Lessons for better use of community pharmacy in primary care

Policymakers have, for some time, recognised the importance of community pharmacy in optimising patient-centred care and reducing GPs’ workload through extended service delivery. However, awareness and use of such services among patients and members of the public remain low^[1]
. The publication of the ‘NHS Long-Term Plan’ in January 2019 details even further investment in developing the roles of pharmacists, including proposals to make better use of community pharmacists’ skills within the new primary care networks.

In February 2019, researchers at the Centre for Pharmacy Workforce Studies, University of Manchester, published a study in BMC Family Practice
, which can help to inform this policy drive.  The study explored how community pharmacies are currently used and how their services may be better used and integrated within primary care in the future. Focusing specifically on people with long-term conditions, the study was informed by earlier systematic reviews conducted by the research team^[1]
,[2]
.

We conducted eight focus groups with community pharmacists, GPs and patients with long-term conditions (diabetes or respiratory conditions). We used a novel approach to guide these discussions by applying marketing theory, specifically the ‘7Ps model’, which considers ‘product’, ‘process’, ‘people’, ‘place’, ‘physical evidence’, ‘promotion’ and ‘price’^[3]
.

We identified a number of areas for improvement that could increase patients’ and GPs’ awareness of — and demand for — community pharmacy services, which would relieve some of the burden on general practice and improve patient care. These areas involved ensuring consistent commissioning of services; enhancing communication between community pharmacies and GP practices; and incentivising joint working along a patient’s primary care pathway. Other areas involved enhancing the consistency and quality of the patient’s experience of community pharmacy services, as well as strategically promoting community pharmacy services.

We grouped the key findings using the 7Ps:

1. Product (community pharmacy services): patients, pharmacists and GPs strongly supported community pharmacies regularly providing routine check-ups and procedures (blood tests, for example) for patients with well managed long-term conditions.
2. Process (service delivery, use and integration into primary care): patients, pharmacists and GPs emphasised the importance of pharmacists having limited read–write access to medical records to facilitate safe and collaborative working with GPs. The development of community pharmacy services that have clear specifications and focus on a single, specific intervention (influenza vaccines or inhaler techniques, for example) was perceived to enhance consistency in delivery and quality of services.
3. People (patients, pharmacy staff and GPs): pharmacists and GPs argued that unless both were adequately remunerated for joint working, they were unlikely to collaborate and/or prioritise the promotion or provision of extended pharmacy services. Pharmacists also encouraged delegating further technical activities to pharmacy support staff so that they could provide more patient-centred care.
4. Place (location and accessibility): owing to the accessibility of community pharmacies, patients preferred them over GP practices for non-urgent and less invasive services.
5. Physical evidence (community pharmacy premises): patients, pharmacists and GPs suggested improving the size and quality of consultation rooms and highlighted the importance of having sufficient privacy within the pharmacy.
6. Promotion of services: patients, pharmacists and GPs recommended nationally promoting community pharmacy services and stressed the importance of a positive first-hand patient experience to build trust in consistent, quality community pharmacy services. On the other hand, existing inconsistencies in the commissioning of community pharmacy services prevented the effective promotion of community pharmacy services.
7. Price (added value): the added value of using community pharmacy services comprised faster access and convenience for patients, and freed-up GP time, allowing them to focus on more complex cases, provided better joint working could be achieved.

Our research shows that community pharmacies could provide more support for patients with long-term conditions within primary care and that this could be acceptable to both GPs and patients. However, these findings also indicate several areas that require further development before community pharmacy services can be fully integrated into primary care networks and can be better used by patients. Our research provides policymakers with an evidence-based framework to develop strategies for enhancing the development and integration of community pharmacy services.

Ali M K Hindi, pharmacy practice PhD student;

Ellen I Schafheutle, professor of pharmacy policy and practice;

Sally Jacobs, lecturer in social pharmacy;

All at Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry; School of Health Sciences; Faculty of Biology, Medicine and Health, University of Manchester