Envisioning pharmacists in care homes for older people: inter-disciplinary research to develop a new role

Providing a designated pharmacist for every care home, with overall continuing responsibility for medicines management, could address noted shortcomings in residents’ care (Alldred et al. 2009). An enhanced, more homes-focused model than the current external pharmacy team reviews of care homes medication could improve resident-related outcomes (Alldred et al. 2013; Patterson et al. 2014).

The Care Homes Independent Pharmacist Prescribing Study (CHIPPS) is a 5-year, NIHR-funded research programme. It used inter-disciplinary methods to engage stakeholder groups in envisioning and developing an innovative Pharmacist Independent Prescriber (PIP) role to optimise care homes medicines, contribute to the design of a trial and explore the key components and feasibility of this new model. Stakeholder-specific focus groups (n=13) and interviews (n=13) were held with GPs, pharmacists, care-home managers and staff, residents and relatives to identify expectations of relevant issues, challenges and benefits of a PIP. Transcripts were framework-analysed and linked to a potential service specification and training for the new role, further reviewed by stakeholder intervention development workgroups.

All stakeholder groups articulated specific shortcomings and challenges in the current and potential management of medicines in care homes, as in ensuring clarity in the PIP role. Distinct concerns also emerged, such as a few relatives fearing commercial conflicts of interest, as well as disagreements between some groups on specific areas where PIPs might prescribe. Areas of agreements and disagreements informed the trial design. Our paper critically examines these groups’ perspectives on PIP innovations and their implications for refining and researching these further.