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Collaboration not competition

It has become a controversial area because of the workforce situation but community pharmacists should welcome the role of practice-based pharmacists. They are a useful link with GPs – and it should be about collaboration, not competition. So says Carmel Hughes, professor of primary care pharmacy at Queen’s University Belfast, talking to Mark Greener

Practice-based pharmacists (PBPs) aim to relieve some of the pressures in primary care. Recent research published in the British Journal of General Practice1 reports that PBPs integrate well into general practice, improve healthcare delivery and support community pharmacists — but PBPs are still finding their feet and have not yet realised their full potential. 

With relatively few studies assessing healthcare professionals’ views about PBPs, Professor Hughes and colleagues recruited 11 triads of a GP, a PBP and a community pharmacist from across Northern Ireland: one triad from each practice. “Although we focused on Northern Ireland, there are PBPs across the UK. We hope that our findings will have relevance to all UK practice,” Professor Hughes says.

The team used ‘snowball sampling’. In other words, they contacted GPs and PBPs who they already knew and felt would take part. The GPs and PBPs identified the community pharmacist who they had most contact with and suggested other GPs and PBPs who may be interested. 

“We recognise that snowball sampling may lead to bias, but this study was undertaken during the height of the Covid pandemic,” says Professor Hughes. “The snowball method was the most efficient form of sampling that we could use under the circumstances. Qualitative research should be interpreted in the light of the methods used, with transparency in the reporting of the study.”

The researchers interviewed GPs, PBPs and community pharmacists separately, either by phone or during online meetings. All PBPs had previously worked in community pharmacy. 

Promising results

Interviewees reported that PBPs integrated well into their practices and enhanced healthcare delivery. For instance, PBPs reduced GPs’ workload, saved time, ensured GPs were aware of current guidelines, reduced interruptions experienced by GPs and made errors less likely.

Interviewees suggested, however, that PBPs, other members of the practice team and community pharmacists need to better understand each other’s roles and communicate clearly to deliver efficient patient care. For example, patients could contact the practice to speak to a PBP about an acute problem. Practice teams could also refer patients to the PBP rather than to the GP.

The study found that PBPs reconciled medicines with hospital discharge and outpatient letters, and performed medication reviews – but PBPs can have wider roles, such as independent prescribing and conducting clinics reviewing chronic diseases, such as hypertension and diabetes. Nevertheless, time pressures mean that PBPs will probably prioritise medication reconciliation and drug reviews.

“Communication pathways between practice-based pharmacists and community pharmacists need improvement”

Areas for improvement

The study highlighted certain areas that need improvement. For example, interviewees said that shared education, training and meetings involving the multidisciplinary team, including community pharmacists, are essential to ensure that all healthcare professionals adhere to the same principles and procedures. 

“One aspect that came through strongly in this study was the perceived lack of awareness of patients about the PBP role,” Professor Hughes adds. “We hope to do more work on this. We need robust studies that seek to produce evidence about the impact of the PBP on patient care and the wider primary care team.” 

The ideal composition of the practice team may also need consideration as PBPs become more integrated. “For example, PBPs may be able to delegate some administrative and other activities to other people such as pharmacy technicians, if they became part of general practice staff.” 

Friends or foes?

Practice-based pharmacists said that working in a GP practice offered more opportunities to acquire new skills than in community pharmacy. 

“Pharmacist positions within general practice have affected community pharmacy and we need to consider the impact of PBPs on the workforce. However, our findings suggest that the links between community pharmacists and PBPs could lead to better collaboration, and by extension, integrated care,” Professor Hughes says. 

For instance, many interviewees regarded PBPs as a “central hub” between GPs and community pharmacies, as well as between primary and secondary care. However, communication pathways between PBPs and community pharmacists need improvement.

Professor Hughes says that community pharmacists should welcome PBPs, even as their role expands. “We found that there were generally good links between PBPs and community pharmacists, and the PBPs acted as a link between community pharmacists and GPs. 

“Community pharmacists reported often being able to contact PBPs faster and resolve issues more quickly than with GPs. Some PBPs thought that community pharmacists were not always aware of [their] role – something community pharmacists confirmed, particularly when a PBP first joined a practice. However, this changed over time as the community pharmacist had more dealings with the PBP and became aware of what the PBPs were doing.” 

“I think that community pharmacists should welcome PBPs. Both groups should see the development as a way for pharmacists, irrespective of practice setting, to contribute to patient care. The roles should be considered as complementary,” she adds. “Liaison between community pharmacists and PBPs should lead to greater collaboration, better mutual understanding and hopefully a more holistic approach to patient care.”

Professor Hughes argues for a “clearly articulated vision” for community pharmacists and PBPs in primary care. “This vision should not be about professional competition, but rather as a collaborative approach to patient care. Delivering on this vision means considering any skills gap for community pharmacists and PBPs. 

“Evidence generated by research showing the benefits of this type of care provision should underpin the vision,” Professor Hughes concludes. “I think community pharmacists should take time to get to know the PBPs in their area, work towards better collaboration, and see PBPs as facilitators to enable community pharmacists to contribute fully to primary care. This is not a competition,” she says.

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