Day 6: Life in General Practice - it's a journey

It’s my first weekend blog. I have been known to attend educational events, conferences and networking events at the weekend before. Luckily this weekend I’m spending it with my Mini K’s. We have been given the honour (or curse) of Brian Bear. It means for course of the next 3 days we will take Brian on our adventures, share pictures and our experiences.

This has got me reflecting on my adventures in General Practice, how did I get to this point in my career. I feel I am like Brian Bear, happily going along with any adventure than comes my way, whether it’d be mundane or a magically mystery ride. We’re both just content to go with the flow.

Hello everyone! Meet Brian Bear

Another hat I wear is for an organisation called PCPA (Primary Care Pharmacy Association) as a Committee Chair for the Pharmacy Practice Group. Basically representing those working in General Practice. Yesterday PCPA released a working document for PCN (Primary Care Network) Clinical Pharmacist’s job description covering different levels of applicant. Overall I feel the document has been well received and provides some guidance for both potential candidates and PCN Clinical Directors. Typically there's been some discussions on social media too. So here's just a few of my thoughts.

Primary Care Pharmacy Association (PCPA)

1. Pharmacists are not doctors. I promise you I never wanted to be a doctor. I still don't. Our skill sets are very different but together we can do amazing things. These relationships take time to forge. Everyone needs to be patient. Hard work does play off. As with all relationships trust and respect are so vital for success but they are earned not assumed nor given freely.

2. 1 x PCN pharmacist to do work of multiple practices. Yes. But it's worth remembering the PCNs are designed for future work for the next 5 years. NHSE designed the Additional Roles Scheme so that PCN could add in NEW additional people EACH year to the workforce without haemorrhaging other sectors where pharmacists may be working. This is year one. Directed Enhanced Service (DES) is looking at how PCNs will provide at extended hours access for patients. For many sites this might not be new and is already managed by existing clinical teams. So what can the PCN pharmacist do? Possible idea, relieve pressure elsewhere in workload to ensure extended hours continues, allow time for the PCN pharmacist's experiences and skills to develop. No one will have exact picture of how this will look like but it's critical that honest conversations are had, so expectations meet realistic aims and support is essential. There's no point in recruitment if we can't retain staff. This applies to the whole workforce.

3. There's no career progression in General Practice for pharmacists. Hell no. My career in General Practice started by freelancing for a local General Practice Federation only 6 hours a week. Neve was 5 months old when my friend, who is also a pharmacist, was approached by a local doctor during an appointment to ask what could pharmacists do for General Practice. As I was on maternity, I thought 'I like a challenge' and I knew I could sell the value of having a pharmacist in the team. I then did my Independent Prescriber course when Neve was 6 months old, still just dabbling a few hours a week. But it was all I could manage with uni studies and having two kids. Then the NHS England pilot was launched in 2015 and South Worcestershire secured the largest bid site funding, one full-time pharmacist for all 32 GP surgeries. My role evolved to encourage practices to invest into this pilot scheme to expand their workforce. I know first hand how hard the whole process was to deliver at scale and the concerns of potential employers and potential candidates. Then I've progressed on to do my MSc. in Advance Clinical Practice (ACP) because I felt it would benefit my clinical role and type of patients I felt comfortable about seeing. ACP is not suited to all pharmacists, the managing uncertainty and complex decision making is hard and gruelling. We shouldn't set ourselves unrealistic ambitions and be forced into roles we don't feel comfortable doing. ACP is more than just expanding clinical examination skills. I actually feel the HEE Multidisciplinary ACP Competency Framework illustrates this well. As the Primary Care workforce is generally being upskiled, the boundaries are blurring but the skill set demonstrated in pharmacists and pharmacy technicians is so diverse and varied there is enough workload for everyone. I've been part of lead neighbourhood teams for the past few years but now the official title is PCN Clinical Director. Neve just turned 5 years old a couple of weeks ago. Honestly endless possibilities.

No matter what happens on the 1st July. The vision is clear. We want to expand Primary Care Workforce. We do not want to destabilise existing networks and working relationships. We all add value to the quality of patient care. Pharmacists are individual people, with individual hopes and ambitions, with unique experiences and specific skills. It's really hard to compare us. Honest conversations and strong support is needed now to ensure future investment in the pharmacy workforce. I've seen how amazing the Black Country & West Birmingham STP have ignited passions and demonstrated grit determination to recruit and retain their GPs, especially in their first 5 years in General Practice. I've been fortunate to be asked to be involved with creating a network like this for the pharmacy workforce too.

Follow the team on Twitter @PCWorkforce & #PCWorkforce

My journey has been a lucky one and I have always had an open mindset. Change is never easy. I do feel scared at times with the unknown but I'm systematic, pragmatic, why.... I'm Helen Kilminster.

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Helpful links:

PCPA PCN Clinical Pharmacists Job Description

https://pcpa.org.uk/pcn-resources.html

HEE Multi-professional framework for ACP

https://www.hee.nhs.uk/sites/default/files/documents/Multi-professional%20framework%20for%20advanced%20clinical%20practice%20in%20England.pdf