We had concerns about poor communication between clinicians, pharmacists and the patient and poor efficiency in the prescribing system, leading to compromised patient care and dissatisfaction all round.
When pharmacists had a question for the GPs about a prescription, they had to wait for a long time on the telephone queuing system prior to being able to speak to the doctor (meaning the patient had to wait a long time in the pharmacy before it was resolved). On the other side, GPs felt uncomfortable writing prescriptions based on what they were being told directly from patients and the receptionist and would have felt more comfortable if they had this information directly from pharmacists in a timely manner. The reception team also received multiple requests for the same prescription (from both the pharmacist and the patient) and this was confusing and caused unnecessary increases in workload.
What we did
We decided to host an evening event for our five local pharmacists and our practice members. A nominated GP chaired the three-monthly meetings and acted as a point of contact for the local pharmacies. After the first meeting there was immediate enthusiasm and an immediate change in the relations and quality of communication.
We started in September 2014 and now have regular meetings to maintain the benefits of discussion. The chair provided GPs and pharmacists opportunities to add discussion points to the agenda of each meeting. Where there was previously no clear communication portal between all of the pharmacists and GPs, we successfully managed to build a recognised network.
We have also integrated multi-professional education (from doctors and pharmacists) into these meetings covering topics such as asthma and dementia. As a result, pharmacists are now able to check inhaler technique and spend more time with patients on this and we as a practice direct patients to this service. Pharmacists are very accommodating and have offered the surgery team opportunities to visit them during their consultations to see how the process works from their end.
All pharmacists were informed of a bypass number, which directly connects to the surgery without waiting in a long queue. All pharmacists were informed of the surgery mobile number for texting urgent queries to the on-call doctor or calling if very urgent, group emails for doctors, nurses, reception and the practice manager.
Pharmacies were asked to warn surgery of medication shortages so we avoid prescribing unavailable medications, which would increase pharmacist and GP workload, as we had to rewrite the prescription if we prescribed an unavailable medication.
The pharmacists display our practice’s flu clinic dates and we as a surgery promote the smoking cessation clinic that the pharmacists run.
The doctors at the practice write pharmacy messages on the prescription paper to communicate blood test results or asking the pharmacy to ask the patient to come in for a medication review. This communication is free and saves money.
The challenge was to find a time where all members could meet together. It had to be outside the workday, on a weekday night so we had to engage the practice team to commit their own time to the cause. We overcame this by making the meetings personal and interactive, offering refreshments and trying to make it fun.
Since we’ve worked more closely together, patients are particularly happier with their prescription service, delivery and reduced waiting times.
We have reduced patient queues and waiting as pharmacists now collect prescriptions at by entering through the side door of reception, preventing long queues building at the reception desk.
We also shared hospital discharge summaries to the pharmacist. The pharmacists say that this has been useful to them in identifying medications changes and ensuring that this is changed on the patient record.
We are exploring the option of prescribing dressings for named patients rather than issuing them from our own supplies. This is particularly suitable for long-term patients where this would save money on stock supply. Pharmacists are positive about this scheme and advise other local healthcare bodies to adopt this policy.
Dr Lukshmy Jeyalingam is a GP in North Harrow, London