Boundaries and development; clinical pharmacists in general practice

The GP pharmacist role is becoming a common feature of the practice workforce. Previously, we spoke with Ceinwen Mannall, the Centre for Pharmacy Postgraduate Education’s (CPPE) national lead of clinical pharmacists in GP education, about the role of pharmacists and pharmacy technicians in general practice and the CPPE training pathway which is leading the way.

As a follow up to this, Emma Wright, lead pharmacist of general practice education (south), discusses the patient-facing and medicines leadership aspects of the role in more detail, plotting out the progression of the GP pharmacist role and highlighting some common starting points for pharmacists and their practices on the road to patient-led care.

The University of Nottingham independent evaluation report for the Clinical Pharmacists in General Practice: Pilot scheme was published in June 20181. This report highlights how crucial the first two years of the pathway have been in building trust and awareness’ around the ‘boundaries and development of the role’ (p143) of clinical pharmacists in general practice.

The patient-facing aspect of the role of the GP pharmacist was clearly outlined initially in the NHS Five Year Forward View document2, reinforced in the GP workforce 10 point plan3 and reiterated in the Nottingham evaluation4. In this paper Mann et al outline one measure of success of GP pharmacist role development by site leads as pharmacists who are working fully autonomously, patient-facing by 24 months’ (p22).

Clarity around the clinical leadership aspects of the GP pharmacist role was recognised by the Nottingham evaluation as one of the ‘most notable differences between the operationalisation of the pilot scheme (phase 1) and the next iteration (phase 2)’ (p6).

In this article we will add to the conversation about the patient-facing and the medicines’ leadership aspects of the GP pharmacist role. We will share what barriers were identified and addressed in phase 1 and how this learning has been taken forward into tangible resources for pharmacists on phase 2 or the Clinical pharmacists in general practice education (CPGPE) programme.

A little background

Over 450 pharmacists were recruited into post by NHS England from a variety of backgrounds, with the national training pathway for phase 1 being awarded to CPPE. Between three-to-six months into the pathway (for most pharmacists) it was recognised that there were still a number of pharmacists struggling with the need 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 four clinical pharmacists outlining their view of barriers and solutions regarding pharmacists and practices embracing the patient-facing role. The top five barriers were listed as:

  1. Administration – large volumes of administrative or ‘back office’ tasks expected (n=13)
  2. Expectations – unrealistic or inappropriate expectations from GP practice (n=9)
  3. Confidence – pharmacist’s own lack of confidence in the patient-facing role (n=7)
  4. Competence – perception of pharmacist and practice of competence in role (n=6)
  5. Environment – lack of physical space and resources to carry out role (n=3)
  6. 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 Nottingham report (p18) and referenced studies.

In order to address these barriers a series of five webinars were created to support clinical pharmacists to take 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 – referred to as (time 1) and after (time 2) the webinar series4.

Clinical, or medicines, 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 2 of the programme was awarded to CPPE it was recognised 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’ (Mann et al, p143).

Role progression handbook

Reviewing phase 1, it was recognised that there is no ‘one size fits all’ to role progression for clinical pharmacists in general practice. Pharmacists’ roles will 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 2 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 with practical examples given to pharmacists.

Boundaries and development; clinical pharmacists in general practice Practice Business

Boundaries and development; clinical pharmacists in general practice Practice Business

This diagram can be found on the CPPE website6. This learning has helped contribute to the range of materials available to support all GP pharmacists7.

Sharing the learning around 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 provide a ‘roadmap’ for the role development of the GP pharmacy workforce.

  1. Mann, C et al. Clinical Pharmacists in General Practice: Pilot scheme Independent Evaluation Report: Full Report 2018 https://www.nottingham.ac.uk/pharmacy/documents/generalpracticeyearfwdrev/clinical-pharmacists-in-general-practice-pilot-scheme-full-report.pdf (accessed 26 Sept 2018)
  2. NHS England, Public Health England, Health Education England, Monitor, Care Quality Commission, NHS Trust Development Authority Five Year Forward View.http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf (accessed 26 Sept 2018)
  3. NHS England. Building the workforce: the new deal for general practice. Secondary Building the workforce: the new deal for general practice 2015. http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/ 2015/01/building-the-workforce-new-deal-gp.pdf (accessed 26 Sept 2018)
  4. Bradley F, Seston E, Mannall C and Cutts C Evolution of the general practice pharmacist’s role in England: a longitudinal study British Journal of General Practice, Online 2018(1) https://bjgp.org/content/bjgp/early/2018/08/27/bjgp18X698849.full.pdf (accessed 26 Sept 2018)
  5. https://www.cppe.ac.uk/career/cpgpe/role-progression#gpptpMenu (accessed 26 Sept)
  6. https://www.cppe.ac.uk/programmes/l/genpract-w-01 (accessed 26 Sept)
  7. https://www.cppe.ac.uk/wizard/files/clinical_and_pharmacy_therapeutics/general%20practice%20pharmacy%20brochure.pdf (accessed 26 Sept)

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