A key aspect of Scotland’s new GP contract introduced in 2018 is facing “significant challenges” and will not be achieved without further investment, the Scottish government has been warned.

Clare Morrison, director of the Royal Pharmaceutical Society (RPS) Scotland, and Dr Andrew Buist, chair of the BMA’s Scottish GP committee, both say more funding is needed to realise the benefits of embedding pharmacists, pharmacy technicians and assistants in GP practice teams.

A series of concerns relating to staff shortages, IT systems that are ‘not fit for purpose’ and slow progress on electronic prescribing have been highlighted in a joint statement.

The 2018 contract set out ambitious proposals to recast the role of GPs as expert medical generalists.

The introduction of more nurses, paramedics and pharmacists to practice teams, as well as the transfer of some traditional GP responsibilities to health boards, was supposed to reduce GP workload and allow them to spend more time with patients.

Changes were originally intended to be achieved in full earlier this year but progress has been slowed by the pandemic, workforce shortages and funding problems.

The joint statement, published yesterday, relates to one key aspect of the changes, the delivery of a pharmacotherapy service to manage medicines prescribed to patients, which was one of several initial priorities.

Under the agreement every practice was to receive pharmacy and prescribing support, with in-house pharmacists taking on medicines-related activities normally done by GPs.

RPS and the BMA say almost all of Scotland’s roughly 900 GP practices have some level of pharmacy support but “significant challenges” remain.

‘These challenges are undermining the professional role of some pharmacists and have prevented workload reduction for GPs which would help to free up time to perform their role as expert medical generalists,’ they say.

They are calling for better workforce planning, as a shortage of pharmacy technicians and support workers means some pharmacists are unable to focus on patient-facing roles as intended.

IT systems also come under criticism, with the timeline for electronic prescribing systems that could reduce hours spent on repetitive tasks described as “too slow”.

The statement says: ‘Significant change in NHS IT happened at speed during the covid-19 pandemic. We recommend that this level of urgency and priority is given to the National Digital Prescribing and Dispensing Programme.’

Meanwhile, the current serial prescribing system, increasing the length of time between a patient having to get a new prescription to 24 or 48 weeks, which again would free up practice teams’ time, is viewed as ‘not fit for purpose’.

RPS Scotland’s Clare Morrison said: “We believe it is essential that use of pharmacists’ clinical skills is maximised in general practices. Pharmacists should be delivering clinical medication reviews, supporting safer use of high-risk medicines and improving pharmaceutical care.

“And they should be doing this in patient-facing clinical roles, using independent prescribing. But this is only achievable if the right infrastructure is in place: that means improving skill mix and the digital systems that underpin the pharmacotherapy service.”

 

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