Community pharmacist consultation service: survey insights into impact of learning on practice, and barriers and enablers to service implementation
Authors: Schafheutle E , Seston E M , Anoliefo C J , Asrat H , Guo J , Lane J , Okoro Aroh C , White S 
Published: November 2022

Abstract

Introduction
Some patients attend NHS services with ‘clinically divertible’ urgent low acuity conditions. The NHS Community Pharmacist Consultation Service (CPCS) enables the referral of such patients and subsequent consultation with a community pharmacist. The Centre for Pharmacy Postgraduate Education (CPPE) offered a learning programme to prepare pharmacists for a more clinical and person-centred approach when delivering the CPCS.

Aim
To investigate the impact of the CPPE CPCS learning programme on learnt skills and their application in practice, and barriers and enablers to CPCS delivery.

Methods
A survey was designed to explored participants’ knowledge, confidence and application of taught skills/tools, including clinical history-taking, clinical assessment, record-keeping, Calgary-Cambridge, L(ICE)F (lifestyle, ideas, concerns, expectations, feelings) and SBARD (situation, background, assessment, recommendation, decision) communication tools. Statements on barriers and enablers to CPCS delivery were included. In November/December 2021, CPPE emailed an online survey (one reminder) to CPCS learners who had agreed to be contacted (n=2836). The University of Manchester’s Research Ethics Committee decision tool confirmed that ethics committee approval was not required for this study.

Results
One-hundred and fifty-nine pharmacists responded (5.6%). Sixty percent were female, all ages were represented, the most populous groups being 55-64 (33.3%) and 45-54 years (27.7%). Ethnicity was broadly representative of community pharmacists: 49.0% white, 38.9% Asian, 8.2% black, and 1.9% Arab. Sixty-eight (43%) of respondents were working in a large multiple community pharmacy, 33.3% (n=53) in an independent pharmacy, and 17.0% (n=27) in a small to medium pharmacy multiple. Knowledge of, and confidence in, taught skills were high and respondents reported applying skills in CPCS consultations and wider practice. There was strong positive correlation between the perceived levels of competence and confidence when delivering CPCS (r=0.966, p=&lt;0.001). The level of competence (r=0.259, p=0.003) and confidence increased (r=0.264, p=0.002) with an increasing number of NHS111 referrals. With regards to specific skills learnt, the highest levels of knowledge were recorded for ‘taking a clinical history’ (86% agreement), ‘clinically assessing a patient’ (84%), ‘using L(ICE)F’ (84%), and ‘completing an accurate and concise clinical record’ (81%). Seventy-three percent of respondents agreed they knew how to use the Calgary Cambridge, whilst only 49% knew how to use SBARD. Barriers to CPCS included lack of GP referrals, staffing levels, workload, and GP attitudes. Enablers included a clear understanding of what was expected, minimal concerns over indemnity cover and privacy, and positive patient attitudes towards pharmacy. Those working in independent pharmacies were more likely than those in multiple pharmacies to report that they were receiving GP referrals (68.5% vs. 49.0%, X2=5.249, p=0.022), that they had enough staff to provide the CPCS (45.3% vs. 26.3%, X2=5.526, p=0.019), and that the local GP considers community pharmacy to be an integral part of the primary healthcare team (54.7% vs. 37.2%, X2=4.214, p=0.040). Employed pharmacists were more likely than locums to report that they had a good relationship with their local general practice (57.5% vs. 37.5%, X2=5.436, p=0.020).

Discussion/Conclusion
This study demonstrates that CPPE learning contributed to community pharmacists’ extended knowledge and skills in CPCS delivery, which contributes to enhanced provision of urgent care in England. This study identified barriers, both interpersonal and infrastructural, that may hinder service implementation.