New ways of working releasing general practitioner capacity with pharmacy prescribing support: a cost-consequence analysis

Background General practice in the United Kingdom is experiencing a workforce crisis. Greater multidisciplinary working, including more general practice pharmacists, is seen as part of the solution. However, it is unknown what impact and cost-consequences that pharmacists may have in freeing general practitioner (GP) capacity. Objective To evaluate the cost-consequences of additional pharmacists in releasing GP capacity. Methods This cost-consequences evaluation of a prospective observational cohort study in 15 urban practices involving 69 GPs in 1 locality serving a population of 82,000 people. GPs recorded the time they spent addressing key targeted prescribing activities during 5 distinct 2-week audit periods. Pharmacists performed these key prescribing activities to release GP capacity. An additional 225 h of pharmacists' time per week was committed to the locality. Standardized staff costings were used to estimate the financial impact. Prescribing indicator performance was assessed against the other 7 localities within the health board. Results When compared with employing extra nonsalaried GPs this required an estimated additional investment of 16.73 pound (range 5.97-20.87) pound per h to free GP capacity. This achieved a sustainable 47% (73 h per week, F(4,56) = 16.05, P < 0.001) reduction in GP time spent on key prescribing activities; equating to 4.9 h (95% confidence interval 3.1-6.7) per practice per week. No significant step changes in locality safety and quality prescribing measures, and no negative effects on locality-level prescribing cost-efficiency work were observed. Conclusion Appropriately resourced general practice pharmacy teams delivered prescribing cost-efficiencies as well as sustainably freeing GP capacity by performing key prescribing activities. Lay Summary General practice in the United Kingdom is experiencing a workforce crisis, and is struggling to deliver services. Pharmacists have been shown to be effective in freeing general practitioner (GP) capacity. However, it is unknown how much it costs to do this. Therefore, we aimed to assess the cost-consequences of releasing GP capacity. All practices in 1 region took part. GPs recorded the time it routinely took them to address key prescribing activities, Spring 2016. Pharmacists then delivered the key prescribing activities. The region got an extra 225 h of pharmacists' time to do these activities. Then in Spring 2018, the GPs and pharmacists recorded the time took to do the key prescribing activities. Standard salary costs were used to estimate how much money was needed to free GP capacity with pharmacists. The impact on routine cost-effective work was also assessed. Pharmacists delivering key prescribing activities freed 73 h per week of GP time. This equalled an average of 5 h per week per practice. Freeing GP capacity was estimated to cost an extra 16.73 pound (range 5.97-20.87) pound per h. There were no negative effects on cost-efficiency work. Appropriately resourcing general practice with pharmacists delivers sustainable prescribing cost-efficiencies and frees GP capacity.