Pharmacists working in primary care networks (PCNs) in England are “underappreciated” by GPs and are often given tasks below their competency level, a government-commissioned report has found.
The report — published by independent think tank The King’s Fund on 4 March 2022 and commissioned by the Department of Health and Social Care — reviewed the implementation of four PCN roles funded through the ‘Additional Roles Reimbursement Scheme’ (ARRS), including pharmacists.
The ARRS, which was first announced in the GP contract for England in January 2019, enables every PCN to claim funding for hiring from a selection of 14 different healthcare roles.
This includes the ability to claim at least £57,318 for hiring an additional pharmacist. The GP contract in 2019 set a target for PCNs to hire six clinical pharmacists by 2023/2024.
However, following interviews with 48 people working in PCNs, including 15 pharmacists, The King’s Fund report found that PCNs “lack a clear, shared overall purpose and strategy” for the ARRS roles.
“The potential contribution of additional roles to general practice is not universally understood, despite large amounts of written guidance, job descriptions and roadmaps, all of which may even have added to the confusion,” the report said.
For pharmacists, the report found “a strong sense that they were not being given tasks appropriate to their competencies”.
“Many felt that GPs underappreciated their abilities or wanted them to focus on ‘tick-box’ tasks and medication reviews,” it added.
“Pharmacists often felt isolated, especially if they had moved from hospital settings where team structures were in place. There was a strong consensus that having a critical mass of pharmacists and technicians, with leadership support, was important.”
In response to the findings, The King’s Fund recommended that PCNs and practices “carefully plan their strategy for embedding ARRS roles, considering the implications for staff who work in network-wide roles or across multiple practices that have individual systems, cultures and practices”.
Commenting on the report, Nick Kaye, vice chair of the National Pharmacy Association, said: “I recognise from direct experience many of the issues highlighted in this report, including the confusion around the PCN pharmacist roles.
“It’s time for the NHS to think flexibly about allowing PCNs to utilise ARRS funding to commission community pharmacy colleagues to deliver services locally.
“We are also reissuing our call for mandatory local impact assessments before any further recruitment of pharmacists into PCN pharmacist roles.
“These assessments should consider the impact on the ability of all healthcare providers in the area — including community pharmacies — to deliver their objectives on behalf of the NHS.”
Graham Stretch, chief pharmacist at Argyle Health Group and clinical director at Brentworth PCN, said the report was welcome as it “shines a light on issues that we know colleagues are experiencing” across the country.
“It’s all very well having the staff, but if you don’t have the sense of direction and, importantly, the mentorship that staff need, and the influence to ensure that they get both the estate — so a desk with a room where they can see patients — and the correct delegation of workload, you find that you’ve got people who are rudderless,” he said.
“If you throw that in together with the very considerable pressures on general practice and primary care networks, and availability of appropriate tutoring and mentorship, you end up with a situation where you’ve got pharmacists who are very keen to get on but don’t find themselves properly supervised to do the kind of work that is perhaps too advanced for the new people in post.”