| The change in community pharmacists' practice from compounding and effectively unregulated medicines supply through to the highly regulated and largely automated high- volume dispensing process of today has been challenging. The economic and social standing of community pharmacy was transformed creating a need for further adaptation. This thesis explores 'how business and professional practice models for community pharmacy in England in ten to twenty years are likely to be structured'. It has six sections, plus an overarching discussion. A work sampling study of ten community pharmacies found that pharmacists continue to spend two-thirds of their time on dispensing related activities, compared to one tenth on counselling. The accompanying analysis links this to an increase in prescription volumes and payments that have incentivised pharmacy contractors to focus on medicines supply. A significant decrease in the average prescription duration for eight chronic disease medications over the past decade is revealed, and its desirability questioned. Using the Kingdon model of the policy process as an evaluative framework, 16 interviews with 'policy leaders' provided insight into how seven factors (identified from a structured thematic review of the implementation of Medicines Use Reviews) have influenced the implementation of the New Medicines Service. In addition, role theory-based thematic analysis involving 17 stakeholders in pharmacy policy highlighted the tensions between community pharmacists' roles as shopkeepers, clinicians and businessmen, and the effects that new technologies will have on them. The analysis identifies a need for pharmacy to embrace a new strategic direction that enhances pharmacy's contributions to health outcomes. In conclusion, community pharmacy in England should offer timelier and economically efficient ways of solving contemporary health problems. The evidence presented here suggests that without stronger internal leadership and robust external stakeholder support medicines supply will split from the provision of clinical pharmacy in the community setting, leaving community pharmacies as 'commodity cost', low return medicines suppliers. |
