The role of clinical pharmacists in general practice in England: Impact, perspectives, barriers and facilitators.

Abstract

By 2020/1 NHS England plans to invest over 100 m to ensure that there is one clinical pharmacist post in primary care for every 30,000 patients. A recent realist review identified key questions in the literature related to the implementation of a clinical pharmacist (CP) in a general practice role. These relate to the impact of the role, perspectives on the role (patients, GPs and pharmacists), and barriers and facilitators to the implementation process. The data collected in the national evaluation of the pilot scheme provides data to answer the realist questions identified. This paper examines the experience of implementing the clinical pharmacist in general practice role, in relation to the areas identified above. The research took a mixed methods approach to understanding the scheme implementation and this research draws on both survey and qualitative interview data from a wide range of stakeholders. Pharmacists in the pilot phase are motivated to develop clinical skills and make a positive impact on patients. Data suggests that clinical pharmacists have a positive impact, in particular on health outcomes related to polypharmacy and long-term conditions. GPs have a broadly positive response to the CPs, in particular when they save time and money for the practice. However, GPs have to invest time in mentoring and building relationships to realise the benefits of the role. Patients appreciate the CP role for increasing access to a practitioner and providing expertise in medications. There are some barriers to successful implementation of the role, including policy and funding, lack of clarity around the role and lack of quantitative and economic validation of the role. Facilitators of success include supportive working relationships, integration and mentoring. The pilot implementation of this new role was successful but there are lessons which can be learned for the success of future iterations and more work is required to economically validate the role which is likely to in turn generate positive relationships with GPs.