Discussion of Initial Study results

This Initial Study began to determine the key aspects of the PP role, within CCGs, regarding its constituent activities and the understanding of that role by GPs and pharmacists. The IS had limitations; purposive sampling yielded pharmacists and GPs with experience in working as, or with, a PP, but as inclusion in the study was dependent on both volunteering and availability, it is likely that the most interested and motivated individuals took part and

therefore their observations and opinions may not be representative. The small sample sizes may also mean that the full range of activities and perceptions may not have been identified.

The CCG PP Team was not necessarily representative of other teams. The IS was

conducted during a period of assimilation of new responsibilities and consolidation for CCGs, therefore, conducting the study within this period may have affected the results.

I conducted all the focus group and interviews for the IS which could have posed several issues regarding my position in the team. I was a senior professional within my organisation and part of the culture, ethos and workplace mission (Drake, 2010), I tried to ensure

objectivity when considering the outcomes of this evaluation, but I was an early adopter of the PP role and had worked in GP practices for 16 years. My “insider” status conferred

responsibilities of loyalty, confidentiality and trust (Lytle and Zeni, 2001) to my colleagues.

Regardless of the outcome of the evaluation, I had to continue to work with the pharmacists and GPs who participated in the IS.
My colleagues may have felt obliged to take part in the evaluation and thought that it might provide unspoken benefits or have even felt threatened because of my position in the team and this may have discouraged frank and open

discussions in my presence (Drake, 2010) or affected what was said.

The IS pharmacist respondents reported similar reasons for becoming PPs that have previously been reported in the literature, related to the perceived shortcomings of

community pharmacy and the more clinical nature of the PP role. Despite this, community pharmacy was considered by GPs to be a good background for PPs in helping them to understand the motivations for some prescription requests and to also facilitate liaison with community pharmacy on medicines issues. A prescribing qualification was felt to make the PP role more effective with pharmacist prescribing freeing up GP time for more complex patients which were valued by GPs.

The correlation between the views of GPs and PPs of the PP role suggests that there is now a good understanding between the two professional groups of the activities undertaken. The GP respondents were easily able to differentiate between community and practice pharmacy.

The PP role had grown over time. The IS identified several themes for PP activities, practice education, patient safety, freeing up GP time, efficiencies, liaison with community pharmacy and checking the suitability of repeat medication. This kind of advice and the PPs specific skills were seen as a resource and valued by GPs. The IS has identified both established activities and some new ones, indicating that the role continues to evolve in response to changes in local and national priorities.

Pharmacists brought a different perspective to the consultation, more medicines focused.

Patients were felt to be more open about medicines with pharmacists, but this was also linked to PPs longer appointments. GPs wanted more support from their PP and there was evidence of some degree of dependence on PPs by the practice.

The relationship between GPs and PPs has evolved from uncertainty, through acknowledgement of the role and skills required, to mutual respect and increasing dependence on the PPs to manage the primary care workload. The perception of this relationship was tempered by issues about employment based on a lack of continuity that was identified by both respondent groups. Both professions identified formal qualifications and good communication skills as important attributes. The ability of the pharmacist to socially interact with practice staff is also important. A prescribing qualification was felt to make the PP role more effective. The PPs thought that they were part of the practice team and had a different relationship with patients to that of the GP.

The direct employment of pharmacists could be a solution to the dilemma around prioritising PP work. It is not clear from the IS if pharmacists would like to be employed directly by GPs or if this would detach them from central or peer support. The PPs identified increased job satisfaction, but also an increasing workload because of practice requests. Practice pharmacists may reduce GP workload, but there were concerns about the amount of this work that transferred to the pharmacist. The excessive workload may have a detrimental effect on the role perception and may reduce pharmacists’ appointment times that were perceived as advantageous to patient care. Not all the PPs work full time and will often have a portfolio career including community pharmacy and other roles. A preference for a portfolio career may limit the time that some pharmacists contribute to the PP role. Also, the trust built between GPs and PPs may be potentially undermined by a conflict of interest with other portfolio roles.