title: Restructuring supervision and reconfiguration of skill mix in community pharmacy: Classification of perceived safety and risk.
abstract: Broadening the range of services provided through community pharmacy increases workloads for pharmacists that could be alleviated by reconfiguring roles within the pharmacy team.
  
  
  
  To examine pharmacists' and pharmacy technicians (PTs)' perceptions of how safe it would be for support staff to undertake a range of pharmacy activities during a pharmacist's absence. Views on supervision, support staff roles, competency and responsibility were also sought.
  
  
  
  Informed by nominal group discussions, a questionnaire was developed and distributed to a random sample of 1500 pharmacists and 1500 PTs registered in England. Whilst focused on community pharmacy practice, hospital pharmacy respondents were included, as more advanced skill mix models may provide valuable insights. Respondents were asked to rank a list of 22 pharmacy activities in terms of perceived risk and safety of these activities being performed by support staff during a pharmacist's absence. Descriptive and comparative statistic analyses were conducted.
  
  
  
  Six-hundred-and-forty-two pharmacists (43.2%) and 854 PTs (57.3%) responded; the majority worked in community pharmacy. Dependent on agreement levels with perceived safety, from community pharmacists and PTs, and hospital pharmacists and PTs, the 22 activities were grouped into 'safe' (n = 7), 'borderline' (n = 9) and 'unsafe' (n = 6). Activities such as assembly and labeling were considered 'safe,' clinical activities were considered 'unsafe.' There were clear differences between pharmacists and PTs, and sectors (community pharmacy vs. hospital). Community pharmacists were most cautious (particularly mobile and portfolio pharmacists) about which activities they felt support staff could safely perform; PTs in both sectors felt significantly more confident performing particularly technical activities than pharmacists.
  
  
  
  This paper presents novel empirical evidence informing the categorization of pharmacy activities into 'safe,' 'borderline' or 'unsafe.' 'Borderline' activities will deserve particular attention, especially where they are part of processes, e.g. dispensing. This categorization could help inform reconfiguration of skill mix in community pharmacy and thus make an important contribution to the rebalancing medicines legislation agenda and pharmacist supervision.
authors.affiliation: Centre for Pharmacy Workforce Studies (CPWS), Manchester Pharmacy School, The University of Manchester, Manchester, UK.
authors.forename: Fay
authors.initials: F
authors.lastname: Bradley
authors.affiliation: Centre for Pharmacy Workforce Studies (CPWS), Manchester Pharmacy School, The University of Manchester, Manchester, UK.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Willis
authors.affiliation: Centre for Pharmacy Workforce Studies (CPWS), Manchester Pharmacy School, The University of Manchester, Manchester, UK.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Noyce
authors.affiliation: Centre for Pharmacy Workforce Studies (CPWS), Manchester Pharmacy School, The University of Manchester, Manchester, UK. Electronic address: ellen.schafheutle@manchester.ac.uk.
authors.forename: Ellen I
authors.initials: EI
authors.lastname: Schafheutle
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004739:England; D006801:Humans; D010595:Pharmacists / Q000458:organization & administration* / Q000523:psychology / Q000706:statistics & numerical data; D010607:Pharmacy Service, Hospital / Q000458:organization & administration*; D010596:Pharmacy Technicians / Q000458:organization & administration* / Q000523:psychology / Q000706:statistics & numerical data; D024382:Professional Role; D011795:Surveys and Questionnaires; D016526:Workload
keywords: Community pharmacy; Pharmacy technician; Professional accountability; Role delegation; Role substitution; Scope of practice; Supervision