Community, empowerment and sustainable development

This book explores a compelling range of community-based activities from different cultures and nations which help nurture intercultural understanding and practices of sustainable development. The specially commissioned chapters from practitioners and academics offer a set of interconnected case studies, personal stories, philosophical discussions and critical reflections on direct experiences focussing on co-operative action, creative media innovation and community empowerment connecting individuals, groups, organisations from across our converging world. At the bookís core is a central belief that ecological sustainability can only be attained through social learning, community empowerment, participation and a commitment to global justice. It is the first in a series of books addressing issues emerging from the Schumacher Instituteís Converging World Initiative.

An examination of the role of the concept of the community within the current reorganisation of English local government

The thesis will examine the role and impact of the concept of the community within the structural reorganisation of English local government between 1992 and 1995. The methodological approach adopted within this thesis has been to compare the use, application and significance of the community with a case study of a specific local authority and its preparations for reorganisation. The authority in question was Wychavon District Council located in the County of Hereford and Worcester. The conclusions from this case study were then compared to the role and significance of the community in the reviews of other local authorities in England. This study produced two important results. These were that there was an established body of literature which argued that the community could be of value to local government and that the community should be identified by measuring individuals sense of belonging and feelings of attachment, as well as such daily activities as shopping and working (which help to stimulate these feelings). The then Conservative Government even instructed the specially appointed Commission to apply this particular interpretation of the community to their reviews, and to attempt to base any new unitary authorities upon the social and spatial area it created. The Conservative Government also gave the Commission a Community Index to assist with the identification of communities, and appointed the pollsters MORI to support the Commission with the task of identifying the emotional and more subjective senses of community. The Commission eventually came to rely entirely on the MORI polls, and whilst these polls attempted to faithfully apply the Governments interpretation of the community, they unfortunately produced small and often complex communities, which the Commission felt could not be applied to its reviews. This therefore led to the community becoming a secondary consideration to the factors of cost and efficiency. Furthermore the problematic nature of the community - that is, the production of small and complex communities - was repeated in this thesis' own survey of community identities in the District of Wychavon. In fact this authority's proposals for reorganisation were based almost entirely upon the factors of cost, size and efficiency.

Community knowledge management (CKM): a framework for community action

Knowledge management (KM) is a developing field that focuses on harnessing knowledge for use by a person or community. However, most KM research focuses on improving decision making capacity in business communities, neglecting applications in wider society and non-decision making activities. This paper explores the potential of KM for rural communities, specifically for those that want to preserve their social history and collective memories (what we call heritage) to enrich the lives of others. In KM terms, this is a task of accumulating and recording knowledge to enable its retention for future use. We report a case study of Cardrona, a valley of approximately 120 people in New Zealand’s South Island. Realising that time would erode knowledge of their community a small, motivated group of residents initiated a KM programme to create a legacy for a wider community including younger generations, tourists and scholars. This paper applies KM principles to rural communities that want to harness their collective knowledge for wider societal gain, and develops a framework to accommodate them. As a result, we call for a wider conceptualization of KM to include motives for managing knowledge beyond decision making to accommodate community KM (cKM).

A study of the role of the community pharmacist in responding to symptons

Factors affecting the current role of the community pharmacist in responding to symptoms are investigated. Communication and collaboration with general medical practitioners (GPs), and the competency of pharmacists and counter assistants to perform the role of responding to symptoms, are examined. A national survey of GPs, conducted by postal questionnaire, explores attitudes towards the role of the community pharmacist in the treatment of patients' symptoms, and towards future extension of such a role. A majority (over 90%) of respondents thought that the counter prescribing activities of the pharmacist should be maintained or increased. Doctors supported treatment of most minor illnesses by pharmacists, but there was relatively little support for the deregulation of selected Prescription Only Medicines. Three quarters of respondents were in favour of joint educational meetings for pharmacists and doctors. Most GPs (85%) expressed support for a formal referral route from pharmacists to doctors, using a "notification card". A pilot study of the use of a notification card was conducted . Two thirds of the patients who were advised to see their doctor by the pharmacist subsequently did so. In most cases , the GP rated the patients' symptoms " significant" and the card "helpful". Pharmacists' and counter assistants' competency in responding to symptoms was assessed by a programme of pharmacy visits, where previously-defined symptoms were presented. Some pharmacists' questioning skills were found to be inadequate, and their knowledge not sufficiently current. Counter assistants asked fewer and less appropriate questions than did pharmacists, and assistants ' knowledge base was shown to be inadequate. Recommendations are made in relation to the education and training of pharmacists and counter assistants in responding to symptoms .

