GP trainee prescribing assessment - a qualitative evaluation of the involvement of pharmacists.

In 2019, the Royal College of General Practitioners (RCGP) introduced a mandatory workplace-based prescribing assessment for general practice trainees in their final year of training (GPST3). This assessment aimed to improve the quality of prescribing and reduce prescribing errors and it did not require pharmacist involvement. NHS Education for Scotland (NES) is the education and training body for NHS Scotland: delivering postgraduate training for GP trainees working in NHS Scotland. NES wished to evaluate the role that general practice pharmacists could have in this assessment.A training event for pharmacists was designed and delivered by the researchers in collaboration with the NES pharmacy team. Pharmacists attached to training practices in the West region of Scotland, where a GPST3 was undertaking the prescribing assessment, were invited to attend. The training described the prescribing assessment and the value that pharmacists could add to this workplace-based assessment. The evaluation aimed to explore the role of appropriately trained pharmacists in the prescribing assessment and their feedback to GP trainees, and evaluate the impact pharmacists had by exploring the views of GP trainers, GP trainees and pharmacists.Results showed that the intervention was viewed as a positive educational experience for all participants, and the interprofessional approach broadened the learning experience for GP trainees. We believe this to be innovative work replicable to primary healthcare colleagues to promote prescribing safety and interprofessional learning with pharmacy colleagues.

Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study.

BACKGROUND: Homelessness and associated mortality and multimorbidity rates are increasing. Systematic reviews have demonstrated a lack of complex interventions that decrease unscheduled emergency health services utilisation or increase scheduled care. Better evidence is needed to inform policy responses. We examined the feasibility of a complex intervention (PHOENIx: Pharmacist led Homeless Outreach Engagement Nonmedical Independent prescribing (Rx)) to inform a subsequent pilot randomised controlled trial (RCT). METHODS: Non-randomised trial with Usual Care (UC) comparator group set in Greater Glasgow and Clyde Health Board, Scotland. Participants were adult inpatients experiencing homelessness in a city centre Glasgow hospital, referred to the PHOENIx team at the point of hospital discharge, from 19th March 2018 until 6th April 2019. The follow up period for each patient started on the day the patient was first seen (Intervention group) or first referred (UC), until 24th August 2019, the censor date for all patients. All patients were offered and agreed to receive serial consultations with the PHOENIx team (NHS Pharmacist prescriber working with Simon Community Scotland (third sector homeless charity worker)). Patients who could not be reached by the PHOENIx team were allocated to the UC group. The PHOENIx intervention included assessment of physical/mental health, addictions, housing, benefits and social activities followed by pharmacist prescribing with referral to other health service specialities as necessary. All participants received primary (including specialist homelessness health service based general practitioner care, mental health and addictions services) and secondary care. Main outcome measures were rates of: recruitment; retention; uptake of the intervention; and completeness of collected data, from recruitment to censor date. RESULTS: Twenty four patients were offered and agreed to participate; 12 were reached and received the intervention as planned with a median 7.5 consultations (IQR3.0-14.2) per patient. The pharmacist prescribed a median of 2 new (IQR0.3-3.8) and 2 repeat (1.3-7.0) prescriptions per patient; 10(83%) received support for benefits, housing or advocacy. Twelve patients were not subsequently contactable after leaving hospital, despite agreeing to participate, and were assigned to UC. Two patients in the UC group died of drug/alcohol overdose during follow up; no patients in the Intervention group died. All 24 patients were retained in the intervention or UC group until death or censor date and all patient records were accessible at follow up: 11(92%) visited ED in both groups, with 11(92%) hospitalisations in intervention group, 9(75%) UC. Eight (67%) intervention group patients and 3(25%) UC patients attended scheduled out patient appointments. CONCLUSIONS: Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.