GPs, nurses and pharmacists as prescribers in primary care: an exploration using the social identity approach / Hausärzte/-innen, Diplomierte Pflegefachpersonen und Apotheker/-innen als Arzneimittelverschreiber/-innen: eine Exploration mit dem Ansatz der Sozialen Identität

Abstract

The social identity approach was used to explore the inter-professional relations between nurse prescribers, pharmacist prescribers and general practitioners (GPs) in primary care in the United Kingdom. We investigated their social identities as prescribers, the influence of social structure in practice settings and the implications for further development of nurse and pharmacist prescribing. Interviews were conducted with 21 GPs, nurse prescribers and pharmacist prescribers in primary care from the south of England. Five themes emerged, including the ambiguous social identity of some nurse and pharmacist prescribers (‘a no man’s land’), constraining social structures (‘the doctor is king’), the content of GPs’ social identity (‘subtle prescribing’), the content of nurse and pharmacists’ social identity (‘more than just competent’) and context (‘engaging with each other’s identities’). At some GP practices, there was a willingness to engage with the different social identities and reframe them within the organisational context of a GP surgery. At these sites, where social identities were respected and supported, the social identity approach offered insight into how the resulting teamwork could lead to a shared practice identity focused on multi-disciplinary working. This research provides evidence of how professional and organisational identities can be enhanced and supported. Further, there is the potential for an intervention using the social identity approach to improve patient care.

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

“…Reorganization services to include a multidisciplinary care team may be necessary 37 . Delegation of duties of prescribing drugs to non‐physician health care workers like nurses and pharmacists may help to reduce waiting times and improve control 38–40 . In Thailand, there is evidence that reorienting services to have a more patient‐centered approach, allowing for continuity of care and greater patient‐provider communication, may be useful for hypertension control 41 .…”

The rise of non-medical prescribing and medical dominance

“…In an interview study with 21 prescribers including GPs, nurse independent prescribers and pharmacist independent prescribers, nurses and pharmacists were considered to engage in a lower level of complexity in their clinical decision-making process than doctors and were thus suitable for more routine prescribing: continuing existing prescriptions or following standardised clinical protocols. 46 In a study exploring the role of physician associates in general practice, nurses were considered by GPs to be not very good at dealing with complexity. 47 Doctors' source of professional status shifted slightly, with less emphasis on the singular ability to diagnose, to being able to deal with complex cases in all their variety.…”

“…As noted in Weiss et al, a more nuanced role for GPs, as prescribers and diagnosticians needed to be developed. 46 This more nuanced role focused on the subtleties and indeterminacy of prescribing which could not be reduced to a protocol. As noted by a GP in Weiss et al 46 : "I mean, this is a good example and I mention it because I'm still very pleased with myself for spotting this menopausal patients' hot flushes were not menopausal hot flushes.…”

“…46 This more nuanced role focused on the subtleties and indeterminacy of prescribing which could not be reduced to a protocol. As noted by a GP in Weiss et al 46 : "I mean, this is a good example and I mention it because I'm still very pleased with myself for spotting this menopausal patients' hot flushes were not menopausal hot flushes. And I don't know how I knew that they weren't but I thought, hang on, what else is going on here?…”

“…Rather, this new metier for doctors was directed towards abstraction and the intellectual challenge of dealing with complex cases. 46 Medicine's gaze shifted from prescribing (in general) to 'subtle prescribing' in dealing with complex cases where their particular expertise was best suited. Thus complexity, or dealing with complex patient cases, became an integral part of medicine's ideology.…”