Posted by: Evgenia Paloumpi8 NOV 2017
You don’t have to be a PhD scholar to realise that community pharmacy faces turbulent times in England, with funding cuts and unpopular reforms. However, as a PhD scholar, I can look beyond the surface, explore causes and contribute solutions.
My journey towards a vision for the future of community pharmacy services started a few months ago. To share my experience with you, I am going to use the multiple streams theory1, which describes policy formation as a result of three processes (or streams). When three streams come together simultaneously, a ‘window of opportunity’ is created:
- The problem stream – a particular problem is recognised and gains attention;
- The policy stream – a technically and politically feasible solution is available;
- The politics stream – the political climate is positive for a change.
The problem stream
Several problems co-exist within community pharmacy services. The need for NHS reform has received widespread attention and has been a priority for policymakers. The year 2018 marks the 70th anniversary of the NHS, a service that needs to respond to the challenges of the 21st century and the demands of its population. Global austerity, rapidly developing technology, ensuring high quality of care, pressures from an ageing population with more long-term conditions and political instability reflect the complexity of healthcare challenges. In addition, community pharmacy is recognised as a highly valued resource but underutilised.
The policy stream
Over the last decade, governments have proposed various solutions to reform the health system. There have been structural changes and a gradual but noticeable shift from central to local leadership. Examples include the NHS Five Year Forward View, sustainability and transformation plans and accountable care systems. Solutions for community pharmacy as a service provider have been proposed not only by the government, but also in visions published by various professional organisations. An example is the publication of Community Pharmacy Forward View in August 2016 as the first sector-wide vision for the future. The need for community pharmacy to secure its future in a world of constantly changing proposals for NHS reforms is highlighted.
The politics stream
According to multiple streams theory, political motivation is necessary for a positive change to emerge. This may explain why the policies above have not resulted in positive change for community pharmacy. In general, the signals in this stream are positive, since the NHS is a priority topic for governments. Numerous policy publications aiming to transform primary care and general practice demonstrate this with specific mention of pharmacy. For example, manifestos of three major political parties in the recent elections including pledges for community pharmacy. In September 2017, during the Royal Pharmaceutical Society conference, Steve Brine (the newly appointed pharmacy minister) was clearly supportive of the profession: “We recognise that to date we have not made the best use of pharmacists and pharmacy teams as effectively as we could do — I am determined to correct this.”2
From theory to practice
The multiple streams theory helps us understand that there is infrastructure for a positive change because these three streams are present. My research has identified this ‘policy window’ and aims to contribute to a brighter future for community pharmacy. My ambition is to facilitate responses to current challenges and identify realistic steps for the future.
Initially, I will conduct a health policy review to compare government and professional policies, and summarise the drivers behind them. This will be followed by gathering opinions from all relevant stakeholders, including patients, pharmacists, other healthcare professionals, businesses and commissioners. The third phase will comprise case studies of existing innovative community pharmacy services, and their development from and contribution to past and future policy developments.
Community pharmacy teams are an untapped resource. Carmen Peña, president of the International Pharmaceutical Federation, stated that pharmaceutical services are an intrinsic part of health services and investment in them can help achieve universal health coverage3. My PhD research aims to contribute towards this vision.
Evgenia’s project is located in the Department of Pharmacy and Pharmacology at the University of Bath. The three-year PhD scholarship is donated by Dr Bharat Shah, Sigma Pharmaceuticals, and supervised by Dr Matthew Jones (lecturer in pharmacy practice), Dr Piotr Ozieranski, (lecturer in the Department of Social & Policy Sciences) and Professor Margaret Watson (Professor of health services research).
1. Cairney P and Jones MD. Kingdon’s multiple streams approach: what is the empirical impact of this universal theory? Policy Stud J 2016;44(1):37–38. doi: 10.1111/psj.12111
2. Robinson J. Pharmacy minister pledges to make better use of pharmacists’ expertise. The Pharmaceutical Journal Available at: http://www.pharmaceutical-journal.com/news-and-analysis/news/pharmacy-minister-pledges-to-make-better-use-of-pharmacists-expertise/20203508.article (accessed November 2017)
3. Invest in pharmaceutical services to drive universal healthcare, FIP says. The Pharmaceutical Journal Available at: http://www.pharmaceutical-journal.com/news-and-analysis/news/invest-in-pharmaceutical-services-to-drive-universal-healthcare-fip-says/20203554.article (accessed November 2017)