Pharmacist Independent Prescribers Research Articles

Perspectives of people experiencing homelessness with recent non-fatal street drug overdose on the Pharmacist and Homeless Outreach Engagement and Non-medical Independent prescribing Rx (PHOENIx) intervention.

In Scotland, a third of all deaths of people experiencing homelessness (PExH) are street-drug-related, and less than half of their multiple physical- and mental health conditions are treated. New, holistic interventions are required to address these health inequalities. PHOENIx (Pharmacist Homeless Outreach Engagement and Non-medical Independent prescribing Rx) is delivered on outreach by National Health Service (NHS) pharmacist independent prescribers in partnership with third sector homelessness charity workers. We describe participant's perspectives of PHOENIx. This study aims to understand experiences of the PHOENIx intervention by participants recruited into the active arm of a pilot randomised controlled trial (RCT). Semi-structured in-person interviews explored participants' evaluation of the intervention. In this study, the four components (coherence, cognitive participation, collective action, reflexive monitoring) of the Normalisation Process Theory (NPT) framework underpinned data collection and analyses. We identified four themes that were interpreted within the NPT framework that describe participant evaluation of the PHOENIx intervention: differentiating the intervention from usual care (coherence), embedding connection and consistency in practice (cognitive participation), implementation of practical and emotional operational work (collective action), and lack of power and a commitment to long-term support (reflexive monitoring). Participants successfully engaged with the intervention. Facilitators for participant motivation included the relationship-based work created by the PHOENIx team. This included operational work to fulfil both the practical and emotional needs of participants. Barriers included concern regarding power imbalances within the sector, a lack of long-term support and the impact of the intervention concluding. Findings identify and describe participants' evaluations of the PHOENIx intervention. NPT is a theoretical framework facilitating understanding of experiences, highlighting both facilitators and barriers to sustained engagement and investment. Our findings inform future developments regarding a subsequent definitive RCT of PHOENIx, despite challenges brought about by challenging micro and macro-economic and political landscapes.

Exploring prescribing volume among pharmacist independent prescribers in community pharmacies across Wales

Abstract Introduction In a 2019 document titled ‘Delivering a Healthier Wales’, the Welsh Government presented a transformative vision for healthcare that emphasises a shift from hospital-centred healthcare to community-based care.[1] As part of this vision, independent prescribing (IP) is to be implemented in every community pharmacy by 2030.[1] Recently, the independent prescribing service (IPS) has allowed pharmacists to manage and treat patient conditions within the community pharmacy, offering a potential solution to the increasing demand for general practitioners (GPs). A substantial increase in IP consultations is evident, with 16,005 consultations recorded across 33 out of the 713 community pharmacies in Wales since 2016.[2] Aim This study aimed to explore, for the first time, the number of items prescribed by community pharmacists across Wales and in each of the seven local health boards (LHBs), as well as determining from which British National Formulary (BNF) chapter the medicines were prescribed. Methods A retrospective secondary data analysis of community pharmacy prescription data was conducted. Monthly prescription data of prescribed items were obtained from the Comparative Analysis System for Prescribing Audit (CASPA) from January 2020 to December 2022 and analysed on a three-monthly basis. To compare changes in prescribing volume across LHBs, the number of items per 100,000 population was calculated. The CASPA data were categorised into BNF chapters, and a Pareto analysis was performed to determine the most prescribed therapeutic areas. These accounted for 80% of total prescribing, which was used for further analysis. LHBs were coded as LHB1, LHB2, etc., to ensure anonymity. Results There were considerable variations in prescribed items across LHBs. Despite LHB 1 having the largest number of prescribed items in the overall population (n=13,982), it ranked third (n=1,988) in the number of prescribed items according to the number of items per 100,000 population, LHB 2 (n=2,542) and LHB 3 (n=2,659) ranked first and second, respectively. LHB 7 had the lowest number of prescribed items in the overall population (n=51) and per 100,000 (n=38). Based on the Pareto analysis, 80% of the items prescribed during the study period fell into the following six BNF chapters: Infection; Eye, Ear–Nose–Oropharynx; Skin; Obstetrics–Gynaecology–Urinary Tract Disorders; Appliances; and Central Nervous System. The infection chapter had the highest number of prescribed items (n=20,107), with most of the items being antibacterial (n=19,583, 96%). Nitrofurantoin was the most prescribed antibacterial agent (n=5,682). Conclusion This study explored the increase in prescribed items in community pharmacies across Wales, aligning with the 2030 vision for a healthier Wales. IPS plays a crucial role in pharmacist-led care for conditions such as urinary tract infections, potentially alleviating some of the burden facing GPs. While CASPA data captured prescribed and dispensed items specifically for community pharmacies, items prescribed but not dispensed are not accounted for in the data analyses. This study lacks information regarding the appropriateness of consultations. Further research is needed to examine prescribing appropriateness and patient outcomes.

