My background and experience

I qualified as a pharmacist in 1976 and worked as a hospital and community pharmacist before becoming a proprietor in 1985. Owning a pharmacy gave me more freedom, but after 14 years I became disenchanted with the community pharmacy role, which had not

appreciably changed since I qualified. One aspect of the role that remained interesting was building a relationship with local practices and being asked for advice about medicines. I had also become interested in the burgeoning role of the practice-based pharmacist but was concerned about my lack of knowledge about disease and therapeutics. I felt that I needed some formal qualification to prove that I could work at a postgraduate level and to support my future career as a PP, so I undertook a postgraduate diploma in 1998. In 1999, encouraged by my initial success, I started work as a PP for a local PCG.

The PP role was a revelation to me; it was challenging because there was a steep learning curve; often you would have to research a problem to find a solution, but also satisfying because of this. There were opportunities for much more satisfying patient interaction, and it was also much less professionally isolating than community pharmacy had been. It was based on teams of pharmacists and pharmacy technicians and had excellent educational

support from the NPC and other organisations giving access to high-quality therapeutic training, further consolidating my PP skills. It was refreshing to be out of a commercial environment and into a more professional role. There was a significant difference in the way that PPs interacted with GPs and their staff, compared to interacting with a community pharmacist and, in most practices, I felt part of their team. I watched the genesis of

pharmacist prescribing with interest and began considering how I might become a prescriber myself. I was among the first pharmacists in the UK to qualify as a supplementary prescriber in 2003 and then converted to an independent prescriber in 2007.

I took on a more strategic role in 2007 but was still able to see patients and prescribe for them, while supporting the management of a large team of PPs, most of whom were prescribers. During this period, I worked closely with secondary care on formulary

management and the implementation of NICE guidance across primary care. Some of the most rewarding work was supporting our prescribing PPs to run CDM clinics.

In 2010, I started a Diploma in Advanced Professional Practice and after completion I was invited to undertake the new Doctor of Pharmacy (DPharm) course. I had to complete an Initial Study (to determine my suitability for part 2 of the course, so I chose to look at the activities that PPs carried out and their relationship with GPs. This was because I felt that the PP role was professionally fulfilling with the potential to develop into a future alternative to traditional pharmacist roles, but I had observed some issues with the integration of PPs into GP practices. Sometimes the PP/practice relationship broke down, or the PPs were reluctant to prescribe. I found this interesting because the practices were turning down a resource and I wondered why a pharmacist would take on the prescribing course and not want to

prescribe. There were other issues that needed clarification.

There was published research on the PP role, but none related to hard patient outcomes (e.g. a reduction in morbidity or mortality), perhaps not surprisingly due to the cost of

undertaking long-term research and lack of obvious funding streams. The lack of evidence was a little disappointing, but there was burgeoning local evidence of PPs being

cost-effective. Further background reading showed that the numbers of primary care pharmacists had declined in 2008 (Hassell et al., 2004, 2006; Seston and Hassell, 2009). I felt that the declining numbers and lack of evidence were disappointing and contrary to my personal experience and expectation for the future of the PP role. I was also curious about how the latest iteration of the NHS and changes in primary care structures had affected the PPs and their role. These changes provided an opportunity because CCGs were new organisations there was no published evidence, at the time, describing the current range of activities carried out by CCG PPs and the relationship between PPs and GPs within CCGs.

I felt compelled to research the PP role because it changed my life. It helped rescue me from processing endless repeat prescriptions and made me believe that there was an alternative long-term future for the profession in primary care. I have witnessed the benefits of a pharmacist in a GP practice where PPs have used their pharmaceutical knowledge and judgment to problem-solve and facilitate solutions for patients around medicines taking. I believe there is a need for pharmaceutical input in primary care that is independent of the need to compensate for shortages of other HCP groups, which is reported to be a driver to integrate pharmacists into general practice (NHS Alliance and Royal Pharmaceutical Society, 2014). I believe that the assumption that suitably qualified pharmacists can offset the lack of GPs and practice nurses in primary care is overly simplistic. While undoubtedly there is a role for prescribing and non-prescribing pharmacists in CDM, this must be appropriate for the skill mix within the individual practice. Pharmacists should be part of the primary care

multidisciplinary team where they can flourish and deliver a truly clinical pharmaceutical role.

I feel privileged to be practising at a time when pharmacist prescribing has emerged, and there has been the opportunity to work in an alternative patient-facing role to hospital and community pharmacy. These factors have positively transformed my outlook on my career and the pharmacy profession. It has given me job satisfaction, motivation and continually

challenged me to increase my skills and knowledge.