How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems

Background: In England, there is an ongoing national pilot to expand pharmacists’ presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists’ impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. Methods: All pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately one hour, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically. Results: In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs (“whether or not we actually have positive impact on KPIs is beyond our control”); depth and breadth of pharmacists’ activity (“we see a huge plethora of different patients and go through this holistic approach - everything is looked at”); awareness of practice based pharmacists’ roles (“I think the really important [thing] is that everyone knows what pharmacists in general practice are doing”); and central evaluation versus local initiatives (“the KPIs will be measured by National Health Service England regardless of what we think” versus “what I think is more pertinent, are there some local things we’re going to measure?”). Conclusions: Measures that will effectively capture pharmacists’ impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists’ activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists’ presence in general practice

Community pharmacy teams’ experiences of general practice-based pharmacists: an exploratory qualitative study

Background: In England, since 2015, there has been a formal drive to integrate pharmacists into general practice as a new healthcare service. Research efforts have offered insights into how general practice-based professionals and patients view the service, however, they took no account of community pharmacy teams’ opinions. There have been anecdotal statements about opposition from community pharmacies to the service, due to fears of losing business. The aim of the current study was to identify the experiences and perceptions of community pharmacy teams regarding pharmacists’ presence in general practice. Methods: The National Health Service Choices website was used to identify community pharmacies within a radius of two miles from eight West London general practices. The search resulted in 104 community pharmacies which were all contacted via telephone. Pharmacy staff who verbally expressed their interest to participate were then provided with the study’s documents. Qualitative, face-to-face, semi-structured interviews were conducted inside the pharmacy from which each participant was recruited. Interviews lasted 30 to 45 minutes and were audio-recorded. Audio-recordings were transcribed verbatim and transcripts analysed thematically. Results: Forty-eight community pharmacy staff participated. Four themes were discerned: awareness (“I knew that [pharmacists] have already been implemented [in general practice] but I haven’t really followed it…where does the pharmacist role come?”); interactions (“I’m just so pleased that there’s a pharmacist professional in the general practice…because we speak the same language!”); patient care (“if I was a patient knowing that there is a general practitioner and a pharmacist [in general practice], I would…think ‘nothing can go wrong at the moment’”); and funding challenges (“if general practices take on the extra responsibility of stop smoking or flu vaccination campaigns…financially, this would affect this pharmacy”). Conclusions: The current study revealed the perceived impact of general practice-based pharmacists on community pharmacies would be improved communication between pharmacies and practices. Findings will inform policy so that any future framing of pharmacists’ presence in general practice considers the needs of community pharmacies

