Pharmacist non-medical prescribing in primary care. A systematic review of views, opinions and attitudes

Poster presentation by PhD student, Timothy Mills, at the PhD Pharmacy Conference, April 2019, Henley Business School, University of Reading.

Timothy Mills
Dr Nilesh Patel and Professor Kath Ryan
Reading School of Pharmacy, University of Reading, Reading, RG6 6UB UK

Introduction: Non-medical prescribers (NMPs) are healthcare professionals, such as pharmacists and nurses, who have obtained an advanced qualification in prescribing. Uptake of non-medical prescribing by pharmacists has been slow. Pharmacist prescribing is intended to provide quicker and more efficient patient access to medicines, a reduction in doctor workload and enhanced professional satisfaction. This systematic review asks: “What are the barriers and facilitators to non-medical prescribing by primary care pharmacists?”

Aim: The purpose of this review is to look at the views, opinions and attitudes of pharmacists or graduates towards or about non-medical prescribing in primary care.

Methods: Medline, ScienceDirect, Embase and the University of Reading Summon Service were searched to identify qualitative and mixed methods papers that addressed the Aim. Papers published between January 2003 and September 2017 were included. Studies were quality assessed using the CASP checklist. The articles were coded and analysed using thematic synthesis.

Results: Eighty-five full text articles were reviewed from which 14 met the inclusion criteria. All articles were of moderate or high quality. Thematic synthesis identified two themes: (1) practice environment and (2) pharmacist’s role. Non-medical pharmacist prescribers reported increased job satisfaction and sense of professionalism, however, they often felt under prepared for the reality of unsupervised practice. Some pharmacists report prescribing has legitimised previous practice. Mentoring during training and post qualification improved pharmacists’ confidence to prescribe. They experienced both support and resistance from members of the primary care team, including other pharmacists and doctors. The practicalities of doing the job are hindered by the lack of access to patient records and resources.

Conclusion: The review identified perceived and real barriers to non-medical prescribing that could be overcome with appropriate training, mentoring and a supportive environment. Consideration of these will assist and advance pharmacist prescribing in primary care, with the associated positive outcomes for both patient care and the pharmacy profession