True extended role not yet a reality for majority of
community pharmacists
It will be some years before most community pharmacists
have a fully extended role, according to a researcher at the University
of Greenwich. However, support mechanisms can help pharmacists take on
new activities and services.
Dr Annmarie Ruston of the centre for health research
and evaluation conducted a national survey of community pharmacists in
Britain to identify the factors that influence adoption of an extended
role. She found that involvement in extended role activities is low where
skills not traditionally associated with community pharmacy are required.
Such activities include the provision of screening and other specialist
services and prescribing advice for general practice.
Dr Ruston used a national database to generate a
10 per cent random sample of community pharmacies in Britain. Each pharmacy
was sent a questionnaire relating to pharmacists’ involvement in extended
role activities and about barriers to such involvement. Pharmacists were
asked to provide information about the business, their position within
the pharmacy and other pharmacist-related characteristics. Dr Ruston found
that, in general, the explanations for involvement in extended role activities
are more to do with a pharmacist’s professional orientation than the settings
in which they work. In particular, where a greater level of perceived
autonomy was reported, pharmacists were found to be involved to a greater
extent in an extended role.
In terms of the barriers to taking up extended-role
activities, shortage of time and insufficient remuneration were cited
by 96 per cent and 92 per cent of respondents respectively. Other barriers
included a shortage of staff, no locum cover and a lack of contact with
other health professionals. Lack of confidence and a shortage of skills
were also difficulties to be overcome.
“Overall, the majority of respondents saw the profession
as adaptable and capable of supporting an extended role but 81 per cent
felt that pharmacists needed to undertake further training,” she said.
Dr Ruston identified a number of factors that could
help the process of role expansion. These include fostering levels of
autonomy, promoting uptake of post-registration education and establishing
means by which pharmacists can leave their pharmacies to work with other
professionals. (Journal of Social and Administrative Pharmacy 2001;18:103.)
Tim O’Donoghue from the Greenlight Pharmacy, London,
said: “It is true that it could be a long time before pharmacists are
able to take on extended roles. Pharmacists are hungry to take them on,
it is just that pharmacies are not set up for them.”
Dr Darrin Baines, director of medM (a company that
provides educational services) said: “[This paper] identifies a whole
range of opportunities where pharmacists can move beyond their traditional
role and proves that pharmacists can deliver effective services to patients.
However, unless the profession takes immediate action,
progress in extended roles will be slow.” He added that policy conclusions
could not be drawn from this type of research.
Noel Dixon, of Dixon and Hall, County Durham, told
The Journal that from his experience of working with a group of
pharmacists within a single premises, that they were able to support each
other. This meant that they did not need the more formal support mechanisms
identified in the paper. Mr Dixon pointed out that the survey had not
really addressed the influence that business factors, such as income,
overheads and management issues, have on taking on extended roles.
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