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1. How do organisational configuration and context influence the quantity and quality of NHS services provided by English community pharmacies? A qualitative investigation.

Author

Jacobs, Sally, Fegan, Tom, Bradley, Fay, Halsall, Devina, Hann, Mark, and Schafheutle, Ellen I.

Subjects
DRUGSTORES, PHARMACEUTICAL services, HEALTH products, PHARMACY management, SUPPLY & demand
Abstract

Community pharmacies are expanding their role into medicines-related healthcare and public health services, previously the domain of physicians and nurses, driven by policies to improve healthcare access for patients and to address problems of increasing demands and rising costs in primary and urgent care services. Understanding the organisational context into which this expansion is taking place is necessary given concerns over the extent to which pharmacies prioritise service volume over the quality of service provision. As part of a larger programme of work, this paper aims to explore stakeholder perceptions of the organisational and extra-organisational factors associated with service quality and quantity in community pharmacy as an established exemplar of private sector organisations providing publicly-funded healthcare. With ethics committee approval, forty semi-structured interviews were conducted with service commissioners, superintendent and front-line pharmacists, purposively selected from across nine geographical areas and a range of community pharmacy organisational types in England. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Findings highlight the perceived importance of appropriate staffing and skill-mix for promoting service quantity and quality in community pharmacy. Organisational cultures which supported team development were viewed as facilitatory whereas those prioritising business targets over service quality seen to be inhibitive. Older local populations and low patient expectations were thought to limit service uptake as was poor integration with wider primary care services. The contractual framework and commissioning processes were also seen as a barrier to increasing service quality, quantity and integration in this sector. These findings suggest that healthcare administrations should take account of organisational and extra-organisational drivers and barriers when commissioning services from private sector providers such as community pharmacies to ensure that the quality of service provision is incentivised in addition to service quantity. Additionally, collaborative working should be encouraged through integrated commissioning mechanisms. [ABSTRACT FROM AUTHOR]

Published
2018
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2. How do organisational configuration and context influence the quantity and quality of NHS services provided by English community pharmacies? A qualitative investigation

Author

Mark Hann, Ellen I. Schafheutle, Fay Bradley, Devina Halsall, Tom Fegan, and Sally Jacobs

Subjects
Economics, Project commissioning, Health Care Providers, Social Sciences, Health Care Sector, Pharmacists, Geographical locations, State Medicine, 0302 clinical medicine, Drug Discovery, Health care, Medicine and Health Sciences, Public and Occupational Health, Medical Personnel, 030212 general & internal medicine, Qualitative Research, media_common, Allied Health Care Professionals, Multidisciplinary, 030503 health policy & services, ResearchInstitutes_Networks_Beacons/work_and_equalities_institute, Public relations, Europe, Professions, England, Medicine, 0305 other medical science, Research Article, Drug Research and Development, Attitude of Health Personnel, Science, media_common.quotation_subject, Staffing, Community Pharmacy Services, 03 medical and health sciences, Health Economics, Professional Role, Humans, Quality (business), European Union, Quality of Health Care, Pharmacology, Service (business), Service quality, Health Care Policy, business.industry, Private sector, United Kingdom, Health Care, Work and Equalities Institute, People and Places, Population Groupings, business, Qualitative research
Abstract

Community pharmacies are expanding their role into medicines-related healthcare and public health services, previously the domain of physicians and nurses, driven by policies to improve healthcare access for patients and to address problems of increasing demands and rising costs in primary and urgent care services. Understanding the organisational context into which this expansion is taking place is necessary given concerns over the extent to which pharmacies prioritise service volume over the quality of service provision. As part of a larger programme of work, this paper aims to explore stakeholder perceptions of the organisational and extra-organisational factors associated with service quality and quantity in community pharmacy as an established exemplar of private sector organisations providing publicly-funded healthcare. With ethics committee approval, forty semi-structured interviews were conducted with service commissioners, superintendent and front-line pharmacists, purposively selected from across nine geographical areas and a range of community pharmacy organisational types in England. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Findings highlight the perceived importance of appropriate staffing and skill-mix for promoting service quantity and quality in community pharmacy. Organisational cultures which supported team development were viewed as facilitatory whereas those prioritising business targets over service quality seen to be inhibitive. Older local populations and low patient expectations were thought to limit service uptake as was poor integration with wider primary care services. The contractual framework and commissioning processes were also seen as a barrier to increasing service quality, quantity and integration in this sector. These findings suggest that healthcare administrations should take account of organisational and extra-organisational drivers and barriers when commissioning services from private sector providers such as community pharmacies to ensure that the quality of service provision is incentivised in addition to service quantity. Additionally, collaborative working should be encouraged through integrated commissioning mechanisms.

Published
2018