Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

NHS England | November 2018 | Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

NHS England are running a national consultation on items which should not routinely be prescribed in primary care (for example GP practices, pharmacies, the dentist, and 
eye clinics.) The consultation involves 9 medicines and products. According to NHS England, research shows that some medicines can be replaced with other medicines that
work better, are safer or cost less money.


Overview Items which should not routinely be prescribed in primary care: an update and a consultation on further guidance for CCGs

Easy read version of the consultation document

Consultation document 

See also:

NHS Clinical Commissioners [press release]

Clinical Pharmacists save GP five hours, finds small study

OnMedica | September 2018 | Practice-based pharmacists free up GP time

A small study published in the British Journal of General Practice finds that pharmacists based in GP Practices can save 5 hours of prescribing work a week for GPs.  The study identified further benefits to clinical pharmacists working at practices, such as having a positive impact on patient safety, staff morale, and staff stress. The research sought to address a gap in the literature as the impact of clinical pharmacists on GP practices, it investigated the effects of  clinical pharmacists in 16 urban practices  Greater Glasgow and Clyde, Scotland  (via OnMedica).



Background General practice in the UK is experiencing a workforce crisis. However, it is unknown what impact prescribing support teams may have on freeing up GP capacity and time for clinical activities.

Aim To release GP time by providing additional prescribing resources to support general practices between April 2016 and March 2017.

Design and setting Prospective observational cohort study in 16 urban general practices that comprise Inverclyde Health and Social Care Partnership in Scotland.

Method GPs recorded the time they spent dealing with special requests, immediate discharges, outpatient requests, and other prescribing issues for 2 weeks prior to the study and for two equivalent periods during the study. Specialist clinical pharmacists performed these key prescribing activities to release GP time and Read coded their activities. GP and practice staff were surveyed to assess their expectations at baseline and their experiences during the final data-collection period. Prescribing support staff were also surveyed during the study period.

Results GP time spent on key prescribing activities significantly reduced by 51% (79 hours, P less than 0.001) per week, equating to 4.9 hours  per week per practice. The additional clinical pharmacist resource was well received and appreciated by GPs and practices. As well as freeing up GP capacity, practices and practitioners also identified improvements in patient safety, positive effects on staff morale, and reductions in stress. Prescribing support staff also indicated that the initiative had a positive impact on job satisfaction and was considered sustainable, although practice expectations and time constraints created new challenges.

Conclusion Specialist clinical pharmacists are safe and effective in supporting GPs and practices with key prescribing activities in order to directly free GP capacity. However, further work is required to assess the impact of such service developments on prescribing cost-efficiency and clinical pharmacist medication review work.


Full reference: Maskrey, M.,  JohnsonC. F.,  Cormack, J.,  RyanM.,  &  Macdonald, H. | 2018 | Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study | 

Read the full paper at British Journal of General Practice 

Mental health therapists in GP practices could be the norm

NHS England | August 2018 | Mental health therapists in GP practices could be the norm

New guidance to support GPs, practice managers and commissioners integrate mental health therapists into primary care pathways has been created by NHS England. 

The guidance will enable therapists to become  integrated into primary care teams and focus on common mental health disorders such as anxiety and depression, particularly where this occurs in patients with a long term physical health condition such as diabetes, respiratory or heart problems.


Evidence suggests 90 per cent of  adults with mental health problems are supported in primary care and broadening the range of services for patients, means local health services are better equipped to deal with patients’ physical and mental health needs (Source: NHS England).

See NHS England  Guidance on co-locating mental health therapists in primary care

NHS England news release Mental health therapists in GP practices could be the norm

In the media:

Pulse NHS England asks GPs to house mental health therapists within practices

GP Online GPs urged to bring mental health therapy services into practices

The Daily Mail Every GP surgery in England should hire a mental health expert to tackle depression that makes physical illnesses worse, experts say

Clinical Pharmacists in General Practice

University of Nottingham | July 2018 |Clinical Pharmacists in General Practice

The University of Nottingham has published its findings into the role of the clinical pharmacist in general practice, it looks at the first stage of the pilot to integrate the role into general practice. Researchers from the university investigated the work of the newly created clinical pharmacist roles from the perspectives of the pharmacists, those working immediately with them in their roles, professional stakeholders and patients. These were evaluated in a range of ways including; observational studies, one to one interviews with staff and patients, patient focus groups and case study site visits.


