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.

Institutional shifts in inter-municipal service delivery:an analysis of developments in eight Western European countries

Comparative research on inter-municipal cooperation in eight European countries shows that there is a great variety of institutional arrangements for cooperation across the different countries. Also, these arrangements tend to change over time in terms of the scope of cooperation among partners, their composition and the degree of organizational integration. This article describes and analyzes the variety of and shifts in institutional arrangements for a specific class of inter-municipal cooperation arrangements: those that are set up to provide for the joint delivery of public services. It is argued that specific arrangements are typically the outcomes of interaction between national institutional contexts,?environmental factors and local preferences.

Lessons learned from INTAMAP, an interoperable web service for the real-time interpolation of environmental variables

Interpolated data are an important part of the environmental information exchange as many variables can only be measured at situate discrete sampling locations. Spatial interpolation is a complex operation that has traditionally required expert treatment, making automation a serious challenge. This paper presents a few lessons learnt from INTAMAP, a project that is developing an interoperable web processing service (WPS) for the automatic interpolation of environmental data using advanced geostatistics, adopting a Service Oriented Architecture (SOA). The “rainbow box” approach we followed provides access to the functionality at a whole range of different levels. We show here how the integration of open standards, open source and powerful statistical processing capabilities allows us to automate a complex process while offering users a level of access and control that best suits their requirements. This facilitates benchmarking exercises as well as the regular reporting of environmental information without requiring remote users to have specialized skills in geostatistics.

UncertWeb processing service:making models easer to access on the web

Models are central tools for modern scientists and decision makers, and there are many existing frameworks to support their creation, execution and composition. Many frameworks are based on proprietary interfaces, and do not lend themselves to the integration of models from diverse disciplines. Web based systems, or systems based on web services, such as Taverna and Kepler, allow composition of models based on standard web service technologies. At the same time the Open Geospatial Consortium has been developing their own service stack, which includes the Web Processing Service, designed to facilitate the executing of geospatial processing - including complex environmental models. The current Open Geospatial Consortium service stack employs Extensible Markup Language as a default data exchange standard, and widely-used encodings such as JavaScript Object Notation can often only be used when incorporated with Extensible Markup Language. Similarly, no successful engagement of the Web Processing Service standard with the well-supported technologies of Simple Object Access Protocol and Web Services Description Language has been seen. In this paper we propose a pure Simple Object Access Protocol/Web Services Description Language processing service which addresses some of the issues with the Web Processing Service specication and brings us closer to achieving a degree of interoperability between geospatial models, and thus realising the vision of a useful 'model web'.

A formal model of the Semantic Web Service Ontology (WSMO)

Semantic Web Service, one of the most significant research areas within the Semantic Web vision, has attracted increasing attention from both the research community and industry. The Web Service Modelling Ontology (WSMO) has been proposed as an enabling framework for the total/partial automation of the tasks (e.g., discovery, selection, composition, mediation, execution, monitoring, etc.) involved in both intra- and inter-enterprise integration of Web services. To support the standardisation and tool support of WSMO, a formal model of the language is highly desirable. As several variants of WSMO have been proposed by the WSMO community, which are still under development, the syntax and semantics of WSMO should be formally defined to facilitate easy reuse and future development. In this paper, we present a formal Object-Z formal model of WSMO, where different aspects of the language have been precisely defined within one unified framework. This model not only provides a formal unambiguous model which can be used to develop tools and facilitate future development, but as demonstrated in this paper, can be used to identify and eliminate errors present in existing documentation.

Reverse resource exchanges in service supply chains:the case of returnable transport packaging

