Ensuring patient safety is a priority for all healthcare professionals. However, the patient journey is becoming increasingly complex, with a host of healthcare professionals now involved directly in their care. Multidisciplinary teams are adept at providing quality care and help improve health outcomes, whilst optimising the efficient use of resources at the same time. In order to seamlessly transition a patient from any provider of care, information and summary of care received must be relayed effectively. Hospital discharge summaries are what hospitals use to document and communicate with other care providers.
Each year NHS Digital provides information, data, and statistics relating to the NHS. The Hospital Admitted Patient Care Activity, 2017-2018, gives a snapshot of hospital admissions, a surge in the number of hospital admissions can be seen, with a 23.3% increase from 2007/8 to 2017/18. Such a staggering increase in the provision of care has to be coupled with effective modes of communication between the hospital and primary care.
The 1843 fax machine still going?
Prior to the introduction of e-discharge summaries, the sharing of information was troublesome, to say the least. The National Audit Office estimates that delays with discharges to elderly patients are costing the NHS £820 million a year. As a result, it is estimated that over 2.7 million bed days are lost due to the unnecessarily delayed transfer of elderly patients from the hospital. Delays in discharge summaries being processed via fax machines, incomplete variants of discharge summaries, unstandardised templates, and illegible information are also a major issue creating difficulties for medicines reconciliation. Staff working in hospitals would attempt sending discharge summaries via fax machines numerous times, often to no avail as GP fax machines weren’t even switched on at the weekends. Hold-ups in patients receiving appropriate treatment can lead to potentially serious consequences, with patient safety and care compromised. The Clinical Data Standards Assurance programme began a national project to enhance discharge summaries and how they are accessed, with the goal of GPs receiving the discharge summary electronically within 24 hours of the patient being discharged from the hospital.
What’s included in a Hospital Discharge Summary?
Discharge summaries include the following important pieces of information:
The hospital discharge summary will be written by the doctor who was looking after your care during your admission in the hospital. An e-discharge summary template is provided here.
You can request a copy of your discharge summary from the ward manager or request a copy from Patient Advice and Liaison Service (PALS). It’s always good to have a copy at hand, also making sure you are fully involved in your treatment and care.
Who receives your discharge summary?
NICE Guidance states that patients should be discharged from the hospital at the right time, to the right place and in the right way – whether that is to their own home or a community, or care home setting.
Why are discharge summaries important?
Discharge summaries are paramount in ensuring safe provision of care across the board in primary and secondary care. If completed correctly with the relevant information recorded, they assist your GP surgery and pharmacy of what has happened to you during your stay in hospital. In many instances, you are provided with either 7 days or 14 days’ worth of medication to take home, especially if there have been any changes to your medication. This gives you sufficient time to arrange with your surgery and pharmacy any medication requests that you may have.
Your doctor can then also change your prescriptions accordingly, chase any test results, and arrange any follow-ups where needed.
Check out our Services page, to see the many different ways that Firza is assisting GP practices, NHS CCG’s, care homes, and pharmacies in patient and non-patient facing ways, including the best ways in implementing effective hospital discharge summary reviews.
This article was written on behalf of Firza by Hassan Riaz from Pharmacy Mentor.
A CQC Inspection is a daunting experience for most GP practices, but here’s an article we have put together that gives you guidance and support in ensuring that your visit goes as smoothly as possible.
What is the CQC?
The Care Quality Commission (CQC) is the independent regulator of all health and social care services in England. It ensures that health and social care services are providing patients with safe, effective, compassionate and high-quality care, whilst encouraging care providers to improve in their services.
The CQC asks five key questions to any provider of care. These five questions are the cornerstones of any inspection: is the practice safe, is it effective, are the staff caring, are they responsive to the needs of people, and are they well-led?
The CQC also looks at the care provided specifically to six different population groups: older people, people with long-term conditions, families, children and young people, working age people, vulnerable or at-risk patients, and people experiencing poor mental health.
