‘I expected just to walk in, get my tablets and then walk out’: on framing new community pharmacy services in the English healthcare system

Abstract

Reconfiguration of the healthcare division of labour is becoming increasingly attractive in the context of increased patient demand and resource constraints. One example is the introduction of extended roles for pharmacists to provide patients additional support to manage their medicines, while also reducing work pressures experienced by other health professionals. Understanding how such policies are framed by those delivering and receiving care has been under-theorised. Using Goffman's frame theory, we examine one newly introduced community pharmacy service (New Medicines Service (NMS)) to illustrate how a policy intended to support patient medicine-taking through the extended roles of pharmacists is framed and where this deviates from its proposed aims. Three themes emerged: (i) the spatial-material artefacts; (ii) existing discursive culture and practice around medicine-taking; and (iii) the NMS interactions that shape and govern framing and subsequent interpretation of the NMS. Our study offers an explanatory and dynamic view of the framing process with important lessons for reconfiguring medicine management policy and practice. As well as illustrating framing as being variegated, complementary or conflicting, it also shows how this plurality and fragility had consequences for patient engagement and sense-making. The consequences for engagement and recommendations for implementing future initiatives are discussed.

‘New Medicine Service’: supporting adherence in people starting a new medication for a long-term condition: 26-week follow-up of a pragmatic randomised controlled trial

“…Key strengths of this study are the rigorous design, pragmatic nature, economic analysis, long-term follow-up, and extensive observational and interview-based work alongside the RCT to examine implementation from the perspectives of patients, pharmacy teams and prescribers 34–36…”

“…To understand perception, implementation and execution of NMS in a real-world setting, our work included in-depth exploration of NMS with key stakeholders (patients, prescribers, pharmacists), providing essential insight into future developments and commissioning 34–36. The NMS workload had been absorbed into pharmacists’ daily routines alongside existing responsibilities with no extra resources or evidence of reduction in other responsibilities 34.…”

“…We found pharmacists were pragmatic, simplifying and adapting the NMS to facilitate its delivery which may have affected fidelity and thus effectiveness. Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service 36. Patients who had few problems with medicines had varied reactions to the service 36.…”

“…Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service 36. Patients who had few problems with medicines had varied reactions to the service 36. Where there was ambiguity or poor prior understanding of the NMS, people were reluctant to engage with the service.…”

Pestle and mortal: the demise of community pharmacy in the UK

“…In addition, important ‘frames’ of reference for the public to understand community pharmacy roles might be even further ‘misaligned’ due to these changes, as seen potentially in other activities such as the New Medicines Service. [ 10 ]…”