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.

Developing the public health function of locum pharmacists under the auspices of the new pharmacy contract

Focal Point - There are reduced opportunities for locum pharmacists to access training and education that meets their needs and enables them to play a full role under the new pharmacy contract - Eighty-six per cent of locums consider themselves to be more health professional than business person, compared to just 48% of pharmacy owners - Forty per cent of locums believe that a lack of access to training is a major barrier to the development of their public health function - While locum pharmacists are arguably more likely to embrace 'professionalising', patient-care-based roles, they are also the group least likely to be able to access the necessary training to fulfill such roles Introduction It has been suggested that locum pharmacists do not want the business-based responsibilities (e.g. staff management, meeting targets, etc) that come with pharmacy management.1 Research also suggests that locums derive great satisfaction from the health-professional aspects of the pharmacists’ role (e.g. patient contact, the provision of advice, etc).1 However, upon the introduction of the new pharmacy contract (April 2005), concerns were expressed that it was becoming increasingly difficult for locum pharmacists to access training and education that would meet their needs and enable them to play a full role under the new framework.2,3 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. Respondents were asked ‘indicate how you view yourself as a pharmacist’ – in terms of their relative focus on the health-professional and business aspects of their role. Respondents were also asked ‘do you consider a lack of training opportunities to be a barrier to the development of the public health role of community pharmacists?’. Results Locums were significantly more likely than owners or employees to consider each factor a major barrier. Discussion Four in 10 locums consider a lack of training opportunities to constitute a major barrier to the development of their public health function. Pharmacy may not be able to provide the services required of it by the policy agenda if pharmacists are unable to be involved in extended role activities through a lack of training opportunities. Therefore, the paradox that needs to be addressed is that while locum pharmacists are arguably more likely to embrace ‘professionalising’, patient-care-based roles, they are also the group least likely to be able to access training to fulfil such roles. The training needs of this large subset of the pharmacist population need to be assessed and met if the whole community pharmacy workforce is going to maximise its contribution to public health under the new contractual framework. References 1 Shann P, Hassell K. An exploration of the diversity and complexity of the pharmacy locum workforce. London: Royal Pharmaceutical Society of Great Britain; 2004. 2 Almond M. Locums – key players in workforce – cast adrift as contract launched. Pharm J 2005;274:420. 3 Bishop DH. A lack of appreciation of what really happens. Pharm J 2005;274:451.

Critical practice and the public pedagogy of environmental and conservation media

Natural History filmmaking has a long history but the generic boundaries between it and environmental and conservation filmmaking are blurred. Nature, environment and animal imagery has been a mainstay of television, campaigning organisations and conservation bodies from Greenpeace to the Sierra Club, with vibrant images being used effectively on posters, leaflets and postcards, and in coffee table books, media releases, short films and viral emails to educate and inform the general public. However, critics suggest that wildlife film and photography frequently convey a false image of the state of the world’s flora and fauna. The environmental educator David Orr once remarked that all education is environmental education, and it is possible to see all image-based communication in the same way. The Media, Animal Conservation and Environmental Education has contributions from filmmakers, photographers, researchers and academics from across the globe. It explores the various ways in which film, television and video are, and can be, used by conservationists and educators to encourage both a greater awareness of environmental and conservation issues, and practical action designed to help endangered species. This book is based on a special issue of the journal Environmental Education Research.

The future of the public library:reimagining the moral economy of the 'people's university'

New media technologies, the digitisation of information, learning archives and heritage resources are changing the nature of the public library and museums services across the globe, and, in so doing, changing the way present and future users of these services interact with these institutions in real and virtual spaces. New digital technologies are rewriting the nature of participation, learning and engagement with the public library, and fashioning a new paradigm where virtual and physical spaces and educative and temporal environments operate symbiotically. It is with such a creatively disruptive paradigm that the £193 million Library of Birmingham project in the United Kingdom is being developed. New and old media forms and platforms are helping to fashion new public places and spaces that reaffirm the importance of public libraries as conceived in the nineteenth century. As people’s universities, the public library service offers a web of connective learning opportunities and affordances. This article considers the importance of community libraries as sites of intercultural understanding and practical social democracy. Their significance is reaffirmed through the initial findings in the first of a series of community interventions forming part of a long-term project, ‘Connecting Spaces and Places’, funded by the Royal Society of Arts.

