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Community pharmacist independent prescribers (CPIPs) can relieve pressure on GPs and primary care teams, but more must be done to bring them up to independent prescriber (IP) status if the benefits are to be felt widely, a report from the University of Nottingham has found.
The study looked at the GP Pharmacy Transformation project, which was funded by NHS England, to assess what CPIPs in general practice could offer to broaden the services they provide in extending the capacity of primary medical services.
The project covered five clinical commissioning groups in the East Midlands; six general practices were matched to six CPIPs for a period of one year. The CPIPs worked for between one and four days per week in each practice, completing a total of more than 13,000 consultations throughout the year.
The study found that from day-one of their placement, CPIPs were conducting medication reviews that immediately freed up time for GPs. It also found that CPIPs were able to begin chronic disease reviews in the first six months of the role and were in a position to undertake them independently thereafter; this further released time for GPs and generated income for practices through the Quality and Outcomes Framework (QOF) scheme.
CPIPs who had either been working for more than six months, or who had experience of secondary care, could also support primary care colleagues in the hospital discharge process, which had a significant impact on preventing readmissions.
Source: Courtesy of Matthew Boyd
Matthew Boyd, study lead, highlighted the timely nature of the pilot and report, citing multiple factors, such as the UK’s ageing population and growing chronic disease burden, putting GP practices under increasing pressure
However, the report also highlighted recruitment of CPIPs as being particularly challenging, due to the limited supply of qualified CPIPs. As a result, one post was filled via a secondment of a hospital pharmacist. The authors suggested that further upskilling of pharmacists to IP status may benefit the overall development of the sector.
“This pilot and report is very timely, as it comes at a time when GP practices are under increasing pressure to provide services, with factors like an ageing population and management of a growing number of chronic conditions adding to the pressure they are under,” said Matthew Boyd, study lead and associate professor in patient safety and pharmacy practice at the University of Nottingham.
Sandra Gidley, chair of the Royal Pharmaceutical Society English Pharmacy Board, described the potential that pharmacists have in taking pressures off of GPs as “immense”; however, she said that many community pharmacists were not able to access IP training because of the lack of clarity over who will fund ongoing prescribing activity.
“We need to train the prescribing pharmacists, alongside giving urgent consideration to how we can incorporate them into the primary care system. We now have the evidence base, so there are no longer any excuses for putting barriers in the way of becoming IPs,” she said.
Gidley added, “There are no longer any excuses to avoid developing ways in which prescribing community pharmacists can become integral members of the primary health care team.”
Among other key findings in the report was that proper induction was vital to the success of the scheme. The induction usually lasted around eight days, and included clinical shadowing and IT training. Mentoring was also found to be valuable, although it was noted that this took up GP time.
The report concluded that the most noteworthy benefit of having CPIPs in GP practices was that, by offering longer appointment times, they were able to deliver more holistic person-centred care, increase medication adherence and deprescribe on a regular basis, leading to more efficient and effective use of medicines.
The CPIPs also used motivational interviewing and monitoring to generate lifestyle changes in patients which, the report said, could have a long-term impact on the overall wellbeing of patients.
The patients reported increased satisfaction through management of medication reactions and interactions to minimise side effects.
“As well as the data we collected, there were many individual patient cases which demonstrated the value of the service the CPIP was providing,” Boyd commented.
“For example, one patient was able to give up smoking after 50 years, after receiving lifestyle advice and support from the CPIP.”
The report added that management roles were vital to allow neutral support to both the pharmacists and the GPs to manage the scheme, overcome barriers and achieve key performance indicators.
The University of Nottingham will also be involved in evaluating the NHS England Clinical Pharmacist programme pilot and second-wave implementation.
