Tension as practice pharmacists ‘encroach’ on nurse duties

One family doctor interviewed for the project described a “turf war” going on between the two professional groups.

The academics visited 10 surgeries across the South East of England to explore how the advent of practice pharmacists had changed the team dynamic.

The study – called ‘General practice pharmacists in England: Integration, mediation and professional dynamics’ – included interviews with 19 pharmacists, nine nurses and nine general practitioners.

The recruitment of pharmacists into general practice has increased over the past five years following a pilot scheme by NHS England to fill rota gaps and relieve pressure on doctors and nurses.

However, the study authors found there was uncertainty over their place within the primary care workforce and warned of a “discord between pharmacists and nursing staff based around perceptions of role encroachment”.

They found some of the duties taken onboard by practice pharmacists were those traditionally done by nurses such as independent prescribing, asthma and diabetes reviews and diabetes management.

One general practitioner interviewed by the researchers said the overlap between the practice pharmacists and nurse was “quite dramatic” and added: “I think it is fair to say when [the pharmacist] started there was a bit of turf war going on”.

A pharmacist described nurses as being “closed minded” about the introduction of the role to the team and that nurses as a profession “have seen us as a threat”.

The researcher said that while most nurses interviewed broadly accepted and supported the integration of pharmacists into primary care they also found “implicit examples of frustration”.

One nurse determined that pharmacists were only good for “follow up” appointments and that nurses were still best placed to deal with patients with chronic diseases.

The study authors concluded: “The data suggested that the pharmacists who had enhanced roles perceived some uncertainty about their professional role and identity, which resulted in instability and insecurity and that this uncertainty led to both professional and interprofessional tension with their primary care colleagues.”

To tackle this, they called for better planning of the integration of pharmacists into primary care and for better clarity over what the role encompasses, including a specific job description.

They said relationships between the different roles in general practice would be strengthened by “interprofessional education” at undergraduate and postgraduate level.

The study was published in the Research in Social and Administrative Pharmacy journal and was led by researchers from Kingston University in London; Health Education England; iheed education centre in Dublin; and NHS Lambeth Clinical Commissioning Group.