Holistic health and social care outreach for people experiencing homelessness with recent non-fatal overdose in Glasgow, Scotland: the Pharmacist and third sector Homeless charity worker Outreach Engagement Non-medical Independent prescriber Rx (PHOENIx) pilot randomised controlled trial

ObjectivesTo examine randomised controlled trial (RCT) progression criteria including emergency department (ED) attendance and non-fatal overdose, from a holistic, integrated health and social care outreach intervention (PHOENIx), for people experiencing...

Pilot scheme explores value of protected learning time for pharmacist independent prescribers

Pilot scheme explores value of protected learning time for pharmacist independent prescribers

The Care Home Independent Pharmacist Prescriber Study (CHIPPS): development and implementation of an RCT to estimate safety, effectiveness and cost-effectiveness

Background Medicine prescribing, monitoring and administration in care homes can be significantly enhanced. Effective interventions to improve pharmaceutical care and resident outcomes are required. The enablement of pharmacists to prescribe provides an opportunity for pharmacist independent prescribers to assume responsibility for improving pharmaceutical care, medication-related outcomes and resident safety whilst reducing general practitioner workload. Objective(s) To determine the effectiveness and cost-effectiveness of pharmacist independent prescribing in care homes. Design Development work was undertaken through five work packages before the delivery of the definitive trial. Triads of pharmacist independent prescribers, care home and general practice with responsibility over 20 care home residents were recruited and cluster randomised to intervention or usual care for 6 months. Researchers were blinded at recruitment stage only. Recruitment of 880 residents was required to provide 80% statistical power, to show a 21% reduction in falls over 6 months, assuming 20% attrition. Randomisation was undertaken electronically at triad level, stratified by geographical area. Intention-to-treat analysis undertaken using a negative binomial model. Parameters were estimated using a generalised estimating equation approach. Costs were captured from an NHS perspective. Quality of life (EuroQol; five domain; five level) was collected by proxy to enable cost/quality-adjusted life-year estimation. A concurrent process evaluation was performed. Safety was monitored through a review of pharmacist independent prescriber activities, independent concerns reporting and review of adverse events. Participants Forty-nine triads of general practitioners, pharmacist independent prescribers and care homes were recruited with 454 residents allocated to the intervention arm and 428 to the control arm. Intervention Medication review and care planning, medication reconciliation, staff training, support with care home medication-related procedures, deprescribing and authorisation of monthly prescriptions. Main outcome measure Fall rate per person over 6 months. Results Data for 449 intervention and 427 control residents available for final analysis. The 6-month fall rate ratio in favour of intervention was 0.91 (95% confidence interval 0.66 to 1.26; p=0.58). No significant difference in secondary outcomes was identified except Drug Burden Index (rate ratio 0.83, 95% confidence interval 0.75 to 0.92; p<0.001). No harms were identified. One quarter of medication-related interventions were associated with a reduced risk of falls. The intervention was positively received. Limitations Participant self-selection bias may have affected the generalisability of findings. Open-label cluster randomised controlled trial limited by 6-month follow-up. Potential ceiling effect due to concurrent pharmacist-led interventions. Falls potentially insufficiently proximal to the intervention. Conclusions To enhance effectiveness and acceptance of the proposed model, effective integration into care home and general practitioner teams was identified as a central requirement. A core outcome set and a training package were developed. The final model of care, whilst being safe and well received and resulting in a reduction in drug burden, demonstrated no improvement in the primary outcome of falls. With no improvement in quality-adjusted life-years identified, the pharmacist independent prescriber intervention was not estimated to be cost-effective. Future work To develop and evaluate better models of care for enhancing medication outcomes and safety in care homes or re-test with a longer intervention and follow-up period and a stronger primary outcome. Trial registration This trial is registered as ISRCTN10663852, definitive trial: ISRCTN17847169. Study registration This study is registered as PROSPERO CRD20150907. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0613-20007) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 10. See the NIHR Funding and Awards website for further award information.