Purpose: The purpose of this paper is to understand how reverse resource exchanges and resource dependencies are managed in the service supply chain (SSC) of returnable transport packaging (RTP). Design/methodology/approach: A single case study was conducted in the context of automotive logistics focusing on the RTP SSC. Data were collected through 16 interviews, primarily with managers of a logistics service provider (LSP) and document analysis of contractual agreements with key customers of the packaging service. Findings: Resource dependencies among actors in the SSC result from the importance of the RTP for the customer’s production processes, the competition among users for RTP and the negative implications of the temporary unavailability of RTP for customers and the LSP (in terms of service performance). Amongst other things, the LSP is dependent on its customers and third-party users (e.g. the customer’s suppliers) for the timely return of package resources. The role of inter-firm integration and collaboration, formal contracts as well as customers’ power and influence over third-party RTP users are stressed as key mechanisms for managing LSP’s resource dependencies. Research limitations/implications: A resource dependence theory (RDT) lens is used to analyse how reverse resource exchanges and associated resource dependencies in SSCs are managed, thus complementing the existing SSC literature emphasising the bi-directionality of resource flows. The study also extends the recent SSC literature stressing the role of contracting by empirically demonstrating how formal contracts can be mobilised to explicate resource dependencies and to specify, and regulate, reverse exchanges in the SSC. Practical implications: The research suggests that logistics providers can effectively manage their resource dependencies and regulate reverse exchanges in the SSC by deploying contractual governance mechanisms and leveraging their customers’ influence over third-party RTP users. Originality/value: The study is novel in its application of RDT, which enhances our understanding of the management of reverse exchanges and resource dependencies in SSCs.

Leadership in high-value services for manufacturers:advanced services and their impact on vertical integration

The debate about services-led competitive strategies continues to grow with much interest emerging around the differing practices between production and servitised operations. This paper contributes to this discussion byinvestigating the vertical integration practice (in particular the micro-vertical integration otherwise known as the supply chain position)of manufacturers who are successful in their adoption of servitization.Although these are preliminary findings from a longer-term research programme, through this technical note we seek to simultaneously contribute to the debate in the research community and offer guidance to practitioners exploring the consequences of servitization. Keyword: Servitization, Product-Service Systems, Through-life Services.

An exploratory study of ICT usage in small logistics service providers

Information and communication technology (ICT) developments have strongly affected supply chain management (SCM) in recent years. ICT has had a great impact on all supply chain processes including planning, purchasing, production management, stock management, physical distribution and related integration management. Technology has become an important dimension of third party logistics (3PL) service supply as competitive advantage increasingly depends on the ability to create value for customers through the effective application of ICT. Within this process, while large 3PLs are gaining substantial benefits from technology usage and implementation, the magnitude of changes spurred by ICT dissemination in small logistics service providers remains unclear. This is reflected by the existing gap in literature where the role and competitive developing processes of small 3PLs are seriously underestimated. This gives rise to the need to develop research and investigation in this particular area. The objective of this paper is to narrow the knowledge gap in the field of ICT adoption in small 3PLs through an empirical investigation. It presents the results of a survey on a sample of small Italian 3PLs.

Logics of marginalisation in health and social care reform:integration, choice, and provider-blind provision

The period 2010–2013 was a time of far-reaching structural reforms of the National Health Service in England. Of particular interest in this paper is the way in which radical critiques of the reform process were marginalised by pragmatic concerns about how to maintain the market-competition thrust of the reforms while avoiding potential fragmentation. We draw on the Essex school of political discourse theory and develop a ‘nodal’ analytical framework to argue that widespread and repeated appeals to a narrative of choice-based integrated care served to take the fragmentation ‘sting’ out of radical critiques of the pro-competition reform process. This served to marginalise alternative visions of health and social care, and to pre-empt the contestation of a key norm in the provision of health care that is closely associated with the notions of ‘any willing provider’ and ‘any qualified provider’: provider-blind provision.

Service productivity:what stops service firms from measuring it?

Productivity measurement poses a challenge for service organizations. Conventional management wisdom holds that this challenge is rooted in the difficulty of accurately quantifying service inputs and outputs. Few service firms have adequate service productivity measurement (SPM) systems in place and implementing such systems may involve organizational transformation. Combining field interviews and literature-based insights, the authors develop a conceptual model of antecedents of SPM in service firms and test it using data from 276 service firms. Results indicate that one out of five antecedents affects the choice to use SPM, namely, the degree of service standardization. In addition, all five hypothesized antecedents and one additional antecedent (perceived appropriateness of the current SPM) predict the degree of SPM usage. In particular, the degree of SPM is positively influenced by the degree of service standardization, service customization, investments in service productivity gains, and the appropriateness of current service productivity measures. In turn, customer integration and the perceived difficulty of measuring service productivity negatively affect SPM. The fact that customer integration impedes actual measurement of service productivity is a surprising finding, given that customer integration is widely seen as a means to increase service productivity. The authors conclude with implications for service organizations and directions for research.