General practice pharmacists in England: Integration, mediation and professional dynamics.

Background: A number of key publications in recent years have advocated a more integrated vision of UK primary care involving increased multi-professional communication and understanding. This has resulted in a marked change in the roles being undertaken by pharmacists. Community pharmacists have traditionally provided a medicine supply function and treated minor ailments in addition to delivering a suite of locally commissioned services; however these functions have not necessarily been part of a programme of care involving the other clinicians associated with the patient. An integrated model of care would see much closer working between pharmacy and general practice but also with pharmacists not only working with, but in the practice, in an enhanced patient-facing role, trained as independent prescribers. This has implications for the dynamics amongst professionals in this environment. Objectives: This exploratory multiple case study attempts to explore these changing dynamics across ten GP surgeries throughout the South-East of England. Methods: Semi-structured, in-depth interviews were conducted with one nurse, one pharmacist and one physician from each clinic, and survey data was collected from 38 patients who had appointments with a pharmacist. Results: The data suggested that the pharmacists who had enhanced roles perceived some uncertainty about their professional role and identity, which resulted in instability and insecurity and that this uncertainty led to both professional and interprofessional tension with their primary care colleagues. The survey data revealed that n=35 (92%) patients stated they were 'very satisfied' or 'satisfied' with their appointment. And n=37 (97%) were 'very comfortable' or 'comfortable' discussing their medications with the pharmacist. In addition, 36 patients (95%) reported that they strongly agreed or agreed with the clinical recommendations made by the pharmacist. Conclusions: These findings are discussed in relation to role expansion and professional/interprofessional relations before key practical suggestions are offered.