Using the theoretical domains framework to explore stakeholder perspectives of a “prescriber-ready pharmacist” to help develop the future workforce
Authors: Fawkes M , Mullen R , Cutler S 
Published: November 2022

Abstract

Introduction
The General Pharmaceutical Council’s (GPhC’s) revised standards for the Initial Education and Training of Pharmacists, enable pharmacists to prescribe on registration”.1 This major reform is transforming the education and training of ‘day-one pharmacist prescribers’ allowing them to play a greater role in patient care.

Aim
To explore stakeholder perspectives on a “prescriber-ready pharmacist” to help inform the initial education and training of the future pharmacy workforce.

Methods
Structured interviews with a diverse group of stakeholders, and an interview and focus groups with pharmacy students, took place in Autumn 2021. The schedule was developed using the Theoretical Domains Framework (TDF).2. Participants were identified and recruited via email by the investigators, who had legitimate access to their contact details. All were held and recorded on Microsoft Teams, then transcribed and analysed using Framework Method.3 Ethical approval from LJMU, School of Pharmacy, REC (PBS/2021-22/01).

Results
The study included 50 participants; interviews with six patients, eight community pharmacists (two independent prescribers (IPs)), 10 hospital pharmacists (six IPs), 12 primary care pharmacists (eight IPs), two nurses (one IP), five GPs, and one second year pharmacy student; and two focus groups, with three, final-year pharmacy students. Participants felt person-centred care, communication and consultation skills were very important for ‘day-one pharmacist prescribers’. Professional knowledge and clinical skills e.g., “interpretation of diagnostic tests” [Hospital Pharmacist_04], were cited by hospital and primary care pharmacists. Conversely, professionalism were more likely to be mentioned by community pharmacists, “General knowledge about legalities of prescribing” [Community Pharmacist_07] and understanding their limitations. Many felt the pharmacy degree needed to become more clinical with additional placement opportunities, which would be challenging in terms of time constraints and staff capacity “… have to provide training for a large number of students that [they] haven't had to train in that way before” [Primary Care Pharmacist_05]. Barriers to ‘day one’ pharmacists prescribing included a lack of experience and confidence and pharmacist respondents felt it was important for them to gain the trust of other health care professionals. Barriers specifically for community pharmacy were: a perceived lack of support and commercial pressures, along with logistical barriers including lack of space, equipment, IT issues and pharmacists sitting outside of the ‘parent team’ in hospitals.

Discussion/Conclusion
Hospital and primary care pharmacists in the study were more likely to mention professional knowledge and skills, for example clinical and diagnostic skills. This may be explained because many were qualified independent prescribers and so have a better understanding of the knowledge and skills to perform the role. The additional challenges faced by community pharmacy presented may be because of a lack of defined roles for independent prescribers working within this setting. A limitation of the study is a lack of stakeholder representation from medics and other health care professionals in secondary care. ‘Prescriber-ready pharmacists’ require appropriate professional knowledge and skills, and provide a person-centred service within their sphere of competence. Stakeholders need assurance that these pharmacists are competent as independent prescribers at the point of registration before, through changes to the undergraduate programme, in particular placement opportunities.

References
1. General Pharmaceutical Council. New standards for initial education and training of pharmacists approved [Internet]. London. [Updated 2020 December 11; Cited 2022 July 25]. Available from: https://www.pharmacyregulation.org/news/new-standards-initial-education-and-training-pharmacists-approved#:~:text=The%20GPhC%20Council%20has%20approved%20new%20standards%20for,public%20from%20their%20first%20day%20on%20the%20register
2. Gale, N.K., Heath, G., Cameron, E. et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol13, 117 (2013). https://doi.org/10.1186/1471-2288-13-117
3. Atkins, L., Francis, J., Islam, R. et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Sci 2017;12:77. https://doi.org/10.1186/s13012-017-0605-9