title: Community, autonomy and bespoke services: Independent community pharmacy practice in hyperdiverse, London communities.
abstract: BACKGROUND
  The landscape of pharmacy continues to evolve including in Great Britain, where, by 2012, almost 50% of pharmacy contracts were held by just 9 national chains.
  
  
  OBJECTIVE
  To further explicate the concept of 'independence' as it was positioned by independent pharmacists, particularly examining personal interpretations of their role in contemporary pharmacy and health care delivery.
  
  
  METHODS
  Research was situated in East and South-east London between 2008 and 2009. The study took an ethnographic approach; combining participant observation within 7 pharmacies and 36 active interviews with pharmacists. Recruitment criteria demanded that pharmacists self-identified as independent and were either owners or managers in sole-owned or independent chain pharmacies.
  
  
  RESULTS
  Independence was expressed through a framework of three overarching themes: autonomy, engagement and bespoke practice. Autonomy formed the basis of professional expression ultimately enabling pharmacists to exercise control over customer relationships. This facilitated engagement with communities and individuals and ultimately made possible an offering of a bespoke 'personal' service. The diverse urban environment was a space where independence was seen to be of particular value. The complexity of this setting was used symbolically to support the need for independent thinking. These themes are examined through stories of 'acceptance' and developing pharmacy 'communities' alongside the practise of maintaining personal relationships to provide a distinct service offer.
  
  
  CONCLUSIONS
  This study highlights distinct 'independent' expression of professional identity and suggests the need to assess the value of independent community pharmacy as being different from but complementary to the service provided by multiples/large chains.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London WC1E 7HT, United Kingdom. Electronic address: kathrynduckett@gmail.com.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Duckett
mesh_terms: D003157:Community Pharmacy Services / Q000639:trends; D018864:Cultural Diversity; D006801:Humans; D008131:London / Q000208:ethnology; D010595:Pharmacists / Q000639:trends; D017009:Professional Autonomy; D024382:Professional Role
keywords: Community; Ethnography; Independent; London; Rhetoric