Patient facing Long-term condition clinics See patients with single or multiple medical problems where medicine optimization is required (e.g. Respiratory, cardiovascular, Diabetes.) Review the on-going need for each medicine, a review of monitoring needs and an opportunity to support patients with their medicines taking ensuring they get the best use of their medicines (i.e. medicines optimization). Make appropriate recommendations to Senior Pharmacists or GPs for medicine improvement. Clinical Medication Review Undertake clinical medication reviews with patients and produce recommendations for senior clinical pharmacist, nurses and/or GP on prescribing and monitoring. Work with care home staff to improve safety of medicines ordering and administration. Attend and refer patients to multidisciplinary case conferences. Medicines support Provide patient facing and telephoe clinics for those with questions, queries and concerns about their medicines in the practice. Medicine information to practice staff and patients Answers relevant medicinerelated enquiries from GPs, other practice staff, other healthcare teams (e.g. community pharmacy) and patients with queries about medicines. Suggesting and recommending solutions. Providing follow up for patients to monitor the effect of any changes Unplanned hospital admissions Review the use of medicines most commonly associated with unplanned hospital admissions and readmissions through audit and individual patient reviews. Put in place changes to reduce the prescribing of these medicines to highrisk patient groups. 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 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 highrisk groups of patients (e.g. those with medicine compliance aids or those in care homes). Signposting Ensure that patients are referred to the appropriate healthcare professional for the appropriate level of care within an appropriate period of time e.g. pathology results, common/minor ailments, acute conditions, long term condition reviews etc. Repeat prescribing Implement the practice repeat prescribing policy within each PCN practice where required Manage the repeat prescribing re-authorization process by reviewing patient requests for repeat prescriptions and reviewing medicines reaching review dates and flagging up those needing a review. Ensure patients have appropriate monitoring tests in place when required. Risk stratification Identification of cohorts of patients at high risk of harm from medicines through pre-prepared practice computer searches. This might include risks that are patient related, medicine related, or both. The clinical pharmacists will be responsible for ensuring that all drugs that require regular monitoring are prescribed in a safe manner and that all necessary tests and procedures are carried out according to guidance. Examples of such drugs include NOACs, azathioprine, lithium, warfarin, methotrexate Service development Contribute pharmaceutical advice for the development and implementation of new services that have medicinal components (e.g. advice on treatment pathways and patient information leaflets) Information management Analyze, interpret and present medicines data to highlight issues and risks to support decision- making. This will include areas practices are contracted to improve. E.g. NSAID prescribing Medicines quality improvement &safety Undertake clinical audits of prescribing in areas directed by the GPs, feedback the results and implement changes in conjunction with the practice team. Implement changes to medicines that result from MHRA alerts, product withdrawal and other local and national guidance. Implementation of local and national guidelines and formulary recommendations Monitor practice prescribing against the local health economys RAG list and make recommendations to GPs for medicines that should be prescribed by hospital doctors (red drugs) or subject to shared care (amber drugs). Monitor adherence to North Central Londons Medication Optimization Network Auditing the practices compliance against NICE technology assessment guidance (TAG) Assist practices in seeing and maintaining a practice formulary that is hosted on the practices computer system. Auditing practices compliance against NICE technology assessment guidance. Provide newsletters or bulletins on important prescribing messages. Education and Training Provide education and training to primary healthcare team on therapeutics and medicines optimization. This will include local community pharmacists