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GPs reluctant to give practice pharmacists control of prescribing decisions, study finds


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By Isabel Shaw
Reporter

12 Feb 2020

GPs are reluctant to hand-over control of prescribing decisions to practice pharmacists and instead prefer to approve pharmacists decisions, new research suggests. 

The study, published yesterday (11 February) in the British Journal of General Practice, also revealed that some GPs think pharmacists lack the necessary skills and knowledge required to make clinical decisions, including a relationship with the patients and knowledge of their medical background.

Researchers interviewed 13 GPs and 10 pharmacists, including a community pharmacist, to find out their views and experiences of working together, for the study Barriers and enablers to collaborative working between GPs and pharmacists.

They also found that although GPs agreed that employing pharmacists in their practices reduced GP workload, some argued they tended to take longer to complete tasks than GPs.

This suggests that even though pharmacists cost less per hour than GPs, they were not necessarily more cost-effective, the researchers said.

The study concluded that the key to good relationships between GPs and pharmacists was ‘knowing one another’ and through that developing good relationships.

Pharmacists employed by their practice reported feeling valued members of their practice team, and many GPs and pharmacists described a good collaborative relationship.

In contrast, a non-practice pharmacist, who wouldn’t be exposed to GPs on such a regular basis said he felt underused and claimed he sometimes experienced difficult relationships with GPs.

‘I sometimes feel that we don’t get utilised … people [need to] realize that pharmacists are more useful than just sticking labels on boxes […] The patients don’t realise, the GPs don’t realise….’ he said.

GPs raised concerns about whether practice pharmacists should be allowed to make changes to patient medicines. 

Several GPs, particularly those who had a good knowledge of and relationship with their patients, believed they ought to remain in control of prescribing decisions, rather than delegating some of the responsibility to practice pharmacists.  

Some GPs, however, reported feeling overwhelmed by the responsibility of prescribing complex medication, with some saying they valued and welcomed pharmacist’s knowledge of medicines. Especially around areas they felt less skilled in such as chronic disease management.

‘… they [pharmacists] have such a good clinical knowledge and they also have that kind of pharmacological knowledge … I just think as a GP you can’t possibly know all of those things,’ said one GP. 

Lead author and a GP and National Institute for Health Research In-Practice Fellow at the Centre for Academic Primary Care at the University of Bristol, Dr Polly Duncan said: ‘Our study suggests that building trusting relationships through face-to-face meetings between GPs and pharmacists is key to understanding and valuing one another’s expertise. 

‘Pharmacists could play an important role in making sure that patients who have multiple health problems are happy to take their medicines and that the benefits outweigh any potential harm or side effects.

‘This was a small qualitative study and more research is needed to establish the roles of practice pharmacists and whether they improve patient health outcomes.’

The Pharmacist’s State of Primary Care 2018 report published last year suggested the relationship between GPs and pharmacists was positive on the whole. Almost three-quarters (73%) of pharmacists rated relationships with their local GP practices as good or very good, and nearly two-thirds (63%) of GPs gave the same ratings.


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