Organizational facilitators of public health service provision though English community pharmacies: Findings from a cross-sectional survey

Background: Most community pharmacies in England now provide medicines-related and public health services alongside more traditional medicines supply services. These services are publicly-funded and free at the point of access to patients. Remuneration is as fee-per-service, and is currently not linked to quality or outcome measures. Medicines use reviews (MURs), address both medicines optimization and public health goals by aiming to increase patient understanding and adherence, but concerns have been raised that quantity may be prioritised over quality. Aim: To investigate the organizational characteristics associated with variation in the volume of dispensing and MUR provision in England. Method: Data on organizational characteristics from a cross-sectional survey of 284 English community pharmacies were linked to existing service activity data and socio-economic variables by organizational code and post (ZIP) code. Multivariable regression of numbers of items dispensed/year and MURs conducted/year were run. Findings: Whilst staffing and skill-mix  and average hours/day worked by the main pharmacist were all significant predictors of annual dispensing volume, for MURs, the key predictor was pharmacy type: chains conducted significantly more MURs than independent pharmacies (<6 stores). Longer opening hours and having an accuracy checker were also significantly associated with increased MUR activity. Conclusion: Whilst larger chains have  more capacity to deliver a greater volume of services than independent pharmacies, independent pharmacies might need to be incentivised or reimbursed differently if pharmacists’ public health role is to achieve greater penetration and be associated with quality patient outcomes.