Every GP practice must also ensure that the CQC’s fundamental standards are met and adhered to.
Meeting the CQC’s fundamental standards at a CQC Inspection
GP practices must abide by certain standards. These include the fundamental standards – the standard below which care must never fall. Everybody has a right to expect that the following standards are met from their GP practice, these can all be found under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:
For further information and in-depth examples of all the standards, please see:
Get ready for pre-inspection
Before your GP practice can provide any services to the public, it must apply for CQC registration and meet certain pre-requisites. Guidance on how to apply for registration with the CQC can be found here.
Prior to a CQC Inspection, the CQC will provide you with a letter of notification, notifying you that an inspection will occur. In most instances a two-week window is given prior to the inspection, allowing for minimal disruption in services. The comment cards and posters signifying an impending inspection should be suitably placed.
Key documentation to prepare prior to the CQC Inspection
The CQC inspectors will request to see good clinical governance and management of the practice. Record-keeping and documentation should be made viewable to the inspectors and below are a non-exhaustive list documenting what you may be asked to present. It is always a good idea to have the following documents ready prior to the inspection:
On the day of a CQC Inspection
At the start of the inspection, the inspector and/or inspection team will meet with senior members of the practice team. This brief meeting will detail who the inspection team is, an outline of what to expect, the purpose of the inspection and how the findings will be communicated back. Ensure that on the day of the inspection, your practice is promoting the services and care it provides in the best manner.
GP practice staff will then be asked to deliver a short presentation, allowing practices to give the CQC their own view of the performance of the practice. Some of the points that the presentation can outline include: all the services that the practice provides, access to appointments and triage, examples of training, how it listens to concerns, identify specific patient cases in anonymity where safeguarding issues were raised, and the use of translators or the hearing loop system to accommodate all patients. The presentation should discuss the five questions the inspection will ask, especially in relation to the six different population groups, whilst also including any examples of outstanding patient care.
The inspection team will then focus on areas of concern and areas where the practice is performing well based on the introduction. The team will collect evidence in relation to these matters by finding out the views of the patients using the services of the practice. this will be done by using the comment cards and speaking to patients individually and in groups. They will also speak to staff and gather information relating to the five key questions. Other inspection methods include observing care, reviewing records, looking at documents and policies, and inspecting the facilities.
Feedback after a CQC Inspection
At the end of the inspection, the inspection team will meet with senior members of the practice team and give a summary of the key findings from the inspection, make mention of any issues that need addressing, identify where immediate action is to be taken, outline plans for future inspections and how the judgements and findings will be published.
GP practices will be rated for the five key questions, and finally given an overall rating based on their performance. GP practices will be rated as either: Outstanding, Good, Requires Improvement or Inadequate.
When completed, the rating will be published on the CQC’s website and must be displayed in the GP practice and the practice’s website.
How GP pharmacists can help at your CQC inspection
GP pharmacists are experts in medicines and can prove to be invaluable at a CQC inspection. Pharmacists are already accustomed to a GPhC inspection and can help your practice achieve the top rating at its inspection. The CQC will ask to see the systems in place for safe storage and handling of controlled drugs, how often patients get a medication review, medicines safety alerts, repeat prescribing processes and reviews, triage, and handling of common ailments. All of these are areas where a GP Pharmacist can offer expert support and assistance.
GP pharmacists are allowing healthcare teams working in GP practices to give better local care to patients, allowing patients to see highly trained healthcare professionals specific to their needs. Pharmacists working in GP practices make a positive impact on patients, provide excellent clinical assessment and treatment plans, are experts in the knowledge of medicines and contribute greatly to health economics. They are also experts in providing lifestyle advice to treat long-term conditions and improve patient’s safety.
Having GP pharmacists in practice allows GP’s to better manage their time and to focus their skills on where they are most needed, diagnosing and treating patients with more complex conditions. Take a look at our Services page for more information on how our Clinical Pharmacists are working in GP practices.
