Discusión

Pre-registration training placements in primary care trusts (PCTs) are a relatively new and expanding area. We feel that this area for pre-registration training is a growth area due to the increase in numbers of pharmacy grad-uates. In line with the industrial placements, PCT pre-reg placements must be split equally between a PCT and another sector – either community or hospital.

Although we recognise that this section applies to just a few hospitals, we also recognise that many hospitals may be looking to increase their reg numbers or to expand the range of learning opportunities for their pre-regs. With this in mind we have decided to include this short section for those of you either considering hospital pre-reg programmes with a PCT rotation or joint hospital–PCT programmes, of which there is a growing number. This section should provide you with a brief insight into what it can be like having a rotation in a PCT.

P C T P H A R M A C Y W O R K

PCT pharmacy and medicines management teams vary greatly in terms of team structure and roles and responsibilities, and may encompass such work as working alongside other healthcare professionals to ensure that quality healthcare is delivered to the local population. There may also be some integration with social services, so therefore the boundaries may be blurred.

The core part of PCT pharmacy work is to analyse prescribing patterns of GP practices to ensure that GPs are working within national and local guidelines, and ensuring that healthcare professionals work within budgetary constraints. Pharmacy staff play a vital role in providing and analysing prescribing data to inform prescribers of their performance.

For a pre-reg, it may be a shock to discover that pharmacy work can be undertaken in an office environment! Although much of the work is done in the PCT offices, there are many opportunities for visiting surgeries and other 1 5 7

healthcare professionals in their workplaces, so you will not be as tied to your desk as you might think.

T H E R O L E O F T H E P R E - R E G W I T H I N A P C T

Pre-regs play a large part in supporting many of the activities detailed below.

Analysing prescribing (ePact) data

This is an important job in that the data that are accessed via the NHS Business Services Authority (BSA) are analysed and fed back to the prescri-bers to compare their prescribing practices with national or local guidelines and with PCT or national averages. In this way, prescribers can review their prescribing practices to identify current good practice, plus areas where improvements can be made.

Prescribing reviews, including yearly updates on everything!

The pharmacy or medicines management department at the PCT is respon-sible for reviewing the prescribing patterns of their prescribers and updating prescribers on their budgetary standing. Using the ePact data analysis, phar-macy staff arrange review meetings with their GP practices to talk about their prescribing activities. In addition to this, pharmacists update the GPs on any new developments with drugs or with guidelines, to ensure that practice staff have relevant and up-to-date information. These updates are not just on clinical areas, but may also pertain to legal issues around drugs, e.g. safe and secure handling of drugs. This work exposes pre-regs to the legal aspects of drugs that may be examinable in the registration exam.

Clinic visits

You may be responsible for date checking stock, updating stock lists and writing reports to feed back results to clinic staff. Although this may seem like a technical activity, there are clinical elements involved here because you may be required to ascertain the clinical appropriateness of drugs on the clinic stock list.

GP practice audits

A pre-reg may be required to undertake audit work in a GP practice – the information gathered from the GP practice is audited against important national or local targets. This audit work can obviously be considered good evidence for the performance standard ‘A4.8 Have successfully carried out a small, planned audit assignment’.

Training of healthcare professionals and patients, e.g. community inhaler counselling and cardiac rehab patients

As PCTs deliver locally responsive healthcare, this means that, for locally commissioned healthcare services, PCTs have to ensure that the health-care professionals involved are well trained. Pharmacy is involved in these types of training, especially if the subject matter involves the use of drugs.

Providing pharmaceutical care to managed services: intermediate care, learning difficulties, etc.

This make take a similar form to that for your hospital colleagues, in that you may be required to undertake ward-like activities such as medicines recon-ciliation. Which clinical area this involves depends on the healthcare that the PCT provides in your local area.

Medicines information enquiry answering

Many clinical areas covered in medicines information (MI) involve answering enquiries. The difference in a PCT is that you may not have such a comprehensive library of resources that is available in a hospital MI centre.

Summarising national guidance such as NICE guidance and NPSA alerts

This may then progress into the production of ‘flyers’ which are distributed to PCT contractors such as GPs, community pharmacists, nursing staff.

Primary care trusts 159

Writing guidelines or documents relating to the safe and secure use of medicines

As part of a PCT’s work, the medicines management and pharmacy depart-ments are involved with producing many policies and procedures relating to medicines. There are many opportunities to be involved in this kind of work, which often involves attending meetings and collating people’s opinions and comments.