The report reveals key focus for the clinical pharmacists was medication reviews, as these often accounted for significant amount of their workload. Clinical pharmacists undertook these on a regular basis, releasing capacity for GP’s and alleviating appointment issues.

As part of these reviews they were able to provide invaluable medicines education and usage advice to patients, in particular those with long term health conditions including; diabetes, asthma and heart disease, which led to increased medication understanding and adherence. Where appropriate they were also able to deprescribe medicines, which has potential for positive health and cost saving benefits.


The report also provides many  recommendations including the need to :

  • Manage GP expectations of the clinical pharmacist role capabilities and time for
    return on investment
  •  Manage practice site leads expectations of cost and training commitments
  • Manage local level expectations of wrap around responsibilities for the clinical
    pharmacist role (i.e. clear guidance on senior clinical pharmacist

Dr Keith Ridge, Chief Pharmaceutical Officer at NHS England said “Clinical pharmacists in general practice are playing an important role in the NHS – they are helping GPs to manage demands on their time, they upskill the wider practice team about medicines and crucially, they are providing better outcomes and quality of life for patients, especially elderly patients and those with chronic illnesses. The report’s recommendations are timely and we are confident that the benefits of the programme will continue across more GP practices, as we continue the rollout of the programme.”

Full report: Clinical Pharmacists in General Practice: Pilot scheme Independent Evaluation Report: Full Report 

Executive summary: Clinical Pharmacists in General Practice: Pilot scheme
Independent Evaluation Report: Executive Summary

Celebrating 70 individuals who have made a massive difference to the NHS

Care Quality Commission | July 2018 | Driving improvement – individuals who have made a difference

To mark 70 years of the NHS, the Care Quality Commission (CQC) has published 70 stories underlining individuals who have gone ‘over and above’  and made a significant impact on the care people receive across health and social care services. This collection of 70 case studies highlights the work that individuals – from volunteers, to front line staff to senior leaders – have done to deliver great services in hospitals, care homes, GP practices and elsewhere. (Source: CQC).

Driving improvement
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There are case studies from the following sectors:

The state of care in urgent primary care services

This report presents findings from the Care Quality Commission’s programme of comprehensive inspections of urgent care centres, NHS 111 services and GP out-of-hours services.

state of care
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Urgent primary care services play a vital role in England’s healthcare system. They are the first step to ensure that people are seen by the professional best suited to deliver the right care and in the most appropriate setting.  A quick, safe and effective response from these services provides a good outcome for patients and takes pressure off other parts of the urgent care system.

This report presents some common themes and characteristics that the Care Quality Commission (CQC) have found from their inspections.

The report found:

  • Urgent care services are an essential part of the healthcare system, particularly in taking pressure off other parts of the NHS at times of peak demand.
  • Urgent primary care services have been able to improve. Overall, the quality is good – although one in 10 services still require some improvement, particularly in initial assessment of people and timeliness of response to urgent needs.
  • Urgent care providers face pressures with staffing and workforce planning. This is compounded by the reality of unsocial working hours and high reliance on self-employed clinicians
  • Many providers experience difficulties in accessing people’s medical records.
  • NHS 111 in particular has the potential to take pressure off the NHS – and provide a better experience for people by giving advice and treatment in one place. However, to achieve this it must be adequately resourced. Commissioners need to support providers, take action if they are not meeting their contracts and integrate services more closely.
  • Many people are not aware of the range of urgent care services available. There is a need for more public information – and consistency of service provision.

Full report: The state of care in urgent primary care services. Findings from CQC’s programme of comprehensive inspections in England