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Repositioning independent community pharmacy in the National Health Service primary care sector

Student thesis: Doctoral Thesis

In 1994 the author of this thesis proposed a new role of medicines management (MM)for dispensing community pharmacists, requiring systematic collaboration with GPs. In1998 the Minister for Health approved the proposal and commissioned pilot trials which are currently proceeding.
This thesis explores cultural, inter-professional and operational factors which may impede or facilitate service roll-out nationally. A review of management literature explored two areas, marketing and change management theory, which could be applied to a community pharmacy context. This review revealed innovative ways of presenting new services to target audiences and novel means of engineering organisational change.
'Culture~; 'leadership~; 'motivation"; 'communications"; and, 'competitive force~ were studied alongside the psychology of 'attitudes'; 'needs'; and, 'wants'. The BurkeLitwin change model was selected as the most applicable to pharmacy service change.
Triangulated field research has revealed forces which impede and facilitate change. A series of key informant interviews and focus groups helped identify crucial issues which informed the content and structure of national postal surveys to GPs (1000) and pharmacists (750). Key 'attitudes'; 'needs'; and, '~ants of both professions were revealed:

i. 75% of GPs and 81 % of pharmacists wish to engage in MM;
ii. 36% of GPs already receive pharmacist assistance at varying levels;
iii. 58% and 48% of GPs respectively, do not support pharmacist involvement
with medication selection or identification of sub-therapeutic dosage; and,
iv. 89% of pharmacists do not have the ability and 81% do not have time to do
MM.

The literature research fmdings were theoretically applied to these issues and
suggestions made for managing the proposed transformation of pharmacy service.
This thesis recommends cultural support of the GP by styling and branding the MM service accordingly with the GP as the lead figure, directing the programme of work. It further recommends urgent action by pharmacy leadership, to provide the framework for dispensing pharmacists to acquire the knowledge and time to undertake this transformational service
Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award date2003

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