Pharmacist prescriber smoking cessation intervention during the COVID-19 pandemic.

During the pandemic, smokers who wished to access support to quit faced additional barriers. A smoking cessation service which utilized pharmacist independent prescribers working within community pharmacy was implemented. Clients received behavioral advice via a consultation with an advisor and then three consultations with a pharmacist, who prescribed varenicline, where appropriate. Consultations were by phone or video. This evaluation assessed the self-reported outcomes and experiences of clients and pharmacists. A mixed-methods approach was used involving both on-line questionnaires to clients and interviews with a sample of questionnaire respondents and participating prescribing pharmacists. The questionnaire was completed by 85 clients with 59% reporting they had quit. Eleven clients and seven out of eight pharmacists were interviewed. Varenicline had been received by 96% of clients. The best aspects of the service reported by clients in the questionnaire and at interview were support received from the pharmacist and ease of access to varenicline. Clients regarded the service as being 'safe' to access during the pandemic. Nearly three-quarters of client respondents (72%) stated no service improvements were required. However, national supply challenges made collection of varenicline from the nominated pharmacy an issue. Some clients experienced a long wait-time before accessing the service. For pharmacists, the service offered flexibility including the opportunity to contact clients 'out of office' hours without distractions. However, not being physically in the pharmacy could result in them not being able to access the client's medicine history. Pharmacists identified that remote consultations were not ideal for all clients. Pharmacist prescribers can deliver effective smoking cessation services through remote consultations. Greater flexibility would allow the service to be tailored to the client's need.

What happens when pharmacist independent prescribers lead on medicine management in older people’s care homes: a qualitative study

ObjectiveOlder people in care homes frequently experience polypharmacy, increasing the likelihood of medicine-related burden. Pharmacists working within multidisciplinary primary care teams are ideally placed to lead on medication reviews. A...

P27 An innovative multidisciplinary approach to optimizing the dermatology service for patients with chronic spontaneous urticaria, psoriasis and atopic dermatitis

Abstract The aim of this work was to optimize multidisciplinary practice in the dermatology department of our teaching hospital and to integrate pharmacist independent prescribers (PIPs) into the dermatology team, establish multidisciplinary patient pathways and evaluate patient satisfaction with pharmacist-led clinics. One dermatology lead pharmacist and three specialist pharmacists completed training in dermatologist-led clinics, and multidisciplinary patient pathways were developed. A pharmacist-led clinic for patients with chronic spontaneous urticaria (CSU) was established and delivered under the indirect supervision of a dermatologist. Pharmacist-led eczema and psoriasis clinics were then established, in which care is delivered by PIPs working alongside dermatologists to facilitate medical input when required. Patient satisfaction with the PIP service was evaluated by the administration of anonymized questionnaires sent to patients seen by PIPs over a 1-month period. Patients rated (poor, fair, good, excellent) 11 items and provided free-text comments. Over an 18-month period, dermatologists referred 53 of their 63 patients (84%) with CSU to the pharmacist-led clinic and PIPs delivered 150 CSU appointments. In the 12 months since establishing eczema and psoriasis multidisciplinary pathways, PIPs have delivered 279 eczema and 342 psoriasis appointments. PIPs have 30-min appointments for patients to discuss medication-related issues, assess response to treatments and demonstrate a holistic approach to patient care, including cardiovascular risk assessments. An estimated 400 h of dermatologist time was released over an 18-month period of gradual rollout of clinics as PIPs reviewed return patients, managed repeat prescribing for approximately 550 patients with CSU, psoriasis and eczema (homecare), and supported drug protocol development. In turn, PIPs reported increased job satisfaction. PIP consultations were rated excellent by 85% of eczema responders [85% response rate; 43% female, median age 38 years (range 19–84)] and 89% of psoriasis responders [90% response rate; 44% female, median age 50 years (range 15–77)]. All free-text comments (n = 34) were positive, with two suggestions for improvement (better explanation of pharmacist appointment, online appointments). Thematic analysis of comments revealed appreciation of ‘care and compassion’ (n = 20), ‘multidisciplinary team service delivery’ (n = 15), ‘ensuring patient understanding’ (n = 17), ‘pharmacist knowledge’ (n = 13), ‘professionalism’ (n = 8) and ‘medical team input’ (n = 4). There have been no patient complaints or adverse outcomes related to pharmacist-led clinics since the clinics were launched. Dermatology PIPs have successfully integrated into the dermatology multidisciplinary team, receiving support to develop their clinical roles. Pharmacist-led clinics substantially increase the overall capacity of the dermatology service, while patients report high satisfaction and appreciation of PIP consultation skills and the quality of the service.