International Social Survey Programme: Work Orientations IV - ISSP 2015

Attitude towards work. Work orientation. Conflict and social exclusion. Subjective experience of job. Work satisfaction. Non-standard employment. Work life balance. Job and working flexibility. Human capital. Outcome of work. Employability, new job. Topics: work centrality (a job is just a way of earning money vs. would enjoy having a paid job even if the money is not needed); importance of selected demands of a job like job security, high income, etc. (work values); work life balance: willingness to give up good job opportunities for the benefit of the family; willingness to remain in a job that is not satisfying for the benefit of the family; conflict and social exclusion: experience of discrimination with regard to work, for instance when applying for a job; main reason for the discrimination; experience of harassment at the workplace by superiors or co-workers (for example bullying, physical or psychological abuse); solidarity and conflict with regard to trade unions (workers need strong trade unions to protect their interests vs. strong trade unions are bad for the country´s economy); preferred employment arrangements (full-time, part-time, less than 10 hours a week, no paid job at all); currently working for pay (employment status); preference for more work (and money) or for reduction in working hours (work longer hours and earn more money, work the same number of hours and earn the same money, or work fewer hours and earn less money); characteristics (social dimension) of own job; subjective experience of job: frequency of hard physical work and stressful work; non-standard employment: frequency of working at home during the usual working hours and working on weekends; job and working flexibility concerning starting and finishing times; non-standard employment: usual working schedule in the main job; job and working flexibility: organisation of daily work (free decision, decision within certain limits, no free decision); work life balance: difficult to take an hour off during working hours to take care of personal or family matters; demands of the job interfere with the family life and the demands of family life interfere with the job; human capital: usefulness of the abilities learned from past work experience for the present job; job training over the past twelve months to improve job skills; judgement on the relations between management and employees and the relations between workmates/ colleagues (working atmosphere); outcome of work: work satisfaction in the main job; identification with firm or organisation; occupational commitment (would change the present type of work for something different, proud of the present type of work); employability/ new job: expected difficulties in finding a new job at least as good as the current one; likeliness of job search in the next twelve months; worried about the possibility of losing own job; job and working flexibility: accepted concessions to avoid unemployment (acceptance of a job that requires new skills, acceptance of a lower paid position, acceptance of temporary employment, longer travel to reach the place of work, movement within the country, movement to a different country); existence of a side job in addition to the main job; earning from the additional job(s) in total compared with the main job. Respondents who are not currently employed were asked: ever worked for pay for one year or more; month and year the last paid job ended; work satisfaction in the last job; main reason for the end of last employment; interest in finding a paid job; expected difficulties in finding a new job; worried about the possibility of not finding a job; accepted concessions in order to get a job (acceptance of a job that requires new skills, acceptance of a lower paid position, acceptance of temporary employment, longer travel to reach the place of work, movement within the country, movement to a different country); job seeking activities in the past twelve months and training to improve own job skills; currently looking for a job; main source of economic support; worried about the possibility of losing this main economic support. Optional items: recent work histories: ever worked for pay over the past five years; experience of selected changes in working life (unemployment for a period longer than three months, change of the employer, change of the occupation, started own business/ became self-employed, took up an additional job); self-assessment of current financial situation; change of current financial situation compared to five years ago; expected financial situation in five years; attitude towards senior citizens´ work (good for the country´s economy, employed people aged 60 and over take jobs away from younger people). Optional background variable: self-assessment of physical and mental health. Additional compulsory background variable: age of the youngest child in the household. Demography: sex; age; year of birth; years in school; education (country specific); highest completed degree; work status; hours worked weekly; employment relationship; number of employees; supervision of employees; number of supervised employees; type of organisation: for-profit vs. non profit and public vs. private; occupation (ISCO-08); main employment status; living in steady partnership; union membership; religious affiliation or denomination (country specific); groups of religious denominations; attendance of religious services; top-bottom self-placement; vote in last general election; country specific party voted in last general election; party voted (left-right); self-assessed affiliation of ethnic group 1 and 2 (country specific); number of children; number of toddlers; size of household; earnings of respondent (country specific); family income (country specific); father´s and mother´s country of birth; marital status; place of living: urban – rural; region (country specific). Information about spouse/ partner on: work status; hours worked weekly; employment relationship; supervises other employees; occupation (ISCO-08); main employment status. Additionally encoded: respondent-ID number; date of interview (year, month, day); case substitution flag; mode of data collection; weight

