The much-anticipated pilot evaluation of Clinical Pharmacists in General Practice fuelled by the prospect of the first nationwide, 5-year study of the value of pharmacists working in general practice, sadly failed to deliver. The impact of the new scheme was expected to be measurable through routine collection and reporting of performance data submitted each month to NHS England, in order to evaluate the outcomes delivered by the significant investment of £31m which funded a total of 491 pharmacists.
It certainly came to some positive conclusions, ‘GPs believe the role to be sustainable’ and generated eye catching headlines such as the ‘Majority of GPs will employ ‘clinical pharmacists’ when funding ends’; but our in-depth review of the 190-page report has revealed this claim to be at best borne of misinterpretation from what could only have been a very superficial skim of the summary report, and at worst downright disingenuous. A more honest headline might have been ‘Three out of the four GPs that were asked (n=4) said that they would like to keep the CP that they have been working with’. You have read that right – the responses from only four doctors underpins that great claim. Why are the conclusions from such a wide-ranging evaluation only supported by anecdotal comments?
Poor quality data
When the researchers from the University of Nottingham started their task of evaluating the pilot, not only did they discover that the routine service data was of too ‘poor quality’ to be of any use, but that NHS England ‘were unable to provide the evaluation team with an up-to-date list of clinical pharmacists in post’. Original NHS data reported that there were 491 posts over 658 GP practices, however a subsequent survey by the evaluators could only find 379 posts.
Without any outcome data to analyse, the researchers were forced to employ a ‘mixed methods’ approach that relied solely on qualitative results from questionnaires (completed by 68% of the sites), three case studies, focus groups, and ‘in-depth’ interview work with only 16 people (4 of whom were GPs). The conclusions from the pilot evaluation are heavily reliant on subjective anecdotes.
Missed opportunities
Last year, Professor Anthony Avery, who is also a co-author of the pilot evaluation, commented that many GP practices would only be prepared to fund pharmacists ‘where they genuinely reduce GP workload’. The pilot and its subsequent evaluation could have been the opportunity to showcase the unique benefits of pharmacist input in reducing work load and improving safety.
Research recently published from Scotland has demonstrated pharmacists having a positive impact on releasing GP capacity. It is the first study of its kind to quantitatively link pharmacist input with freeing up GP time. This is a great achievement and this success is acknowledged, in part, to be attributable to ‘building on previous clinical experience and relationships’. Sadly, the NHS England pilot did not draw on existing expertise from established medicines management teams who might have been able to manage and monitor the posts more efficiently, and one is left wondering what the evaluation could have demonstrated had they done so.
Questions to answer
The poor quality of the data and inability of NHS England to account for all the pharmacists that they were funding, hints at a far more worrying issue of lack of oversight of the £31m project and accountability for it. There are many questions that could be posed to the team at NHS England around implementation of the pilot, but sadly whatever the answers, this was a missed opportunity for a national quantitative study on the value of GP pharmacists and has done a huge disservice to all those practising in the sector.
Positive development
It is encouraging to see that NHS England has recently revised criteria for the programme, reducing the population across which each pharmacist works to 1:15,000 and allowing pharmacists working a minimum of 0.5wte to apply. The change from a ratio of 1:15,000 to 1:30,000 following the pilot seemed inexplicable on all but financial grounds and was made before any meaningful evaluation of the pilot was possible. Expecting pharmacists to forge links and make a discernible impact across three or four new practices was never likely to achieve required outcomes, so it is good to see that common sense has prevailed in this regard at least.
References
- Clinical Pharmacists in General Practice: Pilot Scheme Evaluation – The University of Nottingham, available here.
- Lewis G. Majority of GPs will employ ‘clinical pharmacists’ when funding ends. Chemist and Druggist; 26/7/2018
- Avery A. Pharmacists working in General Practice, Editorial. Br J Gen Pract 2017
- Maskrey M, Johnson C, Cormack J, Ryan M, Macdonald H. Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study. Br J Gen Pract 2018