Background Few studies have evaluated roles of general practice-based pharmacists (PBPs), particularly in optimizing medicines management for older people with both multimorbidity and polypharmacy. Objective To explore the types and effectiveness of services provided by PBPs, either alone or in collaboration with other primary health care professionals, that sought to optimize medicines management for older people with multimorbidity and polypharmacy. Methods Eight electronic databases and three trial registries were searched for studies published in English until April 2020. Inclusion criteria were randomized controlled trials, non-randomized controlled trials and controlled before-and-after studies of services delivered by PBPs in primary care/general practice, for patients aged ≥65 years with both multimorbidity and polypharmacy that focused on a number of outcomes. The Cochrane risk of bias tool for randomized trials (RoB 1) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) assessment tool were used for quality assessment. A narrative synthesis was conducted due to study heterogeneity. Results Seven studies met inclusion criteria. All included studies employed PBP-led medication review accompanied by recommendations agreed and implemented by general practitioners. Other patient-level and practice-level interventions were described in one study. The limited available evidence suggested that PBPs, in collaboration with other practice team members, had mixed effects on outcomes focused on optimizing medicines management for older people. Most included studies were of poor quality and data to estimate the risk of bias were often missing. Conclusion Future high-quality studies are needed to test the effects of PBP interventions on a well-defined range of medicines management-related outcomes.

Background There is limited United Kingdom (UK) literature on general practice-based pharmacists’ (PBPs’) role evolution and few studies have explored general practitioners’ (GPs’) experiences on pharmacist integration into general practice. Therefore, this study aimed to investigate GPs’ experiences with, views of, and attitudes towards PBPs in Northern Ireland (NI). Methods A paper-based self-administered questionnaire comprising four sections was mailed in 2019 to 329 general practices across NI and was completed by one GP in every practice who had most contact with the PBP. Descriptive analyses were used and responses to open-ended questions were analysed thematically. Results The response rate was 61.7% (203/329). There was at least one PBP per general practice. All GPs had face-to-face meetings with PBPs, with three-quarters (78.7%, n = 159) meeting with the PBP more than once a week. Approximately two-thirds of GPs (62.4%, n = 126) reported that PBPs were qualified as independent prescribers, and 76.2% of these (n = 96/126) indicated that prescribers were currently prescribing for patients. The majority of GPs reported that PBPs always/very often had the required clinical skills (83.6%, n = 162) and knowledge (87.0%, n = 167) to provide safe and effective care for patients. However, 31.1% (n = 61) stated that PBPs only sometimes had the confidence to make clinical decisions. The majority of GPs (> 85%) displayed largely positive attitudes towards collaboration with PBPs. Most GPs agreed/strongly agreed that PBPs will have a positive impact on patient outcomes (95.0%, n = 192) and can provide a better link between general practices and community pharmacists (96.1%, n = 194). However, 24.8% of GPs (n = 50) were unclear if the PBP role moved community pharmacists to the periphery of the primary care team. An evaluation of the free-text comments indicated that GPs were in favour of more PBP sessions and full-time posts. Conclusion Most GPs had positive views of, and attitudes towards, PBPs. The findings may have implications for future developments in order to extend integration of PBPs within general practice, including the enhancement of training in clinical skills and decision-making. Exploring PBPs’, community pharmacists’ and patients’ views of this role in general practice is required to corroborate study findings.

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Introduction With increasing numbers of pharmacists working in general practices [also called general practice-based pharmacists (PBPs)] and undertaking patient-facing roles, it has been recognised that they must have the necessary clinical skills (clinical examination and procedural skills) (1). However, previous studies have highlighted that PBPs do not feel confident regarding their clinical skills, and it is unclear what skills are needed (1). Aim To develop a core set of clinical skills required for pharmacists who intend to practise as independent prescribers working in general practice. Methods Based on a previous study (2), 18 clinical skills were selected for inclusion in a three-round Delphi consensus questionnaire. Designated leads (n=54) of pharmacist independent prescribing programmes in each United Kingdom (UK) educational provider (n=47) listed on the General Pharmaceutical Council website were invited to participate in March 2021. Following consent, a web-based questionnaire was distributed by email in April 2021 (Round 1). Two subsequent rounds were distributed in May and June 2021 respectively, and comprised the clinical skills for which consensus had not been achieved previously. A 9-point Likert scale was used (ranging from 1=limited importance to 9=critical). The response rate and distribution of scores for each clinical skill were calculated after each round. A clinical skill was included in the core set if 80% or more of participants scored between 7- 9, and 15% or less scored between 1-3. Results From 24 recruited participants (44.4%), 21 participants (87.5%) from 20 providers responded to Round 1 of the questionnaire, and also responded to the second and third rounds (100%). Following Round 1, seven clinical skills met the criteria for inclusion. Two additional clinical skills suggested by participants were added to the list of 11 clinical skills for which no consensus had been reached in the first round, hence, a total of 13 clinical skills were presented in Round 2. Two further skills were added to the core set following the second and third rounds respectively (four in total). The final core set consisted of 11 clinical skills: ‘Measuring heart rate (radial pulse)’, ‘Assessing respiratory rate’, ‘Measuring blood pressure (manual, e.g. with aneroid sphygmomanometer)’, ‘Measuring blood pressure (automated, i.e. electronic blood pressure monitor)’, ‘Measuring peripheral oxygen saturation (using pulse oximeter)’, ‘Measuring temperature’, ‘Undertaking a urinalysis’, ‘Respiratory examination (includes inspection, palpation, percussion and listening to breath sounds)’, ‘Measuring Peak Expiratory Flow Rate’, ‘Screening for/assessment of depression and anxiety using a validated questionnaire (e.g. Patient Health Questionnaire-9 [PHQ-9] scoring)’, and ‘Patient assessment via National Early Warning Score (NEWS)’. No consensus was reached on nine clinical skills. Conclusion This study has produced a core set of clinical skills for prescribing PBPs. The study was entirely UK-based, thus findings may not be generalisable to other countries. Moreover, a lower threshold for consensus would have led to the inclusion of more skills. However, this core set can serve as a reference for other countries developing policies on pharmacist roles. Furthermore, this study may contribute to standardisation of training and assessment for pharmacist prescribers working in general practice. References (1) Girvin B, Wilson D. Clinical skills training for pharmacists in general practice. Prescriber. 2018 Dec 11; 29(12): 19-25. (2) Girvin B, Akpan U, Hampson N, Middleton H, Sims L, Barry H. Establishing the roles undertaken and clinical skills needed by general practice-based pharmacists: a web-based survey. Pharm Educ. 2020 Sep 4; 20(1): 253.