Exploring the role of primary care pharmacists in NHS Lanarkshire following the implementation of the pharmacotherapy hub: a service evaluation

Abstract

Abstract Introduction The General Medical Service (GMS) contract was produced in Scotland in an attempt to tackle General Practitioner (GP) workforce issues. The pharmacotherapy work stream is part of this and provides a framework for pharmacy teams, dividing services into level 1 (core), level 2 (advanced) and level 3 (specialist).1 A statement by the Royal Pharmaceutical Society (RPS) and the British Medical Association (BMA) discussed the introduction of pharmacotherapy hubs to complete level 1 work for multiple practices, centralising the medicines reconciliation process. Theoretically, this would release pharmacists to carry out clinical and more advanced/specialist services.2 There are currently 8 pharmacotherapy hubs within NHS Lanarkshire (NHSL), incorporating level 2 and 3 services into job plans for General Practice Clinical Pharmacists (GPCPs). No work has been undertaken to explore changes in practice since the implementation of these hubs. The qualitative study explored drivers and motivators for pharmacists in practice, shaping future pharmacotherapy services in NHSL and Scotland. Aim To explore the views and attitudes of primary care pharmacists towards their practice role in NHSL following the implementation of the pharmacotherapy hub. Methods Ethical approval was granted from the School of Pharmacy and Life Sciences Ethics Committee (Robert Gordon University). Pharmacists working within the 8 hub localities were invited to participate via email correspondence if they had over 6 months experience in practice pre-hub implementation and then 6 months post-hub implementation. Participants attended a one-to-one interview to share their views towards their practice role since the hub was implemented. Interviews were recorded, transcribed verbatim and thematically analysed. Results Twelve pharmacists across six localities participated. The five key themes identified were job role, managing time, professional development, professional belonging and patient care. The implementation of the hub was an enabler for pharmacists to partake in advanced pharmacotherapy tasks. Pharmacists negatively perceived level 1 core pharmacotherapy tasks in comparison to level 3 clinical patient-facing time. Participants linked the hubs impact on practice with role development, an increase in autonomy, confidence and job satisfaction. Discussion/Conclusion The hub has enabled in-practice pharmacists to move to a more sustainable balance between core and advanced/specialist tasks. Collaboration is required between pharmacy teams and practices to understand the pharmacist role in pharmacotherapy. Further recommendations include continuing the roll-out of pharmacotherapy hubs, standardisation of pharmacist clinical time balanced with core tasks and implementation of protected learning time for pharmacy teams. The study was open to response bias but this was addressed by using semi-structure interview guides in the one-to-one interviews. Researcher bias was minimised by two researchers analysing the data and practicing reflexivity. The study was open to recall bias due to participant’s retrospective thinking. In NHSL prioritising the hub roll-out and collaboration with stakeholders are essential. This will ensure the balance between efficient pharmacotherapy services and maintaining attractive roles, contributing to a sustainable workforce.