P24 A pharmacist-led acne service as a novel and highly effective model of care utilizing the full potential of a multiprofessional workforce

Abstract The aim of this study was to establish a pharmacist-led acne clinic in the dermatology department in our teaching hospital, evaluate its quality and measure patient satisfaction with the new service. Two pharmacist independent prescribers (PIPs) underwent training in dermatologist-led clinics. An acne service was established, where dermatologists refer patients to PIPs for a course of treatment with isotretinoin. A set of evidence-based quality indicators (QIs) was developed and peer-reviewed by a multidisciplinary team and then used to evaluate service quality. Adherence to QIs was established through retrospective review of medical records for all patients seen by PIPs over a 12-month period. Patient satisfaction with the pharmacist-led clinic was measured by administration of anonymized questionnaires over a 1-month period. Patients rated (poor, fair, good, excellent) 11 items and provided free-text comments. During a 12-month period, 81 patients [70% females, median age 23 years (range 14–44)] were referred to a pharmacist-led clinic and PIPs delivered 307 appointments, saving an estimated 100 h of dermatologist time. Five patients required an additional dermatologist appointment and seven required additional dermatologist advice. We report ≥ 90% adherence to 11 of 14 QIs focusing on isotretinoin prescribing and patient monitoring, including mental health assessment using the Patient Health Questionnaire-9 tool. We identified the lowest adherence to QI 5 (45%; a final pregnancy test 5 weeks after stopping isotretinoin); however, six female patients disengaged with the service without completing the treatment. We report 70% adherence to QI 3 [use of Medicines and Healthcare products Regulatory Agency (MHRA)-recommended contraception] and 76% adherence to QI 1 (indication for isotretinoin). Corrective measures were implemented to improve adherence to QI 5 (a patient invitation for a final pregnancy test) and QI 3 (patient consent form compliant with MHRA recommendations on contraception). PIP consultations were rated as excellent by 76% of responders with acne (69% response rate; 33 surveys completed). All free-text comments (n = 10) were positive, with one suggestion for improvement (booking appointments in advance). Thematic analysis of comments revealed appreciation of ‘care and compassion’ (n = 10), ‘multidisciplinary team service delivery’ (n = 4), ‘ensuring patient understanding’ (n = 3), ‘pharmacist knowledge’ (n = 3), ‘professionalism’ (n = 2) and ‘medical team input’ (n = 1). There have been no patient complaints or adverse outcomes related to the pharmacist-led acne clinic since it was launched. PIPs successfully deliver a high-quality acne service that increases the overall dermatology service capacity. Patients report high satisfaction and appreciation of PIP knowledge and skills. The developed QIs and patient satisfaction questionnaire can be used for quality monitoring by other clinicians.

Minimising Prescribing Errors: A Phenomenological Exploration of the Views and Experiences of Independent Prescribing Pharmacists.

This study aims to explore the views and experiences of pharmacist independent prescribing (IPs) regarding prescribing errors and strategies to mitigate errors in practice. One-to-one online semi-structured interviews were conducted with IP pharmacists across the UK. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et. al. A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctor's prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organisational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors. Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organisational and system-related factors linked to prescribing errors can minimise errors and promote patient safety.

Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers.

