Practice Pharmacists demographic background

The demographic background of PPs in published studies is important for comparison with those in the thesis project reported here to indicate if the PPs were similar. The outcomes of the project are more likely to be meaningful to a wider sample of pharmacists if the PPs in the thesis project are similar to PPs studied elsewhere.

Several studies in the UK and Australia have studied multiple aspects of individual groups of PPs regarding demographic and working practices in any detail. The Australian studies (Freeman et al., 2014; Tan et al., 2014a) were undertaken in a different health care system.

Three UK studies, all over ten years old, were undertaken in previous iterations of the NHS (Martin et al., 1998; Blenkinsopp et al., 2001; Mullen et al., 2005), but there is one recent study of PPs working in London and the South-East (Mills, 2016).

Martin et al. (1998) identified 414 pharmacists working in GP practices in 1996, of which 174 (42%) responded to their structured postal questionnaire. Some pharmacists worked in more than one practice, so the total number of practices covered by the 174 pharmacists was 200 from 10 regions of the UK, excluding Northern Ireland. There were fewer male (39%) than female respondents and they were, overall, more likely to have been pharmacists for over 20 years, with 89.1% having more than one role. The most common portfolio roles were

community pharmacy manager (n=68), community pharmacy locum (n=48), a smaller proportion were hospital pharmacists (n=30) and academics (n=12). Postgraduate

qualifications, usually a diploma, were held by 36.2%. The majority were funded by the FHSA or directly by the medical practice and worked between one and ten hours a week. The roles reported were somewhat dependent on the funding source but included analysis of

prescribing data, prescribing advice, formulary, guideline and protocol development and liaison with the FHSA pharmaceutical adviser. Thirty-two pharmacists ran CDM clinics, and more of the PPs funded by the surgeries felt “highly involved” with the practice. Despite a low response rate, the study represents an early example of the profile of PPs in Scotland, Wales and England.

Blenkinsopp et al. (2001) studied PPs in the West Midlands by sending a questionnaire to all working registered pharmacists. Questions explored the sectors in which they worked and might consider working, and the hours worked in each. They achieved an overall sample of 1767 pharmacists of which 53% were female. There was a high level of interest in the PP role amongst the pharmacists surveyed at the time. The authors also carried out a postal survey of sixty-six PPs and 30 newly employed PPs and showed that 98% worked part-time with 82% of these working eight or fewer hours a week as a PP. Twenty respondent also took part in semi-structured telephone interviews that included ten PPs and ten aspiring PPs.

Of the twenty pharmacists interviewed on the telephone, their background role was largely community pharmacy (n=14) with the majority being female (n=14), aged between 21 and 40 years (n=18), and having been qualified for 0-20 years. Four of the ten pharmacists working

as PPs spent 1-4 hours a week in the role, three worked 5-8 hours a week, and a further three worked over thirteen hours a week. Two-thirds of the PPs were under forty years of age, and 60% were female. The authors concluded that PPs found high levels of satisfaction in their work and that the overall level of interest in the PP role was related to pharmacists’

dissatisfaction with other roles.

The tasks undertaken by the telephone interviewees that were PPs included prescribing data analysis, repeat prescribing support, medicines reconciliation and prescribing advice. Several PPs mentioned further qualifications as a way of achieving and maintaining appropriate levels of service, even though they had received some training before starting in the role.

None of the PPs in the telephone interviews had face-to-face contact with patients, but they found their work professionally satisfying and intellectually challenging.

Mullen et al. (2005) used a structured questionnaire and in-depth semi-structured telephone interviews to investigate the motivations for pharmacists to move into primary care in

England. The structured questionnaire was completed by 432 pharmacists, and twelve were interviewed by telephone. Of the PPs who completed the survey, 73% were female

representing a greater proportion than in the 2002 census. There was little difference between the male and female age ranges, and overall 43.2% were in the 30-39 age group with 32.7% in the 40-49 age group. In this study, 52% of pharmacists had migrated into the role completely, and most of these (28%) were former hospital pharmacists compared with 19% former community pharmacists. Community pharmacists were more likely to be portfolio workers (31.5%) than hospital pharmacists (9.3%). Motivations for moving into the PP role included more interesting work, better use of knowledge, increased professional status, a more clinical environment, flexible hours, increased autonomy and responsibility. Drivers from previous employment included the converse of the motivators and needing a change, being undervalued, poor working conditions, and isolation. Hospital pharmacists were less likely than their community pharmacist counterparts to consider that primary care had more

interesting work, made better use of their knowledge, increased their professional status, or was a more clinical environment. They were, however, more likely to refer to flexible hours, better remuneration, increased autonomy and responsibility as factors driving them to the PP role.

