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Practice pharmacists and nurses in ‘turf war’ due to ambiguous job roles, report finds

by Costanza Pearce
1 March 2019

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A lack of clarity about the remit of practice pharmacists has led to some nurses viewing them as a threat, a new report has revealed.

The report, published in the Research in Social and Administrative Pharmacy journal last month, interviewed 37 healthcare professionals from 10 clinics in South-East England, including pharmacists, GPs and nurses.

According to the report, the integration of pharmacists into practices, which was first piloted by NHS England in 2015, has caused professional tension that has in some cases resulted in a ‘turf war’ between nurses and pharmacists.
‘Dramatic’ overlap

One GP said: ‘We have definitely found with having the pharmacist that the overlap with the nursing role is actually quite dramatic.’

‘I think it is fair to say when she started there was a bit of a turf war going on’, they added.

The cause of the tensions between pharmacists and nurses is uncertainty about the specific role of the pharmacist, according to the report.

One pharmacists referred to themselves as a ‘jack of all trades and master of none’. Another respondent said: ‘I am not a pilot pharmacist so they make it up as they go along. The role was created for me.’
Just easing the burden?

The report suggested that the focus on easing the burden on GPs and nurses rather on than the ‘unique value’ pharmacists can add was another cause of tension.

One pharmacist said: ‘The problem is that GPs are only investing in pharmacists because they are forced to.’

The report showed that the tension was not limited to the relationship between pharmacists and nurses but also extended to their GP colleagues. 

The research highlighted a perceived undervaluing of the pharmacists by ‘wary’ GPs and highlighted ‘professional insecurity’ by both professions.

One pharmacist said: ‘When I first came, it was very much focused on getting the medication reviews done and just that role and I don’t think the GPs really understood what I could do’.
Positive experiences

Despite the research, many practices highlight the positive experiences of working with pharmacists.

Practice manager at Lea Vale Medical Group Heidi Newton, who did not take part in the study, said she had no challenges integrating pharmacists into her team and that they are ‘an absolute joy and a godsend to us all’.
She said: ‘I don’t know what kind of roles those pharmacists were doing in practice but pharmacists shouldn’t encroach on a nurse’s role because generally nurses are not prescribers.’
She added that practice managers should ensure that ‘both patients and staff are aware of what [new] roles can do. It’s got to be seen as an important role within the clinical team and supported by the GPs, nurses and reception staff.’

The NHS England pilot scheme, which involved 400 clinical pharmacists, was designed to reduce the workload of primary care doctors and nurses and included structured training, clinical mentorship and partial funding for the pharmacists’ salaries.

NHS England recently announced funding for 22,000 additional practice staff.
This includes covering 70% of pharmacists’ salaries if they are employed in networks as part of the new GP contract and will incorporate those already recruited in previous schemes.