Abstract
Background Growing demands on healthcare globally, combined with workforce shortages, have led to greater skill mix in healthcare settings. Pharmacists are increasingly moving into complex areas of practice, a move supported by policy and education/training changes. Aim To understand the nature of extended roles for pharmacists practising at an advanced level in primary care and community pharmacy settings, to explore how clinical and physical examination was incorporated into practice and to understand the impact of providing such examination on practice and on patient relationships. Method Telephone interviews (N = 15) were conducted with a purposive sample of pharmacists using clinical and physical examination in their practice in Great Britain. The sample included primary care pharmacists (N = 5), community pharmacists (N = 4), pharmacists working across settings (N = 5) and one working in another primary care setting. Participants were recruited through professional networks, social media and snowballing. Results Primary care pharmacists and community pharmacists were utilising clinical and physical examination skills in their practice. Some community pharmacists were operating locally-commissioned services for low acuity conditions. Incorporating such examinations into practice enabled pharmacists to look at the patient holistically and enhanced pharmacist/patient relationships. Barriers to practise included lack of timely sharing of patient data and perceived reluctance on the part of some pharmacists for advanced practice. Conclusion With growing opportunities to provide patient-focussed care, it remains to be seen whether pharmacists, both in Great Britain and elsewhere, are able to overcome some of the organisational, structural and cultural barriers to advanced practice that currently exist in community pharmacy.
Highlights
Ethics approvalIn recent years, growing global pressure in healthcare has led to increased skill mix in a number of settings, with task shifting and labour substitution enabling the development of advanced clinical roles [1, 2]
While pharmacists have been practising at an advanced level in primary care settings for a number of years, an increasing number of community pharmacists are practising at this level, and the experiences of both groups are
The community pharmacy setting posed a number of limitations for pharmacists, not least the limited ability to practise advanced skills, changes to the pharmacy contract and education and training are likely to enhance the ability of community pharmacists to perform advance practice
Summary
In recent years, growing global pressure in healthcare has led to increased skill mix in a number of settings, with task shifting and labour substitution enabling the development of advanced clinical roles [1, 2]. One feature of an advanced scope of practice is the ability to use a range of clinical skills [8]. Aim To understand the nature of extended roles for pharmacists practising at an advanced level in primary care and community pharmacy settings, to explore how clinical and physical examination was incorporated into practice and to understand the impact of providing such examination on practice and on patient relationships. Participants were recruited through professional networks, social media and snowballing
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