Evaluation of GPimhs Pharmacy: a specialist mental health pharmacist medicines optimisation service for people under primary care
Authors: Shuker K 
Published: November 2022

Abstract

Introduction
Surrey Heartlands (SH) Health and Care Partnership ICS was one of the early implementer sites to develop new and integrated models of primary and community mental health (MH) care.1,2 A new service, GP Integrated Mental Health Service (GPimhs) was established with one specialist MH team per Primary Care Network (PCN), offering biopsychosocial intervention to support people in primary care. Specialist Pharmacist input was funded as part of the team with 1 session (3.75 hours) per week per PCN. There was not a specialist pharmacist service within the existing secondary care teams.

Aim
To evaluate the input and impact of the specialist pharmacist for one of the pilot PCN sites specifically the level of medication review, type of recommendation and whether the advice was accepted or rejected.

Methods
A retrospective review of the medical records for people using the specialist pharmacist service between September 2021 and March 2022 was undertaken. An excel spreadsheet was devised to collate the data i.e., type of recommendation(s) and whether the advice was accepted or rejected. If a significant intervention was identified the nature of this was recorded. The data collection was undertaken for one PCN with five GP practices. Ethical approval was not required as this was a service evaluation (retrospective patient notes review).

Results
A total 57 appointments were delivered for 40 people using services. There were 20 Level 2 medication reviews (notes review), 20 Level 3 medication reviews (notes review and consultations) and 17 follow up consultations. The type of recommendations made were no change to current plan (2), commencing/switching/stopping medication (17; all antidepressant switches), advice on optimising medicines (8), advice on physical health monitoring (10), multiple recommendations made* (12), follow up consultation booked (5), referral to SPA/ CMHRS (3; for off-label medicines). *Multiple recommendations comprised a combination of advice on mental health treatment and physical health monitoring. Of the recommendations made 51 (89%) were accepted, 1 rejected and for 5 the outcome could not be assessed. Four significant recommendations were made: (1) involved high dose antidepressants and need for physical health monitoring, (2) identified hypertension where max dose venlafaxine prescribed, (3) identified elevated cholesterol in a person reporting poor adherence to statin and (4) identified intended changes to BP medication had not been made on repeat resulting in poor BP control.

Discussion/Conclusion
A specialist mental health pharmacist medication optimisation service for people under primary care can be delivered as part of mental health transformation. These requests have contributed to reduced number of referrals to secondary care mental health teams / single point of access, where there is no specialist pharmacist provision. Most recommendations related to switching antidepressant treatment, an area which could form part of training for primary care teams. The nature of the significant interventions highlights the importance of holistic review of physical and mental health medications. The limitations of this evaluation were the retrospective nature and relying on documentation in medical records. Future work could include collating GP and patient feedback.

References
1. The NHS Long Term Plan [Internet]. NHS Long Term Plan. 2022 [cited 29 June 2022]. Available from: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/
2. NHS Mental Health Implementation Plan 2019/20 – 2023/24 [Internet]. NHS Long Term Plan. 2022 [cited 29 June 2022]. Available from: https://www.longtermplan.nhs.uk/publication/nhs-mental-health-implementation-plan-2019-20-2023-24/