I speak with GPs every day and several things have become clear
now I can 'sell' pharmacists' expertise.
Firstly the 'accredited' description.
How do I explain that now there are two kinds of pharmacist?
Those good enough to do the job and those who are not up to scratch,
approved accredited etc. (This is how it is viewed by some).
The GP's expectation is that all pharmacists have all been at University
in most cases for four years and with a wealth of experience in
the field have a body of knowledge on drugs they can and do rely
on. 'And they already do confer on patient's medication that I very
much appreciate.'
Where this understanding does not exist no amount of 'accreditation'
is going to convince them otherwise before they refer their patient
on.
I do know where these situations exist unfortunately.
I tend to agree with them on this skepticism on 'accreditation'
- any practicing pharmacist can help the patient's management of
a drug regimen and in the home it allows the time needed to understand
their unique situation.
For many pharmacists the cost of 'accreditation' is formidable and
is one of the reasons pharmacists are not bothering to become involved.
The GPs do not want a clinical scrutiny of their prescribing.
'So can't the usual pharmacist I know do this review and management
report?
They do this anyway with my patients when they talk to them in the
pharmacy'
Then there is the explanation of the time it could take once the
referral is made to the pharmacy of the patient's choice. GPs do
understand the commercial pressures and the fact that it is not
easy for a pharmacist to leave the shop.
But they do need timely reports for ongoing situations and usually
in General Practice these are moderately urgent.
Practicalities do not lend themselves well to this new scheme of
practice but like 'all things new' it takes time to shake down.
The only unfortunate aspect of this is that this 'new thing' comes
at a time when resources are greatly stretched and it is the resources
available that has been the cause of the most angst
.
The EPC items GPs are integrating into their practice for the older
people and those with chronic diseases are giving them opportunities
to consider a medication review done by another professional.
It is a culture change to refer to a pharmacist but on the whole
it is being well accepted.
I
have had many requests from GPs for the referral forms and management
report sheets in the Medication Management Review (MMR) kits and
from visits in this Division it appears that the scheme is viewed
as a good idea.
I have not yet heard of a review being referred, nor are there
many 'accredited' pharmacists available in this area.
This could well be the time of information gathering for GPs.
With continued encouragement and reminders I am hopeful of seeing
MMRs happen.
Language is another concern as we have a huge ethnic diversity
in this Division.
The GPs are well represented across this diversity and patients
choose the GP who can speak their own language.
I am not so sure if the same representation exists amongst the
pharmacies and it is very unlikely that a pharmacist will be able
to speak all the languages.
So it could well be that the patient is referred to not the usual
pharmacy and therein lies other challenges.
So generally GPs see the concept of MMR as a good idea, although
fraught with practical dilemmas.
It remains to be seen how well it goes.
I am convinced of the community need for this service and the
value a pharmacist can bring to QUM, so am committed to make it
happen from where I stand.
I would love to hear from pharmacist readers of their experiences
- positive and negative - because from these anecdotes the scheme
can be fine-tuned to work well for all concerned.
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