Non-medical prescribing - successful models in community pharmacy

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Abstract

AbstractNon-medical prescribing (NMP) – successful models in community pharmacyMaster of Philosophy, University of ManchesterLouise Clare Cope September 2013Despite the introduction of NMP for pharmacists in 2003, uptake amongst pharmacists delivering NMP services from community pharmacies has been poor. This failure has previously been accounted for by a number of perceived barriers. Across the UK however, some pharmacists have overcome these barriers and deliver successful NMP services from a community pharmacy. This study aimed to identify the likely predictors of successful NMP in a community pharmacy setting, what barriers were required to be overcome and how these were overcome in order to achieve success. MethodEighteen pharmacists were recruited via the Royal Pharmaceutical Society NMP forum, Centres for Pharmacy Postgraduate Education (England and Wales), NHS Education for Scotland and NHS NMP leads across England. Participants were also identified from case studies in pharmaceutical literature and snowballing. Semi-structured telephone interviews were carried out with 18 participants. From these, a purposive sample of 14 pharmacists was selected. Eleven were subsequently invited to participate in further face-to-face interviews, by which stage the researcher decided that data saturation had been reached. Interviews were audio-recorded and transcribed verbatim. Thematic analysis of the data was undertaken using Nvivo software. OutcomesAll participants were strongly motivated and innovative, offering their rationales for starting their NMP services as increased job satisfaction and clinical role, identification of local need, professional development and business opportunities. Pharmacists in England and Wales, where central funding was not available, described accessing funding as being a key issue. Pharmacists in Scotland, where central funding was available, cited continuity of funding as being of greater importance. The type of funding model utilised appeared to impact on the area of prescribing. All centrally funded NMP services in Scotland and two in England, supported long-term conditions and areas of public health. Whereas the remainder of the NMP services in England and Wales based on private funding models, prescribed for innovative niche areas such as acute conditions, travel prophylaxis and influenza vaccination. In turn, the therapeutic area prescribed for appeared to be interrelated with the pharmacist prescriber’s ability and need to access patient records. Interviewees delivering a NMP service for long-term conditions all accessed patient records pre and post consultation, whilst those prescribing for non-long-term-conditions did not consistently do so. Differing degrees of collaboration were seen between the pharmacists and local health professionals. The extent of communication between the pharmacist prescriber and the patient’s GP was strongly related to the degree of collaboration between the two. A ‘good relationship’ with the local GPs was deemed essential for success by the majority of the pharmacists.ConclusionsThis study has provided insights into how barriers can be overcome in order to deliver a successful NMP service within a community pharmacy setting. Likely predictors of success have been identified as: strong pharmacist motivation, a high degree of collaboration and a ‘good relationship’ with local healthcare professionals.

Keyword(s)

'community pharmacist prescribing'; 'non medical prescribing'; 'non-medical prescribing'; 'pharmacist prescribing'

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