Objective
Using critical incidents cited by community pharmacists, to explore attitudes to external changes affecting the profession.

Methods
As part of a wider research study, all community pharmacists in one health authority area were asked to participate in an interview survey. Interviews were conducted by telephone using a structured questionnaire based on our previous research^1,2 with a mix of open and closed questions. As part of the questionnaire pharmacists were asked what contact, if any, they had had with local PCGs. At the beginning of the interview pharmacists were asked to relate up to three critical incidents from their own practice involving change. The interviews were conducted by a researcher experienced in social science research methods. Detailed notes were taken during the interview, including verbatim quotes. Immediately after the interview the critical incidents were dictated onto audio tape and subsequently transcribed. The transcripts were then analysed for two features: evidence of specific behaviours and topics involved. A coding frame based on that from our previous work was used^1,2. The critical incidents were coded independently by three members of the research team and a meeting was held at which consensus was reached on any incidents where there was a discrepancy between coders. The data were entered onto a computerised database.

Results and discussion
57 of the 80 pharmacists approached agreed to take part (71%) and 165 critical incidents were generated. The topic relating to external change which featured most commonly was Primary Care Groups (PCGs), spontaneously mentioned by 15 (26%) respondents. In their questionnaire answers those pharmacists who commented on PCGs tended to make positive statements. Pharmacists' descriptions in the critical incidents tended to show strongly positive (7) or strongly negative (6) views, with only two appearing to be neutral or uncertain. Some pharmacists viewed PCGs as an exciting opportunity and described the steps they personally had taken to get involved. Others saw PCGs as further marginalising pharmacists within primary care and were preoccupied by the exclusion of pharmacists from PCG boards: "We have been left behind because because we are not part of PCGs" (P33); "All I can see is that pharmacists will be used for their experience in pricing ... I feel terrible about it" (P46), "I don't even know who is on it" (P53). The accounts of the pharmacists suggested a fundamental difference in both professional behaviour (pro-activity, networking) and attitude (confidence, vision of the future, and perceived control over professional destiny).

Conclusions
The impact of PCGs on community pharmacy was the topic spontaneously mentioned by the largest number of respondents. Their accounts were evenly split between positive and negative views. These findings suggest that a substantial number of community pharmacists may be waiting to be invited to participate in working with PCGs, while the world of healthcare changes around them.

1. Tann J, Blenkinsopp A, Allen J, Platts A. (1996) Leading edge practitioners in community pharmacy: Approaches to innovation. Int J Pharm Pract; 4: 235-45
2. Blenkinsopp A, Tann J, Platts A. (In press) A method for distinguishing leading edge practitioners - a case study in community pharmacy. J Soc Admin Pharm