Critical practice and the public pedagogy of environmental and conservation media

This article addresses the reluctance of mainstream corporate and commercial media to critically address major environmental and conservation issues. The resulting public pedagogy largely reproduces the neoliberal ideology informing much conservation practice and discourse. Nonetheless, the media retains an unrealised critical educative potential that needs to be drawn upon by critical media practitioners and educators. To do this, educators need to be cognisant of the phenomenological experience of spectatorship, the aesthetic form and relational contexts of media consumption, production and informal learning. Referring to the work of Vivian Sobchack, Henry Giroux, Pierre Bourdieu and Gilles Deleuze, the article argues that if critical practitioner-educators apply an analytic framework informed by critical realism, counter-hegemonic elements found within corporate and independent media productions and conservation initiatives may be rearticulated and re-presented in a more positive manner. For this to occur, critical media practitioners-educators need to recognise that feasible political and normative alternatives are both available and practically possible. The article ends by discussing some relatively recent non-fiction productions that express a commonality between human and non-human animals and so form the basis of a critical environmental education-media practice.

Municipal benchmarking:organisational learning and network performance in the public sector

The main purpose of this dissertation is to assess the relation between municipal benchmarking and organisational learning with a specific emphasis on benchlearning and performance within municipalities and between groups of municipalities in the building and housing sector in the Netherlands. The first and main conclusion is that this relation exists, but that the relative success of different approaches to dimensions of change and organisational learning are a key explanatory factor for differences in the success of benchlearning. Seven other important conclusions could be derived from the empirical research. First, a combination of interpretative approaches at the group level with a mixture of hierarchical and network strategies, positively influences benchlearning. Second, interaction among professionals at the inter-organisational level strengthens benchlearning. Third, stimulating supporting factors can be seen as a more important strategy to strengthen benchlearning than pulling down barriers. Fourth, in order to facilitate benchlearning, intrinsic motivation and communication skills matter, and are supported by a high level of cooperation (i.e., team work), a flat organisational structure and interactions between individuals. Fifth, benchlearning is facilitated by a strategy that is based on a balanced use of episodic (emergent) and systemic (deliberate) forms of power. Sixth, high levels of benchlearning will be facilitated by an analyser or prospector strategic stance. Prospectors and analysers reach a different learning outcome than defenders and reactors. Whereas analysers and prospectors are willing to change policies when it is perceived as necessary, the strategic stances of defenders and reactors result in narrow process improvements (i.e., single-loop learning). Seventh, performance improvement is influenced by functional perceptions towards performance, and these perceptions ultimately influence the elements adopted. This research shows that efforts aimed at benchlearning and ultimately improved service delivery, should be directed to a multi-level and multi-dimensional approach addressing the context, content and process of dimensions of change and organisational learning.

An empirical investigation of audit pricing in the public sector:the case of Greek LGOs

This paper investigates the associations between audit pricing and multidimensional characteristics of local governments by using a sample of Greek municipalities. The Greek institutional setting is interesting because it is politically pluralistic. Moreover, independent auditors appointed through a bid process exclusively perform the audits. Our results suggest a considerable variation on audit fees which is mainly driven by politically related factors indicating the importance of relevant theoretical anticipations in audit pricing in the public sector. Agency costs appear strong enough to explain audit pricing. We also confirm prior findings on the significance of audit complexity and size. Results also suggest that audit fees are reduced when an internal team dedicated to accrual accounting is appointed. Therefore, our conclusions offer practical implications for policy setters and regulators in the public sector in relation to audit quality.

