Background
Pharmacy in the Future(1) set out a plan for the modernisation of pharmacy services. While national policy is a driver for development, other "local" factors affect the shape and scope of implementation. Devolution within the NHS following Shifting the Balance of Power(2) means that PCTs are now responsible for commissioning and delivering services to their populations. Local responsibility for community pharmacy development falls to PCT medicines management teams. Anecdotal reports suggest that the views and perceptions of the individuals within these teams are important in determining the extent of local commissioning. The aim of this paper is to explore factors perceived by PCT pharmacists to influence community pharmacy development. It reports on the results from one question within the first national survey of PCTs regarding community pharmacy development.

Methods
A pre-piloted self-completion survey was distributed to the senior pharmaceutical adviser or equivalent at each PCT in England (n=303). The survey included a mixture of closed and open questions. Responses following three follow-ups were obtained from 207 (68.3%) recipients. One of the open questions asked respondents to tell us "What is the ONE thing that would help you most to develop community pharmacy in your PCT?" The responses from this question (n=153) were extracted, independently coded and grouped according to common themes by two members of the team.

Results
The predominant themes were: greater access to funding (39, 25.5%); having a PCT resource for community pharmacy development, either as a dedicated facilitator post or capacity within the organisation (35, 22.9%); improved support and attitude from local pharmacists, with the Local Pharmaceutical Committee specifically cited in several cases (29, 19.0%); a change in culture among community pharmacists (18, 11.8%); implementation of the new community pharmacy contract (12, 7.8%); more personal time to spend on this area (6, 3.9%); and specific projects e.g. minor ailments (5, 3.3%).

Discussion
The development of community pharmacy is multi-factorial: the rationale in asking this particular question was to focus the respondent's thinking on what they perceived as the single most important factor for their PCT in developing community pharmacy. Our work is limited to the views and opinions of PCT respondents: it does not reflect the perceptions of local pharmacists and their representatives. For most respondents better access to money was cited explicitly above all others. Money is also an implicit factor in agreeing to have a community pharmacy development post. This is despite an unprecedented increase in NHS spending committed by the government. While we might expect money to be an important factor, a significant proportion of respondents perceived a change of attitude and culture among community pharmacists (and those that represent them) as being the single most important factor for their PCT. This suggests that, second only to securing resources, developing better local relationships would improve the opportunities for progress in many PCTs.

References
1. Department of Health. Pharmacy in the Future - Implementing the NHS Plan. London: DoH, 2000.
2. Department of Health. Shifting the Balance of Power. London: DoH, 2001.