Negotiating new roles in general practice: a qualitative study of clinical pharmacists

Background: To address general practice workforce shortages, policy in England has supported the recruitment of ‘non-medical’ roles through reimbursement funding. As one of the first to receive funding, the clinical pharmacist role offers insight into the process of new role negotiation at general practice level. Aim: To identify factors influencing clinical pharmacist role negotiation at practice level, comparing the process under two different funding/employment models. Design and Setting: Qualitative interview study, with staff involved in: 1) the national NHS England Clinical Pharmacists in General Practice scheme and; 2) a local Clinical Commissioning Group funded scheme providing clinical pharmacist support to general practices in one area of Greater Manchester. Method: Semi-structured interviews with purposive and snowball sampling of pharmacists, GPs and practice staff; analysed using Template Analysis. Results: Forty-one interviews were conducted. Four factors were found to influence role negotiation: role ambiguity; competing demands/priorities; level of GP control over the role; and potential for (in)appropriate utilisation of clinical skills. Key differences between the two funding/employment models were the level of influence GPs had in shaping the role and how adaptable pharmacists could be to practice needs. The potential for inappropriate utilisation was reported under both schemes, but most apparent under the role reimbursement, direct employment model of the NHSE scheme. Conclusion: This study highlights lessons applicable for the introduction of non-medical roles more widely in general practice. It provides insight into the factors that can influence role negotiation at practice level and how different funding/employment models can impact on this process.