Development of a core set of clinical skills for pharmacist prescribers working in general practice: a Delphi study
Authors: Hasan Ibrahim A S , Barry H E , Girvin B , Hughes C M 
Published: April 2022

Abstract

Introduction
With increasing numbers of pharmacists working in general practices [also called general practice-based pharmacists (PBPs)] and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills (clinical examination and procedural skills) (1). However, previous studies have highlighted that PBPs do not feel confident regarding their clinical skills, and it is unclear what skills are needed (1).

Aim
To develop a core set of clinical skills required for pharmacists who intend to practise as independent prescribers working in general practice.

Methods
Based on a previous study (2), 18 clinical skills were selected for inclusion in a three-round Delphi consensus questionnaire. Designated leads (n=54) of pharmacist independent prescribing programmes in each United Kingdom (UK) educational provider (n=47) listed on the General Pharmaceutical Council website were invited to participate in March 2021. Following consent, a web-based questionnaire was distributed by email in April 2021 (Round 1). Two subsequent rounds were distributed in May and June 2021 respectively, and comprised the clinical skills for which consensus had not been achieved previously. A 9-point Likert scale was used (ranging from 1=limited importance to 9=critical). The response rate and distribution of scores for each clinical skill were calculated after each round. A clinical skill was included in the core set if 80% or more of participants scored between 7- 9, and 15% or less scored between 1-3.

Results
From 24 recruited participants (44.4%), 21 participants (87.5%) from 20 providers responded to Round 1 of the questionnaire, and also responded to the second and third rounds (100%). Following Round 1, seven clinical skills met the criteria for inclusion. Two additional clinical skills suggested by participants were added to the list of 11 clinical skills for which no consensus had been reached in the first round, hence, a total of 13 clinical skills were presented in Round 2. Two further skills were added to the core set following the second and third rounds respectively (four in total). The final core set consisted of 11 clinical skills: ‘Measuring heart rate (radial pulse)’, ‘Assessing respiratory rate’, ‘Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)’, ‘Measuring blood pressure (automated, i.e. electronic blood pressure monitor)’, ‘Measuring peripheral oxygen saturation (using pulse oximeter)’, ‘Measuring temperature’, ‘Undertaking a urinalysis’, ‘Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)’, ‘Measuring Peak Expiratory Flow Rate’, ‘Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)’, and ‘Patient assessment via National Early Warning Score (NEWS)’. No consensus was reached on nine clinical skills.

Conclusion
This study has produced a core set of clinical skills for prescribing PBPs. The study was entirely UK-based, thus findings may not be generalisable to other countries. Moreover, a lower threshold for consensus would have led to the inclusion of more skills. However, this core set can serve as a reference for other countries developing policies on pharmacist roles. Furthermore, this study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice.

References
(1) Girvin B, Wilson D. Clinical skills training for pharmacists in general practice. Prescriber. 2018 Dec 11; 29(12): 19-25.
(2) Girvin B, Akpan U, Hampson N, Middleton H, Sims L, Barry H. Establishing the roles undertaken and clinical skills needed by general practice-based pharmacists: a web-based survey. Pharm Educ. 2020 Sep 4; 20(1): 253.