Pharmacists recruited into primary care networks (PCNs) are experiencing confusion over the purpose of their roles as many are not being integrated into primary care teams properly, analysis by The King’s Fund has found.
The healthcare think tank published a report last week in which it spoke to 15 pharmacists to gather information on the progress made in the recruitment into PCNs via the Additional Roles Reimbursement Scheme (ARRS).
The report found a range of problems with the ARRS, including a lack of understanding from pharmacy staff about their purpose in PCNs and that many were experiencing feelings of loneliness.
Authors of the report said there was ‘a lack of shared understanding about the purpose or potential contribution of [pharmacy] roles’.
There was a strong sense from pharmacists that they were not being given clinical tasks that matched their abilities. Instead, some said they were given lots of smaller tasks such as medication reviews.
One pharmacist told the authors that because they were ‘spread so thinly’ they could not do bigger pieces of work that they wanted to do.
‘I want to run audits, I want to work on opioids… I haven’t got the capacity to do that. The expectation from my PCN was to do [structured medication reviews (SMRs)] and SMRs only. I basically wasn’t given any control of my ledgers; they have just booked me in SMRs. They’ve not listened to me,’ they said.
The authors said that pharmacists reported that there was a ‘lack of understanding or agreement about what the individual roles could, or should, contribute and how they would best be deployed across the network in pursuit of that vision’.
One pharmacist expressed concern over the fact they were being assigned too much work.
The pharmacist said they were told to ‘do all the care homes’ which they said was ‘far too much’.
‘And even though I’ve said this is an issue, nobody’s listening,’ they explained.
NHS England & Improvement is aiming for a total of 26,000 roles recruited via the ARRS by 2022/23. So far, 3,010 pharmacists have been recruited by the scheme with 2,923 filling full-time equivalent roles.
‘You always feel like the outsider’
The report also found PCN pharmacist were experiencing isolation and loneliness.
One pharmacist said: ‘I’ve found myself to be incredibly lonely. It’s been really hard to feel like part of the team but not feel like part of the team. You always feel like the outsider coming in.’
They also said that felt like they were ‘spread so thinly’ and that ‘nobody really knows me all that well’.
Another pharmacist who also suffered from loneliness in the role said: ‘I found it quite hard to start with because coming from a community background, I used to manage a pharmacy and I had 14 members of staff that worked for me.
‘Being told to go in a room on your own and just get on with it, I did struggle with that bit because I’m used to being part of a really big team.’
A rethink of PCN pharmacist roles
Commenting on the report, the National Pharmacy Association (NPA) said there should be a rethink on PCN pharmacist roles.
NPA vice-chair Nick Kaye 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.
‘By investing in connecting existing community pharmacy resources and innovating across the interface between community pharmacy and PCNs, we could realise more effective patient care,’ he said.
He added that there should be 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.’
In December the NPA said that Local NHS teams must consider the impact that the continued recruitment of pharmacists and technicians into primary care networks (PCNs) might have on the delivery of community pharmacy services.
In a letter sent to Ed Waller, NPA chief executive Mark Lyonette said that the body is aware of significant challenges facing pharmacy services as a result of a shortage of pharmacists and other members of staff.
I don't think there's hardly any support for pharmacists entering this new found role. Having been in community for 20yrs I was amazed at how much my confidence was knocked down, there was no respect or understanding just a very high expectation of the role which without regular support in the initial 6 months is not going to develop. All I got told is sorry for not supporting you we were busy with covid. Truth was no one in the team really knew what they were supposed to be doing, it was quite evident. They should initially discuss abilities and expectations. Its shocking, I know one thing is that we have excellent people skills and know how to manage teams so a little credit would be nice. Its constantly having to prove your worth each day. I'm glad to have been given the opportunity but just thinking if you want to get the most out of your pcn pharmacist then you should spend half hr a week to ask how are you finding it, is there anything your unsure of or need clarity with. It's taken me a year to slowly pick myself up again and regain confidence and the reception team and practice managers are the ones I want to thank. I would also like to say to those who feel lonely you have to make the effort with the wider MDT if you want to be recognized it takes time and effort so stop feeling lonely and start networking and making contact.