Over 70% of care home residents are prescribed potentially inappropriate medications (PIMs) associated with morbidity and mortality. Deprescribing is a common recommendation by pharmacists performing medication reviews in care homes, however requiring prescriber authorisation is a barrier. Care home Independent Pharmacist Prescribing Study (CHIPPS), a cluster randomised control trial integrated pharmacist independent prescriber (PIPs) into care homes to improve medication management, providing a unique opportunity to identify their barriers and enablers to deprescribing. To identify barriers and enablers to PIPs deprescribing medications in care homes. Secondary qualitative framework analysis was performed on interviews with CHIPPS' PIPs. A maximum variation sampling approach was used to select from the 14 PIPs included in the process evaluation to achieve diversity of PIPs' contextual factors e.g., previous experience in care homes. Transcripts were coded inductively for barriers and enablers to deprescribing and then mapped to Theoretical Domains Framework (TDF). Eleven PIP's interviews were sampled. Factors acted as enablers and barriers were PIP relationship with General Practitioner (GP), care home staff and residents/families, awareness of the PIP role and family trust in PIPs' deprescribing activities (social influences); PIPs' independent prescribing confidence, previous experience and ability dealing with residents' medications (beliefs about capabilities); understanding of PIP role and PIP confidence in their role as an independent prescriber (Social/professional role and identity); access to residents' records, deprescribing decision support, regular follow-up from care home staff, resident difficulties with medications, teamwork, and time restraints (Environmental context and resources). One factor acted as a barrier: believing negatives of deprescribing outweigh benefits regarding certain medications (Beliefs about consequences). PIPs' involvement in deprescribing within care homes is influenced by multiple barriers and enablers. Data mapped to TDF domains represent barriers that need addressing and enablers that should be highlighted to enhance PIPs' effectiveness in future interventions.

460 Integrating pharmacist independent prescribing in community pharmacy: investigating NHS Pharmacy First Plus using Normalization Process Theory

Abstract Introduction Limited evidence exists for independent prescribing in community pharmacy (CP) (1). In 2020 NHS Scotland launched NHS Pharmacy First Plus (PFP), aiming to facilitate access to pharmacist independent prescribers (PIPs) in CP, focusing on common clinical conditions. Aim To investigate, using Normalization Process Theory (NPT), the integration of PIPs in CP in the context of NHS PFP. Methods A cross-sectional online survey of all 120 community pharmacists offering PFP in 13 Scottish NHS Health Boards. A ‘Think Aloud’ tested, pre-piloted questionnaire was developed using the NPT derived NoMAD tool (2) and including demographic and practice characteristic questions for contextualisation. This was disseminated via email with 3 reminders. Data exported from Online Surveys (JISC) to SPSS was analysed descriptively. Scale score statistics for each of the four NPT constructs (Table 1) were calculated through summation of item scores (5 = Strongly agree to 1 = Strongly disagree) for each respondent with scale item reliability testing using Cronbach’s alpha. Results A 73% (88/120) response rate showed the majority were female (63%, 55/88), <40 years old (51%, 45/88), had worked in CP for >15 years (56%, 49/88) and qualified as a PIP <5 years ago (59%, 52/88). 76% (67/88) indicated on average they consulted with patients under PFP >6 times a week. 38% (33/88) indicated they had <3 staff when offering PFP and 47% (41/88) indicated that they provided the service while working as the only pharmacist; 35% (25/71) had one other pharmacist. Generally, there were high levels of NoMAD item agreement with >90% ‘strongly agreeing’ or ‘agreeing’ in items relating to ‘coherence’, ‘cognitive participation’ and ‘reflexive monitoring’. Responses to ‘collective action’ items showed diversity with more answering ‘neither agree nor disagree’ or ‘disagree’. Conclusion This theory-based work with an excellent response rate offers a robust and unique perspective on PIP integration within CP. The positivity could perhaps be expected from trailblazer respondents but it also highlights challenges within the ‘collective action’ construct and a need to focus on training, staff resource, working relationships and management. More work is planned on scale score inferential analysis and qualitative exploration of key findings.

478 A qualitative exploration of the implementation of the Prescribing course Designated Prescribing Practitioner role in community pharmacy

