This was published when the organisation was the Royal Pharmaceutical Society.

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This guide will support you in working in or with GP practices. It’s useful for pharmacists:

• Thinking of a clinical career in general practice;
• Starting work in a GP practice for the first time;
• Already supporting GPs and their colleagues in primary care roles.

There are more pharmacists across England, Scotland and Wales in clinical roles within GP practices. We support the closer working of pharmacists with GPs and have been encouraging more of these roles to be developed.

About the role

Personal specifications and job descriptions

The Primary Care Pharmacists Association has published a guide for general practices considering employing a practice pharmacist.

This guide has been endorsed by the Royal College of Pharmacy and the Royal College of General Practitioners (RCGP).

It describes the activities that pharmacists may be involved in when working in general practice. It also includes a detailed breakdown of the job roles of entry-level and advanced-level practice pharmacists.

Applying for jobs

New positions for clinical pharmacists, working in GP practices or primary care clusters, are expected to be created across England, Scotland and Wales.

In England, a GP five-year contract framework launched in 2019 to support Primary Care Networks (PCNs) in recruiting additional staff, including clinical pharmacists. In 2016, the Scottish Government announced £16.2m of funding to recruit 140 pharmacist independent prescribers over three years.

Practice pharmacist posts are often advertised on the NHS Jobs website for England and Wales, or the NHS Scotland Recruitment site.

Roles may also be advertised on Pharmaceutical Journal Jobs.

You may also be able to enquire with your local GP practice about any vacancies.

Business cases

We are developing economic models to underpin the benefit of pharmacists working in GP practices. These will be published here when available.

The Haxby Group, a provider of community healthcare services from 11 GP surgeries across York and Hull, shared their experience about the positive impact of employing a practice pharmacist (Guidelines in practice website).

Practical guidance

Indemnity and insurance

It’s a regulatory requirement, and a condition of your registration, to have appropriate professional indemnity arrangement in place before you start to practice. The level of cover needs to be appropriate to you, your practice and the nature and extent of the risks involved.

The GPhC website contains information on professional indemnity requirements.

The RCPharm is not regulated by the Financial Conduct Authority and cannot recommend professional indemnity insurance providers. However, NHS employers have published guidance and a series of Q&As regarding professional indemnity insurance, including for employees of GP practices.

NHS England is likely to provide information about indemnity requirements for practice pharmacists taking part in the national pilot scheme.

Further reading:  

• NHS Resolution: Clinical Negligence Scheme for General Practice (CNSGP)
• NHS Wales: General Medical Practice Indemnity (GMPI)
• National Services Scotland Clinical Negligence and Other Risks Indemnity Scheme (CNORIS).

Using systems such as EMIS, E-PACT, SYSTEM ONE and VISION

Practice pharmacists with expertise in using these systems advise that day-to-day access is essential to become fully competent using these applications. A colleague in the practice with prior experience may be able to help. The following resources may be helpful:

• EMIS health training and support
• Information on E-PACT.

The Department of Health, in collaboration with the Royal College of General Practitioners and the British Medical Association, have published comprehensive good practice guidelines for GP electronic patient records. 

Snomed-CT codes and the NHS dm+d database

Snomed-CT is an international coding standard, and the NHS dictionary of medicines and devices (dm+d) database is a dictionary of the codes used for medicines and medical devices. These are both used in general practice.

The Health and Social Care Information Centre (HSCIC) have published a webinar which provides an introduction to dm+d and the Snomed-CT UK Drug extension.

Further information about Snomed CT is available from HSCIC, at NHS Digital.

Quality improvement and audit

One role of a general practice based pharmacist is to increase the quality and safety of prescribing through mechanisms. Including practice based audit and improvement cycles.

The following quality improvement toolkits and resources may be useful:

• NHS Scotland: Quality Improvement Zone 
• NHS England: Quality, service improvement and redesign (QSIR) tools
• NHS England: Improvement Fundamentals

The Royal College of General Practitioners has also produced resources for clinical audits, including clinical audit guidance.

Responding to medicines related questions in practice

Pharmacists will need to respond to requests for information on medicines from colleagues and patients.

CPPE, NES and WCPPE, together with UKMI, have produced learning programmes to support pharmacists responding to medicines-related questions:

• Answering medicines-related questions in practice (CPPE)
• Answering medicines-related questions in practice (WCPPE).

Consultation skills

You will be taking an increasingly patient-facing role. As you support medicines optimisation and the public health agenda. The Royal College of Pharmacy report, Now or never: Shaping pharmacy for the future, outlines the need for pharmacy to be proactive in patient care.

