Abstract
BackgroundIn England, there is an ongoing national pilot to expand pharmacists’ presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists’ impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice.MethodsAll pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately 1 h, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically.ResultsIn total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs (“whether or not we actually have positive impact on KPIs is beyond our control”); depth and breadth of pharmacists’ activity (“we see a huge plethora of different patients and go through this holistic approach - everything is looked at”); awareness of practice-based pharmacists’ roles (“I think the really important [thing] is that everyone knows what pharmacists in general practice are doing”); and central evaluation versus local initiatives (“the KPIs will be measured by National Health Service England regardless of what we think” versus “what I think is more pertinent, are there some local things we’re going to measure?”).ConclusionsMeasures that will effectively capture pharmacists’ impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists’ activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists’ presence in general practice.
Highlights
In England, there is an ongoing national pilot to expand pharmacists’ presence in general practice
Four overarching themes were discerned during analysis of the focus group transcripts: inappropriateness of the numerical national Key Performance Indicator (KPI); depth and breadth of pharmacists’ activity; awareness of practice-based pharmacists’ roles; and central evaluation versus local initiatives
The national KPI which relates to the Quality and Outcomes Framework (QOF - a voluntary programme for English general practices with the purpose of motivating and rewarding clinical excellence) indicators was deemed by the majority of participants to be irrelevant because QOF measures were thought not always to be based on the latest updated guidelines of the respective health authorities
Summary
In England, there is an ongoing national pilot to expand pharmacists’ presence in general practice. At the time of the study (2016), no national evaluation of pharmacists’ impact in this environment had been formally announced The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. The KPIs do not account for quality indicators around pharmacists’ work (e.g. depth, effectiveness or influence of intervention/consultation) as most of them are purely based on numerical aspects (such as appointment numbers, increase in the total number of medication reviews etc.) and not on any value components. The national KPI which relates to the Quality and Outcomes Framework (QOF - a voluntary programme for English general practices with the purpose of motivating and rewarding clinical excellence) indicators was deemed by the majority of participants to be irrelevant because QOF measures were thought not always to be based on the latest updated guidelines of the respective health authorities. QOF measures related to diabetes were believed to often include a glycosylated haemoglobin target level significantly different from the one reported on the national diabetes guidelines
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