Becoming a leader

Finally, let’s return to Brian to find out how we can take on extended roles to help our teams best manage complex or co-morbid patients.

We met Brian earlier in the course. He is an 81 years old man with multiple co-morbidities who subsequently has a long list of medications he takes daily. He told you that he was tired of taking so many different medications and wondered if he needs to be on so many. As per the discussion in week 3, you determine he would benefit from a medication review and time for a separate discussion about his chronic pain management and support for his low mood.

As we have outlined in week 3, polypharmacy is likely to be a growing problem in the NHS, and inappropriate or ineffective prescriptions increase treatment burden, undermine adherence to treatment, risk adverse reactions, and drug interactions, increase health service use and add to NHS costs. De-prescribing is, therefore, a focus of health policy initiatives to reduce harm, improve health and reduce healthcare costs.

Were you aware that de-prescribing is a key part of the prescribing lead’s role in facilitating the implementation of policies to improve patient care? Becoming a clinical lead is an extended role that any salaried or partner GP can apply to do. It allows you to combine your clinical work with dedicated time to focus on a specific area of patient care or governance, and contribute toward the development of better practice.

The RCGP gives an overview of GPs with extended roles.

You don’t need to become a prescribing lead to share your learning of de-prescribing approaches. Have you tried using a de-prescribing tool or framework such as SAGE before? The SAGE consultation model was discussed in weeks 2 and 3, where we encouraged you to apply it to the case of Omar with stress-related swallowing problems and Brian, to help to structure his medication review. Have you tried applying this in practice yet? If so, what did you discover about using a tool to help prevent polypharmacy? How did you integrate this to change your practice the next time you did a medication review? How could you apply this new knowledge to polypharmacy in your practice population? How could you share this knowledge in your practice to help others learn these new skills?

Let us know and share with your colleagues in the Comments below as usual.