Enhancing skill mix in community pharmacies: understanding barriers and proposing solutions

Principal Investigator: Alison Bullock, Cardiff University

  • Opinions on how skill-mix ‘worked’ and for whom it worked seemed to differ.
  • It looked more likely to be perceived as working well by pharmacy owners and those from single businesses, dispensing fewer prescriptions and open for shorter hours.
  • Respondents in a position to influence (perhaps exemplified by the experienced, small business owner) may have felt more empowered to affect change and make a difference.
  • In contrast, workload pressures seemed to be felt more intensely by those in pharmacy chains, open for longer hours, handling large numbers of prescriptions and those pharmacists in a manager, rather than owner position.
  • Such workload pressure could be alleviated by delegation and indeed, the great majority of respondents were confident to delegate to other members of their team.
  • Although the role of the pharmacy technician was valued by most and could relieve the work pressure of the pharmacist, the value of their role relative to dispensers was questioned by some. These less qualified roles were also seen as easing workloads and releasing pharmacist time for services and greater patient contact.
  • Key barriers to delegating and developing staff roles and responsibilities chimed with existing literature and included resources (funding, time for training, pay), staffing and workload, and relationships (within the team and with GPs/others).
  • There was some uncertainty about scope of practice amongst pharmacy owners and evidence in some pharmacies of team members working beyond their qualification and training.
  • What stood out across the case study pharmacies was dynamic leadership, staff feeling valued and taking pride in their work, a strong patient-focus and a systematic but flexible approach to managing workload where staff roles could be covered by more than one staff member.
  • Training is part of the solution (additional clinical skills, scope of practice, legalities, leadership) but is challenged by lack of time and resources.

This project ran from May 2014 to October 2015. The final report is available here.