Primary Duties and Areas of Responsibility Patient facing long term condition clinics as above See patients in multimorbidity clinics and in partnership with primary healthcare colleagues and implement improvements to patients medicines, including de-prescribing. Manage own case load and run 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 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 optimisation). Patient facing clinical medication review Undertake clinical medication reviews with patients with multimorbidity and polypharmacy and implement own prescribing changes (as an independent prescriber) and order relevant monitoring tests Patient facing care home/residential clinical medication reviews Manage own caseload of care home residents. Undertake clinical medication reviews with patients with multimorbidity and polypharmacy and implement own prescribing changes (as an independent prescriber) and order relevant monitoring tests. Work with care home staff to improve safety of medication. Manage own caseload of vulnerable housebound patients at risk of hospitaladmission 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. Identifying key areas of need for vulnerable patients and formulating care plans. Management of common/minor/self-limiting ailments Managing caseload for patients with common/minor/self-limiting ailments while working within a scope of practice and limits of competence. Signposting to community pharmacy and referring to GPs or other healthcare professionals where appropriate Differential/Un-differential diagnosis Manage own caseload for patients and diagnosis people with long term and/or acute/common conditions/ailments while remaining within scope of practice and limits of competence. Referring to GP and/or other healthcare professionals where appropriate Patient facing medicines support Provide patient facing clinics for those with questions, queries and concerns about their medicines in the practice. Signposts to other services and/or healthcare professionals where appropriate, while working within a scope of practice and limits of competency. Medicine information to practice staff and patients Answers all medicine related 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 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. Management of medicines Including 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 medicinesthey 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. Telephone triage 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 test results, common/minor ailments, acute conditions, long term condition reviews etc. 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. Service development Develop and manage new services that are built around new medicines or NICEguidance, where a new medicine/recommendations allow the development of a new care pathway (e.g. new oral anticoagulants for stroke prevention in atrial fibrillation). Information management Analyse, interpret and present medicines data to highlight issues and risks to support decision-making. Medicines Quality Improvement programmes Identify and provide leadership on areas of prescribing and medicines optimisation. Conduct clinical audits and improve projects or work with colleagues such as GP registrars, practice managers etc. Present results and provide leadership on suggested changes. Contribute to national and local research initiatives. Medicines safety 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. Care Quality Commission Provide leadership to the general practice team to ensure the practice is compliant with CQC standards where medicines are involved. Undertake risk assessment and management and ensure compliance with medicines legislation. 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 toshared 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. Education and Training Provide education and training to primary healthcare team on therapeutics and medicines optimisation. Provide training to visiting medical, nursing, pharmacy and other healthcare students where appropriate. Public health To support public health campaigns. To provide specialist knowledge on all public health programmes available to general public.