A highly specialist mental health prescribing pharmacist in a virtual GP practice - experience from a large London general practice
Authors: Attard A , Koya M , Rex A 
Published: November 2022

Abstract

Introduction
Historically, the career path for highly specialist pharmacists has been focussed on secondary and tertiary services. Recent developments to ensure high quality medication optimisation and improvement of patient access to appropriate medication has seen many pharmacists join GP practices. Alongside this is the drive by the NHS to improve the quality of mental health care in the primary care setting. Digitalisation and providing virtual platforms also improves access to health care for many individuals who are less able to commute and provides an option when there is disruption to face to face services.

Aims
To identify the number of appointments completed in an 8-week period, and evaluate the types of referrals, prescription details and the feedback from consultations with the Highly Specialist Mental Health Pharmacist.

Methods
Anonymised details from consultations carried out in an 8-week period were collected, which included details of appointments, the referral process, prescription details and feedback. The data underwent descriptive statistical analysis. Ethical review was not required as the study was a service evaluation.

Results
The reviewed patient journey for those newly identified with a mental illness, those who self identify as having a mental illness and those with a complex mental illness is presented. Post holder experience is shared. In a 7 clinical session week, with 30 minute consultations a total of 445 patients were scheduled an appointment, 393 patients completed their consultation. 61% of patients were referred for psychotherapy, 18% referred to secondary services. In 43% of patients’ medication was prescribed by the pharmacist, 32% had no medication prescribed while 23% of patients had medication deprescribed (stopped or reduced) Patient feedback was available for 50 patients, 47 left 5 star reviews, 3 left 1 star reviews as they could not get the platform link to work to attend the consultation.

Discussion/Conclusion
Although a small study, the preliminary data shows a high rate of patient attendance and feedback from patients was higher than expected. There is a single point of contact for the practice to risk assess, screen and follow up patients with a mental illness (including serious mental illness). Working in isolation, virtually and making pharmacist interventions after prescribing has occurred are very different ways of working compared to secondary care. With the correct infrastructure, improved referral rates and understanding of specialist pharmacist knowledge and experience - pharmacists can look to joining GP practices as a career option in a highly specialist role.

References
1. NHS London Clinical Networks and Healthy London Partnership. A review of the scientific literature informing the development of models of primary care in mental health. September 2017. Available from: https://www.healthylondon.org/wp-content/uploads/2017/11/Literature-review-Primary-care-mental-health-service-development.pdf
2. Keith Ridge. Pharmacists Prescribing Better Care. NHS England. April 2018. Available from: https://www.england.nhs.uk/blog/pharmacists-prescribing-better-care/