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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 and employment models. Design and setting: Qualitative interview study with staff involved in the following schemes: 1) the national NHS England (NHSE) 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 in the UK. Method: Semi-structured interviews with purposive and snowball sampling of pharmacists, GPs, and practice staff took place. The interviews were analysed using template analysis. Results: In total, 41 interviews were conducted. The following four factors were found to influence role negotiation: role ambiguity; competing demands and priorities; potential for (in)appropriate utilisation of clinical skills; and level of general practice control over the role. Key differences between the two funding and 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 has highlighted lessons applicable for the introduction of non-medical roles more widely in general practice. It has provided insight into the factors that can influence role negotiation at practice level and how different funding and/or employment models can impact on this process. [ABSTRACT FROM AUTHOR]

Objectives: The objectives are to determine the factors that motivated GP practice managers in England to employ non-medical roles, and to identify an ideal hypothetical GP practice workforce. Methods: Cross-sectional survey of GP practice managers in England (n = 1205). The survey focused on six non-medical roles: advanced nurse practitioner, specialist nurse, health care assistant, physician associate, paramedic and pharmacist. Results: The three most commonly selected motivating factors were: (i) to achieve a better match between what patients need and what the practitioner team can deliver; (ii) to increase overall appointment availability and (iii) to release GP time. Employment of pharmacists and physician associates was most commonly supported by additional funding. Practice managers preferred accessing new non-medical roles through a primary care network or similar, while there was a clear preference for direct employment of additional GPs, advanced nurse practitioners or practice nurses. The ideal practice workforce would comprise over 70% of GPs and nurses, containing, on average, fewer GPs than the current GP practice workforce. Conclusion: This study confirms that more diverse teams of practitioners are playing an increasing role in providing primary care in England. Managers prefer not to employ all new roles directly within the practice. A more detailed investigation of future workforce requirements is necessary to ensure that health policy supports the funding (whether practice or population based), recruitment, training, deployment and workloads associated with the mix of roles needed in an effective primary care workforce. [ABSTRACT FROM AUTHOR]

Recent health care reforms in England, combined with financial austerity, have accelerated both corporatization and commercialization in the English National Health Service (NHS) and this has encouraged greater public sector entrepreneurialism (PSE). We advance this argument by examining the meaning and experience of corporatization in this sector, illustrating our argument with qualitative data from a specialist hospital at the forefront of this trend. We demonstrate how the policy and practice of corporatization is entangled with increased commercialism and how this shapes more entrepreneurial conduct from staff. Framed in terms of the recursive relationship between organizational dynamics and individual behaviors, we focus empirically upon the shifting epistemic boundaries associated with increased corporatization, describing the dissonant effects of these shifts upon individuals, their attempts to compartmentalize, and the ethical dilemmas that result. Through this case we draw conclusions about the emerging impact of corporatization, commercialization, and public sector entrepreneurialism across public services. [ABSTRACT FROM AUTHOR]