The Consultation Skills for Pharmacy Practice website has been developed to support. When speaking and consulting with patients and people about their medicines and lifestyle choices.

The practice standards for consultation skills sets out the knowledge, skills, behaviours and attitudes you need when communicating and consulting with patients.

WCPPE have also produced a learning programme to support development of consultation skills.

Prescribing guidance

Becoming a prescriber

There are many ways a pharmacist can support the work of GP surgeries. It isn’t mandatory to be a pharmacist prescriber before starting work in a GP surgery. However, being able to prescribe increases the range of clinical activities a pharmacist can offer to patients. Find out more about becoming a pharmacist prescriber.

Competency framework for prescribers  

We have worked with other Royal Colleges to develop a revised single competency framework for prescribers, published in 2016. This work is based upon the single prescribing framework for all prescribers published in 2012 by the National Prescribing Centre.

Antimicrobial stewardship 

RCGP has published a TARGET antibiotics toolkit hub.

We’ve published an Antimicrobial Stewardship Portal. This signposts resources and information to promote learning about microbiology and antimicrobial stewardship.

Medicines optimisation  

NICE guidelines describe medicines optimisation as “the safe and effective use of medicines to enable the best possible outcomes”.

We have created a wide range of resources on medicines optimisation. Including good practice guidance, a patient leaflet, and briefings on optimising medicines for a number of conditions.

NICE have also developed a medicines optimisation pathway, covering the decision making processes used to help optimise a person’s medicines. Including medicines reconciliation and medication review.

NHS England have developed a Medicines Optimisation Dashboard. This is designed to further understand how patients are being supported with medicines use locally.

Medicines reconciliation  

NICE describes medicines reconciliation as accurately listing the all of a person’s medicines including prescribed, over-the-counter, and complementary medicines.

Pharmacists working in general practice may be involved in reconciling medicines following hospital discharge. They will need to work with patients and community pharmacists to ensure patients receive the medicines they need post-discharge.

You might find our Medication history quick reference guide helpful when conducting a medicines reconciliation.

Clinical medication reviews  

Pharmacists working in general practice will need to provide level 3 clinical medicines reviews.

Comprehensive information about medication review (including level 3) can be found in the document, A guide to clinical medication review 2008. Published by the National Prescribing Centre.

You might find our Medicines adherence quick reference guide helpful when conducting a clinical medication review.

Drug alerts  

The role of a general practice based pharmacist is likely to involve leading and implement changes. As as a result of drug withdrawals, medicine indications changes and alerts.

Changes would be aimed at improving medicines and patient safety across a population.

Information about drug alerts are available from:

• RCPharm pharmacy alerts
• The MHRA drug safety update
• The Drug and Therapeutics Bulletin
• Central Alerting System

Polypharmacy  

One of the roles of a GP based pharmacist is to reduce inappropriate polypharmacy. This could be through clinical medication review.

The Scottish Government has created polypharmacy guidance to address the issues resulting from the use of multiple medicines in the frail and elderly population.

The King’s Fund published a report on medicines optimisation and polypharmacy. Exploring systems for managing polypharmacy and offering recommendations for improving care for older people and those who have two or more chronic medical conditions.

WCPPE have produced a learning programme to help pharmacy professionals understand the impact of polypharmacy and reducing medicines wastage. 

Legal and regulatory framework

CQC inspection

The Care Quality Commission (CQC) have produced a range of support tools to help practices prepare for an inspection. Including a handbook and an explanation of their approach to inspection and what to expect. There are also examples of outstanding practice.

Additionally, the British Medical Association have produced a practical guide for GP practices preparing for their inspection by the CQC.

GP NHS contract

Pharmacists working in general practice may need to be familiar with:

• How services are funded
• How incentives work 
• Contractual arrangements between the NHS and the practice.

In England, the General Medical Services (GMS) contract is agreed between NHS employers and the British Medical Association (BMA).

In Scotland, the BMA’s Scottish GP committee agree a contract with the Scottish Government. A similar arrangement is in place in Wales.

Quality outcomes framework

The quality outcomes framework is part of the GP contract in England, Scotland and Wales. It’s a voluntary incentive programme but is a major source of potential income. Funding awards are dependent upon the practice meeting certain quality outcomes.  

NHS Employers have also published a guide to the quality outcomes framework.

The General Practice – the fundamentals of working with GPs e-course from CPPE has support to help pharmacists start using clinical systems, GP NHS contract and the quality and outcomes framework.

