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Supervision in Community Pharmacy Final Report

to Pharmacy Research UK

submitted February 2013 revised July 2013

Dr Fay Bradley Research Associate Dr Ellen I Schafheutle Senior Lecturer in Law & Professionalism in Pharmacy Dr Sarah C Willis Lecturer in Social Pharmacy Prof Peter R Noyce Professor of Pharmacy Practice Centre for Pharmacy Workforce Studies, Manchester Pharmacy School The University of Manchester, Oxford Road, Manchester M13 9PT

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CONTENTS

NB. An executive summary has been published separately

LIST OF TABLES ........................................................................................................................................ 5

LIST OF FIGURES ...................................................................................................................................... 5

LIST OF BOXES ......................................................................................................................................... 5

LIST OF APPENDICES ............................................................................................................................... 6

ABBREVIATIONS ...................................................................................................................................... 7

1 Introduction .................................................................................................................................... 8

1.1 Background ............................................................................................................................. 8

1.2 Aims and objectives .............................................................................................................. 11

1.3 Structure of report ................................................................................................................ 11

2 Nominal group discussion and interview findings ........................................................................ 12

2.1 Introduction .......................................................................................................................... 12

2.2 Method ................................................................................................................................. 12

2.2.1 Nominal group discussions with pharmacists and pharmacy support staff ................. 13

2.2.2 NGT procedure .............................................................................................................. 14

2.2.3 Interviews with Superintendent Pharmacists ............................................................... 14

2.3 Findings ................................................................................................................................. 15

2.3.1 NGT: Pharmacy activities .............................................................................................. 15

2.3.1.1 Can be safely performed ........................................................................................... 16

2.3.1.2 Cannot be safely performed ..................................................................................... 20

2.3.2 NGT: Overarching themes ............................................................................................. 20

2.3.2.1 Taking professional responsibility ............................................................................. 21

2.3.2.2 Knowing the team ..................................................................................................... 23

2.3.2.3 Pharmacist presence and relinquishing control ....................................................... 24

2.3.3 Superintendent views ................................................................................................... 26

2.3.3.1 The case for change .................................................................................................. 26

2.3.3.2 What change should look like ................................................................................... 26

2.3.3.3 The role of pharmacy technicians ............................................................................. 27

2.3.3.4 Clarity on responsibilities .......................................................................................... 28

2.4 Discussion .............................................................................................................................. 29

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3 Pharmacist and pharmacy technician survey ............................................................................... 29

3.1 Introduction .......................................................................................................................... 29

3.2 Method ................................................................................................................................. 30

3.2.1 Questionnaire design .................................................................................................... 30

3.2.2 Sample selection ........................................................................................................... 31

3.2.3 Questionnaire distribution ............................................................................................ 32

3.2.4 Analysis ......................................................................................................................... 33

3.3 Findings ................................................................................................................................. 34

3.3.1 Response rate ............................................................................................................... 34

3.3.2 Respondent demographics ........................................................................................... 34

3.3.2.1 All respondents ......................................................................................................... 34

3.3.2.2 Community pharmacy respondents.......................................................................... 35

3.3.2.3 Hospital pharmacy respondents ............................................................................... 37

3.3.3 Categorisation of activities............................................................................................ 38

3.3.4 Safe activities .............................................................................................................. 42

3.3.4.1 Safe activities Perceptions of risk ......................................................................... 42

3.3.4.2 Safe activities Differences between professional groups .................................... 42

3.3.4.3 Safe activities Key points ...................................................................................... 44

3.3.5 Borderline activities .................................................................................................... 45

3.3.5.1 Borderline activities Perceptions of risk .............................................................. 45

3.3.5.2 Borderline activities Differences between professional groups .......................... 45

3.3.5.3 Borderline activities - Key points ............................................................................. 47

3.3.6 Unsafe activities .......................................................................................................... 47

3.3.6.1 Unsafe activities Perceptions of risk .................................................................... 48

3.3.6.2 Unsafe activities Differences between professional groups ................................ 48

3.3.6.3 Unsafe activities - Key points .................................................................................. 49

3.3.7 Perceptions statements about supervision .................................................................. 49

3.3.7.1 Differences between professional groups ................................................................ 50

3.3.7.2 Views on supervision & accountability Key points ................................................ 52

3.3.8 Impact of demographics and pharmacy characteristics (e.g. workload & environment)

on community pharmacy respondents ......................................................................................... 53

3.3.8.1 Community pharmacists ........................................................................................... 53

3.3.8.2 Community pharmacy technicians............................................................................ 57

3.3.8.3 Impact of pharmacy and pharmacist/PT characteristics Key points ...................... 59

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3.3.9 Qualitative analysis of open comments ........................................................................ 60

3.3.9.1 Can/ cannot activities............................................................................................ 60

3.3.9.2 Views on supervision ................................................................................................ 60

3.3.9.3 Competent staff ........................................................................................................ 63

3.3.9.4 Who decides? ............................................................................................................ 64

3.3.9.5 Who is r

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