This paper investigates the potential threat to medical dominance posed by the addition of pharmacists as prescribers in the UK. It explores the role of prescribing as an indicator of professional power, the legitimacy and status of new pharmacist prescribers and the forces influencing professional jurisdictional claims over the task of prescribing. It draws upon 23 interviews with pharmacist supplementary prescribers. Data suggest that the legitimacy of pharmacists as prescribers, as experienced in the workplace, has been aided by: (1) blurred definitions of prescribing; (2) the emphasis on new prescribers' competence urging pharmacist prescribers to limit their areas of clinical practice; and (3) a team approach to patient management. Competence, self-limitation on practice and the benefits of team working as part of the ideology of patient safety were thus an important influence on pharmacists' jurisdictional claim over prescribing. While pharmacists have successfully negotiated a role for themselves as prescribers, medicine has retained its high status, relative to other health professionals and with patients; it controls the knowledge base relevant for prescribing practice and has managed to develop an 'overseer' role over the process of prescribing. Prescribing, as an indicator of medicine's autonomy of control over their work and professional status, has changed. Yet the extent to which new prescribers have been able to threaten the professional dominance of medicine is debatable.

The present paper explores how charges for medicines incurred by patients influence their decisions for managing acute or chronic conditions, and whether prescription cost and affordability issues are discussed in the general practitioner (GP)-patient encounter. People suffering from dyspepsia, hay fever or hypertension, or those taking hormone replacement therapy, were recruited through three community pharmacies in the North-west of England. Six focus groups were conducted with a total of 31 participants, the majority of whom were non-exempt from prescription charges. The management behaviour of those participants who had to pay for their prescriptions, particularly those from less-affluent or deprived backgrounds, was influenced by cost. However, cost was not the overriding influence, with other factors, such as symptom or disease severity, effectiveness, or necessity of treatment, playing a more important part in participants' management decisions. Cost as an issue was reflected in the various strategies used by participants to reduce medication cost, such as not having some prescribed items dispensed, taking a smaller dose or buying a cheaper over-the-counter product. Despite the use of numerous strategies, participants did not talk to their GPs about issues of cost and affordability. Participants felt that paying for prescriptions was their problem. There was a belief that discussing cost issues could jeopardise the doctor-patient relationship. Although not the dominant factor, medication cost nevertheless influenced participants when deciding how to manage their condition. Awareness of the existence of prepayment certificates, which can be bought by patients who require regular medication, was low, and this should be addressed through improved information/dissemination. Despite the high level of prescription items exempt, the current level of the prescription charge is still a barrier to obtaining prescription medicines under the National Health Service to those on lower incomes.

This review identified gendered, personal, organisational, collegial and socio-cultural sources of and barriers to emotional labour in healthcare settings. The review highlights the importance of ensuring emotional labour is recognized and valued, ensuring support and supervision is in place to enable staff to cope with the varied emotional demands of their work.

Due to the consistently high levels of agreement reached on competency statements and their associated descriptors, this competency framework should be used to direct education for undergraduate healthcare professionals, and those working in new clinical roles to support healthcare delivery where an understanding of, and engagement with, AMS is important. Although the competencies target basic education, they can also be used for continuing education.

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