We must build a supportive and safe structure for primary care pharmacy teams

The number of pharmacists working in primary care networks (PCNs) in England has increased rapidly, from 2,552 in 2021 to 3,294 in 2022. Pharmacists have become the most common role in the PCN workforce and data show similar increases in Scotland.

At the same time, the number of GPs have reduced: the British Medical Association (BMA) estimates a net loss of 646 individual GPs between January 2022 and January 2023. This has meant that many general practices and primary care networks (PCNs) are leaning increasingly on the expertise of pharmacists, as part of their multiprofessional workforce.

Pharmacists can play a major role in primary care and the evidence shows they can have a positive impact on the care of patients and overall population health outcomes; however, their work is changing​[1]​. With an increased burden of responsibility — not only on medication monitoring and reviews, but on chronic disease management — and as more pharmacists become independent prescribers, they begin to become responsibility for a disease cohort or patients, such as patients with hypertension.

To ensure this workforce is directed and competent it is essential that two things are in place:

• Adequate training and supervision;
• A robust team structure valuing the experience and inexperience of pharmacists moving to the primary care arena​[2]​. 

Training and supervision

Both undergraduate and postgraduate pharmacy education in the UK has evolved over the past few years and, although some great educational providers exist to upskill and give ‘crash courses’ in primary care, there needs to be an adjunct structured supervision model provided by senior pharmacists and GPs​[3,4]​. 

It is imperative that pharmacy teams can achieve substantial outcomes in general practice, but the wider issue is that many pharmacy teams in primary care are undervalued and underutilised​[2]​. A King’s Fund report, published in 2022, said that many pharmacists felt they were ticking a box rather than becoming an integrated member of the team​[5]​. Without a robust supervision structure and pathway, it is my view this problem will continue to disenchant the workforce, threatening to hamper workforce resilience and retention.

A supervision structure will enable pharmacists to hit the ground running and make key and vital interventions, such as structured medication reviews in the most vulnerable and at-risk patient groups, driving a shared patient agenda and improving adherence, but also applying evidence-based principles across a new and changing multiprofessional workforce​[1,6,7]​. 

I joined primary care from the community and many pharmacists take a similar plunge into primary care from other sectors. Adapting to a different sector means that a pharmacy team needs to have clear and directed roles and responsibilities, along with a drive for clinical excellence and interprofessional working to really bring the pharmacy profession into the spotlight. 

General practice is incredibly varied and although fairly predictable in a chronic disease sense with certain specific conditions we encounter, there are plenty of conditions and presentations that a pharmacist either from a different sector or new to practice entirely will need to be competent in. Supervision is essential to help this succeed, combined with clinical education and adequate competency frameworks​[8,9]​.

In my experience, as lead pharmacist for the Horsham Central Primary Care Network, developing this competency framework is essential as a starting point alongside regular learning needs assessments, taking into account the pharmacist’s existing knowledge and also accounting for gaps (such as in relation to clinical expertise or practice) and PCN priorities. I ensure this with regular one-to-one meetings with my team and ensuring they have access to a multitude of other healthcare professionals to learn from, not simply GPs. 

Multiprofessional experience

It is vital in this changing workforce for us to lean on other professionals such as physiotherapists, social prescribers, health and wellbeing coaches to widen our sphere of influence on patients​[10,11]​. In my team, experienced pharmacists, less-experienced pharmacists and a pharmacy technician combine and share knowledge, but also to help to collaborate with the wider multidisciplinary team in driving positive change in the local population. If this structure of sharing competence and experience didn’t exist, it would be difficult to discover learning needs of individuals, but also to ensure we are clinically effective as a team in achieving clinical goals​[12]​. 

The biggest constraint on this development is time, in terms of both supervision and in practice to juggle and deal with all workflows effectively and efficiently. This has been difficult to manage but I feel a solution to this is diversifying the supervision and spreading the load. Involving GPs and also other healthcare professionals to provide competent clinical supervision can help unburden one or two senior people from a huge supervision load, as well as giving the pharmacist a broad primary care experience​[11]​. Although, clinical governance cannot be overlooked while carving time out for clinical supervision, and as governance is a central pillar to good clinical practice it is vital to maintain good quality of care while balancing this clinical supervision need​[13]​.

It can be more efficient to use joint clinics, shared learning meetings and feeding back as a team to provide a much more streamlined way of improving clinical knowledge. Using this feedback in a clinical setting while keeping patient-centred care at the forefront of practice is vital​[14]​.

Overall worked in primary care since 2019, I am hopeful and positive of the great and varied impacts pharmacists are having in this sector. My structured approach to developing the pharmacy team within my PCN has led to some amazing outcomes thus far, such as deprescribing 269 medicines to a total of 470 care home residents over a two-month period. I am thrilled to be developing such clinical excellence within our locality. 

Wider than that, it has been great to work, develop and share the way I work at the level of the integrated care board to benefit other pharmacy teams in general practice. It is exciting to see this develop into a more standardised and robust approach into a developing the pharmacist workforce, maintaining resilience and ensuring good quality clinical education.

Using my secondary role within the academic lecturing team in medicines use for the pharmacy school the University of Brighton means this educational development is not limited to qualified pharmacists and we hope to integrate and embed this competency and clinical knowledge to student and trainee pharmacists as well.