Worldwide, the way in which healthcare is used and delivered is changing. Models of healthcare delivery in the UK have evolved since the establishment of the National Health Service (NHS) in 1948. The 2019 NHS Long-Term Plan delivered a new service model of delivering healthcare with Primary Care Networks (PCNs) being formed that were designed to be more collaborative in nature with more integration of primary health care professionals, including pharmacists. Given the overhaul in the model of service delivery, despite the increased funding of PCN pharmacists’ roles, there was still great uncertainty on how the role of the pharmacist would be defined and how pharmacists would interact with other healthcare professionals in the PCN. In order to demonstrate that pharmacists add value in achieving targets and outcomes in the integrated structures they work in, the role of the pharmacist and factors which affect their integration into these roles need to be evaluated and developed further. This project aimed to understand the roles, scope, and professional relationships of pharmacists working in Primary Care Networks (PCNs) to identify the factors that are necessary to address in order to successfully integrate pharmacists into PCNs in England. A pragmatic approach was adopted to develop the aims of the overall study. First, a systematic review to synthesise the existing evidence on perceptions on the role and integration of pharmacists in general practice was undertaken. Then, qualitative, in-depth semi-structured interviews were conducted with pharmacists, general practitioners (GPs), and nurses working in PCN teams to explore factors affecting the integration of pharmacists into PCNs. The systematic literature review aimed to synthesise the evidence of primary care stakeholders on the perceptions of the role and integration of pharmacists into general practice in the United Kingdom and to inform the research method and topic guide. A qualitative research design was employed in this study with a constructivist stance. Assumptions were made that there was more than one reality in the context of different healthcare professionals because it is subjective to their own backgrounds and beliefs. The most widely used one-on-one in-depth interviews method was used to gather precise qualitative data in this study. These interviews allowed the perceptions and experiences of the study participants to be explored in detail, potentially without the scrutiny or judgement of other healthcare professionals that were part of the professional team. They also allowed in-depth questions to be asked in the context of the healthcare professional being interviewed. Inductive thematic analysis was the analysis method of choice for the qualitative studies presented in this thesis, with its flexibility and adaptability in identifying themes and patterns from the data without any theoretical underpinning. Participants (21 PCN pharmacists, 11 GPs, and 9 nurses) from 32 PCNs and 15 regions of England took part in this study. Nine main themes emerged from qualitative interviews with PCN pharmacists. These main themes were: reflections on PCN pharmacist role development, perceptions on the current role of pharmacists in the PCN, impact of pharmacists working in PCNs, impact of the pandemic on PCN pharmacist work, training and development of pharmacists in PCNs, planning medication reviews, perceptions on working within the PCN team, factors affecting the integration of pharmacists into PCNs and future directions of pharmacists working in PCNs. From qualitative interviews with GPs and nurses, seven main themes were emerged. These main themes were: reflections on PCN Pharmacist role development, perceptions on the current role of pharmacists in the PCN, impact of pharmacists working in PCNs, perceptions on working with PCN pharmacists, factors affecting the integration of pharmacists into PCNs, impact of the pandemic on PCN pharmacist work and future directions of pharmacists working in PCNs. This thesis highlighted the current and expanding roles of pharmacists in PCNs, such as in chronic disease management, medicines reviews, and medicines optimisation. The findings also described factors affecting the integration of pharmacists into their roles, such as role definition, value, and long-term development. Although this research shows that pharmacists have a role to play in fulfilling the intentions of the NHS Long Term Plan, further research is needed to ensure PCN pharmacists’ roles add value, are cost-effective, and are sustainable.
|Date of Award
|25 Apr 2023
|Shahzad Hasan (Main Supervisor), Alison Astles (Co-Supervisor) & Zaheer Babar (Co-Supervisor)