Comparison with literature
Demographic data of GPPs in this study related to age and gender were comparable with the demographic data of other published studies conducted on the same topic in the UK or elsewhere [9, 16, 19, 20]. These data were also consistent with the publicly available data relating to GPPs in NI at the time of this study, as most participants were female and were younger than 40 years of age [15].
Most GPPs were qualified to practise as independent prescribers, with over half using the independent prescriber qualification. This is consistent with previous research in NI and other parts of the UK [9, 14, 16, 20]. The Pharmacy Workforce Review in NI found that over 600 pharmacists were independent prescribers in 2020, with the majority working in secondary care [15]. However, this figure may change as the role of GPPs becomes established in primary care and pharmacist prescribing becomes a key activity [15]. The GPP prescribing role in general practice would appear to be limited at present, with some participants reporting that they were not currently prescribing for patients despite being qualified as independent prescribers. In this situation, GPPs are unable to make any modifications related to prescribing and need to see a GP for advice [26]. Published research has indicated that barriers to pharmacist prescribing include inadequate training on specific knowledge and skills, insufficient assistance from authorities and stakeholders, and a lack of funding or reimbursement [27]. Additionally, the results from this study indicated that there was no association between working arrangements of the GPP (number of practices in which the GPP was working, and number of sessions worked per week) and the prescribing status of the GPP (if the GPP had an independent prescribing qualification or not and if the GPP was currently using the qualification or not). There may be other reasons that are more important than working arrangements that affect whether GPPs prescribe, and such data may not have been collected in this study, e.g. attitudes of GPPs to non-medical prescribing [27].
Over half of the GPP participants worked in multiple general practices. This reflects GP responses (38.7%) in a study in NI where they indicated that occasionally GPPs were not available in the general practice when they were required [14]. This has also been reported by patients stating that the GPP may not be in the general practice when they needed them [28]. Additionally, prior research has found that the restricted amount of time that GPPs dedicate to their practice, primarily due to working part-time, can hinder their integration, availability, and impact in general practice [16, 29, 30]. This finding emphasises how crucial it is for the general practice to have a full-time GPP [14].
More than half of GPPs reported that they ‘always’ or ‘frequently’ had a consulting room available for them to use. This is positive as unavailability of designated workplaces has been noted as a barrier to GPP integration in general practice [20, 30]. Most GPPs in this study had previous experience of working in community pharmacy. Similar results of GPPs’ previous work experience were also highlighted in other research studies conducted in the UK [9, 20]. The Pharmacy Workforce Review indicated that over the period from 2009 to 2020 the need for more pharmacists’ posts had grown in NI in both primary and secondary care [15]. This occurred because of new roles being established in general practice and hospitals implementing seven-day working each week [15]. Many of these new roles have been filled by community pharmacists, which reflects the previous working experience of GPP participants in this study [15].
Almost all GPPs performed patient-level activities, such as medication reviews and reconciliation. These are two essential activities carried out by GPPs in England, Scotland, and NI, based on findings from the literature [14, 16, 20]. By offering these two activities, medication errors—such as duplicate doses, dosage issues, or drug interactions—and inappropriate prescribing can be reduced [31]. Most participants indicated that activities such as these had been determined through mutual agreement between the GPP and GP, which aligns with the findings of the earlier GP study conducted in NI [14].
This study found that over 80% of GPPs reported face-to-face contact as the most common method of communication with GPs. This finding was similarly documented in a prior study conducted in NI, when all GP participants engaged in face-to-face meetings with GPPs [14]. This contrasts with an Australian study where GPPs mainly contacted GPs via telephone [19]. Face-to-face contact facilitates direct communication between GPPs and GPs, which is essential for managing a multidisciplinary approach to healthcare in primary care contexts [32]. Common issues discussed during GPP-GP meetings included medicines interactions, side effects, contraindications, starting new medicines, patients with comorbidities, audit results, and workload within the practice; these had been noted in previous research suggesting that they are the most important issues [14]. The main form of contact between GPPs and community pharmacists was via the telephone, with issues such as medicine alternatives, prescription queries from the practice, cost-effective choices, nursing home queries, and stock of specific items. These findings support previous research that found similar issues were often discussed during such contacts [33].
Most GPPs demonstrated positive attitudes towards collaboration with GPs, agreeing or strongly agreeing with all the ATCI-P statements. Statistical analysis showed that compared to GPPs who worked in a single practice, those who worked across many practices were more likely to agree or strongly agree with most of the ATCI-P statements. These results may indicate that GPPs who work in several practices are more adept at fostering relationships across various practices [20]. Additionally, these results corroborate those of a cross-sectional questionnaire study conducted in NI, which found that GPs' attitudes towards working with GPPs were generally positive [14]. This latter study also used the Attitudes Towards Collaboration Instrument for GPs (ATCI-GP) to measure GPs' attitudes towards collaboration with GPPs [14]. A survey study which assessed collaboration and team effectiveness of GPPs based on four components [professional interactions, relationship initiation, exchange characteristics (trust and role clarity), and commitment to collaboration] showed that GPPs’ collaboration and team effectiveness scores from the survey were high overall [34]. The authors of this survey study proposed that long-term employment and long working hours in general practice may promote interprofessional collaboration and team effectiveness through gradual improvement of trust and working relationships between GPPs and other HCPs [34]. Based on the findings of this present study on the working arrangements of GPPs and ATCI-P responses (i.e. most GPPs work in more than one general practice), it seems that GPPs working in several general practices may enhance their relationships with other HCPs in those practices, including GPs [20]. Nevertheless, it is still essential to have a dedicated full-time GPP in every general practice to promote GPP integration, availability, interprofessional collaboration with HCPs and impact within the general practice [14, 16, 34].
The study found that telephone contact was the most common and preferred method of communication between GPs and patients in general practice. This is consistent with previous research in NI, where GPs' responses indicated that using the telephone was the most common and preferred method of contact with patients [14]. Furthermore, based on the GPPs’ response in the present study, just over one-third of GPPs thought that patients were aware of their role, which may explain why patients sometimes hesitate to accept and schedule appointments with the GPPs [14, 20]. However, most participants agreed that the professional activities of GPPs were valued by patients, which is consistent with literature reporting patients’ high levels of satisfaction with the quality of care received from GPPs [35, 36, 37].
The majority of GPPs agreed that the GPP role had a positive impact on patient outcomes and alleviated work pressure within primary care. This could be as a result of the GPP’s ability to prescribe medicines for patients as shown in the results of this study. The advantages of allowing GPPs to prescribe have been noted before [38, 39], including better use of GPP skills and expertise and improving patient care [38, 39]. Additionally, work pressure in primary care has been alleviated by GPPs and nurses managing conditions that need long-term care which allows the GPs to focus on conditions of acute care [40].
Free text responses emphasised the potential benefits that GPPs could have for GPs and general practice. Analysis of these comments also indicated the need for more GPP patient-facing activities, training tailored to GPPs, promotion of the role to patients, better salaries, mentor support, more GPP sessions, more full-time positions, and changes to GPP employment procedures. Prior research also identified a number of these needs, highlighting how critical it is to address these issues [14].