The computerisation of community pharmacy

Computers have, over the past 10 to 15 years, become an integral part of many activities carried out by British community pharmacists. This thesis employs quantitative and qualitative research methods to explore the use of computers and other forms of information technology (IT) in a number of these activities. Mail questionnaires were used to estimate the level of IT use among British community pharmacists in 1989 and 1990. Comparison of the results suggests that the percentage of community pharmacists using computers and other forms of IT is increasing, and that the range of applications to which pharmacy computers are put is expanding. The use of an electronic, on-line information service, PINS, by community pharmacists was investigated using mail questionnaires. The majority of community pharmacists who subscribed to the service, and who responded to the questionnaire, claimed to use PINS less than they had expected to. In addition, most did not find it user-friendly. A computer program to aid pharmacists when responding to their patients' symptoms was investigated using interviews and direct observation. The aid was not found to help pharmacists in responding to patients' symptoms because of impracticalities involved in its operation. Use of the same computer program by members of the public without the involvement of a pharmacist was also studied. In this setting, the program was favourably accepted by the majority of those who used it. Provision of computer generated information leaflets from pharmacies was investigated using mail questionnaires and interviews. The leaflets were found to be popular with the majority of recipients interviewed. Since starting to give out the leaflets, 27 out of 55 pharmacists who responded to the questionnaire had experienced an increase in the numbers of prescriptions they dispensed. 46 had experienced an increase in the number of patient enquiries they received.

The corporatization of community pharmacy:implications for service provision, the public health function, and pharmacy's claims to professional status in the United Kingdom

Background Pharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension—a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization. Objectives The objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent). Methods A self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n = 1023/1998) was achieved. Results The level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services. Conclusions A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.

Community involvement in urban nature conservation : case studies of the Urban Wildlife Group 1980-85

The effectiveness of the strategies employed by the Urban Wildlife Group (a voluntary conservation organisation) to provide and manage three urban nature parks has been evaluated, using a multiple methods methodology. Where the level of community interest and commitment to a project is high, the utilisation of the community nature park strategy (to maximise benefits to UWG and the community) is warranted. Where the level of interest and commitment of the local community is low, a strategy designed to encourage limited involvement of the community is most effective and efficient. The campaign strategy, whereby the community and UWG take direct action to oppose a threat of undesirable development on a nature park, is assessed to be a sub-strategy, rather than a strategy in its own right. Questionnaire surveys and observations studies have revealed that urban people appreciate and indeed demand access to nature parks in urban areas, which have similar amenity value to that provided by countryside recreation sites. Urban nature parks are valued for their natural character, natural features (trees, wild flowers) peace and quiet, wildlife and openness. People use these sites for a mixture of informal and mainly passive activities, such as walking and dog walking. They appear to be of particular value to children for physical and imaginative play. The exact input of time and resources that UWG has committed to the projects has depended on the level of input of the local authority. The evidence indicates that the necessary technical expertise needed to produce and manage urban nature parks, using a user-oriented approach is not adequately provided by local authorities. The methods used in this research are presented as an `evaluation kit' that may be used by practitioners and researchers to evaluate the effectiveness of a wide range of different open spaces and the strategies employed to provide and manage them.

Community pharmacy in a commissioning-led NHS:can pharmacy compete effectively?

Introduction – The commissioning of services has been a core responsibility of English Primary Care Trusts (PCTs) since 2002. Primary care organisations (PCOs) in Scotland, Wales and Northern Ireland have also increased their commissioning activities but with, arguably, less fervour than their English counterparts. The commissioning function of English PCTs has been reinforced by the introduction of new contractual frameworks across primary care – for medical services, dentistry and pharmacy. The new pharmaceutical services contract for England and Wales introduced an “enhanced” category of services, the provision of which is dependent on the commissioning decisions of local PCTs. As the NHS, most pertinently in England, continues its transformation from a provider to a commissioner of healthcare, the ability of pharmacy to compete effectively for funding is likely to become increasingly important. Method - After piloting, in August 2006 a self-completion postal questionnaire was sent to a random sample of practising community pharmacists, stratified for country and sex, within Great Britain (n=1998), with a follow-up to non-responders 4 weeks later. Data were analysed using SPSS (v12.0). A final response rate of 51% (n=1023/1998) was achieved. Within the section of the questionnaire relating to service provision, respondents were asked “do you believe that pharmacy will be able to compete effectively with other healthcare providers for access to additional funding to develop services that address a public health need identified by your local Primary Care Organisation (PCO), e.g. PCT/LHB etc.?”. Answers were recorded on a three-point scale; pharmacy “will”, “may”, or “will not” be able to compete effectively for funding. Results - The attitudes of pharmacists showed variation depending on the type of pharmacy they worked in (supermarket, multiple (outlets (n)=200), large chain (200>n>20), small chain (20=n>5), or independent (n=5)) (?2 test with p=0.001). Over a third of survey pharmacists working in small chains and independents (37% (n=21/57) and 33% (n=113/341) respectively) believed that pharmacy would not be able to compete effectively for funding compared to 23% (n=15/65) for supermarket pharmacists, 22% (n=21/97) for pharmacists employed by large chains and just 18% (n=62/353) for pharmacists employed most regularly in multiples. Furthermore, attitudes also varied between the countries of residence of respondents (?2 test with p<0.05). 27% (n=242/893) of pharmacists resident in England and Wales believed that pharmacy would not be able to compete compared to 16% (n=18/116) of pharmacists resident in Scotland. Conclusions – It would appear that community pharmacists believe that the larger pharmacy chains and supermarkets will occupy an advantageous position in terms of attracting finance to develop services. This could have notable implications for service provision across the sector. If corporate pharmacy chains were to monopolise commissioning monies then the proportion of funding available to independents will be diminished; arguably further hastening their demise, as well as stifling the professional development of pharmacists employed within the independent sector. These findings, when combined with the variation observed between UK pharmacists operating under different contractual frameworks, may be a reflection of the divergent policy in the different administrations with developments in England, including the new pharmacy contract, reflecting a market-based approach with Scotland taking a near opposite stance with service integration and a commitment to new public health. However, it should be acknowledged that the questionnaire did not allow for detection of ambiguities in, or misunderstandings of, the survey question and this should be considered as a limitation of the research.

