Pharmacists working in general practice have raised concerns about inadequate inductions and a lack of ongoing training and support from practices in a recent UK-wide survey by the Pharmacists’ Defence Association (PDA).

Meanwhile, 35% of the 1,378 respondents said they do not feel they are regarded or treated as a full member of the practice team, while just under 60% said that they were receiving adequate ongoing training and support to enable them to carry out their roles.

The survey was drafted with input from primary care pharmacists within the PDA’s regional committees, and it ran for four weeks during May and June 2023.

The PDA told The Pharmacist that it ‘wants pharmacists to be able to participate in professionally fulfilling and suitably remunerated employment which makes the most of their unique skills in any healthcare setting’.

It said that while the survey shows that the majority of pharmacists working in general practices ‘find the work they do is professionally rewarding’, there were also ‘sufficient concerns raised’.

Inductions, training and support

Particular concerns were raised about inadequate inductions and a lack of ongoing training and support from practices, with just 41% of respondents saying that their induction had been ‘good’ or ‘great’.

And several respondents said they were not given sufficient time for training, with some being told that they had to take annual leave for training time.

A ‘significant number of respondents’ told the PDA that they had been given tasks that fell outside their areas of routine practice while receiving no additional training or support to undertake them.

For instance, one respondent reported that they were asked to take responsibility for setting up and running heart failure clinics with no previous experience and no support or supervision from the practice.

Pay, risk and responsibilities

Several respondents also reported being given workloads ‘that far exceeded the time available to carry them out safely’.

Examples included being expected to undertake up to 100 tasks a day, in addition to clinic appointments and query fielding, or being expected to complete structured medication reviews in 10 minutes.

They also raised concerns that their pay did not adequately reflect the level of expertise and responsibility required in their role.

Some respondents reported that prescribers were expected to take on GP prescribing and, in some cases, diagnostic activities, whilst being paid ‘significantly less’ than their medical colleagues.

‘Pharmacists working in general practice and increasingly taking on prescribing from medical staff should receive remuneration which reflects this level of responsibility and risk,’ the PDA commented to The Pharmacist today.

The PDA also highlighted to The Pharmacist concerns about pharmacists in general practice being employed on lower bandings and with inferior contractual terms than those employed by NHS hospitals, health boards or integrated care systems (ICSs).

For instance, some pharmacists working in general practice were only entitled to statutory sick or maternity benefits. ‘These terms need to be improved,’ the PDA commented.

‘Inappropriate’ workspaces

Practice pharmacists also raised concerns about inappropriate workspaces. Several said they were not provided with suitable work locations – for instance, they reported being expected to conduct medication reviews on the telephone in open plan offices or other ‘inappropriate settings’.

However, nearly three-quarters of respondents felt that their workstations were ‘adequate and suitably located for their activities’.

A survey conducted earlier this year by our sister title Pulse PCN found that (72.8%) of practice staff respondents did not have the space to house their additional roles (ARRS) staff, including pharmacists working in general practices and primary care networks (PCNs).

Calls for better training and support for practice pharmacists

The PDA said that despite the concerns raised, it was encouraging to see the number of pharmacists now working in general practice, as well as the fact that many respondents felt that the work they were doing in general practice was professionally rewarding, ‘albeit still feeling that they were undervalued’.

And it called for more investment in ‘properly structured supervision, training and support for pharmacists working in practice’.

The PDA added that this should include a period of supervised prescribing for newly qualified independent prescribers, or those who have not used their prescribing qualification, ‘based on the model for GP registrars’.

And it added that this was ‘particularly important given that soon all newly registered pharmacists will be prescribers from the first day of their registration’.

In addition, it said it would like to see similar levels of funding for post-graduate pharmacist education as is provided for other healthcare professionals.

The PDA also said that the survey responses reiterated a trend it had observed in cases among its members ‘that show some pharmacists are requested to undertake tasks which are inappropriate to their role and/or beyond their competency’.

And it highlighted that it was set to publish a toolkit for general practitioners planning to recruit practice pharmacists.

‘It is clear from the feedback that whilst some of the concerns raised are deeply felt, individuals can feel isolated and mistakenly conclude that issues are unique to them,’ the PDA told The Pharmacist.

‘The results of the survey, alongside the experience of the many thousands of PDA members working in GP practice settings demonstrate that many issues impact many, or all, of the population.’

It added that it would continue to analyse the survey responses to inform future communications, and continue supporting members with specific and systemic issues.

President of the Primary Care Pharmacy Association (PCPA) Graham Stretch said that he welcomed the work by the trade union to investigate the experiences of its members in primary care.

He told The Pharmacist that there was huge variability between what different pharmacists might experience from their PCN employers, with some getting ‘the very best supervision, the very best mentoring, the very best training and actually just being set up to fly’, with others ‘sadly’ experiencing ‘a benign neglect’.

‘The main finding that worries me the most […] is that lack of help getting going,’ he said.

‘The sort of mentoring and support that you need in the first year or two to get you to the point where you can be much more autonomous.’

And he said that investing in mentoring and supporting pharmacists would generate a return on investment for practices.

Mr Stretch added that the proportion of pharmacists reporting these kinds of issues in the PDA survey were consistent with conversations he had had with pharmacists working in primary care.

‘I think some of these findings aren't unexpected and reflect what I speak to my members, day to day,’ he said.

‘I think it's helpful to have findings such as this to back that up so that we can advocate for improved working conditions for pharmacists and pharmacy technicians.’

Laura Buckley, primary care lead at the Guild of Healthcare Pharmacists (GHP) told The Pharmacist: ‘Primary care pharmacy is unfortunately an emerging area of concern for employment and workforce issues.’

She encouraged all England-based primary care pharmacists to respond to the GHP survey, currently in progress until 30 November.