GP views on the potential role for pharmacist independent prescribers within care homes: Care Homes Independent Pharmacist Prescribing Study (CHIPPS)
Medicines use in care homes has been shown to be suboptimal; to address this it has been suggested that one person should assume overall responsibility for medicines management in a care home. Pharmacist independent prescribing could enable appropriately-trained pharmacists to assume this role and make and implement decision-making about medicines, reducing the input needed from the general practitioner (GP). The transfer of responsibility associated with such a service change entails careful management of the implications for patients, and professional team-working. The Care Homes Independent Pharmacist Prescribing Study (CHIPPS), a 5-year, NIHR-funded research programme, has determined the views of GPs and other stakeholders on the utility and acceptability of pharmacist independent prescribers (PIPs) assuming responsibility for medicines management, including prescribing, within care homes and how best to implement such a service in order to inform the design of a feasibility study, leading to a randomised controlled trial.
Thirteen focus groups, which included GPs involved with care homes, were run by experienced facilitators in England (Norwich/Yorkshire), Scotland (Aberdeen) and Northern Ireland (Belfast), supplemented by thirteen interviews with participants unable to attend groups. Local National Health Service (NHS) research networks assisted recruitment.Discussion topics covered current practice, the proposed PIP service remit, and implementation barriers and facilitators. Discussions were audio-recorded and transcribed verbatim for thematic analysis. Ethical approval was received from Yorkshire and Humber NHS Ethics Committee.
Twenty-eight GPs participated (Norfolk 7, Yorkshire 5, Scotland 6 and Northern Ireland 10). The proposed service was broadly welcomed with enthusiasm for management of repeat prescriptions, reviewing and stopping medications where indicated, predicated on the PIP having full access to residents’ medical records. GPs indicated the potential difference PIPs would make to their workload burden could be positive in specific areas. There were some concerns about PIPs initiating medicines.Potential challenges included building relationships and trust, effective communication, confidentiality, governance, professional indemnity and pharmacists’ knowledge of older people’s medicine and care home culture. GPs valued pharmacists’ specialist knowledge of medicines and their attention to detail.GPs wanted reassurance that a PIP service would be beneficial, without increasing their workload, and preferring the PIP to be practice- rather than care home-based.
GPs were largely supportive of PIPs assuming responsibility for repeat prescription management, but had some concerns about who would initiate medication, and implications for GP workload. The issues of access to records, confidentiality, communication, PIP location and governance required addressing prior to the conduct of the trial. For the service to be successful and make a positive difference to care-home residents, developing strong professional relationships and trust between the two professions is therefore essential.