Pharmacists Want Extended Roles in Primary Care (UK)

There is an enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures, new research has suggested.

The qualitative interview study of UK pharmacists – published in the British Journal of General Practice (Br J Gen Pract 2017; 67 (662): e650-e658. DOI: http://bjgp.org/content/67/662/e650]) – suggests that the training given to pharmacists should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.

While pharmacists are the third largest healthcare profession in the UK, their skills are a currently “underutilised and potentially highly valuable resource” for primary healthcare, according to background material in the study.

Therefore a team from the University of Exeter Medical School set out to evaluate an innovative training programme for pharmacists interested in extended roles in primary care, advocated by a UK collaborative ‘10-point GP workforce action plan’.

The training programme was delivered face to face and consisted of six full days completed over six consecutive months, with associated self-directed learning.

A GP and a pharmacist were the main course facilitators, with practice nurses also involved in delivering the course, which encompassed practical clinical skills training alongside theoretical teaching on acute illness, long-term conditions and multi-morbidity, evidence-based practice, pharmacology in primary care, the organisation, structure, and delivery of general practice, and the importance of patient experience.

The training, which targeted pharmacists in Devon, Cornwall and Somerset – also gave participants an opportunity to attend a one-day placement in general practice.

Of the 1,050 pharmacists contacted by e-mail, 38 replied and 16 were purposively selected for the training programme.

Using pre- and post-course interviews, the authors found that after completing the training, most participants felt that a formal, standardised qualification in primary care pharmacy would improve their employability by practices and their access to indemnity cover.

“The course raised their awareness of a need to manage uncertainty in clinical care and to use critical appraisal, within the bounds of their clinical competence, to flexibly manage situations that could not be approached according to guidelines,” the researchers stated.

They found that many participants anticipated an increase in the numbers of pharmacists with independent prescribing skills, while others visualised practice pharmacists becoming “gatekeepers”: liaising with community pharmacists and addressing medication queries using their access to patient notes.

However, it was also discovered that the pay ‘banding’ currently advertised in many primary care posts in the UK would mean a drop in salary for an experienced community pharmacist, but that this was on par with hospital pharmacy.

While several perspectives were expressed regarding the skills, knowledge, and attitudes required for a role in primary care, as well as the potential outcomes that might be achieved, all participants appeared willing to contribute to the relief of workload pressures on GPs and on the primary care team.

“The most recently qualified pharmacists, and those with less experience of working in primary care, appeared the most willing to engage with training and with career opportunities for extended roles in general practice,” the researchers concluded.

They suggest that a working definition of the role of a primary-care pharmacist, with clear examples of the knowledge, skills, and attitudes required, should be made available to pharmacists, primary care teams and the general public. “This would enable standardised payment bandings and indemnity fees to be developed and applied nationally across primary care.”

The authors added that an interim assessment for NHS England’s ‘GP Forward View’ suggested that “‘the success of many of the pledges made … will depend on frontline GPs being aware of how to access certain programmes… for example the roll-out of practice-based pharmacists”.

The Royal College of General Practitioners reported recently (GP Forward View Assessment of progress, Year 1, http://www.rcgp.org.uk/policy/general-practice-forward-view.aspx) that strong progress was being made with an NHS England pledge to invest an additional Stg£122 million (€135.6m) in the current pilot scheme for practice-based pharmacists, in order to deliver a further 1,500 pharmacists by 2020.

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