Professional status in a changing world: The case of medicines use reviews in English community pharmacy

Pastoral power in the community pharmacy: A Foucauldian analysis of services to promote patient adherence to new medicine use

“…Abbott, 1988;Freidson, 1970) analysis often centres on the connections between pharmacy's expert knowledge, autonomous practice, and jurisdiction with the division of labour (e.g. Britten, 2001;Harding and Taylor, 1997;McDonald et al 2010). Dingwall and Wilson's (1995) M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 4 influential paper challenged the idea of pharmacy being an 'incomplete' profession by showing its distinct ability in the system of modern healthcare to symbolically transform inert chemicals into medicinal drugs.…”

“…Although the profession has lost much of its role in medicines procurement and compounding with the industrialisation of production, it has expanded its jurisdiction in primary healthcare tasks (e.g. Britten, 2001;Harding and Taylor 1997;McDonald et al, 2010;Motulsky et al 2010;Petrakaki et al 2011).…”

“…The extension of pharmacist roles has led to sustained social science debate about the changing status of the profession, especially in relation to family doctors and patients (Britten, 2001;Dingwall and Wilson, 1995;Harding and Taylor, 1997;Hibbert et al 2002;McDonald et al 2010;Petrakaki et al 2012). Change is interpreted as extending pharmacy's jurisdiction in the social organisation of healthcare, e.g.…”

“…Conversely, research suggests the expansion of pharmacy's jurisdiction is often framed by wider political, economic or professional interests, e.g. where new roles are in some sense 'delegated' by other more powerful professions (Hibbert et al 2002;McDonald et al 2010).…”

“…The NMS aims to promote patient adherence to newly prescribed medicines by affording patients the opportunity to discuss their experiences of medicine use with their pharmacist, who can offer advice to support patient learning and encourage adherent behaviour (Elliott et al 2014). Like Medicines Use Reviews (McDonald, et al 2010), the NMS might expand pharmacy's jurisdiction in medicines management, but it also transforms the relations of power within the primary care sector as pharmacists play a greater role in classifying, surveying and disciplining patient subjectivities. Our paper examines this possibility and further demonstrates the relevance of Foucauldian theory to the analysis of contemporary reform in primary care.…”