestingly, during this time, GP prescribing of all the
eye antibiotics fell by 13% – so GPs were not just swapping from chloramphenicol to a different agent.
"

What was seen after 2005 was a surge in use of chloramphenicol. I think it's safe to say many pharmacists use chloramphenicol very liberally when there's no need to. I'm afraid antibiotics will go down the same route. Jane and Joe will go down to the local pharmacy with an acute cough, an overly ambitious pharmacist will prescribe penicillin and be done with it. Next customer. Years of policy trying to reduce antibiotic usage may be undone. I hope if this will be the case that tracking medication dispensing will be common in pharmacies as it is with GP surgeries. It's almost a competition and a 'wall of shame' when the annual report comes in showing which surgeries in the area are underneath antibiotic prescribing targets. Will there be a similar report for pharmacies? We'll have to see. On the bright side, IPs will probably reduce the strain on OOH services especially if CPs have access to SCR.

Will training be adequate? That's what we're being reassured. I'm not confident on this though. I can safely say when I was newly qualified I struggled to name every CCB, or what the difference between dihydropyridine and nondihydropyridine CCBs were and when they're prescribed, or that amitriptyline was unlicensed for pain. There's a lot of lack of experience there. In a hyperbolic analogy it's like giving a hunting rifle to a toddler, and telling them don't shoot if you're not competent. The rifle being a prescription pad and the toddler a newly qualified IP pharmacist.

With regards to devaluation of current IPs, I don't see how flooding the market with increasing numbers of IPs won't devalue the accreditation. At the same time I'm hopeful that it won't affect salaries in general practice because of the time commitment to train a PCN pharmacist. Where clinical knowledge in community is like keeping up a jog to do CPD, working in GP is full on athletics. Having been in both CP and GP I can see the higher demand for maintaining clinical knowledge, and I feel salaries will reflect that with increasing experience. I do see it likely that there will be too many IPs for the number of clinical roles and they will be competitive, probably having to stand out from the crowd by doing clinical diplomas or years of experience.

As for your colleagues looking to join GP, I've read some recent articles in the past week that may shed better insight: https://www.pharmacymagazine.co.uk/news/pcn-pharmacist-workforce-rises-18-in-three-months

Yes, there has been an increase in pharmacists in PCN roles but another article I'm struggling to find mentioned there still being hundreds of PCNs (in the 500+ ball park figure) who still haven't embraced a single pharmacist. I'd advocate looking in local job advertisings, but also being proactive and approaching surgeries in the area and having a discussion with the partners or practice manager. Sell yourself as an HCP and what you can offer, IPs are still valuable qualifications to have now.

(edited 3 years ago)

Reply 26

OP

Extract from an email just received regarding an DMP/DPP enquiry I sent;

''Many thanks for your interest, please ensure with our package we will be able to allocate you into GP and open job opportunities.

Most of our DMP/DPP are either in Edgware road or Wembley however you would only need to carry this out over 2 weeks, please find the points below.

You require a DMP /DPP to apply for the independent prescribing course.
GPPT will be happy to provide you with a DMP/DPP on the basis of paying for the package.

The package includes:
- shadowing a clinician in practice for 90 hours. This will take place over 2 weeks on a full time basis to complete the required hours
- mandatory GPPT online sessions, minor ailment & long term conditions. There are 13 sessions, after completing the courses online you will be awarded a 42 point CPD certificate

The total balance for the package for DPP is £1,900 or DMP is £2,500.

Should you wish to enrol on this programme, kindly make a payment to the following account below:''

Reply 27

Entertainment Forum Helper

That's a shame. I have no doubt that it's a common occurrence to pay for a DPP/DMP.

I suppose I was quite lucky in that I already had a good relationship with the practice that sponsored me, and I was the first one to approach them for such a thing.

Reply 28

quasa

20

Original post by Claremont4ever

Extract from an email just received regarding an DMP/DPP enquiry I sent;

''Many thanks for your interest, please ensure with our package we will be able to allocate you into GP and open job opportunities.

Most of our DMP/DPP are either in Edgware road or Wembley however you would only need to carry this out over 2 weeks, please find the points below.

You require a DMP /DPP to apply for the independent prescribing course.
GPPT will be happy to provide you with a DMP/DPP on the basis of paying for the package.

The package includes:
- shadowing a clinician in practice for 90 hours. This will take place over 2 weeks on a full time basis to complete the required hours
- mandatory GPPT online sessions, minor ailment & long term conditions. There are 13 sessions, after completing the courses online you will be awarded a 42 point CPD certificate

The total balance for the package for DPP is £1,900 or DMP is £2,500.

Should you wish to enrol on this programme, kindly make a payment to the following account below:''

Gppt ripping people off I see. Wasn't something published that dpps aren't allowed to charge people to shadow them

Reply 29

OP

Entertainment Forum Helper

Original post by quasa

Gppt ripping people off I see. Wasn't something published that dpps aren't allowed to charge people to shadow them

The DMP/DPP are hiding under an agency to charge for the service. Unfortunately, they are preying on the desperation of pharmacists who need them to qualify as IPs. I'm guessing the current students who would qualify as IPs already have a DMP/DPP allocated to them by their respective universities, they wouldn't be required to look for one like the rest of us.

Reply 30

quasa

20

Original post by Claremont4ever

The DMP/DPP are hiding under an agency to charge for the service. Unfortunately, they are preying on the desperation of pharmacists who need them to qualify as IPs. I'm guessing the current students who would qualify as IPs already have a DMP/DPP allocated to them by their respective universities, they wouldn't be required to look for one like the rest of us.