The discretionary role of the line manager in inspiring work engagement and innovative behaviour:a study of social exchange and job resources in the public sector

This thesis is about the discretionary role of the line manager in inspiring the work engagement of staff and their resulting innovative behaviour examined through the lens of Social Exchange Theory (Blau, 1964) and the Job Demands-Resources theory (Bakker, Demerouti, Nachreiner & Schaufeli, 2001). The study is focused on a large British Public Sector organisation undergoing a major organisational shift in the way in which they operate as part of the public sector. It is often claimed that people do not leave organisations; they leave line managers (Kozlowski & Doherty, 1989). Regardless of the knowledge in the literature concerning the importance of the line manager in organisations (Purcell, 2003), the engagement literature in particular is lacking in the consideration of such a fundamental figure in organisational life. Further, the understanding of the black box of managerial discretion and its relationship to employee and organisation related outcomes would benefit from greater exploration (Purcell, 2003; Gerhart, 2005; Scott, et al, 2009). The purpose of this research is to address these gaps with relation to the innovative behaviour of employees in the public sector – an area that is not typically associated with the public sector (Bhatta, 2003; McGuire, Stoner & Mylona, 2008; Hughes, Moore & Kataria, 2011). The study is a CASE Award PhD thesis, requiring academic and practical elements to the research. The study is of one case organisation, focusing on one service characterised by a high level of adoption of Strategic Human Resource Management activities and operating in a rather unique manner for the public sector, having private sector competition for work. The study involved a mixed methods approach to data collection. Preliminary focus groups with 45 participants were conducted, followed by an ethnographic period of five months embedded into the service conducting interviews and observations. This culminated in a quantitative survey delivered within the wider directorate to approximately 500 staff members. The study used aspects of the Grounded Theory (Glaser & Strauss, 1967) approach to analyse the data and developed results that highlight the importance of the line manager in an area characterised by SHRM and organisational change for engaging employees and encouraging innovative behaviour. This survey was completed on behalf of the organisation and the findings of this are presented in appendix 1, in order to keep the focus of the PhD on theory development. Implications for theory and practice are discussed alongside the core finding. Line managers’ discretion surrounding the provision of job resources (in particular trust, autonomy and implementation and interpretation of combined bundles of SHRM policies and procedures) influenced the exchange process by which employees responded with work engagement and innovative behaviour. Limitations to the research are the limitations commonly attributed to cross-sectional data collection methods and those surrounding generalisability of the qualitative findings outside of the contextual factors characterising the service area. Suggestions for future research involve addressing these limitations and further exploration of the discretionary role with regards to extending our understanding of line manager discretion.

Working with the public sector:SME medical device innovation and pre-procurement

Healthcare providers are under ever increasing pressure to deliver more technologically advanced care without increasing costs. Innovation is essential (Darzi, 2008), and for this healthcare providers rely on innovation within commercial companies. SMEs have an important part to play in this sector (NHS Supply Chain Parliamentary Brief, 2013). Collaboration between SME suppliers and the NHS for innovation forms the focus of this paper. We examine the academic literature on interorganizational innovation including academic insights from the areas of forward commitment procurement (Environmental Innovation Advisory Group, 2003-2008), pre-commercial procurement (Bos & Corvers, 2007), innovation and SMEs. We then explore practice, first from a policy and business sector perspective. Second, we present evidence from fifteen cases of interorganizational innovation projects involving SMEs and UK healthcare providers. Our findings show much effort is being put into creating opportunities for more interorganizational innovation of medical devices. Working across organizational boundaries presents added complexity to the innovation environment and process, and the challenge of developing high-quality cross-boundary group interaction.

The public benefit requirement for charities in England and Wales:a qualitative study of its impact

The Charities Act 2006 introduced at least three changes leading to renewed emphasis on the public benefit requirement for charities in England and Wales: changes which have the potential to alter substantially society’s understanding of what it means for a body to be a charity. There has been a great deal of technical discussion of the changes, but against that background, this article presents a qualitative assessment of perceptions of the practical impact. The changes made by the 2006 Act took effect in 2008, and by 2012 four years had elapsed for the impact to settle down. We assessed the perceived impact of the renewed public benefit emphasis, using in depth interviews with a number of major stakeholders and open workshops with charity staff, trustees and advisers. We found that most study participants valued public benefit as a central concept distinguishing charitable and non-charitable organisations, although for many charities the impact is experienced mainly at the time of registration and when producing their annual reports.