Summer internship at GP practice (Guest blog)

My summer of 2019 was spent undergoing a summer internship at the College Practice for 9 weeks. Alongside this, I continued working my usual part-time job as a pharmacy assistant at a community pharmacy on Wednesdays and weekends.

I came across the NHS England’s clinical pharmacists in general practice (GP) scheme, it allows pharmacists to practice and prescribe in a safe and effective environment. This has opened many opportunities for current and upcoming pharmacists, as it is a great way to illustrate our clinical knowledge and skills gained on our journey to becoming a pharmacist. Since I heard about this new scheme, I was eager to gain some experience and understand what it would be like working as a clinical pharmacist in a GP surgery. I was constantly researching and looking for any shadowing opportunities I could find to work in a GP surgery. However, since this scheme was new, this proved to be incredibly challenging.

In December 2018, a summer internship at The College Practice in Maidstone was advertised at the university via an email that was sent to all Pharmacy students across years 2 and 3. I applied for the summer internship by emailing my CV and cover letter to the lead practice Pharmacist at the College Practice. My application was considered, and following a telephone and face-to-face interview, I was chosen as the successful candidate to work at the College Practice during the summer.

The College Practice is a GP with circa 19,000 list size over 3 sites in Maidstone. The practice has a multidisciplinary team of general practitioners, nurses, paramedics, physiotherapist, and pharmacists to serve the population. My internship began in July 2019. My main tasks at the surgery were medicine reconciliation from discharges, processing repeat prescriptions, responding to queries, and medication-related audits. During my time at the practice, I was supervised by the lead practice Pharmacist. He guided and supported me in the process of understanding the work at the practice. He was always incredibly approachable and looked out for me to ensure I was well occupied with work and always had the support I needed. We would usually have a brief meeting twice a week, where he would answer any of my queries and concerns and would always ensure I was given all the support I required to make my time as insightful as possible. At the start of the shift, he would ask what I wanted to achieve from the day and who I wanted to shadow and would make sure I was able to do so by allowing me to shadow doctors, diabetic nurses, and other healthcare professionals available on the day.

I was also able to shadow the GP pharmacists conducting medication reviews, running respiratory, warfarin, and minor ailment clinics. During a face-to-face consultation with a patient presenting with a sore throat, the pharmacist asked specific questions before issuing an antibiotic prescription. The pharmacist later explained how he uses the FeverPAIN criteria to guide his prescribing decision, i.e. Fever (during the previous 24 hours), Purulence (pus on tonsils), Attend rapidly (within 3 days after onset of symptoms), Severely Inflamed tonsils, No cough or coryza (inflammation of the mucous membranes of the nose). Each of these criteria scores 1-point. High scores (maximum score of 5) suggest a bacterial cause; therefore a patient will need a course of antibiotics. A score of 0-1 indicates no antibiotics are required. This was incredibly beneficial to me when working in community pharmacy as sore throat is a commonly presented symptom. With this understanding, I was able to direct a patient to a GP or recommend over the counter remedies appropriately based on their symptoms, thus making my patient-care more efficient.

Finally, I also completed several audits for the practice. For example, reviewing patients on orlistat for weight-loss and flagging up patients who are not adherent to their management plan, i.e., no weight loss or an increase in weight. I have also completed an audit on the use of valproate in women of child-bearing potential which involved writing to patients and referring patients to a specialist if they did not have a Pregnancy Prevention Programme or an annual risk acknowledgment form in place. I have also supported the practice lead nurse in switching patients to alternative gonadorelin analogue, which requires less nursing time and maximises practice reimbursement.

There is a vast difference between the role of community and GP pharmacists. Community pharmacy is a fast-paced environment where you may be dealing with a large proportion of customers in a short amount of time. A community pharmacy may be a patient’s final point of contact before they take their medication; therefore, the pharmacist needs to ensure the medication is safe for the patient to take. On the other hand, a GP practice allows a pharmacist to spend more time with a patient on a one-to-one basis to assist a patient in managing their long-term conditions and providing clinical advice regarding any minor ailments by providing the best and most cost-effective treatment available in the pharmacy. This can sometimes be incredibly challenging as patients are historically used to always seeing a doctor in a consultation room at a GP. However, with changing times and more awareness about the role and skills of a clinical pharmacist, this mindset is also changing, and patients are becoming more willing to seek advice from a pharmacist in a GP.

I cannot recommend GP placements enough. It is a unique experience that allows one to learn skills that can be used in any healthcare setting. I finished my GP placement feeling incredibly excited to start my third year as I will now be able to apply what I learned at this placement into the rest of my university degree. Not only do I participate more actively in lectures, but I also found myself being more attentive and motivated so that I can provide the best healthcare to patients one day as a future pharmacist.

This blog was written by Jasmin Kaur Parmar

Jasmin’s Linkedin profile can be accessed here