Employing pharmacists in general practice improved medicine prescribing outcomes over a four-year period, a large study has found.

However, the study also found that employing healthcare workers - such as more social prescribers, pharmacists, paramedics, physiotherapists, nursing associates and physician associates - has also not freed up time for nurses or GPs, and has led to a drop in patient satisfaction.

Researchers behind the the analysis of 6,296 GP practices in England between 2015 and 2019, which is the most detailed study yet of the introduction of newer roles into the general practice team, said their findings had ‘profound implications’ for policy makers.

The analysis found employment increased for all groups over the four-year period but the smallest increase was for nurses and the largest was for ‘healthcare professionals’ – such as clinical pharmacists, physiotherapists, physician associates, paramedics, podiatrists, counsellors, and occupational therapists.

Having more GPs and nurses led to positive changes to practice activity and outcomes, they reported in Social Science and Medicine. But there were larger drops in patient satisfaction in practices that had taken on more healthcare professionals.

Changes in workforce composition did not show significant relationships with most primary care outcomes measured in the study.

Overall, there was ‘little evidence’ of any complementarity or substitution between different staff groups, suggesting that the additional staff were not freeing up GP or nurse time to do other work or making practices more efficient, the researchers concluded.

On average, for one extra full-time healthcare professional employed at a general practice there was a 2.4% drop in overall patient satisfaction, the team from the University of Manchester reported, and a 1.3% drop in patient satisfaction with making an appointment.

However, they found pharmacists contributed positively towards several tasks, improving the quality of medicine prescribing and reducing the burden of these activities for existing staff.

For example, the researchers measured the percentage of all antibiotics prescribed that were narrow-spectrum because of the problem of antibiotic resistance, with 'the underlying assumption that a higher share of narrow-spectrum antibiotics represents an overall sign of good prescribing behaviour'.

The researchers found and increase in the percentage of narrow-spectrum antibiotics prescribing, which they said can be explained by the employment of pharmacists.

Study leader Dr Igor Francetic said it was a complex picture and not about whether these roles should be there at all, but about how they should be integrated and what tasks they should do or patients they should see.

‘The introduction of new roles to support general practice does not have straightforward effects on service quality or patient satisfaction.

‘In fact, we provide substantial evidence of detrimental effects on patient satisfaction when some health professionals and healthcare associate professionals are employed.

‘Patient satisfaction is a crucial dimension of quality of care, as it contributes to individuals’ willingness to seek care through GPs.’

He added that the findings counter the common wisdom that some of these new roles will reduce the workload of existing GPs and nurses.

‘The introduction of several of these new roles requires substantial supervision from GPs and complex changes to how work is organised that may ultimately reduce efficiency,’ he said.

Professor Azeem Majeed, professor of primary care and public health at Imperial College London, said: ‘The study confirms what many GPs are hearing from their patients – that patients often want to see a GP or nurse rather than another type of healthcare practitioner.

‘It may be over time, patients get more used to seeing other type of healthcare practitioners and patient satisfaction improves. Given the reality of falling GP numbers in England, other types of healthcare practitioners will have to play a bigger role in the delivery of primary healthcare.’

This comes after figures from July showed the number of clinical pharmacists working in general practice in England has tripled since 2019, when the Additional Roles Reimbursement Scheme (ARRS) was introduced. 

A version of this article was originally published in our sister publication Pulse.