Working across boundaries: new models of integration and collaboration across the pharmacy workforce in Greater Manchester

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BackgroundIncreasing the role of pharmacists and pharmacy technicians in primary and community care settings is a proposed cost-effective way of improving patient care as well as relieving the pressure on GPs (NHS Alliance/Royal Pharmaceutical Society, 2014). A number of local and national policy initiatives are underway to support this (NHS England, 2016; Primary Care Workforce Commission, 2015).The sparse evidence suggests that while this may be workable, it may not reduce service utilisation or costs (Dennis et al., 2009; Laurant et al., 2009). Little research focuses on different models of pharmacy professional engagement in organisational context (Finn et al., 2010), or locates such developments within wider research on professional boundaries and the identity work involved in establishing new professional roles (Reay et al., 2017). Greater Manchester (GM) presents an ideal location to compare and contrast experiences and impacts.Project aims and objectivesAim: explore, in depth, new roles undertaken by pharmacists and pharmacy technicians in primary care settings in GM.Objectives:1. Synthesise existing literature around new models of pharmacy professional work in primary care;2. Describe emerging models of pharmacy professional work in primary care settings in GM and what they are intended to achieve;3. Explore how new pharmacy professional roles are perceived by key stakeholder groups;4. Understand the impact of new pharmacy professional roles on professional identities; professional boundaries; and multidisciplinary teams working across general practice, community pharmacy and other services.5. Provide early evidence about the extent to which the introduction of such roles is likely to meet current policy objectives of reducing workload pressures in GP practices.MethodologyStage 1: Literature reviewStage 2: Modelling of emerging pharmacy professional rolesDraws on existing data sources to identify the number and range of emerging pharmacist/pharmacy technician roles in primary and community care in Greater Manchester and nationally, including settings and team composition. Stage 3. Information will be extracted from a recent Health Education England (HEE) survey of the pharmacy workforce, supplemented through primary data collection.Stage 3: Case studies (3-4)Up to 4 sites will be studied in-depth, covering different employment models and organisational contexts. Semi-structured interviews will be conducted with commissioners, pharmacists/pharmacy technicians, practice and other healthcare staff. Patient focus groups will be convened to capture their perceptions of access, quality and continuity of care. The student will also spend up to a week in each site observing pharmacy professionals.Anticipated outcomesIt will inform the development of primary care workforce strategies by GMHSCP, by providing insight into how pharmacists are employed in practice and with what impacts. It will provide guidance to inform training packages for pharmacists working in/with general practice. For employers of pharmacists, the findings will provide an understanding of how best to recruit and support pharmacists and their potential contribution. Finally, for NHS commissioners, the studentship will provide knowledge of what works, and how, to inform service redesign and commissioning. It will provide rich insight into the identity work involved in skill-mix change.Planned disseminationPapers will be prepared after each stage of the study for presentation at conferences, and for publication in a range of journals targeting. Academic papers will be submitted to leading international journals. Supported by GMHSCP, findings will also be disseminated through the Local Professional Networks, HEE/GMHSCP and through associated partner channels. Finally, to target patient/public audiences, a lay summary of study findings will be produced for distribution through patient groups and networks.