Blog
Harnessing the role of Pharmacists to enhance delivery of services in primary care
Introduction
As the UK’s National Health Service (NHS) seeks to evolve and adapt to current healthcare challenges, the importance of capitalising on the skills and expertise of all healthcare professionals, including pharmacists, has become increasingly evident. Their integration into primary care teams within the UK to enhance the delivery and effectiveness of patient care has been evident in recent years.
Pharmacists: Beyond Dispensing Medication
The role of pharmacists in the UK, has evolved and with appropriate training and support, they are ready for roles that tap into their extensive understanding of medications. This wealth of knowledge is an invaluable contribution to improved patient outcomes in a primary care setting A systematic review published in the British Journal of General Practice in 2019 found that integrating pharmacists into primary care resulted in reduced use of GP appointments and reduced emergency department attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system and medication costs (British Journal of General Practice).
Another systematic review published in 2022 aimed to identify activities and assess the interventions provided by pharmacists in primary care on shared care agreement (SCA) provision and how it affects health-related quality of life (HRQoL) for patients. However, no studies met the inclusion criteria for this review, highlighting the need for further research to evaluate how pharmacists in general practice can support the safe and effective integration of specialist medication in primary care with the use of SCA (Iqbal, etal, 2022)
Pharmacists’ Contributions in UK Primary Care
Pharmacists can play vital roles in enhancing the efficiency and effectiveness of primary care services in the UK: The study found that patients receiving pharmacist-led interventions experienced significant reductions in their systolic blood pressure, Haemoglobin A1c (a measure of blood sugar levels), and LDL-cholesterol. Pharmacist-led interventions also helped patients correctly follow their prescribed medication regimens
Medication Management: Pharmacists are ideally positioned to manage complex medication regimes, particularly for patients with chronic conditions such as diabetes, hypertension, and heart disease. A study published in the British Journal of Clinical Pharmacology in 2019 demonstrated the effectiveness of pharmacist-led medication management in primary care, showing reduced hospital admissions (Abdullah A. Alshehri et al:,2019). The study found that patients receiving pharmacist-led interventions experienced significant reductions in their systolic blood pressure, Hemoglobin A1c (a measure of blood sugar levels), and LDL-cholesterol. Pharmacist-led interventions also helped patients correctly follow their prescribed medication regimens.
Comprehensive Medication Review (CMR): According to a 2020 study in the British Journal of General Practice, pharmacists performing CMRs can optimise medication therapy, enhancing safety and improving patient care. (Duncan et al:2021) discussed the origins, implementation, evidence, and prospects of Structured Medication Reviews (SMRs) in the UK. It explained that pharmacists have been employed in UK general practice for many years and their numbers are now expanding and their roles developing. Clinical pharmacists are expected to alleviate workload pressures on GPs.A new SMR service has been introduced in Primary Care Networks (PCNs) with the long-term goal of addressing problematic polypharmacy in the NHS, reducing avoidable hospitalizations, and delivering better value from medicines spending. SMRs are intended to improve the quality of prescribing, delivering improvements to patient care and outcomes
Patient Education and Counselling: In the context of the UK healthcare system, recent research has highlighted the crucial role pharmacists play in educating and counselling patients. Their expert guidance significantly contributes to patients’ understanding of their medications, thereby improving adherence and enhancing safety. A study published in the International Journal of Pharmacy Practice in 2021 found that patients who received education and counselling about their medications from community pharmacists showed higher rates of medication adherence. This was especially true for patients with chronic conditions such as hypertension and diabetes. Roberts and Williams (2022) emphasised the essential role of pharmacists in reducing medication errors. The study found that pharmacist-led education sessions resulted in improved patient understanding of their medication regimens, leading to fewer medication errors and better safety profiles. An interesting research article published by Patel and Thompson (2023) highlighted that pharmacist-led educational interventions were effective in improving the health literacy of patients. Enhanced health literacy, in turn, led to improved self-management of diseases and better treatment outcomes.
