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Barriers to developing the clinical pharmacist in general practice

On 26 July 2018, the University of Nottingham published its independent evaluation report, the ‘Clinical pharmacists in general practice: pilot scheme’. The report highlighted the importance of the first two years of the scheme in building “trust and awareness” around the “boundaries and development of the role” of clinical pharmacists in general practice.

The patient-facing aspect of the GP pharmacist role is clearly outlined in the ‘NHS five-year forward view’, reinforced in the GP workforce ten-point plan and reiterated in the University of Nottingham’s evaluation. In the paper, the authors outline one measure of success of GP pharmacist role development, as defined by site leads, as pharmacists who are “working fully autonomously” and “patient-facing by 24 months”. The evaluation identified that clarity around the clinical leadership aspects of the GP pharmacist role is important to take the “operationalisation of the pilot scheme (phase one)” to “the next iteration (phase two)”.

A team at the University of Manchester sought to add to the conversation on the patient-facing and medicines leadership aspects of the GP pharmacist role. We looked at the barriers identified and addressed in phase one, and how this learning has been taken forward in tangible resources for pharmacists in phase two, or clinical pharmacists in the ‘Clinical pharmacists in general practice education (CPGPE) pathway’ programme.

More than 450 pharmacists were recruited into post by NHS England from a variety of backgrounds, and the national training pathway for phase one was awarded to the Centre for Pharmacy Postgraduate Education (CPPE). Between three and six months into the pathway (for most pharmacists), it was recognised that many were still struggling to embrace the patient-facing aspect of the role. This became particularly apparent at this point in the training pathway, as pharmacists were beginning to undertake case-based discussion assessments, which required them to share a face-to-face patient case they had managed.

A survey was completed by 13 CPPE education supervisors and 4 clinical pharmacists, who outlined their view of barriers and solutions regarding pharmacists and practices embracing the patient-facing role. The most common barriers were:

  • Administration — large volumes of administrative or ‘back office’ tasks (n=13);
  • Expectations — unrealistic or inappropriate expectations from the GP practice (n=9);
  • Confidence — the pharmacist’s own lack of confidence in the patient-facing role (n=7);
  • Competence — perception of the pharmacist and the practice of competence in the role (n=6);
  • Environment — lack of physical space and resources to carry out the role (n=3);
  • No support — GP supervisors not having time to provide clinical support (n=3).

Similar barriers of expectation, perception, environment and lack of infrastructure were echoed in the evaluation and referenced studies.

To address these barriers, a series of five webinars were created to support clinical pharmacists in taking up a patient-facing role in their practices. The webinars were hosted by CPPE and co-facilitated by representatives from the NHS Leadership Academy and clinical mentors on the pathway. Improvement in the patient-facing role was difficult to measure; however, there was an increase in patient-facing activities as captured by a questionnaire before and after the webinar series.

Clinical leadership was an expected part of this new role in general practice. Aspects were introduced throughout the training pathway in study days, regional learning sets and education supervisor visits, but there was still a variation in expectation of what this looked like in practice.

When phase two was awarded to CPPE, it was recognised that a new resource was required to help align expectations of both the GP practice and the GP pharmacist to reduce the “variance in GP expectation, within and between practices”.

During review of phase one, it was recognised that there is no ‘one size fits all’ to role progression for clinical pharmacists in general practice. Pharmacists’ roles need to be tailored to the experience and skills of the pharmacists, the needs of individual GP practices and the needs of patient populations.

A role progression handbook was created for phase two pharmacists, along with a 30-minute facilitated session. The role progression handbook is discussed in a regional peer support learning set early on in the CPGPE programme. In this session, pharmacists plan how to implement their personal role progression journey in their GP practice and create an action plan. Progression in both medicines leadership and patient-facing roles are outlined in the handbook, and practical examples are given to pharmacists. And our learning has helped contribute to the range of materials available to support all GP pharmacists.

Sharing learning on the practical aspects of role progression of pharmacists in the general practice education programme may guide future members of the GP practice pharmacy workforce and their practices to common starting points. This will help reduce variance in expectation and give a roadmap for role development of the GP pharmacy workforce.

 

Emma Wright, lead pharmacist, General Practice Education (South), Centre for Pharmacy Postgraduate Education, Manchester Pharmacy School, University of Manchester

Citation: Clinical Pharmacist DOI: 10.1211/CP.2019.20206292

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