The post holder will be the Senior member of a Neighbourhood Team of Pharmacists who will work within their clinical competencies as part of a multi-disciplinary team to provide expertise in clinical medicines management, patient-facing structured medication reviews, manage long term conditions, management of medicines on transfer of care and systems for safer prescribing, manage repeat prescription authorisations and reauthorisation, acute prescription requests, while addressing both the public health and social care needs of patients in the GP practice(s) that make up the PCN. This role is pivotal to improving the quality of care and operational efficiencies so requires motivation and passion to deliver an excellent service within general practice. The post holder will be responsible for the day-to-day management and development of the pharmacists and technicians and the distribution of the pharmacist and technician resource within a Neighbourhood, liaising with the member practices and the PCN Pharmacy lead. Key areas of Focus Patient-facing medication reviews of patients with polypharmacy especially for older people, people in care homes and those with multiple co- morbidities. Leadership to practices and pharmacy team on quality improvement and clinical audit as well as managing some aspects of the Quality and Outcomes Framework. Working as part of a multi-disciplinary team to manage repeat prescription authorisations and reauthorisation, acute prescription requests, management of medicines on transfer of care and systems for safer prescribing. Providing expertise in clinical medicines management while addressing both the public health and social care needs of patients in the GP practice(s). Day to day management of the PCN pharmacists and technicians in the neighbourhood and agreeing allocation of the resource with member practices. Working across and assisting with both practice and PCN requirements Key duties and responsibilities 1. Patient facing medicines support Hold clinics for patients requiring medication reviews i.e. a review of the ongoing need for each medicine, a review of monitoring needs and an opportunity to support patients with their medicine taking. Provide a telephone support for patients with questions, queries and concerns about their medicines. 2. Structured Medication Reviews (SMRs) Undertake structured medication reviews with patients with multimorbidity and polypharmacy and implement own prescribing changes (as an independent prescriber) and order relevant monitoring tests. 3. Risk stratification Design, development, and implementation of computer searches to identify cohorts of patients at high risk of harm from medicines. Responsibility for management of risk stratification tools on behalf of the practice. Working with patients and the primary care team to minimise risks through medicines optimisation. 4. Longterm condition clinics See patients in multimorbidity clinics and in partnership with primary healthcare colleagues and implement improvements to patients medicines, including deprescribing. Manage own case load, run own long-term condition clinics where responsible for prescribing as an independent prescriber for conditions where medicines have a large component (e.g. medicine optimisation for stable angina symptom control, warfarin monitoring and dose adjustment for patients requiring longterm anticoagulants). Review the ongoing need for each medicine, a review of monitoring needs and an opportunity to support patients with their medicines taking. 5. Unplanned hospital admissions Devise and implement practice searches to identify cohorts of patients most likely to be at risk of an unplanned admission and readmissions from medicines. Work with case managers, multidisciplinary (health and social care) review teams, hospital colleagues and virtual ward teams to manage medicines-related risk for readmission and patient harm. Put in place changes to reduce the prescribing of these medicines to high-risk patient groups. 6. Care home structured medication reviews Manage own caseload of care home residents. Undertake clinical medication reviews with patients and implement own prescribing changes (as an independent prescriber) and order relevant monitoring tests. Work with care home staff to improve safety of medicines ordering and administration. 7. Repeat prescribing Produce and implement a practice repeat prescribing policy. Manage the repeat prescribing reauthorisation process by reviewing patient requests for repeat prescriptions and reviewing medicines reaching review dates; make necessary changes as an independent prescriber, and ensure patients are booked in for necessary monitoring tests where required. 8. Medicines safety and quality improvement Identify and provide leadership on areas of prescribing requiring improvement. Conduct own audits and improvement projects and work with colleagues. Present results and provide leadership on suggested change. Demonstrate continuous QI activity focused upon prescribing safety as specified in the QOF guidance. This work for example might include the PINCER tool. Contribute to national and local research initiatives 9. Leadership and management Provide leadership and management to clinical pharmacists, pharmacy technicians and pre-reg pharmacists working within assigned neighbourhoods. Responsibility for line managing clinical pharmacists and technicians within assigned neighbourhoods. Operational management of pharmacy team and clinical support. 10. Domiciliary clinical medication review Manage own caseload of vulnerable housebound patients at risk of hospital admission and harm from poor use of medicines. Implement own prescribing changes (as an independent prescriber) and ordering of monitoring tests. Attend and refer patients to multidisciplinary case conferences. 11. Service development Develop and manage new services that are built around new medicines or NICE guidance, where new medicine/recommendations allow the development of a new care pathway (e.g. new oral anticoagulants for stroke prevention in atrial fibrillation). 12. Care Quality Commission Provide leadership to the practice manager and GPs to ensure the practice is compliant with CQC standards where medicines are involved. 13. Population and Public Health To devise and manage population and public health campaigns to run within the network. To provide specialist knowledge on immunisation. 14. Cost saving programmes Make recommendations for, and manage pharmacy technicians to, make changes to medicines (switches) designed to save on medicine costs where a medicine or product with lower acquisition cost is now available 15. Medicine information to practice staff and patients Answers all medicinerelated enquiries from GPs, other practice staff and patients with queries about medicines. Providing follow up for patients to monitor the effect of any changes. 16. Information management Analyse, interpret and present medicines data to highlight issues and risks to support decision making. 17. Training Provide education and training to primary healthcare team on therapeutics and medicines optimisation. Provide training to visiting medical, nursing and other healthcare students where appropriate. 18. Management of medicines at discharge from hospital To reconcile medicines following discharge from hospitals, intermediate care and into care homes, including identifying and rectifying unexplained changes manage these changes without referral to a GP, perform a clinical medication review, produce a post discharge medicines care plan including dose titration and booking of follow up tests and working with patients and community pharmacists to ensure patients receive the medicines they need post discharge and working with patients and community pharmacists to ensure patients receive the medicines they need post discharge. Set up and manage systems to ensure continuity of medicines supply to high-risk groups of patients (e.g. those with medicine compliance aids or those in care homes). Work in partnership with hospital colleagues (e.g. care of the elderly doctors and clinical pharmacists) to proactively manage patients at high risk of medicine related problems before they are discharged to ensure continuity of care. 19. Implementation of local and national guidelines and formulary recommendations Monitor practice prescribing against the local health economys RAG list for medicines that should be prescribed by hospital doctors (red drugs) or subject to shared care (amber drugs). Liaise directly with hospital colleagues where prescribing needs to be returned to specialists. Assist practices in setting and maintaining a practice formulary that is hosted on the practices computer system. Suggest and develop computer decision support tools to help remind prescribers about the agreed formulary choice and local recommendations. Auditing practices compliance against NICE technology assessment guidance. Provide newsletters on important prescribing messages to improve prescribers knowledge and work with the team to develop and implement other techniques known to influence implementation of evidence such as audit and feedback. 20. Medicines safety Horizon scan to identify national and local policy and guidance that affects patient safety through the use of medicines, including MHRA alerts, product withdrawals and emerging evidence form clinical trials. Manage the process of implementing changes to medicines and guidance for practitioners.