You are correct

Reply 31

Hoganballs

8

Original post by Claremont4ever

I have enjoyed the benefits of being a full-time CP for a few years, but I do believe it's now time to explore other areas of pharmacy. My goal is to have a portfolio career whereby I work 1-2 days in the community, 1-2 days in a GP practice and a day as an academic researcher undergoing a part-time PhD.

Who has explored this? Has it been worthwhile? Is it easy to make the switch from a full-blooded CP to a GP pharmacist? Steps to take etc?

This is code word for “I’m fed up of the daily grind of Community Pharmacy and am looking to get out of it ASAP”.

One wonder if the poster enjoys Community as much as he/she makes out, and especially as it pays so handsomely, why would he/she look to leave it?

Reply 32

OP

Original post by Hoganballs

This is code word for “I’m fed up of the daily grind of Community Pharmacy and am looking to get out of it ASAP”.

One wonder if the poster enjoys Community as much as he/she makes out, and especially as it pays so handsomely, why would he/she look to leave it?

I'm doing a quick 5 hour shift tomorrow for a £50/hour rate. The £250 earned is more than enough to fill up my Range Rover for the next 2 weeks whilst I earn circa £1500/week working 3-4 days in community pharmacy.

Hope life is treating you well.

Reply 33

Hoganballs

8

Original post by Claremont4ever

I'm doing a quick 5 hour shift tomorrow for a £50/hour rate. The £250 earned is more than enough to fill up my Range Rover for the next 2 weeks whilst I earn circa £1500/week working 3-4 days in community pharmacy.

Hope life is treating you well.

Life is great, tomorrow I’ll be taking the family out for the day. Certainly won’t be stuck in a stuffy community Pharmacy with no fresh air and natural light anyway! 😂

Enjoy your Land Rover! 😃

(edited 3 years ago)

Reply 34

OP

I just got offered a role as a GP Pharmacist covering practices in the NE. I'm not accepting it though, £22 as a GP Pharmacist is a shockingly low rate. I earn £50/hour (£1500/week working 3 days only) currently as a locum CP. GP Pharmacist roles in the NE seem to be low for some reason, whilst CP rates have more than doubled. I wouldn't get out of bed for less than £400/day as a Pharmacist regardless of job role.

(edited 2 years ago)

Reply 35

Entertainment Forum Helper

Original post by Claremont4ever

I just got offered a role as a GP Pharmacist covering practices in the NE. I'm not accepting it though, £22 as a GP Pharmacist is a shockingly low rate. I earn £50/hour (£1500/week working 3 days only) currently as a locum CP. GP Pharmacist roles in the NE seem to be low for some reason, whilst CP rates have more than doubled. I wouldn't get out of bed for less than £400/day as a Pharmacist regardless of job role.

I don't blame you. Some surgeries are offering bog standard rates just over £40k a year. Some are taking the piss and offering the same rate for a pharmacist with an IP! And it makes no sense considering they're offered up to £55k to pay towards a pharmacist. It's likely to go up with experience but yeah, I wouldn't accept that either with locum rates in CP at the moment. I'd be curious if you got to the interview stage how your CP rate could leverage what they offer you?

I'm going in for a review of my current pay package in GP so fingers crossed!

(edited 2 years ago)

Reply 36

quasa

20

Original post by ChillBear

I don't blame you. Some surgeries are offering bog standard rates just over £40k a year. Some are taking the piss and offering the same rate for a pharmacist with an IP! And it makes no sense considering they're offered up to £55k to pay towards a pharmacist. It's likely to go up with experience but yeah, I wouldn't accept that either with locum rates in CP at the moment. I'd be curious if you got to the interview stage how your CP rate could leverage what they offer you?

I'm going in for a review of my current pay package in GP so fingers crossed!

Was going to say, £22/hour seems a bit low for band 7 as i know for a fact you can get about £25/£26 around the outskirts of london with somr experience as a registered pharmacist and some negotiation (£22.7-£23.2 seems to be the going rate if you have no experience whatsoever or dont negotiate)

(edited 2 years ago)

Reply 37

Original post by quasa

Was going to say, £22/hour seems a bit low for band 7 as i know for a fact you can get about £25/£26 around the outskirts of london with somr experience as a registered pharmacist and some negotiation (£22.7-£23.2 seems to be the going rate if you have no experience whatsoever or dont negotiate)

Very much an entry level offer, I can't see a pharmacist in their right mind taking the offer given the role. I agreed on just shy of £26/hr starting with intent to go higher based on progress. I have a review coming up and will be aiming for ~£30/hr

Reply 38

OP

Original post by ChillBear

I don't blame you. Some surgeries are offering bog standard rates just over £40k a year. Some are taking the piss and offering the same rate for a pharmacist with an IP! And it makes no sense considering they're offered up to £55k to pay towards a pharmacist. It's likely to go up with experience but yeah, I wouldn't accept that either with locum rates in CP at the moment. I'd be curious if you got to the interview stage how your CP rate could leverage what they offer you?

I'm going in for a review of my current pay package in GP so fingers crossed!

They are saying the rate isn't negotiable. I had offered to take a hit and offer my service to them for £27 which is about half of my current rate, but they declined. It seems they are creaming off the top of what the NHS is paying GP practices to recruit pharmacist. Meanwhile there are good GP practices out there who not only pay a pharmacist the full NHS provision, but also pay a stipend on top from the practice budget.

Oh well, their loss is a gain for the next one.

Reply 39