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Hooman Ghalamkari, director, MORPh Consultancy,
a provider of strategic advice to stakeholders in medicines management
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The proposed new contract for community pharmacists will transform the
extended role of the pharmacist from a concept to everyday practice with
a set framework for its delivery. The challenge for community pharmacists
is the re-engineering of everyday practice to incorporate the many elements
of the extended roles against a background of increasing prescription
volumes and patient expectations.
The opportunity to examine this in detail was created by the National
Pharmaceutical Association and GlaxoSmithKline with the commissioning
of a research project to provide a snapshot of pharmacists’ daily
activities, and assessing their willingness to take on additional activities.
The survey of 200 community pharmacists identified how much time is allocated
to individual activities and how this has changed in the past two to
three years, as well as rewards, frustrations and aspirations of pharmacists
in respect of the balance of their workload. Semi-structured telephone
interviews were conducted with a sample of community pharmacists in the
working environment, during June and July 2003. This article draws on
the findings of this survey and observations of implementation of extended
role activities into everyday practice.
Even before the formal implementation of the extended roles suggested
for pharmacists, some areas of workload have already increased compared
with two to three years ago. The pharmacists reported that they spend
more time on medicines management (64 per cent), dispensing prescriptions
and discussing prescriptions with the public (65 per cent).
And opinion among pharmacists supports the trend. Almost two-thirds (64
per cent) of respondents believed that the key reward of being a pharmacist
is helping people and 42 per cent stated that providing a community service
was a key reward. Financial rewards were less frequently mentioned (25
per cent). This is an interesting finding since pharmacy’s professional/commercial
mix is often seen as a barrier to further role developments.
In fact, the key frustrations of being a pharmacist were time management,
cited by 43 per cent of respondents, and expectations of the public,
cited by 27 per cent. Pharmacists reported that they manage their time
well considering that they carry out a number of activities, handling
the demands of the public, increasing dispensing workload and shortages
of staff. In the face of this, the pharmacists still reported that they
would like to spend more time counselling patients (87 per cent), discussing
prescriptions (86 per cent), in medicines management (83 per cent) and
in personal (75 per cent) and staff training (70 per cent).
Proponents of the extended roles of pharmacists will no doubt cheer the
pharmacists for their enthusiasm. However, finding time for the extended
roles seems to be difficult if not impossible. So how would these pharmacists
like to see their time commitments change to fulfil their aspirations?
Most strikingly, 59 per cent of respondents reported that they would
like to spend less time in dispensing and that they may be willing to
delegate some of their dispensing activities, as suggested in the pharmacy
workforce document.
The NPA survey findings confirm, however, that pharmacists’ main
activity still remains dispensing and a relatively small amount of time
is spent on the new advisory roles. Indeed, the list of activities that
pharmacists would like to spend less time on is also a list that most
pharmacists would say is currently imperative and a commercial necessity — dispensing,
financial management and ordering stock. Delegation of activities is
not simply a matter of letting go of a certain activity. In the case
of dispensing, delegation of the task may mean the employment of additional
and more competent staff. This will incur extra costs for which funding
needs to be found. Similarly, involvement in the extended roles is not
simply a matter of the willingness of the pharmacist to be involved.
To realise the potential benefits of the extended roles as part of everyday
activities, formal schemes need to be developed that are integrated,
accepted and demanded by the local health economy. These are difficult
and complex issues for local pharmacy leaders and local primary care
organisations who are charged with implementing national policies. It
is encouraging, however, that the recent enabling policies and consultations
are moving pharmacists’ attitudes and activities towards the implementation
of the new roles. It will be interesting to see if pharmacists’ responses
to the survey are different in three to five years’ time once national
strategies have been implemented and established.
There seems to be willingness by community pharmacists to extend their
roles and implement aspects of the new contract, despite the increasing
demands on their workload due to public expectations and increases in
dispensing volume. Pharmacists are also willing to make changes in their
practice, for example by spending less time in dispensing and administrative
activities and by investing time in both personal and staff training.
The extended roles and the new contract will not become everyday practice
through willingness alone. The activities that pharmacists want to relinquish
for the extended roles are still priorities in everyday practice and
the demand for these activities is increasing. This situation legitimises
current activities as priorities for pharmacists. Extended roles also
need to be legitimised as priorities.
This legitimisation includes training, terms of service, job descriptions,
financial incentives, consumer expectations, and work practices, especially
the simple action of “making time”. These factors, however,
are all inter-related and cannot be addressed in isolation. For example,
the uptake of continuing education within pharmacy is the envy of many
professions. However, this has not translated into extended roles within
everyday practice. Similarly, although many pharmacists would like to
delegate certain activities to other personnel, they are uncertain about
the activities that they would be undertaking since there are no formal
schemes in place. Despite these observations, the process of legitimisation
of the extended roles seems to be under way as indicated by the findings
of this survey and the proposals for the introduction of the new contract.
Acknowledgements The National Pharmaceutical Association commissioned
the study. Taylor Nelson Sofres was the independent research company
appointed to carry out the survey. MORPh Consultancy was asked to interpret
and present the results of this survey. GSK as part of the +Plus services
for pharmacies supported the initiative by providing an educational grant. |
The
Pharmaceutical Journal