How can Pharmacists and Allied Health Professionals Support delivering research in General Practice?

Authors: Faiza Yahya, Rachael Thornton, Dr David Shukla, Sarah Baig, Professor Ian Maidment 

‘Widening the Lens’  

Building a successful research-positive culture among primary care teams needs a multidisciplinary approach. Embedding research in primary care can improve population health outcomes and aligns with the NIHR aim to widen access for patients to clinical research¹. To do this, we must utilise the increasing skill mix of varied clinicians working in primary care teams, helping empower staff and create opportunities for them to become involved in research as an integral part of their role.² Building on the NHS Long Term Plan, workforce strategies such as the NHS People Plan have focused on innovative ways of working and drive towards a more multidisciplinary approach.³  

In recent years, Pharmacists have become an essential part of the Primary Care workforce and have been very successful in supporting GP workload.^4,5 Where traditionally GP's and nurses would have led on research, there is little known about the role of Pharmacist in Primary Care research delivery. 

What we did? 

A research delivery pilot utilising pharmacists across multiple practices within Dudley Integrated Health and Care trust (DIHC) was set up to support GP practices to deliver research and increase capacity and capability. Although this began with focus on one trial (DaRe2THINK), this further expanded to supporting three further research studies in the same way (ATHENA, CPRD SPRINT EXHALE ASTHMA Studies and the Cardisio Trial). The pharmacy team in Dudley is unique in that it integrates both Integrated Care Board (ICB) and primary care network (PCN) funded Pharmacists, all working in practice, which ensures full integration into multidisciplinary teams (MDTs) in general practice and the best use of the skill mix available. The experienced prescribing Pharmacists have therefore been able to lead on and deliver a, first of its kind, model of primary care research at scale across multiple sites and PCNs. 

What were the experiences through research delivery? 

Service Evaluation  

A 6-month evaluation survey was sent out to the General Practitioners those pharmacists supported, as well as the study support team, the trial manager and pharmacists that were involved in the research delivery. The feedback received was very positive, emphasising that the GPs welcomed support to carry out research, making the trial more manageable and that they were more likely to engage in further studies with ongoing pharmacist involvement. Practices that were not previously research active were keener to engage knowing that they could use the skills of other AHP's such as Pharmacists. 

Enhanced professional competency and the Associate Principal Investigator scheme 

Through involvement in research delivery, pharmacists were able to widen their scope of practice (for example, in Atrial Fibrillation management) and support prescribing and counselling as part of the trial, where necessary. In addition, some Pharmacists enrolled into the Associate Principal Investigator (API) scheme which allowed them to start building the foundations of a research portfolio, with the supervision of a Principal Investigator (PI) mentor. 

Recognising that pharmacists and allied health professionals (AHPs) are keen to develop their portfolios for advanced practice, this forms a good ‘stepping-stone’ into the world of research delivery in general practice. The API scheme forms a basis of guidance and focus when carrying out the research in practice. Primary Care encourages staff to have portfolio careers as it recognises that this improves job satisfaction, retention, resilience and capacity in what are very challenging times in general practice.⁶ 

Collaborative working 

Having pharmacists involved as an integrated member of the research delivery team, enhanced multidisciplinary working and strengthened working relationships and trust between GPs and pharmacists. By utilising and maximising the skills of our current workforce, it becomes evident that a substantial portion of the research delivery workload associated with clinical trials can be effectively delegated to the pharmacists. This pilot model showed that a collaborative approach working with the Clinical Practice Research Datalink (CPRD) team, the study team and the Clinical Research Network (CRN), allowed streamlining of work effectively and regular review of data to guide the workplan.  Furthermore, recognising that having a single point of contact across multiple practices allowed reassurance and co-ordination of practice engagement, trial set-up and research delivery. Trained pharmacists were able to use their knowledge and skills working across multiple sites supporting all study tasks. This meant that less time was needed training multiple individuals at each site and likely enhanced efficiency and expertise within the wider team. This model also allowed the pharmacists to build and benefit from a peer support network to resolve any queries efficiently, in addition to the helpful support from the trials team. 

Quality improvement 

Above and beyond delivery of the trial, the pharmacists felt that their involvement was a great opportunity for quality improvement and holistic review of patients. Whilst reviewing records, several matters were identified and actioned such as coding issues and suboptimal long-term condition management. Patients with undiagnosed hypertension, poorly controlled blood pressure, missing monitoring and overdue medication reviews were just a few examples of interventions that were actioned. Hence corroborating with previous reviews that have demonstrated that organisations engaging in research can contribute to improved healthcare performance.⁷ 

Learning points 

The need for protected time to work on research is beneficial, as fitting it in to the day-to-day role during a busy clinical day may not always be easy or will be less productive. Access to clinical systems or databases can sometimes take a while whilst awaiting approval and practical set-up can be a minor hurdle. Another challenge can be establishing connections and trust with GP practices and building mutual understanding of roles. Understanding the working dynamics of the practice and often being a known connection can be a facilitator and contribute to efficiency of the process.  Learning from this pioneering model, has shown that a cross-practice model working across primary care networks may find less barriers operationally, whilst allowing the wider outreach of clinical research to patient populations. Additionally, being able to work well with your GP practices and regular communication between the PI and the associate PI is also a key driver for success and multi-disciplinary collaboration. Although this model has focused on pharmacists, it can also be extended to nurses, other allied health professionals and newer roles within the additional roles reimbursement scheme (ARRS) in primary care networks.⁴ This will maximise use of skills and relationships that professionals in MDTs may have with patients and assist clinical research capacity to thrive. Aligning with the ambitions of the Lord O’Shaugnessy report, innovative models can allow optimal use of resources while widening capacity and enhancing implementation of clinical trials in primary care. ^8,9 

Author Affiliations

References 

1. National Institute of Health and Care Research (2023) Embedding a research culture. [cited 2023 Oct 22] Available from: https://www.nihr.ac.uk/health-and-care-professionals/engagement-and-participation-in-research/embedding-a-research-culture.htm  (Accessed: October 22, 2023). 
2. Department of Health and Social Care (2021) Saving and Improving Lives: The Future of UK Clinical Research Delivery. Policy paper. 23rd March 2021. [cited 2023 Oct 22] Available from:https://www.gov.uk/government/publications/the-future-of-uk-clinical-research-delivery/saving-and-improving-lives-the-future-of-uk-clinical-research-delivery#our-vision-for-uk-clinical-research-delivery   
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8. O'Shaughnessy J. Commercial clinical trials in the UK: the Lord O'Shaughnessy review - final report. Updated 26 May 2023. [cited 2023 Dec 6]. Available from: https://www.gov.uk/government/publications/commercial-clinical-trials-in-the-uk-the-lord-oshaughnessy-review/commercial-clinical-trials-in-the-uk-the-lord-oshaughnessy-review-final-report#part-3-transforming-how-the-uk-does-clinical-trials 
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