Service evaluation of advanced clinical practitioner pharmacists in primary care pilot
Authors: Tyers K L 
Published: November 2024

Introduction

Workforce shortages and increasing patient demands have strengthened a movement for alternative health care professionals (HCPs) to meet these needs1. Advanced Nurse Practitioner roles are well-established with a strong evidence base2. However there is a lack of evidence for other HCPs, in particular in primary care settings3. The author’s organisation therefore piloted a primary care Advanced Practitioner Pharmacist (AP-P) role, and a service evaluation was undertaken.

Aim

This study aimed to evaluate and explore the viability of the role of primary care AP-Ps. It explored the clinical activities, experiences, opinions, and recommendations of AP-Ps working in primary care.

Objectives

To describe AP-P’s attitudes to the role through semi-structured interviews. To explore training and support needs.

Research Question

What are the experiences, opinions, and recommendations of primary care trainee/AP-Ps in the researcher’s organisation?

Method

A qualitative phenomenological methodology was utilised to explore the participants’ lived experiences, utilising semi-structured interviews and reflexive thematic analysis within an interpretivist, critical-realist philosophy. Five trainee/AP-Ps were interviewed.

In line with Sheffield Hallam University protocols, ethics form UREC2 was completed and approved prior to approaching participants, and letters of support for the study were obtained from the organisational line manager and Research & Development lead.

Results & Discussion

Findings showed participants were able to successfully train and work as trainee/AP-Ps. They provided same-day appointments for a wide variety of conditions and age ranges, increasing capacity in primary care. It was however also noted some preferred to utilise the skills in more specialised clinics.

Thematic analysis revealed four key themes and three sub-themes addressing the research aim:

1. Utilising skills is vital to build on and retain them – “Use it or lose it”.

a. Lack of exposure.

b. Hands-off approach.

c. Generalist versus specialist.

2. The importance of risk management.

3. Ongoing support is vital.

4. How role identity impacts on relationships.

The implications to practice were therefore increased capacity through an alternative funded workforce in primary care, and learning about the structure and support required to maximise this resource and improve the experience of trainee/AP-Ps.

Key learnings included a need for more time and exposure in the role while training, concerns from some participants about increased risks and the negative impact of this on retention, recommendations for support needs including a structured wrap-around programme alongside university studies, and the need to provide education to administrative teams about the role in order to ensure it is optimally utilised.

The study was limited in several ways, including the lack of transferability of findings, self-selection bias as only pharmacists who had chosen to complete this training and volunteered were interviewed, the researcher’s lack of experience in qualitative interviewing and reflexive thematic analysis, the immaturity of the roles in the study and the variation in stages of training and post-qualification of the participants.

Conclusion

In the current National Health Service climate with workforce shortages and increasing demands, primary care AP-Ps can be successfully trained to assess many same-day presentations and increase capacity with the appropriate support, training, and resource.

References

1. NHSE, NHS long term workforce plan, 2023, NHS Long Term Workforce Plan (england.nhs.uk)

2. Sibbald, B, Should primary care be nurse led? yes. BMJ : British Medical Journal Online, 2008, 337 doi:https://doi.org/10.1136/bmj.39661.707083.59

3. Evans, C., Pearce, R., Greaves, S. et al., Advanced Clinical Practitioners in Primary Care in the UK: A Qualitative Study of Workforce Transformation. Int. J. Environ. Res. Public Health, 2020, 17,4500. doi:10.3390/ijerph17124500