International Social Survey Programme: Role of Government V - ISSP 2016

Die Rolle der Regierung Themen: Gesetze befolgen ohne Ausnahme vs. Entscheidung nach Gewissen; öffentliche Protestveranstaltungen, Protestmärsche und Demonstrationen gegen die Regierung sollten erlaubt sein; Erlaubnis für Revolutionäre, öffentliche Versammlungen abzuhalten und Bücher zu veröffentlichen, die ihre Ansichten zum Ausdruck bringen; schlimmerer Justizirrtum (eine unschuldige Person zu verurteilen oder einen Schuldigen freizulassen); Zustimmung oder Ablehnung verschiedener wirtschaftlicher Maßnahmen durch die Regierung (Kürzungen der Staatsausgaben, staatliche Finanzierung von Projekten zur Schaffung neuer Arbeitsplätze, weniger staatliche Regulierung von Unternehmen, Unterstützung der Industrie bei der Entwicklung neuer Produkte und Technologien, Unterstützung für rückläufige Industrien zum Schutz von Arbeitsplätzen, Verringerung der Wochenarbeitszeit zur Schaffung von Arbeitsplätzen); Präferenz für mehr oder weniger Staatsausgaben in verschiedenen Bereichen (Umwelt, Gesundheit, Polizei und Strafverfolgung, Bildung, Militär und Verteidigung, Altersrenten, Arbeitslosenunterstützung, Kultur und Kunst); Frage der Regierungsverantwortung (Arbeit für alle, Preiskontrolle, Gesundheitsfürsorge für Kranke, angemessener Lebensstandard für alte Menschen, Hilfe für die Industrie, angemessener Lebensstandard für Arbeitslose, Verringern der Einkommensunterschiede zwischen Arm und Reich, Unterstützung für Studenten aus einkommensschwachen Familien, menschenwürdige Unterkünfte für diejenigen bereitzustellen, die es sich nicht leisten können, strenge Gesetze auferlegen, um die Industrie zu veranlassen, weniger Umweltschäden anzurichten, Förderung der Gleichstellung von Männern und Frauen); Verantwortlichkeit für die Gesundheitsversorgung Kranker, die Versorgung älterer Menschen und die Schulbildung (Regierung, private Unternehmen/Gewinnorganisationen, Non-Profit-Organisationen/ Wohlfahrtsverbände/Genossenschaften, religiöse Organisationen, Familienangehörige oder Freunde); Akteure mit dem größten und zweitgrößten Einfluss auf das Handeln der Regierung (z.B. Medien, Gewerkschaften, Unternehmen, Banken und Industrie usw.); Politik im Land mehr abhängig von der Weltwirtschaft als von Regierenden und vice versa; Meinung zu Bürgerrechten und öffentlicher Sicherheit: Regierung sollte das Recht haben zur Videoüberwachung von Personen in öffentlichen Bereichen und zur Überwachung von E-Mails; alle Regierungsinformationen sollten öffentlich zugänglich vs. begrenzt sein; Regierung sollte das Recht haben, Informationen zu sammeln über jeden, der im Land oder im Ausland lebt ohne dessen Wissen; Regierung sollte das Recht haben, Menschen ohne Gerichtsverfahren in Haft zu nehmen, Telefongespräche anzuzapfen und Leute auf der Straße nach dem Zufallsprinzip zu stoppen und zu durchsuchen; Politikinteresse; Leute wie ich haben kein Mitspracherecht über das, was die Regierung tut; gutes Verständnis wichtiger politischer Fragen; Abgeordnete versuchen Wahlversprechen zu halten; den meisten Beamten kann vertraut werden; Bewertung der Höhe der Steuern für hohe Einkommen, mittlere Einkommen und niedrige Einkommen; Steuerbehörden stellen sicher, dass die Menschen ihre Steuern zahlen und behandeln alle in Übereinstimmung mit dem Gesetz; große private Unternehmen halten sich an Gesetze und versuchen Steuerzahlungen zu vermeiden; Korruption: geschätzte Häufigkeit von Korruption unter Politikern und Beamten; persönliche Erfahrungen mit Korruption in den letzten fünf Jahren: Häufigkeit von Bestechungsversuchen durch Beamte; Bewertung des Erfolgs der Regierung in den Bereichen Gesundheitsversorgung, Bereitstellung eines angemessenen Lebensstandards für Alte und im Umgang mit Sicherheitsbedrohungen. Demographie: Geschlecht; Alter; Geburtsjahr; Jahre der Schulbildung; Bildung (länderspezifisch); höchster Bildungsbschluss; Erwerbsstatus; Wochenarbeitszeit; Arbeitsverhältnis; Zahl der Beschäftigten (Unternehmensgröße); Weisungsbefugnis; Anzahl der Mitarbeiter für die Weisungsbefugnis besteht; Art des Unternehmens: Profit vs. Non-Profit und öffentlich vs. privat; Beruf (ISCO/ILO-08); Hauptbeschäftigungsstatus; Zusammenleben mit einem Partner; Gewerkschaftsmitgliedschaft; Religionszugehörigkeit oder Konfession (länderspezifisch); Konfessionsgruppen; Kirchgangshäufigkeit; subjektive Schichteinstufung (Selbsteinstufung auf einer Oben-Unten-Skala); Wahlbeteiligung bei der letzten allgemeinen Wahl und gewählte länderspezifische Partei; Links-Rechts-Einstufung der gewählten Partei; Selbsteinschätzung der Zugehörigkeit zu einer ethnischen Gruppe 1 und 2 (länderspezifisch); Anzahl der Kinder im Haushalt; Anzahl der Kleinkinder im Haushalt; Haushaltsgröße; Einkommen des Befragten (länderspezifisch); Familieneinkommen (länderspezifisch); Geburtsland von Vater und Mutter; Familienstand; Urbanisierungsgrad des Wohnortes; Region (länderspezifisch). Informationen über Ehegatten/Partner zu folgenden Themen: Erwerbsstatus; wöchentliche Arbeitszeit; Arbeitsverhältnis; Weisungsbefugnis; Beruf (ISCO/ILO-08); Hauptbeschäftigungsstatus. Zusätzlich verkodet wurde: Befragten-ID; Datum des Interviews (Jahr, Monat, Tag); Kennzeichen für die Ersetzung von Fällen; Art der Datenerhebung; Gewicht; Ländercode ISO 3166, Ländercode/Sample ISO 3166; Ländercode Präfix ISO 3166