An exploration of the development and effect of collaboration between community pharmacists and general practitioners
: (Alternative Format Thesis)

  • Marianna Liaskou

Student thesis: Doctoral ThesisPhD

Abstract

Introduction
Over the last decade, several policies within the National Health Service (NHS) have called for increased integration of community pharmacists within the primary care team. Whilst several theoretical collaborative models exist, there is limited empirical evidence of collaborative working models between general practitioners (GPs) and community pharmacists. This doctoral research aimed to explore the development and operation of existing GP-community pharmacist collaborative models, and their effect on service provision and stakeholders involved, by adopting Operations and Supply Chain Management (OSCM) perspectives.


Methods
The research comprises two empirical studies: a systematic literature review, and a series of case studies. Findings were analysed by adopting a process perspective of service provision and buyer-supplier (GP-community pharmacist) relationship dynamics – both grounded in OSCM. The systematic review adopted standard systematic review methods. Multiple inductive and qualitative case studies were explored. Data were collected through semi-structured in-depth interviews and observations, and analysis followed the Gioia Methodology. Within and cross-case data analysis was mapped across micro (individual), meso (organisation), and macro (healthcare system and society) levels.


Results
The systematic review identified 43 articles corresponding to 37 studies. A narrative synthesis produced a typology of GP-community pharmacist collaboration, and a sequence of the steps in the collaboration process. Four types of collaborative models were identified based on the pharmacist’s physical location and the collaboration’s purpose (jointly planning patient care; pharmacy-based patient-facing services; pharmacists/pharmacy co-location with general practice; and interprofessional education to improve prescribing behaviour).

Four case studies explored five collaborative models in English primary care. At the micro-level, individual collaborators’ persona was identified as crucial in establishing a collaboration. Interorganisational integration of existing resources was a key aspect of collaboration at the meso-level. Finally, macro-level patient-orientated national policy encouraged collaborative working.


Discussion and Conclusion
Across both studies, key characteristics of the collaboration were the co-location of pharmacist/pharmacy and general practice; and having a pharmacy-based collaborative service. Stakeholders were generally positively affected by the collaborative working. Overall, the findings indicate a buyer-supplier relationship highly affected by institutional forces.

This is the first systematic exploration of GP-community pharmacist collaborative models in practice to adopt OSCM perspectives. Key contributions of this research include the evidence of community pharmacists-GPs’ collaborative models in England. From a methodological point of view, this was new context for operations and professional services research, utilising the Gioia Methodology to explore collaborative relationships and their adoption through micro, meso and macro levels. In turn, this emphasised buyer-supplier relationship dynamics, which were highly affected by personal, organisational and institutional factors.

It was not possible to determine the sustainability of all included models (beyond the reported data in published literature and at the time of the case studies’ data collection). Other limitations included the inability to generalise findings (due to the qualitative methodology) and the coronavirus pandemic’s impact on recruitment.

The influence of institutional forces means that the existing policy framework ought to elaborate on resolving practical problems, which currently hinder system integration of community pharmacists and GPs. Moreover, competition between professionals requires community pharmacists demonstrating their capabilities. As such, further large-scale and longitudinal studies are needed to establish community pharmacists’ value and the sustainability of collaborative working to inform wider implementation of policy encouraging primary care services’ integration.
Date of Award12 Oct 2022
Original languageEnglish
Awarding Institution
  • University of Bath
SponsorsThe David Evans Scholarship
SupervisorPhilip Rogers (Supervisor), Alistair Brandon-Jones (Supervisor) & Margaret C. Watson (Supervisor)

Keywords

  • general practitioners
  • pharmacists
  • community pharmacy
  • collaboration
  • Operations management
  • supply chain management

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