Provision of pharmaceutical care by community pharmacists:a comparison across Europe

Objective To investigate the provision of pharmaceutical care by community pharmacists across Europe and to examine the various factors that could affect its implementation. Methods A questionnaire-based survey of community pharmacies was conducted within 13 European countries. The questionnaire consisted of two sections. The first section focussed on demographic data and services provided in the pharmacy. The second section was a slightly adapted version of the Behavioral Pharmaceutical Care Scale (BPCS) which consists of three main dimensions (direct patient care activities, referral and consultation activities and instrumental activities). Results Response rates ranged from 10–71% between countries. The mean total score achieved by community pharmacists, expressed as a percentage of the total score achievable, ranged from 31.6 (Denmark) to 52.2% (Ireland). Even though different aspects of pharmaceutical care were implemented to different extents across Europe, it was noted that the lowest scores were consistently achieved in the direct patient care dimension (particularly those related to documentation, patient assessment and implementation of therapeutic objectives and monitoring plans) followed by performance evaluation and evaluation of patient satisfaction. Pharmacists who dispensed higher daily numbers of prescriptions in Ireland, Germany and Switzerland had significantly higher total BPCS scores. In addition, pharmacists in England and Ireland who were supported in their place of work by other pharmacists scored significantly higher on referral and consultation and had a higher overall provision of pharmaceutical care. Conclusion The present findings suggest that the provision of pharmaceutical care in community pharmacy is still limited within Europe. Pharmacists were routinely engaged in general activities such as patient record screening but were infrequently involved in patient centred professional activities such as the implementation of therapeutic objectives and monitoring plans, or in self-evaluation of performance.

Supply chain learning needs:towards a port community perspective

The traditional role of ports in the wider supply chain context is currently being subject to a process of radical review. In broad terms, the traditional model is being replaced by a model which focuses on higher value and more knowledge intensive activities. This trend requires a change in the way in which new knowledge and skills are developed by staff in companies of all kinds within port communities. Traditional models need to be re-evaluated to reflect the increasing importance of knowledge and skills acquisition, particularly in relation to the supply chain management (SCM) concept and the evolving role of information and communications technology (ICT) in improving supply chain capability. This paper describes the case of NITL’s Foundation Certificate Programme (FCP) learning programme with specific reference to its use in addressing some of current shortcomings related to supply chain knowledge and skills in port communities. The FCP rationale is based on the need to move from traditional approaches of supply chain organisation where the various links in the chain were measured and managed in isolation from each other and thus tended to operate at cross purposes, towards more cooperative and integrated approaches.

Developing community and social cohesion through grassroots bridge-building: an exploration

In the context of the UK public policy goal to increase community and social cohesion, this article explores the nature of local 'bridge-building' – activities intended to increase interpersonal contacts between diverse ethnic, faith and nationality groups. We draw on earlier research in a range of fields to develop the bridge-building concept and present findings from a study that identified community-level projects with bridge-building as a specific aim. We show the range of groupings involved, the activities encompassed and their organisational features. We consider the actual and potential contribution of local bridge-building to cohesion in the light of earlier research and our own study.

The roles of community pharmacists and other pharmacy staff:public perceptions

Introduction: The focus of the community pharmacist’s (CP’s) activities continues to move away from traditional dispensing activities towards the provision of health services. Current functions of CPs cover a combination of roles including prescription matters, counselling and service provision. These expanding roles, along with raised prescription volume, have increased CP workload. Therefore, it has become commonplace to delegate certain activities to other pharmacy staff (PS). This research aimed to examine public perceptions of CPs and other PS functions. Methodology: A self-completion postal questionnaire was sent to a random sample of 9769 members of the general public in England. Participants were asked to indicate which functions they believed CPs and other PS perform. Data were imported into SPSS 22 for analysis. Results: A response rate of 15.7% (n = 1537) was achieved. The roles most commonly attributed to CPs were monitoring prescription appropriateness (90.4%, n = 1390) and counselling patients on prescribed medicines (90.4%, n = 1389). The role most commonly attributed to other PS was sales transactions (92.4%, n = 1420). Similar numbers of responders agreed that the delivery of health services was the role of both CPs and other PS (58.9%, n = 906; 57.0%, n = 876). Conclusion: Despite a move towards more service based practice, the public still primarily associate the CP’s role with activities centred on dispensing. The provision of health services was seen to be equally carried out by CPs and other PS. As the CP’s service-based activities continue to develop, promotional activities may be required to ensure developments in CP functions are recognised by the public