Interested in becoming a GP pharmacist? Then please send your CV and a cover letter to firstname.lastname@example.org
This article was written on behalf of Firza by Hassan Riaz from Pharmacy Mentor.
Clinical governance is an umbrella term used to describe a wide variety of activities carried out by healthcare workers to improve the quality of services. It is a continuous process and not a single event, thus clinical governance is emerging as a specialisation in itself. It requires organisation-wide cultural change. It is about creating a system to manage poor performance and finding new approaches for improving the standards by learning from failures.
It is a concept that is similar to corporate governance in business, and gained relevance in healthcare in the 1990s. This article by Firza Group looks into the various principles of clinical governance, the role of the pharmacist and its career challenges, along with perspectives.
Why clinical governance matters
Clinical governance is about integrating quality improvement and professional development to confirm that everyone on the team provides his or her best. It is about moving towards multidisciplinary education and team-based learning.
Clinical governance is mandatory for GP's. The recommendation is for them to have at least 30 hours of continuing professional education and three audits each year. And of course, pharmacists play a critical role in clinical governance too.
Role of the pharmacist in delivering clinical governance
Clinical governance is not a new phenomenon and has been practiced by pharmacists for years. It should not be considered something extra or optional. From a pharmacist perspective, it should include:
Clinical governance is essential for all healthcare stakeholders. It aims to improve every aspect of medical practice, and pharmacists have a vital role to play in it. Therefore, pharmacists must learn from their mistakes, invest in continuous learning, and ensure that they continuously improve their practice.
Career opportunities for pharmacist and clinical governance
So as pharmacists start getting more and more involved in clinical governance, it also opens up many possibilities. Slowly, a new kind of role is emerging, and now, large hospital pharmacies are appointing a separate person to take care of clinical governance.
Generally, a senior pharmacist with several years of experience is appointed for such a job, as it requires lots of knowledge and various skills. It is a job that requires identifying problematic areas and coming up with solutions.
People working in the area of clinical governance find the job highly satisfying, as it has different responsibilities. Another source of satisfaction for pharmacists in this job is the realisation that their job makes a significant impact on patient care.
Interested in the job of clinical governance?
Specialists advise that it is a job for those with at least five or more years of experience. It is a job for pharmacists who have worked at various positions earlier, and have good medical knowledge and clinical experience.
It's usually a more senior management role. However, various institutions may have specific requirements. A couple of decades back when it was all starting, there were no official courses on clinical governance. However, nowadays there are many courses available from online certificate programs to masters in clinical governance.
Most of those working in the field find the job highly rewarding due to the direct impact it makes on improving patient care. For many, what really appeals is that it is a role that involves making changes to healthcare practice, improving services.
Another attractive factor in the job is diversity. On one day, a person may work with the diabetes treatment protocol, and on another day, they may be working on alcohol-withdrawal, or looking at the risk of paediatric drugs. Thus there are lots of learning opportunities and great scope for personal development.
Financial rewards for the job are also something that attracts many towards clinical governance.
And on a final note, some pharmacists experienced in clinical governance warn that this job is not for everyone. Rather it is a job for people with thick skin. It is a job for those who do not worry about being unpopular or disliked by others. That being said, the rewards certainly outweigh the risks.
Interested in helping our GP's with Clinical Governance? Then please send your CV and a Cover Letter to email@example.com
In line with the success of the pilot programme that gave rise to over 400 full-time pharmacists taking up roles in general practice, there is a goal that by the year 2020, an additional 1,500 clinical pharmacists should begin working in general practice. This initiative is geared towards expanding the GP workforce in order to increase the possibility of patients having access to a wide range of health experts to cater to their health needs. Statistics show that by September 2018, the number of WTE clinical pharmacists who took up jobs in general practice was 810 and hundreds of other sites have received the approval to begin recruiting. In line with the NHS scheme to have clinical pharmacists included in the general practice, millions of patients can now receive medical advice directly from a pharmacist each time they have an appointment with their GP. GP practices today already have pharmacists in their employ and that is why this article will serve as the comprehensive guide for a practising GP pharmacist.