Dissemination of national guidance for local use: cost comparisons of different pharmaceutical products using Drug Tariffs

When first discussing this placement with the Royal Pharmaceutical Society of Great Britain (RPSGB), we explored the ways in which the performance standards could be covered, because PCT pharmacy is not seen as mainstream pharmacy. Although it is correct that some of the performance standards cannot be covered, for example, it would be difficult to fulfil the dispensing and checking requirements (performance standards: ‘C1 Manage the dispens-ing process’) if you are not based in a dispensary environment, it can also be said that the work that a pre-reg undertakes WILL cover most of the perfor-mance standards because many of these cover how pre-regs manage them-selves, their work, their learning and their interpersonal skills.

As can be seen from the above examples, many of the pieces of work with which a pre-reg can get involved require working with a wide variety of healthcare professionals and communicating in a number of ways (perfor-mance standards ‘B1 Communicate effectively’ and ‘B2 Work effectively with others’), working to an agreed high standard. Also, a lot of your day-to-day work may involve answering MI enquiries for GP practice staff and clinic staff on a wide range of clinical areas (performance standards ‘C2 Provide additional clinical and pharmaceutical services’).

Some pre-regs will be concerned with the lack of ‘clinical’ work. We would dispute this, because we feel that pharmacy in all sectors is ‘clinical’.

Although there may be little day-to-day contact, there can be no dispute that pre-regs will be working with the latest up-to-date national and local guid-ance and asked to interpret the clinical and pharmaceutical aspects contained within. In the PCT, pre-regs also learn about how differently pharmacy can influence prescribing. They may well be involved with influencing many clinical practitioners by producing flyers or newsletters proactively providing them with information. This differs greatly to practice in other sectors; in hospital or community pharmacy, at pre-reg stage, your influence is as one

pre-reg to one clinical practitioner, or one patient, whereas, at the PCT, by undertaking one piece of work, one pre-reg can influence ALL the clinical practitioners in that PCT.

Although hospital timetables involve rotations through different areas, requiring you just to turn up to the right place at the right time, you will have the additional responsibility of organising your own time and your own workload, because no one else will do this for you. This will give you extra evidence for hitting the ‘A1 Managing self’ performance standard.

In addition, added benefits come from working in a smaller team, because your role as a pre-reg may involve extra responsibilities to which your community or hospital counterparts may not be exposed. A major component to this is the additional responsibility that you may have to take for your own learning. Experiences at a PCT will definitely propel you into thinking and acting like a pharmacist.

‘At first I didn’t know what to expect from my PCT placement. I got given work on the first day, work that got given to GPs. I saw that my presence was having an impact straight away. I started off on enquiry answering which was the same as answering enquiries in MI and so this did not feel strange. A couple of months in, I was working jointly with the pharmacists. Then I did a statin audit in GP practices and went in on my own to identify patients eligible to be switched onto different statins. I had a lot of responsibility, but the end decision was still with the GP. It was great that I had real input and that what I was saying was actually listened to.’

‘The work at the PCT has been linking well with the performance standards.

For instance I worked on the new antihypertensive guidelines and it highlighted to me that I actually know quite a lot. I definitely achieved tasks and was in situations where I was hitting performance standards without even realising it. I was definitely achieving performance standards through-out the placement.’

‘I think that I think quite differently now, I’m not so narrow focused.

Probably for 3 days a week I’m doing the same as the other pre-regs but coming at if from a different viewpoint, that’s all.’

‘I went from very structured rotations to no structure at the PCT, which has made me think about my own work and how to organise myself; I have to recognise what my own workload is and actively find things to do to plug gaps in my own knowledge. I used to be spoon fed, but the PCT is totally different; I am organising myself here.’

Primary care trusts 161

T O P T I P S

* PCT work is challenging in its own way

* Be prepared for extra responsibility for your own development when in the PCT

* Be prepared to learn a lot about local and national NHS initiatives

* Think about the patient at population rather than individual level

‘I think that I have changed a lot. I feel that I have the power to sort myself out. I have that control now. It was difficult at first but now I take more responsibility for my own development. I am becoming more confident about what I know and don’t know.’

‘I thoroughly enjoyed the PCT – if I were to do my pre-reg again, I would still do the PCT placement. It has made me think so differently from the other pre-regs. Although there was little direct patient contact I have learnt lots of different things.’