Clinical productivity in Community Pharmacy

Community pharmacies play a key role in healthcare systems. Not only do they dispense prescriptions, but they are becoming increasingly involved in helping patients use their medicines more effectively (e.g. through medicines use reviews or ‘MURs’) and in providing services such as minor ailment schemes and smoking cessation services. Community pharmacy organisations vary widely from small independently-owned businesses to large national chains and supermarkets. Whilst some pharmacies may provide a greater volume of additional services, we do not fully understand which organisational factors contribute to this.

This study aims to investigate existing variation in both the quality and quantity components of clinical productivity in community pharmacies and the organisational factors associated with this variation. The findings will serve both service commissioners and pharmacy contractors seeking to improve productivity in community pharmacy.

Starting in April 2013, it is being conducted in two stages over 27 months, in five geographical areas.

Stage 1 will combine analysis of existing datasets with primary data collection to examine variation in clinical productivity across community pharmacies and analyse associations between organisational characteristics and productivity. Data will be obtained through three sources (linked by contactor code and postcode):

• Survey of community pharmacies

A questionnaire will be distributed to all pharmacies in the five study areas. A list of pharmacies and their contact details will be obtained from NHS England area teams. Information will be collected on key organisational characteristics: ownership; staffing and skill-mix; working patterns; management structure; use of locums. Organisational culture and safety climate will also be measured.

• Community pharmacy returns

Since April 2013, NHS England (through its local area teams) is responsible for the routine collection of data from pharmacies in respect of delivery of the pharmaceutical services contract. These data include monthly dispensing volume and volume of advanced and enhanced services. These data will be obtained from the BSA or study sites (area teams) for each pharmacy, identified by postcode and contractor code. Identifiers will only be used for linkage purposes and no single entity will be identified in published research.

• National socio-economic datasets: 2011 Census; NHS postcode directory; Index of Multiple Deprivation; QoF 

Stage 2: Quantitative methods will examine the inter-relationships between organisational characteristics, productivity and service quality. Qualitative methods will explore issues around service quantity and quality in community pharmacies, their relationship and the mechanisms by which they are influenced by organisational characteristics.

• Quantitative data collection

A two-sided questionnaire will be distributed to two samples of consecutive patients following receipt of a) dispensing and b) MUR services from each pharmacy in 40 pharmacies, 8 from each study area. Participant information sheets will also be provided for patients together with reply-paid envelopes to return the questionnaire directly to the research team. Questionnaires will be anonymous other than a pharmacy identifier and non-responders will not be followed up. The questionnaire will collect some background data (socio-demographic, existing conditions, medications received) in addition to two self-reported measures of a) satisfaction with information about medicines (SIMS, 17 items) and b) adherence to medicines (MARS, 5 items).

• Qualitative data collection

Semi-structured, face-to-face interviews will be conducted with up to 50 pharmacy and commissioning representatives. Topic guides will be developed from the aims of the research and the research literature and will broadly explore the relationship between the quantity and quality of service provision in community pharmacies, opportunities and barriers to increasing clinical productivity in this setting and the mechanisms by which different organisational characteristics may help or hinder this objective.

The project team, led by Dr Sally Jacobs, includes Professor Karen Hassell and Dr Ellen Schafheutle, Dr Fay Bradley and Dr Rebecca Elvey (all CPWS), together with Dr Mark Hann, Institute of Population Health, University of Manchester, Dr Devina Halsall, NHS Merseyside, and Andrew Wagner, Primary Care Research Network – East of England.

For further information on the project, which was commissioned by the National Institute for Health Research (NIHR), see: Health Services and Delivery Research Programme (HS&DR).

You can read more about the study in our list of Frequently asked questions (FAQs) (PDF, 64 kB)

For more information, contact: Sally.Jacobs@manchester.ac.uk or karen.hassell@manchester.ac.uk