Applying a whole systems lens to the general practice crisis: A cross-sectional survey looking at patients with long-term respiratory conditions’ use of community pharmacy services in England

Objectives: United Kingdom policy initiatives aiming to extend community pharmacy services to moderate patient demands and reduce general practitioners’ (GPs’) workload have had limited success. This study used marketing theory to identify factors which could influence patients to make better use of community pharmacies within the primary care pathway. Design: Cross-sectional postal survey design applying the “7Ps marketing mix” (“product”, “price”, “place”, “promotion”, “people”, “process”, “physical evidence”). Setting: Greater Manchester, England. Participants: Patients with asthma or chronic obstructive pulmonary disease registered at two GP practices Primary outcome: Patient preference for community pharmacy services. Results: The response rate was 29% (289/1003). Most respondents preferred to use GP practices for invasive/diagnostic services (“product”) whilst preferring using community pharmacy for medicines supply and minor ailments (“place”). Stronger preferences for using GP practices over community pharmacy were significantly associated with gender (male>female), age group (≥65years) and healthcare services previously accessed at the pharmacy. Respondents perceived they would be more likely to use community pharmacy services if pharmacists offered them enough time to discuss any concerns (73.3%) (“price”), community pharmacies had private/clean consultation rooms (70-73%) (“physical evidence”) and pharmacy staff had strong interpersonal skills (68-70%) (“people”). Respondents were divided on likelihood to use community pharmacy services if pharmacists could access their whole medical record but wanted pharmacists to add information about their visit (59.6%) (“process”). Respondents would be encouraged to use community pharmacy for healthcare services if they were offered services by pharmacy staff or recommended/referred to services by their GP (44%) (“promotion”). Conclusions: Using the 7Ps marketing mix highlighted that community pharmacies having staff with strong interpersonal skills, good quality consultation rooms and integrated information systems could positively influence patients to use community pharmacies for management of long-term conditions. There are opportunities for community pharmacy to alleviate GP workload but a whole system approach will be necessary.