Researchers from Manchester University used the ‘7Ps marketing mix’ theory (product, price, place, promotion, people, process and physical evidence) to explore how community pharmacy services may be better used and integrated within primary care pathways for people with long-term conditions (LTCs). Taking part in the research were individual focus groups of respiratory patients, type 2 diabetes patients, pharmacists and GPs.
All the stakeholder groups saw the potential for using community pharmacies to reduce GP visits and all agreed that patients with LTCs would benefit from community pharmacies regularly providing check-ups and medication reviews. They all perceived pharmacists’ skills to be underutilised and supported more active involvement in LTCs.
Conversely, pharmacists underestimated patients’ support for them and perceived that they preferred GPs and nurses to manage their LTCs. There was a general consensus amongst all stakeholder groups that, unless pharmacists took the initiative, their perceived status as ‘shopkeepers’ would not change.
This apparent reticence to step forward was reflected in neither GPs nor patients recalling referring or being referred to extended pharmacy services. Pharmacists were held partially responsible for this lack of referrals because they did not promote their skills and services beyond dispensing.
A possible solution could be the proposal from most of the pharmacists and GPs to develop community pharmacy services with clear specifications focused on a single, specific intervention. Flu vaccination and inhaler technique services were mentioned as examples. However, all groups generally agreed that pharmacists’ workload was a major barrier to providing extra services beyond dispensing medications.
Pharmacists underestimated patients’ support for them
It was evident from all focus group discussions that community pharmacies and GP practices needed to improve integration to establish a seamless pathway for patients with LTCs. All stakeholders agreed that they currently work in separate silos, which led to duplication of services and miscommunication. All groups supported giving pharmacists more access to patient information (i.e. medical records) in order to facilitate collaborative working.
Patients were in agreement that their pharmacists and GPs did not collaborate with each other. And while all pharmacists and GPs stressed the importance of enhancing inter-professional relationships to improve the delivery and uptake of services for patients with LTCs, the pharmacists saw the issue of GPs’ unwillingness to recognise pharmacists as healthcare providers as being a barrier to collaboration.
GPs were unanimous that community pharmacies were better co-located in GP practices, and both pharmacists and GPs perceived co-location as improving their communication, relationship and workflow, although GP participants were concerned that referring patients might affect their practice revenue. Nonetheless, all GPs stressed the importance of raising public awareness regarding the benefits of using community pharmacy services to reduce unnecessary patient visits to GPs.
“This study has further highlighted strong support for community pharmacies to regularly provide routine checkups/ procedures, such as blood tests, for well managed LTCs,” says study leader Ali Hindi. It also “strengthens the evidence for incentivising GPs to refer patients to community pharmacy services” and that reimbursement models should take account of the workload implications for community pharmacies “to ensure that extended services take equal priority to dispensing”.