Abstract
BackgroundIncreased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. In 2016, NHS England began a 3-year- pilot study of pharmacists in general practice, however, this is not an entirely new initiative. There is limited, current, evidence-based, UK research to inform the pilot so studies of pre-existing services must suffice until findings from a formal national evaluation are available.MethodsThe aim of this exploratory, descriptive interview study was to explore the experiences of stakeholders in eight general practices in the Ealing GP Federation, West London, where pharmacy services have been provided for several years. Forty-seven participants, including pharmacy team members (pre-registration and clinical pharmacists, independent prescribers and pharmacy technicians), general practitioners, patients, practice managers, practice nurses and receptionists took part in semi-structured, audio-recorded qualitative interviews which were transcribed verbatim, coded and analysed thematically to extract the issues raised by participants and the practicalities of providing pharmacy services in general practice.ResultsFindings are reported under the themes of Complementarity (incorporating roles, skills, education and workloads); Integration (incorporating relationships, trust and communication) and Practicalities (incorporating location and space, access, and costs). Participants reported the need for time to develop and understand the various roles, develop communication processes and build inter-professional trust. Once these were established, however, experiences were positive and included decreased workloads, increased patient safety, improved job satisfaction, improved patient relationships, and enhanced cost savings. Areas for improvement included patients’ awareness of services; pharmacists’ training; and regular, onsite access for practice staff to the pharmacy team.ConclusionsRecommendations are made for the development of clear role definitions, identification of training needs, dedication of time for team building, production of educational materials for practice staff members and patients, and provision of on-site, full-time pharmacy services. Future work should focus on evaluation of various models of employing pharmacy teams in general practice; integration of pharmacists and pharmacy technicians into multidisciplinary general practice teams; relationships between local community pharmacy and general practice personnel; and patients’ service and information needs. A formal national evaluation of the pilot scheme is overdue.
Highlights
Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery
The Ealing General Practitioners (GPs) Federation model of integration of pharmacy services into general practice is probably unique in employing pharmacy technicians but no work has been done to determine the variety of integrating models in existence across the UK
Gaps in the literature include the experiences of other stakeholders involved in the patient’s care. In this exploratory study we interviewed six stakeholder groups aligned with the Ealing GP Federation to answer the question: What are the experiences of the various stakeholders in a group of general practices currently employing pharmacists?
Summary
Increased patient demand for healthcare services coupled with a shortage of general practitioners necessitates changes in professional roles and service delivery. Pilot sites can provide preliminary insights into the practicalities, benefits and barriers of employing pharmacists in general practice, multidisciplinary team development, and stakeholder experiences of service provision. The pharmacy team, at that time, was comprised of a prescribing lead pharmacist (manager), lead pharmacy technician, field-based clinical diploma pharmacist, six prescribing pharmacists, six technicians, a pre-registration trainee pharmacist and prescription delivery drivers. They provided a variety of services, including face-to-face medication reviews; long term condition, repeat prescription and medication management; triage; and acute care. Because of its pre-existing nature, this model provides a timely case study to give insight into how integration might evolve given time
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