A GP pharmacist is expected to handle day to day issues with medicines, consult with patients directly, and provide treatment. GP pharmacists can assist patients in managing long-term sickness, advise polypharmacy patients and give treatment-related clinical advice. They will also help with communication all through patient care, deal with shortages by proffering alternatives, and also guide new pharmacists along their journey. GPs have to submit an official application showing how they plan to utilize the skills of a pharmacist since pharmacists were originally not being employed by GPs.
Having GP pharmacists helps GPs direct their skills more effectively to where they are really needed. Clinical pharmacists are expected to collaborate with other members of the GP team in order to enhance the value and outcomes that patients get from medicines. They are also meant to consult with these patients and give them direct treatment. As earlier mentioned, they will help these patients to manage their long-term conditions, provide the best tips and medical advice for patients who make use of multiple medicines, and also provide access to better health checkups for these patients.
Performing as a GP pharmacist has a lot of highlights and possibilities which you may not often come across at a community pharmacy. In comparison to the Community Pharmacy role, a GP Pharmacist will be using more of their clinical expertise day-to-day and be collaborating with other healthcare professionals much more often.
There is always the feeling that a pharmacist at a surgery may take up all the work of other personnel like nurses, thus, leaving them with nothing to do. However, this is not the case as every personnel at a GP have specific roles and parts to play while functioning as a team.
As many GPs are recruiting clinical pharmacists at present, the opportunities are numerous for pharmacists who wish to practice at GPs even with no previous work experience in a GP practice. Pharmacists can scout for these roles by themselves. GPs today need pharmacists to assist in the reduction of the pressures faced primary care doctors who seem to be decreasing in number. A GP pharmacist will be concerned mostly with medicines.
To take up a role as a GP pharmacist, it is recommended that you have experience in general, be willing to learn, have a teamwork spirit and valuable transferable skills from a community pharmacy like business, analytical, and consultation skills, as well as, confidence, good time management, independence, and record keeping skills.
SKILLS & TRAINING
All pharmacists who are interested in the GP pharmacist role must undertake relevant training and develop the needed workplace-based skills and knowledge.
There is a nationwide learning pathway which lasts for 18 months aimed at developing clinical pharmacists in conjunction with relevant bodies to teach clinical pharmacists to perform effectively in general practice. The training is centered on these themes –
CHALLENGES OF THE ROLE
Of course, there have been some challenges as GP that applied for the pilot faced some setbacks because their setup did not permit them to make such forms of applications. There is also the challenge of hiring the right GP pharmacist once a job advert is put out.
For pharmacists who want to switch from community practice to surgeries, it is important that they understand what the role really entails and what will be expected of them when they take up the role. GPs are obligated to really specify what the practice really needs and match their needs with the pharmacist’s abilities and skills to ensure the easy assimilation of the pharmacist into the role. It is important that aspiring pharmacists really get to find out what the leadership is like at the GP and the form of support that is made available to them if they happen to get stuck while carrying out their duties.
Taking up a role as a GP pharmacist is a good way to expand your career opportunities. It is a very exciting role for new pharmacists and it is a way of adding value to patients, especially, with the advent of much more complex drugs, polypharmacy, and also care fragmentation between health agencies. Working in GP is provides a perfect opportunity to build a practice portfolio that is advanced and put yourself on the path to becoming a member of the Faculty.
If you are looking to become a GP practice pharmacist, talk to us today and we will be willing to provide you with all the guidance, tools, and necessary resources that you need to facilitate your professional development as a general practice pharmacist today.
Call us today to book an appointment.
Please send your CV and a Cover Letter to firstname.lastname@example.org