Abstract Introduction To alleviate NHS workload pressures Scottish Government wish to train more pharmacist independent prescribers (IPs) for community pharmacy (1). A critical aspect for IP training is the role of Designated Prescribing Practitioner (DPP) for the period of learning in practice. A paucity of work has focussed on implementation of the DPP role with a recent cross-sectional survey (2) indicating that further qualitative exploration is warranted. Aim To explore the implementation of the DPP role in Scottish Community Pharmacy (CP). Methods Following a survey (2) participants opted in to qualitative semi-structured online mini-focus groups. This included key stakeholders likely be involved in the implementation of the DPP role (e.g Directors of Pharmacy, Prescribing Leads, Education and Training leads, IP qualified CPs). The topic guide was informed by the survey key findings, Royal Pharmaceutical Society DPP Framework and the Consolidated Framework for Implementation Research and piloted with academic and practice-based stakeholders. All focus groups were conducted using Zoom, recorded, transcribed, and independently analysed thematically, by two researchers, using the Framework Approach. Data generation continued until data saturation. Results Data were generated from six mini-focus groups with 12 key stakeholders across Scottish Health Boards. Key themes derived related to: views on the DPP role, characteristics of potential DPPs, facilitators and barriers to implementation. Participants supported DPP implementation and noted benefits of pharmacists training pharmacists. They noted that potential DPPs need to be confident and competent and be active prescribers. Facilitators for implementation included: new contracted services (e.g. NHS Pharmacy First Plus), growing need for more IPs, and the impact of COVID-19. Barriers included: limited time, capacity, resources, and support to take on the DPP role. Pharmacists were also considered risk averse which could influence role uptake. Conclusion This theory-based work involved a range of key stakeholders and highlights that there is a need to further consider interventions to overcome barriers related to capacity and resource related issues. A limitation relates to the dyadic nature of some focus groups that may have affected data collection. Future research should focus on further theory-based work evaluating structures, processes, and outcomes of DPP role implementation.

95 - Assessing the impact of the pharmacist independent prescriber as part of the multi-disciplinary care of patients receiving adjuvant treatment for NSCLC

95 - Assessing the impact of the pharmacist independent prescriber as part of the multi-disciplinary care of patients receiving adjuvant treatment for NSCLC

Empowering future pharmacists - Embedding prescribing in the United Kingdom pharmacy undergraduate degree

IntroductionPharmacy education within the United Kingdom (UK) is on the cusp of a major change with the integration of pharmacist independent prescribing into the undergraduate Master of Pharmacy (MPharm) degree and foundation year. This presents an opportunity for schools of pharmacy to completely review and redesign the MPharm degree in order to embed prescribing. This commentary details what needs to change within the MPharm degree and how these changes can be enacted. CommentaryThe learning outcomes for the new degree place greater emphasis on diagnostic and consultation skills, risk management, professional judgement, and leadership. Course content needs to be sequenced so that complexity builds throughout the programme and clinical skills are taught and practised within the context of prescribing. There will be more emphasis on higher-order cognitive skills, such as collaborative clinical decision-making, considering potential risks and benefits. Teaching will need to align with learning on placements and time needs built into the curriculum for preparation and debrief sessions following placements and simulation scenarios. The increased responsibility that comes with prescribing rights will require review of how professional identity is formed and professionalism skills are taught and assessed. ImplicationsPharmacists' expertise in medicines means that they are well-placed to be prescribers, which will help meet health service demands. Long-term funding will be required for placements in community, general practice, and hospital settings, including the provision of training and support to pharmacists mentoring students on placements. In spite of the challenges of curriculum redesign, this opportunity is wholeheartedly welcomed.

Development of a core set of clinical skills for pharmacist prescribers working in general practice: A Delphi study.

With increasing numbers of pharmacists working in general practices and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills. However, previous studies have highlighted that practice-based pharmacists (PBPs) do not feel confident regarding their clinical skills, and it is unclear what skills are needed. To develop a core set of clinical skills (CSs) required for pharmacists who intend to practise as independent prescribers working in general practice/family medicine. Based on a previous study, 18 CSs were selected for inclusion in a three-round Delphi consensus questionnaire. These skills were rated by a Delphi panel on a 9-point Likert scale (ranging from 1=limited importance to 9=critical). The Delphi panel comprised designated leads of pharmacist independent prescribing programmes in each United Kingdom educational provider listed on the General Pharmaceutical Council website. A CS was included in the core set if 80% or more of participants scored between 7 and 9, and 15% or less scored between 1 and 3. Following Round 1, seven CSs met the criteria for inclusion: 'Measuring heart rate (radial pulse)', 'Assessing respiratory rate', 'Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)', 'Measuring blood pressure (automated, i.e. electronic blood pressure monitor)', 'Measuring peripheral oxygen saturation (using pulse oximeter)', 'Measuring temperature', 'Measuring Peak Expiratory Flow Rate'. After two further rounds, a further four CSs were included consisting of 'Undertaking a urinalysis', 'Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)', 'Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)', and 'Patient assessment via National Early Warning Score (NEWS)'. No consensus was reached on nine CSs. This study has produced a core set of CSs for prescribing pharmacists. This study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice/family medicine.

