Exploring the views of key stakeholders on an intervention aimed at improving the safety of prescribing of GP Associates in training

Problem

Funded by the General Medical Council, the PRACtICe study, which was a large study undertaken to review prescribing errors in UK general practice, encouraged engaging in strategies to enhance the prescribing skills of GP Associates in Training (GPAiTs). This is because GPAiTs were a group of prescribers identified as being more susceptible to making prescribing errors. One of the strategies piloted was an educational intervention involving a pharmacist-led review of prescribing by GPAiTs, followed by feedback (REVISIT). The results of this pilot study indicated that the REVISIT intervention had been positively received by GPAiTs and their trainers and had the potential to improve prescribing of GPAiTs. This qualitative study explores what factors would facilitate a more wide spread adoption of REVISIT in general practice, in its current form or following any necessary modifications suggested by key stakeholders.

Approach

Twenty-seven interviews with key stakeholders from medical, pharmacy, and legal organisations; two focus group with 19 members of the public; and a stakeholder event with 19 participants took place between January and November 2017 to address the study aims. Participants were identified through engaging local and national training networks; a simulated patient group; contacts already known to the research team; and through searching organisation websites. Sharing a summary of findings from previous REVISIT studies preceded all data collection opportunities. Interviews and focus discussions were guided by a semi-structured interview schedule; audio recorded; transcribed verbatim; and thematically analysed. Field notes were compiled for the stakeholder event. Although no inconvenience allowance was paid to participants, where applicable travel expenses and light refreshments were provided.

Findings

Using the REVISIT intervention to improve prescribing by GPAiTs was positively encouraged by study participants. Although no major modifications to the REVISIT intervention were being proposed, suggestions of how the intervention could be enhanced through widening the scope of who could deliver or receive the intervention were put forward. Nonetheless, where resources allowed, the model of using practice pharmacists to retrospectively review the prescribing was considered preferable. The preference was less clear when considering which practitioner was best placed to provide feedback following the prescribing review. Opinions differed regarding what stage of GP training the REVISIT intervention would be more beneficial. The view that REVISIT would benefit all prescribers was shared by many. Establishing robust evidence for REVISIT was considered an important prerequisite for future funders to release financial resources.

Consequences

There is growing support for REVISIT as an intervention that can contribute to improving prescribing safety. Although undertaking some modifications may benefit the intervention, the more urgent need communicated is that of gathering robust evidence on the effectiveness of the intervention when used in general practice.