More recently, Mills (2016) looked at the training needs of PPs who were not participating in the NHSE Pilot. The thirty-two PPs who were recruited to the study self-disclosed as working at a senior (n=16) or junior level (n=16). The junior PPs were statistically more likely to be younger and had been registered as pharmacists for less time than the senior PPs. The PPs had worked in this role for a mean of 5.3 years (range 0-19 years). The number of PPs in each age range was as follows:

21-30 years (n=8); 31-40 years (n=12); 41-50 years (n=8); 51-60 years (n=3); 61-70 years (n=1). The proportion of time spent in face-to-face consultation with patients was: less than 20% (n=11); 21-40%(n=10); 41-60% (n=3); 61-80% (n=6); 81-100% (n=2). Most of the PPs, (n=20) were directly employed by a GP surgery with eleven being employed by a CCG.

Three PPs had more than one employer for their PP role, and eighteen worked full-time; they all had previous experience in community (n=22) and hospital pharmacy (n=14) with smaller numbers in the pharmaceutical industry (n=2), academia (n=2). Other pharmacy role (n=6) and other non-pharmacy related role (n=1). Twenty-two PPs also continued to work in another sector of pharmacy, community (n=13) and hospital pharmacy (n=3) with two PPs working each of the following: academia, other pharmacy role and other non-pharmacy related role. Senior pharmacists were statistically more likely to work in a wide variety of sectors. Nine PPs had no postgraduate qualifications at all, and senior PPs were significantly more likely to hold a diploma or prescribing qualification. Ten PPs had a postgraduate

certificate, fifteen a postgraduate diploma, twelve were prescribers and five had higher degrees. Of the twelve prescribers, nine prescribed less than 50 items a month and the remaining three prescribed less than 100, less than 200 and more than 200 items a month

respectively.

The training needs identified by Mills were dependent on the length of experience of the pharmacists but overall were related to clinical examination and assessment, monitoring, long-term conditions, minor ailments, leadership and management. Mills recommended that, to work in general practices, pharmacists should have a postgraduate diploma and a

prescribing qualification (possibly delivered via distance learning) and that the pharmacist’s role needs further examination.

Tan et al. (2014a) explored stakeholders’ views on pharmacist integration into general practices in Victoria, Australia in 2010-11. They used qualitative sampling techniques to identify a sample of GPs (n=11) and pharmacists (n=16). The respondents were interviewed via the telephone or face-to-face. Eleven of the pharmacists were female, and five were male. Eleven of the pharmacists came from a community pharmacy background; overall their average age was 39.6 years (range 25-65 years) with an average of 11 years of experience (range 3-45 years) as a pharmacist. Three pharmacists had previous experience as a PP.

This study focused on integration, and only a few PP roles were reported, such as

prescribing advice. There was no intention to provide robust quantitative data, and many of the pharmacists were not fully integrated into practices.

Freeman et al. (2014) recruited 26 Australian PPs to a mixed-methods study that looked at the PP role, their attributes and the impact of working in a general practice setting. Most of the respondents were female (58%) and were in the 30-49 age group (62%). The PPs had been qualified for between 1 and 45 years with 6 in the 6-10 years band and 4 in each of the 11-15 and 16-20 years band. The average length of time that they had worked as a PP was 1.2 years (range 0-16 years). Over half of the PPs (58%) had postgraduate qualifications, with 27% having a coursework masters, 23% a graduate diploma and 15% a research doctorate. Fifty-eight percent continued to work in other areas such as independent

consultancies (27%), academia (23%), and in community pharmacy (23%). The qualitative results showed that the respondents gained professional satisfaction from the role and felt valued by GPs.

The common limitation in all the studies is that there is no national register of PPs in the UK (Jesson, 2001) or Australia (Freeman et al., 2014) from which to obtain a definitive list.

Sampling frames are, therefore, uncertain and vary with the method of respondent recruitment and may not identify representative respondents.

Formal national workforce surveys were undertaken in the UK in 2002 and 2003 (Hassell et al., 2004), 2005 (Hassell et al., 2006), 2008 (Seston and Hassell, 2009), 2011 (Hassell, 2012), and most recently in 2013 (Phelps et al., 2014). Care must be taken when comparing figures from these surveys as the methods used to collect data in each survey were different (Phelps et al., 2014), not all pharmacists took part, and there were biases regarding gender and age with female and older pharmacists more likely to respond (Hassell et al., 2006, 2004; Phelps et al., 2014; Seston and Hassell, 2009). Nevertheless, the surveys provide national data for comparison.

Part-time working has become more prevalent, and the numbers of pharmacists working in primary care appear to have grown steadily until 2005 but have declined since then. The NatCen Social Research Registrant Survey for the General Pharmaceutical Council (GPhC) (Phelps et al., 2014) was carried out after the NHS changes in 2013, which may have contributed to the lower reported figures as PP teams were realigning into new NHS organisational structures during this time. This 2014 survey also reported data on

postgraduate education and indicated that prescribing pharmacists were more likely to have postgraduate qualifications than non-prescribing pharmacists.