Pharmacists’ perceptions of their emerging general practice roles in UK primary care: a qualitative interview study

Abstract

BackgroundUK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative ‘10-point GP workforce action plan’.AimTo explore pharmacists’ perceptions of primary care roles including the potential for greater integration of their profession into general practice.Design and settingA qualitative interview study in UK primary care carried out between October 2015 and July 2016.MethodPharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted — one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used.ResultsSixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants’ experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role.ConclusionThere is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners.

Development of an education and support framework for pharmacists working in GP practice

“…It may be that these courses need to be further and continually promoted. The networking opportunity of training events was valued, which was echoed in the Exeter training study . Independent Prescribing courses cover clinical and communication skills in detail.…”

“…There is going to be an increased number going through courses to work in GP Practice; therefore, it is essential that courses have strong emphasis on the type of clinical and prescribing work that is being undertaken. The Exeter study noted the potential of a formal, standardised qualification in primary care pharmacy . A small qualitative study in London noted the importance of measuring impact of this new role in pharmacy .…”

“…Only one small study was identified of pharmacists undergoing training to prepare them for their new role. It noted the importance of clinical skills training based in the primary care context and delivered by experienced primary care practitioners . At the start of this current project, there was no framework for training and development for pharmacists (or pharmacy technicians) undertaking this new role and no formal clinical supervisory structure – unlike medical GP trainees.…”

The Foundation Pharmacist Project: exploring new models of dual-sector postgraduate pharmacy training

“…In addition, over the past 12 months, directors from commissioning and delivery organisations within the NHS believe the quality of care in their area has deteriorated . Measures to meet the demand have included exploring new modes of service delivery, including increasing the availability of step‐down facilities, offering increased remuneration rates for agency staff and outsourcing elective care, as well as integrating services . With multiple contributory factors to the increases in demand, the service estimated deficits in the region of £873 million for 2016/17 .…”

“…Such errors included use of beta‐receptor antagonists in patients with asthma and angiotensin‐converting enzyme inhibitors in elderly patients without assessing electrolytes . Indeed, more recent work has demonstrated that pharmacists are enthusiastic to take on roles in non‐traditional care settings, such as general practices . Such studies highlight the positive impact pharmacists can have on patient outcomes and have provided an opportunity for pharmacists to contribute to the delivery of pharmaceutical care within emerging models of health service delivery.…”