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

背景：增加药剂师和药学技术人员在初级和社区护理环境中的作用，是改善患者护理以及减轻全科医生压力的一种具有成本效益的方法（NHS联盟/皇家药学会，2014）。许多地方和国家政策倡议正在进行中，以支持这一点（英国国民保健服务体系，2016年；初级保健劳动力委员会，2015年）。稀疏的证据表明，虽然这可能是可行的，但它可能不会降低服务利用率或成本（Dennis et al., 2009; Laurant et al., 2009）。很少有研究关注组织背景下药学专业参与的不同模式（Finn et al., 2010），或者将这种发展定位于更广泛的专业边界研究和建立新专业角色所涉及的身份认同工作（Reay et al., 2017）。大曼彻斯特提供了一个比较和对比经验和影响的理想地点。目的：深入探讨基层医疗机构中药师和药学技术人员的新角色。1 .综合现有文献，围绕初级保健药学专业工作的新模式；2 .描述在GM初级保健环境中出现的药学专业工作模式，以及它们的目的是什么；3 .探索关键利益相关者群体如何感知新的药学专业角色；了解新的药学专业角色对职业认同的影响；专业的界限;以及跨全科执业、社区药房和其他服务的多学科团队。提供早期证据，证明引入这些角色在多大程度上可能满足当前减少全科医生工作压力的政策目标。方法第一阶段：文献回顾第二阶段：新兴药学专业角色建模利用现有的数据来源来确定大曼彻斯特和全国初级和社区护理中新兴药剂师/药学技术人员角色的数量和范围，包括设置和团队组成。阶段3。信息将从最近的健康教育英格兰（HEE）调查药房劳动力，补充通过主要数据收集。第三阶段：案例研究（3-4）将深入研究多达4个地点，涵盖不同的就业模式和组织环境。将与专员、药剂师/药房技术人员、执业人员和其他保健工作人员进行半结构化访谈。将召集患者焦点小组，以了解他们对护理的可及性、质量和连续性的看法。学生还将花一周的时间在每个地点观察药学专业人员。预期的结果将告知初级保健人力战略的GMHSCP的发展，通过提供洞察药剂师是如何在实践中使用的，并与什么影响。它将为从事全科医生工作的药剂师的培训方案提供指导。对于药剂师的雇主来说，研究结果将有助于了解如何最好地招聘和支持药剂师及其潜在贡献。最后，对于NHS专员来说，该奖学金将提供有关什么有效以及如何有效的知识，以便为服务的重新设计和调试提供信息。它将为涉及技能组合变化的身份工作提供丰富的见解。计划的传播将在研究的每个阶段之后编写论文，以便在会议上介绍，并在一系列针对的期刊上发表。学术论文将提交给国际领先的期刊。在GMHSCP的支持下，调查结果还将通过当地专业网络、HEE/GMHSCP以及相关的合作伙伴渠道传播。最后，为了针对患者/公众受众，将制作一份研究结果的概要，以便通过患者群体和网络分发。

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.