Clinical Pharmacist

Job description Job responsibilities Patient facing - long-term condition clinics

Working within the practice-based team to undertake medication reviews particularly in high-risk groups such as:

• Frail elderly
• Polypharmacy
• Renal impairment
• Hepatic impairment
• Substance misuse
• Patients on high-risk

medicines

• STOPP/START identified

patients

Revolving door Hospital admissions

Review the on-going need for each medicine, a review of monitoring needs and an opportunity to support patients with their medicines taking ensuring they get the best use of their medicines (i.e. medicines optimisation).

Make appropriate recommendations to GPs for medicine improvement.

Patient facing Structured Medication Review

Undertake structured medication reviews with patients and produce recommendations for nurses and/or GPs on prescribing and monitoring. This would be a level 3 clinical medication review looking at the patients full clinical condition, blood monitoring, interface care arrangements, social isolation etc. including reducing inappropriate polypharmacy and wasteful prescribing.

Care Home Medication Reviews

Undertake structured medication reviews and produce recommendations for nurses or GPs on prescribing and monitoring. Work with care home staff to improve safety of medicines ordering and administration.

Management of common/minor/self-limiting ailments

Managing caseload of patients with common/minor/self-limiting ailments while working within a scope of practice and limits of competence. Signposting to community pharmacy and referring to GPs or other healthcare professionals where appropriate.

Patient facing medicines support

Provide patient facing clinics for those with questions, queries and concerns about their medicines in the practice.

Telephone medicines support

Provide a telephone help line for patients with questions, queries and concerns about their medicines.

Medicine information to practice staff and patients

Answers relevant medicine-related enquiries from GPs, other practice staff, other healthcare teams (e.g. community pharmacy) and patients with queries about medicines. Suggesting and recommending solutions. Providing follow-up for patients to monitor and effect of any changes.

Unplanned hospital admissions

Review the use of medicines most commonly associated with unplanned hospital admissions and readmissions through audit and individual patient reviews. Put in place changes to reduce the prescribing of these medicines to high-risk patient groups.

Management of medicines at discharge from hospital

To reconcile medicines following discharge from hospitals, intermediate care and into 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).

Medicines Optimisation

Deliver medicines optimisation outcomes against a set workplan dealing with cost saving initiatives, QIPP and medication safety work streams.

Interface

Interface with community and hospital pharmacy colleagues and develop referral processes between primary care professionals including the promotion of the repeat dispensing service

Signposting

Ensure that patients are referred to the appropriate healthcare professional for the appropriate level of care within an appropriate period of time e.g. pathology results, common/minor ailments, acute conditions, long-term condition reviews etc.

Repeat Prescribing

Participate in the repeat prescribing reauthorisation process by reviewing patient requests for repeat prescriptions and reviewing medicines reaching review dates and flagging up those needing a review. Ensure patients have appropriate monitoring tests in place when required.

Risk stratification

Identification of cohorts of patients at high risk of harm from medicines through pre-prepared practice computer searches. This might include risks that are patient related, medicine related, or both.

Service Development

Contribute pharmaceutical advice for the development and implementation of new services that have medicinal components (e.g. advice on treatment pathways and patient information leaflets).

Information management

Analyse, interpret and present medicines data to highlight issues and risks to support decision-making.

Medicines quality improvement

Undertake clinical audits of prescribing in areas directed by the GPs, feedback the results and implement changes in conjunction with the practice team.

Medicines safety

Implement changes to medicines that result from MHRA alerts, product withdrawal and other local and national guidance.

Increase safe and effective prescribing through mechanisms such as audit. Improve quality in prescribing using Quality Improvement methodology including the use of Plan Do Study Act (PDSA) cycles.

Implementation of local and national guidelines and formulary recommendations

Monitor practice prescribing and make recommendations to GPs for medicines that should be prescribed by hospital doctors or subject to shared care. Auditing practices compliance against NICE guidelines.

Education and training

Provide education and training to primary healthcare team on therapeutics and medicines optimisation.

Care Quality Commission

Work with general practice team to ensure the practice is compliant with CQC standards where medicines are involved.

Public Health

To support public health campaigns. To provide specialist knowledge on all public health programmes available to the general public.