GP patient survey

In England, the GP patient survey is managed by Ipsos MORI under contract with NHS England. Information about the survey, and data resulting from past surveys, can be found on the GP patient survey website.

NHS England publish annual results of the GP patient survey on their website. Including further information about how they use the results.

In Wales, information about the GP Patient survey can be found on the NHS Wales website.

Each GP practice or group of practices in England will need to have a patient participation group (PPG). Information about PPGs has been published by the National Association for Patient Participation. It will be important to engage with the PPG and for the role of clinical pharmacists to be explained and understood.

NHS complaints procedure

The British Medical Association (BMA) has published information and guides on the NHS complaints procedure in England, Scotland and Wales.

Managing and optimising medicines

NHS repeat dispensing and Medicines Care Review Service

The roles of general practice pharmacists may include promoting Repeat Dispensing (England), Batch Repeat Dispensing service (Wales), and Medicines Care Review (previously Chronic Medication Service) (Scotland).

Practice pharmacists may be involved in developing and improving repeat prescribing systems, and training staff to identify safety issues and processes to reduce medicines waste.

Guidance for the implementation of NHS repeat dispensing has been jointly published by PSNC, NHS Employers and the General Practitioner Committee of the BMA. The guidance provide background to the service, patient selection, benefits of using repeat dispensing, and top ten tips for successful implementation.

NHS England have also published Electronic Repeat Dispensing Guidance which could be useful to GP practice teams.

Other resources include:

• Benefits of NHS repeat dispensing schemes for patients and practices (PSNC)
• Training for community pharmacists on repeat dispensing (CPPE)
• Repeat Dispensing Service Specification for community pharmacies (PSNC).

WCPPE have produced a distance learning pack that explains the NHS Repeat Dispensing arrangements in Wales. NES have resources to support pharmacists with the Medicines Care Review (previously Chronic Medication Service)

Professional guidance and ethical issues

Consent and confidentiality

The need to protect patient confidentiality and obtain patient consent is layered through legislation, regulation and contractual frameworks.

Resources useful in the context of general practice include:

• BMA confidentiality and disclosure of health information toolkit
• The NHS code of practice for confidentiality
• The NHS constitution
• Information commissioner’s office guide to data protection
• NHSX Information governance

Registered pharmacists also need to be aware of GPhC regulatory guidance for consent and confidentiality:

• GPhC guidance on consent
• GPhC guidance on confidentiality.

Safeguarding

The Royal College of Paediatrics and Child Health worked with 19 different bodies to produce Safeguarding children and young people: roles and competencies for health care staff. A framework for healthcare staff, which describes the level of competency and training required for different roles.

Clinical Pharmacists working in GP Practices would be expected to achieve Level 3 training for safeguarding. As they will contribute to assessing, planning, intervening and evaluating the needs of children, young people, vulnerable adults and in assessing parenting capacity.

Appropriate training will normally be provided by the practice to all staff working in a GP practice.

Other sources of information include:

• Safeguarding guide (Royal College of Pharmacy)
• Protecting children and young people quick reference guide (Royal College of Pharmacy)
• Safeguarding training – Level 1 and 2 (CPPE, England)
• Safeguarding training – Level 1 and 2  (WCPPE, Wales)

Prescription direction

Prescription direction is defined by PSNC as the sending of prescriptions to a pharmacy, other than the one which the patient wanted them to go to. The British Medication Association (BMA), Pharmacy Voice and PSNC published a statement regarding prescription direction. Including a list of activities to avoid in order to maintain good practice.

In October 2015, NHS England produced a poster on prescription direction highlighting patient choice.

Working with a multidisciplinary team

Pharmacists working in general practice will work with other healthcare professionals as part of a multi-disciplinary team. This may involve training or mentoring multi-disciplinary colleagues in prescribing and medicines optimisation.

We have developed a leadership framework and tools. This includes a section on engaging your team which may be helpful. We have also created mentoring support tools to help train and mentor colleagues.

Other useful resources include:

• Multi-disciplinary team handbook to support personalised care delivered through multidisciplinary teams (NHS England)
• The GP practice: A guide for community pharmacists and pharmacy staff (NHS Employers, BMA, PSNC).

Clinical guidance and support tools

NICE guidelines and pathways

One role of a general practice based pharmacist is to implement NICE and other evidence-based clinical guidelines:

• NICE guidelines are evidence-based recommendations for managing specific conditions.
  SIGN produce similar guidelines for use in Scotland
• NICE clinical pathways are clinical flow decision trees designed to help clinicians to make decisions
• MedicinesComplete (subscription required) is a platform that provides online access to a range of drug and healthcare reference sources.