Protocol for a pilot randomised controlled trial to evaluate integrated support from pharmacist independent prescriber and third sector worker for people experiencing homelessness: the PHOENIx community pharmacy study

BackgroundPeople experiencing homelessness (PEH) have complex health and social care needs and most die in their early 40 s. PEH frequently use community pharmacies; however, evaluation of the delivery of structured, integrated, holistic health and social care intervention has not been previously undertaken in community pharmacies for PEH. PHOENIx (Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx) has been delivered and tested in Glasgow, Scotland, by NHS pharmacist independent prescribers and third sector homelessness support workers offering health and social care intervention in low threshold homeless drop-in venues, emergency accommodation and emergency departments, to PEH. Building on this work, this study aims to test recruitment, retention, intervention adherence and fidelity of community pharmacy-based PHOENIx intervention.MethodsRandomised, multi-centre, open, parallel-group external pilot trial. A total of 100 PEH aged 18 years and over will be recruited from community pharmacies in Glasgow and Birmingham. PHOENIx intervention includes structured assessment in the community pharmacy of health, housing, benefits and activities, in addition to usual care, through weekly visits lasting up to six months. A primary outcome is whether to proceed to a definitive trial based on pre-specified progression criteria. Secondary outcomes include drug/alcohol treatment uptake and treatment retention; overdose rates; mortality and time to death; prison/criminal justice encounters; healthcare utilisation; housing tenure; patient-reported measures and intervention acceptability. Analysis will include descriptive statistics of recruitment and retention rates. Process evaluation will be conducted using Normalisation Process Theory. Health, social care and personal resource use data will be identified, measured and valued.DiscussionIf the findings of this pilot study suggest progression to a definitive trial, and if the definitive trial offers positive outcomes, it is intended that PHOENIx will be a publicly funded free-to-access service in community pharmacy for PEH. The study results will be shared with wider stakeholders and patients in addition to dissemination through medical journals and scientific conferences.Trial registrationInternational Clinical Trial Registration ISRCTN88146807.Approved protocol version 2.0 dated July 19, 2022.

Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial

ObjectiveTo estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes.DesignCluster randomised controlled trial, with clusters based on triads of a pharmacist...

Integration of pharmacist independent prescribers into general practice: a mixed-methods study of pharmacists’ and patients’ views

BackgroundSince 2015, the National Health Service (NHS) has funded pharmacists to work in general practice (GP practice) to ease workload pressures. This requires pharmacists to work in new roles and be integrated effectively in GPs. Independent prescribing is a key part of the GP pharmacist role, but little is known about pharmacists’ integration into GP practice as well as patients’ perceptions and experiences of the care provided by GP pharmacists. This study aims to explore the perceptions of pharmacist independent prescribers (PIPs) about their integration into GP practice and gain insight into patients’ perceptions about the care provided to them by pharmacists.MethodsA mixed-methods study comprising semi-structured interviews with PIPs (n = 13) followed by questionnaire-based assessment of patients’ (n = 77) evaluation of pharmacists’ care was conducted between December 2019 and March 2020. Quantitative data were analysed using descriptive statistics. Interviews and open comments of the survey were thematically analysed.ResultsPharmacist independent prescribers reported undertaking a range of patient-facing and non-clinical roles. Lack of understanding about PIPs’ clinical role and working beyond their clinical area of competence were some of the barriers to their integration into GP practice. Most patients were satisfied with the consultations they received from pharmacists and reported confidence in the pharmacist’s recommendations about their health conditions. However, a few patients (14%) felt they would still need to consult a general practitioner after their appointment and 11% were not sure if a further consultation was needed.ConclusionsPharmacist independent prescribers provide a range of clinical services for the management of long-term conditions which appear to be recognised by patients. However, there is a need to address the barriers to PIPs’ integration into GP practice to optimise their skill-mix and patient-centred care.

Pharmacist prescribers can reduce sedative use in care homes, study demonstrates

Pharmacist independent prescribers (PIPs) can help to significantly reduce the burden of anticholinergic and sedative drug use in care home residents, a large five-year study, published in the BMJ on 14 February 2023, has concluded. However, the study intervention failed to demonstrate a reduction in the number of falls; the primary outcome measure of the […]