Changes within community pharmacy: Implications for professional, public and commercial policy making.

This research considers the effects of a major change in the provision of community pharmaceutical services in England. Commercial companies now provide the majority of the service with a marked decrease in provision by independent contractors. This change may be described as the corporatisation of community pharmacy. This is important because public policy assumes the service is of a uniform standard irrespective of the occupational status, working pattern and organisational setting of the practitioner. Professional policy has also subscribed largely to this belief, but allowed models of practice to develop in which pharmacists seem to have a considerable variation of control over their professional work. Commercial policy has been driven by organisations seeking to maximise profitability and develop cost effective models of professional practice.Pressures from these sources impact upon community pharmacists and give rise to concerns regarding their ability to carry out their professional responsibilities fully. Of particular concern is their professional autonomy, regarded by many commentators as the distinguishing characteristic of the professions. This research is an exploration of whether, and to what extent community pharmacists' professional autonomy has been affected by corporatisation. Empirical work undertaken led to an instrument that made use of practice based scenarios to locate the degree of professional autonomy that community pharmacists perceived they possessed. After two successful pilots, the instrument was used in a large-scale survey of community pharmacists throughout England. The results indicated that community pharmacists' perception of their professional autonomy varied considerably. The variation was linked to their occupational status and whether they worked on a full or part-time basis. These factors are closely related to the corporatisation of community pharmacy. The findings have considerable policy implications. From the perspective of professional policy, the erosion of professional autonomy found with respect to some categories of community pharmacists calls into question the professional status of pharmacy. From the perspective of public policy the tacit assumption that professional services provided through a variety of organisational structures are essentially the same has been shown to be naive. With regard to commercial policy the overwhelming strength of the commercial agenda risks deprofessionalising community pharmacy. The conclusion reached is that the existing contractor model for the provision of pharmaceutical services should be reviewed and consideration given to replacement with a model that takes into account the realities of current provision.