Hepatic

NICE have developed a clinical pathway for patients with liver conditions.

You may also find Drugs and the Liver: A guide to drug handling in liver dysfunction (Pharmaceutical Press, £34.99, £26.25 for Royal College of Pharmacy members) a useful resource.

The United Kingdom Clinical Pharmacy Association (UKCPA). A partnership group of the Royal College of Pharmacy and a member association for clinical pharmacy practitioners, have a special interest group for hepatology.

Renal

NICE have developed a clinical pathway for patients with kidney conditions.

The UK Renal Pharmacy Group have identified a list of useful references for healthcare professionals.

CPPE has launched an Acute Kidney Injury (AKI) campaign with the Think Kidneys programme  to highlight the risk of acute kidney injury.

High risk medicines

CPPE run a distance learning programme linked to medicines use reviews and high risk medicines.

Healthcare Improvement Scotland has published a High Risk Medicines Framework.

Substance misuse

The key UK guideline for the clinical management of drug misuse and dependence is published by the National Treatment Agency and endorsed by the Department of Health, Welsh Assembly Government and Scottish Government.

SLD Training has also published factsheets about medicines misuse and dependence.

Older people

NICE have published a range of guidance and clinical pathways to help with the care of older people.

The United Kingdom Clinical Pharmacy Association (UKCPA) – a partnership group of the Royal College of Pharmacy, and a member association for clinical pharmacy practitioners, have a special interest group for care of the elderly.

CPPE have published an older people learning programme [UPDATE] to highlight health and medicines use and polypharmacy in older people. The consulting with older people workshop is part of the consultation skills for pharmacy practice programme. It helps you to support the older person in making decisions about their medicines.

WCPPE published Older People – an online course which provides you with key issues affecting medicines management and older people.

Minor ailments

Part of the role of a general practice based pharmacist might be to undertake minor ailments triage, dealing with minor ailments and triaging patients appropriately. RCGP offers online training for self-care for minor ailments.

It may also be useful to understand how minor ailments services work within community pharmacy. PSNC have published a service specification. Similarly, Community Pharmacy Scotland have published information about the core service in Scotland.

Understanding pathology results

One role of a general practice based pharmacist is to review pathology results for patients on known medicines. Pharmaceutical Press have published a clinical pharmacy practice resource Pathology and therapeutics for pharmacists (£50, £37.50 for Royal College of Pharmacy members) which can help pharmacists to understand these results.

Avoiding hospital admissions

An important role of a general practice based pharmacist is to contribute to reductions in medicine related hospital admissions and re-admissions. The King’s Fund has examined the research evidence around avoiding hospital admissions and prepared a report. This includes recommendations for how general practice can help.  

Using the Foundation framework to prepare for working in a GP surgery

Pharmacists interested in embarking on a career working in GP practices should complete the RCPharm Foundation programme. 

The Foundation Programme supports pharmacists through your first 1,000 days of practice. Helping you to develop essential knowledge, skills, and values to be a safe and effective pharmacist.

It also provides you with the tools and resources to become a more independent learner. So you can identify gaps in your development and take necessary steps to address these.

By working your way through the Programme, and associated workplace-based tools, you’ll learn how to apply the knowledge and skills you’ve acquired during your undergraduate studies, and pre-registration training, to patient scenarios and day-to-day practice.

Over time, this will empower you to effectively manage more complex patients/cases and pharmaceutical care issues. This will be crucial to your role as a pharmacist working in GP practices.   

Building your Faculty portfolio while working in a GP practice

Working in general practice presents an ideal opportunity to develop and to build your Advanced Practice Portfolio, submit for assessment and become a Faculty member.

Joining the RCPharm Faculty gives you the opportunity to benchmark and perhaps distinguish yourself from your peers. Gaining a post-nominal to reflect your stage of advanced practice as you do so.

You’ll also receive access to a library of tools and resources to support your professional development.

Building a portfolio could be an effective way of developing your practice, supporting your career progression and may help prepare you for revalidation in the future.    

Clinical training and support

CPPE run courses to introduce pharmacists to working in GP practices at multiple times throughout the year.

CPPE have also developed a Primary care pharmacy education pathway to train pharmacists taking part in the NHS England pilot, encouraging clinical pharmacists to work in GP practices.

Affiliated groups

The United Kingdom Clinical Pharmacy Association (UKCPA) is a partnership group of the Royal College of Pharmacy, and a member association for clinical pharmacy practitioners for sharing knowledge, research and experiences in providing clinical care for patients.