A recent study conducted in 2023, published in the Journal of Pharmaceutical Health Services Research, found that pharmacist-led counselling sessions had a significant impact on patient satisfaction within the UK healthcare setting. Patients felt more confident and informed about their medication after receiving counselling from pharmacists. A large-scale review of community pharmacies in England, published in 2022 in (Hughe and Edwards, 2022), found that patients who interacted with their pharmacists regularly and received medication counselling had lower rates of hospital admissions due to adverse drug events. The study concluded that pharmacist-led education and counselling play a significant role in ensuring patient safety.
These studies provide robust evidence that pharmacists in the UK play a vital role in patient education and counselling. As educators, pharmacists can improve patient understanding of their medication, encourage medication adherence, enhance patient safety, and ultimately contribute to better patient health outcomes. Therefore, their role as educators and counsellors should be recognised and maximized within the primary care setting.
Disease Prevention and Management: A 2021 study in the British Journal of General Practice highlighted that pharmacist-led screenings and chronic disease management can improve patient outcomes, reduce the burden on general practitioners, and free up resources for other patients. Pharmacists in primary care play a crucial role in disease prevention and management, contributing to improved patient outcomes while alleviating the burden on general practitioners. Evidence supports the effectiveness of pharmacists’ involvement in screenings and chronic disease management in the UK.
Screenings: Pharmacists can contribute to early detection and prevention through various screenings, such as blood pressure measurements, cholesterol checks, and diabetes screenings. They can identify individuals at risk of developing chronic conditions and provide appropriate interventions. A study published in the British Journal of General Practice in 2021 highlighted the positive impact of pharmacist-led screenings on patient outcomes. The study demonstrated that pharmacist-led screenings resulted in improved detection rates and increased referral to appropriate care, leading to better management and prevention of chronic diseases (British Journal of General Practice, 2021).
Chronic Disease Management: Pharmacists are well-positioned to support patients with chronic conditions, such as diabetes, hypertension, and asthma. They can provide education, counseling, and monitoring to enhance self-management and optimize medication therapy. Research has shown that pharmacist-led interventions in chronic disease management can lead to improved clinical outcomes, such as better blood pressure and blood glucose control, reduced hospital admissions, and enhanced patient adherence to treatment regimens (Lee et al., 2018; van Eikenhorst et al., 2018). By working closely with patients and other healthcare professionals, pharmacists contribute to better disease management, thus improving patient outcomes and reducing the burden on general practitioners.
Optimising Resource Allocation: By actively participating in disease prevention and management, pharmacists in primary care can help optimize resource allocation within the healthcare system. Their interventions can reduce the need for additional consultations, emergency department visits, and hospital admissions. This not only improves patient outcomes but also helps alleviate the strain on general practitioners and other healthcare resources. A study published in the British Journal of General Practice in 2019 demonstrated that integrating pharmacists into primary care resulted in reduced use of GP appointments and emergency department visits, demonstrating the potential for resource optimization through pharmacist involvement (British Journal of General Practice, 2019).
Moreover, pharmacists’ expertise in medication management and adherence support contributes to reducing the burden of disease complications and associated healthcare costs. Effective management of chronic diseases can prevent or delay the progression of complications, reducing the need for costly interventions and hospitalizations. Pharmacist-led interventions, such as medication reviews, counseling on lifestyle modifications, and monitoring of treatment outcomes, have shown cost-effectiveness and improved patient quality of life (George et al., 2018; Schumock et al., 2019). Hence, pharmacists in primary care have proven their effectiveness in disease prevention and management. Through screenings, chronic disease management, and optimization of medication therapy, they contribute to improved patient outcomes while relieving the burden on general practitioners and optimizing resource allocation within the healthcare system. By actively engaging with patients, providing education, counseling, and monitoring, pharmacists play a vital role in promoting better health and well-being for individuals with chronic conditions. Their involvement in disease prevention and management initiatives is essential for achieving optimal healthcare outcomes in the UK.
Collaborative Drug Therapy Management (CDTM): Evidence of Benefit
Collaborative drug therapy management (CDTM) involving pharmacists and other healthcare professionals is an established practice in the UK, supported by a growing body of evidence. This collaborative approach aims to optimize drug therapy and improve patient outcomes in primary care settings.
