Introduction

As community pharmacy is undergoing rapid change and reform in relation to the reorganisation of work and attempts to optimise the use of pharmacists and their support staff, the Department of Health commissioned a 'scoping' study to describe and assess the evidence of 'skill mix' initiatives in community pharmacy practice. This abstract is based on some of the findings of that study, and provides an overview of the current situation regarding 'skill mix' and related issues in UK community pharmacy.

Methods

The study was extensive and comprised numerous components. Reported here are the findings from the appraisal of work in progress in the UK via interviews with key stakeholders in pharmacy, community pharmacists and PCG/T staff. This comprised 32 qualitative semi-structured telephone interviews. Fifteen were with community and research pharmacists purposively sampled because of their knowledge or experience of skill mix initiatives and issues, and 17 were with personnel from PCG/Ts in which innovative service developments involving community pharmacy staff had been introduced. These were randomly sampled from a national database. The duration of the interviews ranged from 20 to 30 minutes, some were tape recorded, but most were recorded by hand.

Findings

The unpredictable nature of community pharmacy workload, the heterogeneity of community pharmacy (in terms of prescription volume, organisational size and resources (both human and financial), poor remuneration for professional roles, and difficulties regarding the training of technician and other support staff, were identified as the main threats to the implementation of skill mix initiatives in community pharmacy settings. Some of the key barriers identified in specific relation to support staff included their lack of aspirations to undertake training and extend responsibilities, retention problems once they had been trained, and cost implications of training. Pressures working against skill mix developments from the pharmacists' perspective mainly concerned boundary encroachment and the perceived threats to professional responsibility that comes with delegation.

Discussion and conclusion

Identifying a universal, ideal model of skill mix for community pharmacy is impossible. A myriad of contextual factors must be considered if skill mix is to be adequately addressed and it is likely that different configurations of a pharmacy team will be required for different pharmacy types and different pharmacists. Further research is required to clearly define tasks, skills and competencies across different grades of staff and different skill mix models. Additional basic research is also needed to identify actual labour deployment patterns across pharmacies and attitudes of different grades of staff to roles.