One hundred and twenty respondents started the survey and 93 participants completed in full. However, data were analysed using responses to the question regardless of whether they completed the whole survey. For some questions, respondents were asked to select all that applied and thus not all responses match the number of participants. Eighty-eight (94.6%) were pharmacists and five (5.4%) were pharmacy technicians. There were 68 (73.1%) female respondents and 25 (26.9%) male respondents. Just over one-third (34.41%, n = 32) held a non-medical prescribing qualification and twenty-five of these respondents (26.9%) were currently prescribing in practice.
The following demographic figures illustrate the age of the respondent (Table 1
), the number of years in practice (Table 2
), and their professional sector of employment. (Table 3
Participants could select as many care sectors as applicable. Of the 93 participants who completed the survey, thirteen worked in more than one care sector. Of those 13, five worked in a third care sector, illustrating the increasingly complex employment portfolios that pharmacy professionals hold. [14
Question 35 asked respondents to select which geographical region represented their main region of practice as highlighted in Figure 1
below. Eighty-nine respondents completed and 31 skipped this question. 77.5% (n
= 69) respondents to this question mainly practiced in England, 14.6% (n
= 13) in Scotland and 7.9% (n
=7) in Wales.
3.2. Prior Knowledge and/or Experience of Social Prescribing
Forty-four participants (36.7%) had heard the term ‘social prescribing’ prior to completing the survey while 76 (63.3%) had not. This latter group included the five pharmacy technicians, all of whom had never heard the term before. Respondents who had previously heard the term mainly practiced in primary care and community pharmacy. Analysis of free text answers provided by respondents when asked about their personal understanding of what SP was, resulted in six key themes. These were:
treatment without the use of medication (n = 15);
treatment that is non-clinical or non-medical (n = 12);
exercise on prescription/lifestyle changes (n = 4);
a way of linking patients to services in the community to improve health, wellbeing, and/or social interaction (n = 4);
treatment specialised for a specific need e.g., social isolation/increasing activity (n = 3);
a way to refer patients to groups/organisations that provide social care (n = 3);
emergency (A&E) attendance (n = 1); and 2 were not sure, but had heard the term before.
This is exemplified by the following quotes:
“My understanding is where (social) prescribing is for non-medicinal strategies, for example wellbeing, CBT, dietary, exercise, support.”
Respondent 23 (Pharmacist)
“Physical activity rather than a pill for every ill.”
Respondent 45 (Pharmacist)
Eighteen (39.1%) of those who were familiar with the term were aware of SP schemes in their local area, while 28 (60.9%) were not. Free text answers grouped into two main categories: those that knew of specific exercise or health related schemes (n = 11), and those who were just aware that schemes were available (n = 7).
Only six of 120 respondents had been directly involved in SP project and Table 4
illustrates the different schemes respondents were involved with.
3.5. Who Should Be Involved?
Twenty-five (26%) respondents believed only healthcare professionals should be involved in SP, whereas the majority (74%, n = 71) believed SP should not be limited to healthcare professionals, and include a wider range of individuals and other professions.
“HCP qualifications do not seem necessarily required for this type of intervention, it should be expanded to other people too, as then it has more likelihood of succeeding and being managed through larger networks.”
Participant 13 (Pharmacist)
“Any person should be able to refer a needy patient for help.”
Participant 76 (Pharmacy Technician)
Of those who believed SP should only include healthcare professionals, the most common emergent theme from free text responses, was the need for the process to have some type of regulation to ensure those with real clinical needs had access to appropriate and timely clinical care. These also included ensuring individuals were referred to the most appropriate services based on their needs. Another theme was that healthcare professionals would have access to health information and the wider healthcare team of the patient; but non-health professionals would not have the same access. A few respondents worried about the cost to the wider NHS if those who were not professionally trained made inappropriate referrals to health services. It is important to note, that a few respondents believed that only healthcare professionals should be involved in certain aspects of SP, particularly the prescribing of medicines, but other areas would not exclusively need healthcare professionals. Participants felt that the training healthcare professionals received ensured the advice they delivered to potential SP participants was safe.
The respondents who indicated that SP was not just a role for healthcare professionals, believed that healthcare professional qualifications were not necessary, because in SP you did not need to be an expert to refer individual’s needing SP activities.
“Some vulnerable people may not come into contact with healthcare professionals on a regular basis; however there may be others in the community with whom they have contact.”
Participant 37 (Pharmacist)
The caveat to this was that anyone who held a referring role should have appropriate training. Respondents identified the following groups of people as being able to refer to a SP pathway: carers, peer group members, other staff working in health, teachers, social workers, and self-referral by the public. Members of these groups all had regular close contact with individuals who may benefit from SP. Within pharmacy, respondents suggested dispensers and counter assistants would be suitable for this role and this could also help to release pharmacist time.
3.5.1. Pharmacist Involvement in Social Prescribing
Eight-six (89.6%) of respondents believed pharmacists should be involved in SP whereas 10 (10.4%) did not. For those who believed pharmacists should be involved in SP, the most common theme was the accessibility of pharmacists in the community with no need to book an appointment, and the strong relationships that develop with their patients. Others expressed this role should already be part of a pharmacist’s job as it is their duty to help patients, even if it does not directly involve medication. Other comments included that pharmacist involvement could reduce GP workload by minimizing unnecessary appointments; pharmacy was an important part of the healthcare team and importantly, that as pharmacists, they have seen that medication is not always the answer, and an alternative option was needed.
“We can get to know patients over consultations for different care aspects, and may come to realise that drugs are not always the most appropriate therapy. As HCPs we should be signposting for all aspects of healthy lifestyle changes.”
Participant 90, Pharmacist
For those who believed pharmacists should not be involved in SP, respondent comments included pharmacists already had enough to do and the lack of resources and funding to implement SP in community pharmacy was a barrier. Others shared that SP was not within the pharmacists’ remit and other professionals were better placed to be involved in SP.
“Pharmacists are there to clinically check/provide/counsel patients on medicines. Although a nice idea (and something other healthcare professionals/volunteers are suitable placed to encourage/advise patients on this), this activity is not in the pharmacist remit.”
Participant 24, Pharmacist
3.5.2. Pharmacy Team Involvement
Overall, eighty respondents (83.3%) believed the entire pharmacy team should be involved; including 100% (n = 5) of pharmacy technicians and 81.8% (n = 72) of pharmacists. Free text analysis demonstrates the most common theme was the belief that anyone with a bit of training would be capable of being part of SP, especially if they had experience in patient interaction—as many pharmacy technicians do. Similarly, many also saw benefit in the whole pharmacy team working together to be involved in SP, where everyone would have a role that best suited their skills and specialties. Others believed this would help with time pressures that arise from increased pharmacist workload. Also identified was that counter assistants and other pharmacy team members often spent more time talking to patients and would be valuable in identifying people who would benefit from SP.
“Suitably trained technicians would be just as capable in providing this service, in some respects they may well be better placed to do so, to free up the pharmacists time for clinical roles.”
Participant 1, Pharmacy Technician
Conversely 16.7% (n = 16) of pharmacist respondents did not believe the entire pharmacy team should be involved, due to the belief that the pharmacist is the professional and has appropriate training and that information may be taken more seriously by the public, if it was offered by a pharmacist.