The role of independent pharmacist prescribers in primary care settings in Wales: a mixed-methods evaluation

Abstract

In Wales, the role of independent prescribing pharmacists (IPPs) has developed over time, particularly since 2015, when the Welsh Government implemented its primary care plan and primary care clusters. The aim of this PhD was to explore the development of the role of IPPs within the primary care setting with a focus on the role of IPPs in general practitioner (GP) practices and community pharmacies. The study adopted a mixed-methods approach in which a quantitative stage involved analysis of prescribing data related to IPPs and other nonmedical prescribers, and the qualitative studies utilised semi-structured interviews with IPPs in GP practices and community pharmacies, and community pharmacy leads in different Health Boards (HBs) in Wales. The findings show that the number of non-medical independent prescribers and the volume of prescribing in GP practices in Wales increased over the study period, particularly since the implementation of primary care clusters. Thematic analysis of the interviews revealed that this increase, as perceived by participants, may have helped reduce the pressure on GPs, enhanced IPPs’ skill sets across various therapeutic areas, and increased their job satisfaction and motivation. Moreover, the role of IPPs in community pharmacies was more related to acute conditions, whereas their involvement with chronic conditions was more evident in GP practices. Some challenges to the role of IPPs were identified in this study, such as the lack of funding and support, the lack of access to GP records in community pharmacies, unclear indemnity insurance in GP practices, an unclear strategy and plan to develop the role, and a high workload. However, most of these challenges were resolved over time with the progression of the role, except for the high workload issue that needs more support. Some of the enablers for their roles were the Welsh Pharmaceutical Committee’s (2030) vision, which included a strategy to increase the number of IPPs in community pharmacies, and support from other healthcare professionals, GP practices, and HBs in Wales. The vision and the new Pharmacy Workforce Plan published by Health Education and Improvement Wales (HEIW) may help develop the role of IPPs and allow them to use their skills more effectively. This eventually may help in improving patient care and relieving the increased pressure on primary care settings. However, these plans need to be monitored to ensure the successful development of this role and its effective integration into the future healthcare service and workforce in Wales. Future research should focus on further understanding the prescribing patterns of IPPs in both GP practices and community pharmacies in Wales, patients’ satisfaction with the role of IPPs in these areas, clinical outcomes of patients managed by IPPs, and different stakeholders' and other healthcare professionals’ views on the role.