Investigating practice integration of independent prescribing by community pharmacists using Normalization Process Theory: a cross-sectional survey

Abstract

Background In several countries independent prescribing (IP) has been supported as a practice model but its integration into community pharmacy (CP) has not been extensively investigated. Aim To use Normalization Process Theory to investigate the integration of pharmacist IP in CP. Method In 2020, NHS Scotland launched Pharmacy First Plus (PFP) which uses community pharmacist IP for common clinical conditions. Questionnaire items were developed using the NPT derived Normalisation MeAsure Development (NoMAD) questionnaire tool for a cross-sectional online survey of all PFP CPs. Demographic data were analysed descriptively. Item scores for the 4 NPT constructs were reliability tested using Cronbach’s alpha and scale scores calculated and used for inferential analysis. Results A 73% (88/120) response rate showed that 76% (67/88) consulted with patients for PFP >6 times a week. Thirty-eight percent (33/88) indicated they had <3 staff when offering PFP and 47% (41/88) provided the service while working as the only pharmacist. Generally, there were high levels of NoMAD item agreement with >90% ‘strongly agreeing’ or ‘agreeing’ in items relating to the NPT constructs ‘coherence’, ‘cognitive participation’ and ‘reflexive monitoring’. Responses to ‘collective action’ items showed diversity with more answering ‘neither agree nor disagree’ or ‘disagree’. Conclusion This theory-based work offers a perspective on IP integration within CP. Despite its geographic focus it offers insights relevant to wider contexts. It shows ‘collective action’ focussed ‘organisation’ and ‘group process’ challenges with a need for further work on staff training, resource availability and utilisation, working relationships, communication and management.