野狼社区

An by researchers from University of 野狼社区 and ICF International provided lessons learned from the evaluation in terms of clinical governance, clinical supervision, skill mix, digital infrastructure and funding model.

Principal Investigator Dr Imelda McDermott said: 鈥淥ur evaluation shows how different independent prescribing models were expected to work (or not) and achieve their intended outcomes.鈥�

Under the NHS 10 year health plan, community pharmacies will become better integrated with primary care and general practice; pharmacists are becoming increasingly clinically qualified, many with the ability to prescribe.

In anticipation of the change , NHS England is running the Independent Prescribing in Community Pharmacy Pathfinder , which was evaluated by the researchers.

The programme allows community pharmacist prescribers in around 200 鈥榩athfinder鈥� sites to deliver prescribing models as part of integrated primary care clinical services.

Participating pharmacists reported significant increases in job satisfaction and many felt the programme "saved" them from leaving the sector by allowing them to use their full clinical skills.

The pathfinder sites tested three different clinical models to examine how pharmacist prescribing can be incorporated into community pharmacy clinical services:

• Existing services, including acute minor illnesses and contraception
• Long-term conditions, including prescribing for cardiovascular diseases (e.g. hypertension, lipid optimisation), respiratory diseases, and women's health.
• Novel services, including reducing over prescribing, reviewing antidepressants and menopause

For the Long-term condition models, a 鈥榡oint partner鈥� approach between the pharmacist prescriber and the local GP practice was fundamental, to ensure joined up collaboration for improved patient access and care.

However the implementation and long-term viability of an IP service were found to be dependent on five key areas as laid out by Stephen  , Minister of State for Care: clinical governance, clinical supervision, optimal skill mix, digital infrastructure and a financially viable funding model.

Integrated Care Boards (ICBs) -  the regional NHS organisation in England responsible for planning and funding local health services - were instrumental in guiding sites through assurance processes, developing clinical governance, and fostering stronger relationships between GPs, community pharmacy and other stakeholders.

However, securing clear indemnity to deliver pharmacist prescribing in community pharmacy was challenging due to insurance companies鈥� lack of familiarity with the new model.

Clinical supervision, something which is traditionally scarce in community pharmacy, was usually provided by a GP through regular one-to-one sessions and was highly valued by pharmacist prescribers as it helped to build their confidence and GP鈥檚 trust.

The researchers also found:

• Commissioning strategies were needed to generate predictable patient volumes to ensure a financially viable service
• Having read-only access to patients鈥� medications and limited details of their medical histories made holistic patient care more challenging. Those IP pharmacists who had read/write access to patient records found it easier to collaborate in a timely fashion with GPs and other GP practice based healthcare professionals.
• A good skill mix is needed across the wider pharmacy team to ensure pharmacist prescribers have the capacity to deliver the service.