A study of practice-based pharmacists (PBPs) in Northern Ireland has found that they have integrated well and were perceived to have had a positive impact on healthcare delivery in primary care.

But researchers said that more work was needed to ensure that all PBPs, members of the practice team and community pharmacists understood each other’s roles and could communicate well, with many seeing the practice-based pharmacist as a ‘central hub-middleman’ between general practice and community pharmacies.

The study included views from eleven triads – consisting of a practice pharmacist, a community pharmacist and a GP – from across Northern Ireland’s five administrative areas.

Some lack of clarity on PBP role

GPs and PBPs said that the practice pharmacist’s role could differ between practices but largely consisted of two main activities: medicines reconciliation of hospital discharge letters and outpatient letters, and medication reviews.

They also said that the role evolved over time, to include activities like independent prescribing and conducting chronic disease review clinics.

These clinics were expected to expand and evolve over time, with better integration as practice-based pharmacists undertook more clinical roles. But sometimes this was prevented by workload pressures and time constraints, leading to prioritisation of medication reconciliation and medication reviews, the interviewees reported.

Practice pharmacists also reported that their time was wasted on some administrative tasks – such as reconciling hospital letters – that could be passed to pharmacy technicians to allow the practice pharmacist to do more clinical work.

While GPs suggested that if they were able to recruit more full-time pharmacists to work in general practice there was ‘a huge amount of work that could be done’.

There were also some difficulties over who decides what the practice-based pharmacist should do.

Some PBPs reported feeling like they had ‘two bosses’: the federation that employed them and the practice manager or GP lead.

Some GPs and PBPs said that practices should have had more input in tailoring the role of the pharmacist to the individual practice.

But some said that some GPs did not use PBPs to their full potential.

Interviewees also reported a lack of awareness about the practice pharmacist role among community pharmacists (CPs).

‘I think sometimes they [CPs] think we don’t do anything … but in a word “no”, I don’t think they know the role’, one practice pharmacist commented.

However, they said that understanding of the role improved over time as PBPs and CPs worked more closely together.

Patients were also unclear about the role of the practice pharmacist, the interviewees reported.

Many did not understand the difference between community and practice-based pharmacists, and might think that the PBP worked in community or did not realise that there was a pharmacist based in the practice.

Most GPs and PBPs said that full integration of pharmacists into general practice would look like patients knowing that they didn’t always necessarily need to speak to a doctor, contacting the practice to speak to the practice-based pharmacist about an acute problem, or the practice team being able to refer patients to the PBP rather than the GP when appropriate.

PBPs as communication link between community and practice

Interviewees said that communication skills were essential for practice-based pharmacists to undertake their role.

‘They need good communication skills as they are quite a link between everybody’, said one GP.

And community pharmacists said that they found it easier to communicate with the PBP rather than the GP.

Many participants across the professions said that they saw practice-based pharmacists as a ‘central hub–middleman’ between general practice and community pharmacies and between primary and secondary care.

To facilitate relationship building and collaborative work, healthcare professionals needed to trust and respect each other’s expertise and individual skills, participants said.

And where healthcare professionals were able to work collaboratively, healthcare delivery could be streamlined, duplication of effort could be reduced, healthcare professionals could respond more quickly and patient outcomes and safety could be improved.

Most GPs and PBPs flagged the need for regular protected time for PBPs to meet with others within the practice, such as including them in more formal meetings, patient care meetings and shared education and training, as well as social activities.

They also said that having full-time pharmacist roles based within each general practice also assisted with communication and integration, because it allowed them to develop relationships across the practice team and with patients.

While working across multiple practices made it difficult for practice-based pharmacists to complete the tasks they needed to do each day, they said.

Some community pharmacists also reported occasional delays in response if a PBP was not in the practice on a full-time basis.

And community pharmacists also highlighted the need for direct access – like a direct access telephone line – to the PBP.

PBPs taking on more clinical work

Practice-based pharmacists also need skills related to consultations, teamwork, leadership, independent working, time management, and IT, participants said.

They also needed clinical skills and the confidence to use them.

Pharmacists working in general practice said that their previous experience working in community pharmacy gave them good communication skills and the ability to work with the community sector.

And they said that working in general practice gave them more opportunities to develop and acquire new skills.

Many GPs and PBPs said that where PBPs were independent prescribers, this saved GP time and gave PBPs greater clinical confidence and experience.

And GPs said that PBPs freed them up to spend more time with patients, resulting in better patient care.

GPs also said that PBPs helped them stay up to date with the most current medicines guidelines and reduced the risk of errors by taking on work like hospital discharge letters.