1. Successes and Challenges Factors Driving Change
Exploring the new General Practice Based Pharmacist role working in Sustainability Practices in NHS Forth Valley
David MacPhee (Pharmacist NHS Forth Valley, student University of Strathclyde), Prof Marion Bennie, supervisor & Mrs Emma D. Corcoran, advisor (University of Strathclyde), Laura Byrne, clinical supervisor (NHS Forth Valley)
Introduction:
Over the past 5 years the Royal College of General Practitioners Scotland has been warning that rising workloads, declining resources and a shortage of GPs is putting pressure on local practices and posing a threat to patient care.(1) Since April 2015 some GP practices within NHS Forth Valley have required permanent multidisciplinary staff support due to partnerships dissolving, retirement and lack of recruitment. The new workforce has been essential to ensuring continuation of day to day activities due to the previous workforce reaching critical levels in these “sustainability” practices.
Aim:
This study aims to explore the journey so far of the new sustainability pharmacist role in NHSFV, and how changes have shaped development and collaborative working. It also looks to gain insight into the individual pharmacist’s thoughts on how their roles could evolve and how it compares to the guiding principles laid out in the joint policy statement from the RCGP and RPS published in October (2)
Methods:
Semi-structured One to One interviews
Thematic Analysis of interviews using Nvivo v11 (QSR International Pty Ltd)
Web Based Survey designed using SurveyMonkey based on the guiding principles of the joint policy statement from the RCGP and RPS published in October (2)
Sample = All pharmacists working in sustainability practice in NHSFV n=14
Thematic Analysis
Results:
 From the interviews the main themes that emerged were:
Current Activities
Successes and Challenges
Factors Driving Change
The Role Evolving
New team members:
Advanced Nurses, Physios, Mental Health nurses.
Contract changes
Familiar with role – faster
More confident and autonomous
MDT meetings, protocols
Streamlining processes
Capping special requests
Consulting room availability
Would like a more patient facing clinical role
Special/acute med requests,
Ad hoc medication queries
Repeat med reauthorisations
Docman: Hospital discharges
Meds rec
Clinic Letters
Outpatient Rx
Part of the team
Valued
Respected
Listened to
Necessary
Make a difference
Improve Safety
Workload
Stressful
Lots of staff turnover
Less resource
Hospital discharge system
Admin type role
Transition from community/hospital
Cannot see this happening unless resource is increased/capacity released
Unsure if service needs this...
The survey showed that pharmacists feel part of the surgery team with professional autonomy, and the majority do feel that they their non patient interactive roles improve patient safety however responses to the question about what extent do the pharmacists have a patient interactive role returned only a figure of 46%, and very few pharmacists use the recent NES Competency and Capability framework. (3)
“Successes I think - the integration into the practice - it was quite nice that when they advertised for a new partner that they updated the advert to say they had pharmacists.... we've had some really good feedback from them and in fact one of the GPs said to me that they wouldn’t be without us now” (Ph7)
“For me personally it was particularly tough coming from community to primary care....I think what’s hard about it is that there's no rigid recognised framework to follow” (Ph11)
Conclusions
In NHSFV the General Practice Based Pharmacist (GPBP) role in sustainability practices have facilitated pharmacist integration into surgery teams yet unable to progress their role to a desired patient facing setting due to a demanding workload and lack of resources.
More research which seeks the opinions of other health professionals working alongside pharmacists on a nationwide scale would be needed to evaluate future education and development of the GPBP in sustainability practices. To the right Fig 1 shows some quotes from the interviews from the GPBPs.
“In order to develop you need to have the time - you need to have the resource and at the moment if I'm being brutally honest with you I don't see it changing at the moment, I feel we don't have the capacity” (Ph13)
Figure 1: Feedback quotes from participants
REFERENCES: 1. David Webster, Jonathan Ware, Matthew Chisambi & Catherine Witcombe, Scottish Blueprint for General Practice. RCGP Scotland, July 2015, p2 2. Joint Policy Statement on General Practice Based Pharmacists, October 2016, available at National Education for Scotland, Competence and Capability Framework. 2017, available at