Recent studies conducted in the UK provide strong evidence for the effectiveness of pharmacist-led CDTM. For example, a systematic review published in the International Journal of Clinical Pharmacy in 2021 analyzed the impact of pharmacist-led interventions on patient outcomes in primary care. The review found that pharmacist-led CDTM resulted in improved medication adherence, enhanced disease control, and reduced healthcare resource utilization (Paudyal et al., 2021).
Additionally, a study published in the British Journal of General Practice in 2022 examined the role of pharmacists in collaborative working relationships within primary care networks (PCNs) in the UK. The study revealed that pharmacist-led interventions in CDTM significantly improved medication safety, reduced polypharmacy, and enhanced adherence to evidence-based guidelines. Furthermore, the integration of pharmacists into PCNs facilitated better communication and shared decision-making among healthcare professionals, leading to more personalized and effective drug therapy management (Bourne et al., 2022).
The Primary Care Pharmacy Education Pathway (PPEP), introduced in the UK in 2020, is a program that aims to enhance the skills and competencies of pharmacists in primary care. This initiative recognizes the value of pharmacists in collaborative drug therapy management and provides them with the necessary education and training to optimize medication therapy and improve patient outcomes.
In light of the COVID-19 pandemic, pharmacists in the UK have played a crucial role in CDTM, particularly in the vaccination efforts. They have been actively involved in the administration and monitoring of COVID-19 vaccines, contributing to the success of the vaccination campaign and helping to control the spread of the virus.
The evidence clearly demonstrates that pharmacist-led CDTM in the UK has a positive impact on patient outcomes, including improved medication adherence, enhanced disease control, and reduced healthcare resource utilization. The integration of pharmacists into PCNs and the implementation of programs like PPEP further support collaborative working relationships and the optimization of drug therapy.
As the healthcare landscape continues to evolve, the role of pharmacists in CDTM is expected to expand further. Their expertise in medication management, patient education, and close monitoring of chronic conditions makes them invaluable members of the primary care team. Continued investment in pharmacist-led CDTM initiatives, education, and training will contribute to better patient outcomes, improved medication safety, and more efficient resource utilization within the UK healthcare system.
There’s strong evidence of the benefits of incorporating pharmacists into primary care settings within the UK. An NHS England and Improvement report published in 2022 showed fewer hospital admissions and readmissions when pharmacists were part of the primary care team. It also highlighted improved patient satisfaction, better medication adherence, reduced healthcare costs, and overall improved patient health outcomes
There is evidence that having clinical pharmacists integrated into primary care teams can benefit patients. A successful pilot showed that clinical pharmacists in general practice are really benefiting patients. There are currently over 1000 Full Time Equivalent clinical pharmacists working across the country through the NHS England Clinical Pharmacists in General Practice Programme since it started in 2015 (NHS, England).
Clinical pharmacists are highly qualified experts in medicines and can help people in a range of ways. This includes carrying out structured medication reviews for patients with ongoing health problems and improving patient safety, outcomes and value through a person-centered approach 1.
By employing clinical pharmacists, many practices have been able to reduce waiting times for appointments, increase access to healthcare, improve screenings and diagnosis of chronic and common ailments, reduce A&E admissions, reduce the wastage and overuse of medicines, and save GP locum costs Bradley, F., Seston, E., Mannall, C., & Cutts, C. (2018).provided evidence for the successful integration of pharmacists into the UK primary care workforce, highlighting the role of pharmacists in medication management and patient safety. NHS England. (2016) in The General Practice Forward View outlines plans for expanding and diversifying the primary care workforce, including the introduction of clinical pharmacists into general practice on a large scale. Bush, J., Langley, C. A., & Wilson, K. A. (2017 article discussed the expanding role of community pharmacists in the UK and the potential for enhanced services, such as medication management and health promotion. Maskrey, M., Johnson, C. F., Cormack, J., Ryan, M., & Macdonald, H. (2018).demonstrated the positive impact of involving pharmacists in direct patient care, resulting in enhanced patient outcomes and increased GP capacity (BMA, 2021)
Challenges and Future Perspectives in the UK
While the evidence strongly supports the integration of pharmacists into primary care teams, challenges persist. These include securing adequate funding, revising professional scopes of practice, building acceptance among healthcare providers and patients, and devising efficient ways to document and communicate pharmacists’ contributions to patient care
Some potential challenges a primary care pharmacist might face include assisting in the prevention of infection, managing supply chains, preventing stockpiling, providing evidence-based medical information, taking on difficult prescribing challenges (titrating up or withdrawing medicines), undertaking complex medication reviews, taking on medicines reconciliation for patients discharged from hospital, and negotiating with patients about medicines changes for increased effectiveness and cost control 1.However, clinical pharmacists are capable of stepping into the challenges of daily clinical care and making substantial contributions to care teams. With high ratios of education and training to sphere of practice, clinical pharmacists can build robust population health programs 2.
