Features

Prescribing needs a recognised model

Pharmacist prescribing is lacking a recognised national model that the health service understands. This is one of the emerging findings from a piece of research into pharmacist supplementary prescribing carried out by Amanda Evans, deputy head of medicines management and non-medical prescribing lead at Burntwood, Lichfield and Tamworth Primary Care Trust.

“Doctors are not against pharmacist prescribing. They just do not understand how it benefits their practice,” she told P&MM. “Pharmacists prescribers will only exploit the opportunities created by practice-based commissioning if there is a pharmacist prescribing model that doctors understand.” Therefore, Ms Evans said, a national piece of work needs to be undertaken, perhaps by the Royal Pharmaceutical Society, in which an evidence-based model of pharmacist prescribing is defined.

In her research, Ms Evans examined the implementation of pharmacist supplementary prescribing in primary care. Her work is ongoing so, although it is too early to draw conclusions, she was able to describe the preliminary themes that have emerged.

She explained that the main barrier is that GPs are not able to visualise a role for a prescribing pharmacist, particularly because so many practices already employ prescribing nurses. “Nurses are pretty well established as prescribers so there are not many gaps that pharmacists can fill. The pharmacists that have found roles have tended to identify something nurses do not want to do or something that nurses are not confident in doing, for example, treating pharmacologically difficult patients with complicated chronic disease,” she commented.

“Doctors also think nurses’ training equips them to become prescribers. They particularly value the hands-on skills that nurses have. However, doctors have much less understanding of what pharmacists’ training involves and of pharmacists’ skills set,” Ms Evans added.

On the positive side, the research found that pharmacist prescribers believe they offer something unique: much higher levels of concordance than other prescribers. The reason for this is that they provide more explanations about the drugs prescribed, which promotes a more concordant approach.

The main enabler of pharmacist prescribing seems to be the pharmacists themselves: those who are successfully using their prescribing skills are the pharmacists who have looked for a role and pushed for a service to be developed. “It has come down to individual solutions driven by individual pharmacists,” she explained. “Successful implementation of a prescribing service is really dependent on the qualities of the individual pharmacist.” However, Ms Evans believes that if a recognised model of pharmacist prescribing is developed and promoted to doctors and health care organisations, then more pharmacists would take on prescribing roles.

Her research involves focus group discussions between pharmacists, doctors, nurses and practice staff. In addition, individual interviews were carried out with pharmacist prescribers. These interviews are being repeated this summer, along with interviews with GPs, nurses and policy makers.

The research is being undertaken through the department of medicines management, Keele University, under the supervision of Alison Blenkinsopp, professor of pharmacy practice. It has been funded by The Health Foundation, an independent charity that aims to improve health and the quality of healthcare in the UK, and the results are expected to be published early next year.