Introduction

This project forms part of an ongoing task of tracking the changing role of pharmacists in primary care organisations (PCOs). The first study was the evaluation of primary care pharmacists (PCP) in a Total Purchasing Pilot (TPP) followed by a survey of the training needs of PCPs at a time when the role was still new and developing. Since then the constantly evolving role, pushed by the pharmacy profession and pulled by Department of Health modernisation initiatives, has been studied by several researchers through their links with the National Prescribing Centre. This paper reports on a collaborative study to record the position in three urban English locations during the transition from primary care groups (PCGs) to Trusts (PCTs). The aim was to map the current distribution of PCPs; describe their current role; and note key similarities and differences between areas.

Method

Three health authorities (Midlands; Inner London; Outer London) were selected on a pragmatic basis. They served affluent and deprived urban areas with mixed ethnicity, were local, and links with staff already existed. Three undergraduate research project students undertook the fieldwork, using a mixture of literature review, survey and interview. Data collection was completed by March 2002 .

Results

The three areas were all at different stages in the PCO evolution process. Outer London (3 PCTs; no PCGs) had completed in April 2001. The Midlands area (5 PCGs) had two "trail blazer" PCTs, set up in 1999 The Inner London area ( 6 PCGs; no PCTs) was about to make the transition.

Two main categories of PCP were reported: 1) based at PCG/T 2) practice-based, ranging from occasional sessions on request to a regular commitment and funded in a variety of ways. Only one PCT (Midlands) had a full-time practice-based PCP. For some PCG/T-based PCPs the changes had regularised previously insecure employment status. There were differences between areas in the labels used to describe the job, but all three areas reported similar tasks and activities. There was a clear division between strategic and operational roles, and very little patient contact.

Across all areas, the number of GP practices was positively correlated with the size of the local population. However, no such relationship existed for the PCG/T-based or total PCP workforce., In Inner London, there were marked North-South differences in sessional PCP numbers.

Discussion

The PCPs were all doing the same job, but their distribution was not related to GP practice numbers, suggesting that other factors were driving local provision of practice support. The "inheritance" that a PCG brings with it in terms of protected funding could be one factor in the development of the local PCP workforce. The quality of existing GP -pharmacist relationships, and the power of local pharmacy politics could also be important legacies.