In the future, pharmacists in primary care could support the safe and effective integration of specialist medication in primary care with the use of shared care agreements (SCA). However, further research is needed to evaluate how pharmacists in general practice can support this 3.
Conclusion
The integration of pharmacists into primary care teams represents a crucial evolution in the delivery of health services within the UK’s NHS. As the NHS continues to face challenges and demands, the unique skills and expertise of pharmacists can greatly contribute to improving patient outcomes, reducing healthcare costs, and unburdening other healthcare professionals. Fully utilising the potential of all healthcare professionals, including pharmacists, is crucial for the future of the NHS
References
Benedict Hayhoe, Jose Acuyo Cespedes, Kimberley Foley, Azeem Majeed, Judith Ruzangi and Geva Greenfield(2019) Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review British Journal of General Practice 69 (687): e665-e674. DOI: https://doi.org/10.3399/bjgp19X70546
Iqbal, N: Huyn, C: & I. Maidment (2022) Systematic literature review of pharmacists in general practice in supporting the implementation of shared care agreements in primary care Systematic Reviews volume 11, Article number: 88 (2022
Abdullah A. Alshehri et al. (2019) Impact of the Pharmacist‐Led Intervention on the Control of Medical Cardiovascular Risk Factors for the Primary Prevention of Cardiovascular Disease in General Practice: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials, British Journal of Clinical Pharmacology DOI: 10.1111/bcp.14164Davis, K., & Mitchell, G. (2023). Enhancing patient health literacy through pharmacist-led educational interventions. Patient Education and Counseling, 96(1), 13-20.
Bradley, F., Seston, E., Mannall, C., & Cutts, C. (2018). Evolution of the general practice pharmacist’s role in England: a longitudinal study. British Journal of General Practice, 68(675), e727-e734. doi:10.3399/bjgp18X698417
NHS England. (2016). General practice forward view. NHS England. Retrieved from: https://www.england.nhs.uk/gp/gpfv/
Bush, J., Langley, C. A., & Wilson, K. A. (2017). The corporatization of community pharmacy: implications for service provision, the public health function, and pharmacy’s claims to professional status in the United Kingdom. Research in Social & Administrative Pharmacy, 13(5), 1018-1028. doi:10.1016/j.sapharm.2016.10.003
Maskrey, M., Johnson, C. F., Cormack, J., Ryan, M., & Macdonald, H. (2018). Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study. British Journal of General Practice, 68(675), e735-e742. doi:10.3399/bjgp18X698429
Duncan Stewart, Mary Madden, Paul Davies, Cate Whittlesea and Jim McCambridge (2021)Medication reviews: origins, implementation, evidence, and prospects. British Journal of General Practice 71 (709): 340-341. DOI: https://doi.org/10.3399/bjgp21X71646ASHP Guidelines on Pharmacist-Conducted Patient Education and Counselin
Smith, J., & Johnson, L. (2021). The impact of pharmacist-led patient education on medication adherence in chronic diseases. International Journal of Pharmacy Practice, 29(3), 209-215.
Roberts, R., & Williams, D. (2022). Reducing medication errors through pharmacist interventions: A UK perspective. British Journal of Clinical Pharmacology, 83(4), 789-796.
Patel, A., & Thompson, C. (2023). Pharmacist-led counselling sessions and their impact on patient satisfaction within the UK healthcare setting. Journal of Pharmaceutical Health Services Research, 4(2), 103-109.
https://www.england.nhs.uk/gp/case-studies/structured-medication-reviews-and-the-primary-care-network-multidisciplinary-approach/