community pharmacy businesses and community pharmacists
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Community Pharmacy Businesses and Community Pharmacists
JAMES EDWARD DAVIES
A thesis submitted to the UCL School of Pharmacy for the degree of Doctor of Philosophy in
the Department of Practice and Policy
UCL SCHOOL OF PHARMACY
This thesis describes research conducted in the UCL School of Pharmacy between October
2009 and November 2012 under the supervision of Professor David Taylor and Professor
Nicholas Barber. I certify that the research described is original and that any parts of the
work that have been conducted by collaboration are clearly indicated. I also certify that I
have written all the text herein and have clearly indicated by suitable citation any part of
this dissertation that has already appeared in publication.
PUBLICATIONS FROM THIS RESEARCH
Thum-Bonanno, S., J. Gill, J.E. Davies et al. (2012). From making medicines to optimising
outcomes: The evolution of a profession 1912-2012, Federation Internationale
Davies, J.E, R.Hamilton et al (2012) The imbalance between pre-registration training and
undergraduate pharmacy student numbers. A BPSA discussion paper, The British
Pharmaceutical Students Association. London.
Davies, J. E. and D. G. Taylor (2012). "Individualisation or standardisation: trends in National
Health Service prescription durations in England 19982009." Primary Health Care
Research & Development FirstView: 1-11.
Davies, J. E., S. Neidle, et al. (2012). "Developing and paying for medicines for orphan
indications in oncology: utilitarian regulation vs equitable care?" British Journal of Cancer
Forbes, A., J. Davies, et al. (2011). "Dispensing substitution: avoid the impression of
therapeutic chaos." The Pharmaceutical Journal 286: 129.
Davies, J. E. (2010). "Telepharmacy - Friend of Foe?" British Journal Clinical Pharmacy July
Davies, J. E. and D. Taylor (2010). Making a difference. London, The School of Pharmacy.
Davies, J. E., K. Cottrell, et al. (2010). "Improving patient safety through electronic transfer
of prescriptions and automation: an audit of near miss errors." International Journal of
Pharmacy Practice 18(Supplement 2): R57.
Davies, J. E. and D. Taylor (2010). "The Uncertain future: a pilot study if pharmacy student
views." International Journal of Pharmacy Practice 18(Supplement 2): R78.
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 pharmacys contributions to health
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
There are many people who have helped shape not only this thesis, but also me as a
person, over the last few years.
My sincere thanks go to Dr Phillip Brown, not only for his financial support of this research,
but also for the valuable insight that he has provided throughout the synthesis and
development of this research. His pharmacy team have been a great help in sense checking
the findings presented here and for providing insight into the pressures that pharmacists
Professor David Taylor has not only been a supervisor to this program of research but also
a friend. He has assisted my personal development and helped to take me out of the rigid
pharmacist mindset to which I first approached this project. Invariably the many
distractions that David threw my way ended up helping to shape and form this final piece
of work. I am genuinely grateful for all of the help and support that he has provided me
with over the years. Thank you for gently assisting me to achieve a more thoughtful gaze on
Professor Nick Barber has provided the framework and the pharmacy base to this thesis.
Thank you Nick for your insight, your wisdom and your help in getting this finished.
As with any research project, I am indebted to all those participants who gave up their time
so willingly to help me carry out these projects. This includes all of the pharmacists at work
sampling sites and the different stakeholders who gave their time for interviews. While
your names remain anonymous your efforts do not go unrewarded.
Several students Saira Aslam, Folake Olafare, Rukeya Begum, Thusanth Thayaparan,
Gursharan Sira, Mohammad Mansoor Hashemi, Umara Uddin, Zainab Shafiq and Sarah
Khan were invaluable for their help in data collection and entry.
Many other people in this practice and policy department have helped me along the way.
Thank you to Felicity, Andreia, Ralph, Christina, Lina, Kirsty, Jenny, Jen, and Eman for all
their humour, conversation and distinctively individual contributions.
I am particular indebted to my parents, my brother and my grandmother for their financial
support as well as their tolerance and understanding.
Finally, a huge thanks to my wife Helen, who has been my rock over the last few years. She
did much more than look after me at home, but proofed much of my written work (and
pointed out the distinction between s and s) and provided a useful sounding board for
many of my ideas. To you I give both my love and gratitude.
AESGP Association of the European Self-medication industry APPG All Party Pharmacy Group BMA British Medical Association BPC British Pharmaceutical Conference (now the RPS conference) BPSA British Pharmaceutical Students Association CCA Company Chemists Association CHD Coronary Heart Disease CPPE Centre for Pharmacy Postgraduate Education DH Department of Health DHSC Department for Health and Social Case EHC Emergency Hormonal Contraception EPS Electronic Prescribing Service FIP International Pharmacy Federation (Fdration Internationale de Pharmaceutique) GDP Gross Domestic Product GMC General Medical Council GMS General Medical Services GP General Practitioner GPC General Practitioners Committee (of the BMA) GPhC General Pharmaceutical Council GSL General Sales List (medicine) HLP Healthy Living Pharmacy IPA Interpretative Phenomenological Analysis IQR Inter Quartile Range KNMP Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie (Dutch
Pharmacy Association) LMC Local Medical Committee LPC Local Pharmaceutical Committee LPS Local Pharmaceutical Services MCA Medicines Control Agency (now the MHRA) MHRA Medicines and Healthcare Products Regulatory Agency MUR Medicines Use Review NAO National Audit Office NCCSDO National Co-ordinating Centre for NHS service Delivery and Organisation NHS National Health Service NHSCB NHS Commissioning Board NHSE NHS Employers NICE National Institute for Health and Clinical Excellence NMS New Medicines Service NPA National Pharmacy Association NSF National Service Framework OFT Office of Fair Trading OTC Over the Counter (Medicines) P Pharmacy only (medicines) PAGB The Proprietary Association of Great Britain PCA Prescription Cost Analysis PCPA Primary Care Pharmacists Association PCT Primary Care Trust PGD Patient Group Direction PHE Public Health England PIANA Pharmacy in a new age PIL Patient Information Leaflet PMR Patient Medication Record
POM Prescription only Medicine PPRS Pharmaceutical Price Regulation Scheme PRLOG Pharmacy Regulation and Leadership Oversig