Evaluation of the Community Pharmacy Quality Scheme (PQS) in England: Evidences from stakeholder interviews

Background: Community pharmacies are important to primary healthcare, with pharmaceutical care services increasing in number and scope in many countries. Evidence suggests that under a fee-per-service reimbursement model, service activity may be prioritised over service quality. To incentivise quality and prepare for the introduction of more clinical services in community pharmacy, the Pharmacy Quality Scheme (PQS) was implemented by NHS England from 2017, focussing on patient safety, patient experience, and clinical effectiveness. PQS was funded by reallocating a portion of the global sum of the nationally negotiated Community Pharmacy Contractual Framework. Under the PQS, pharmacies are reimbursed when they can prove meeting specific quality criteria.

Purpose: To evaluate PQS implementation and its impacts, at both pharmacy and system level, by examining what works, for whom, in what circumstances, and how?

Method: Part of a wider mixed-methods evaluation, this abstract focusses on qualitative analysis of 41 interviews with pharmacists, employers and representative bodies recruited from across community pharmacy. Interviews examined views of PQS and experiences of its implementation, utilising the framework of realist evaluation. Verbatim transcripts were analysed thematically. University ethical approval was granted.

Findings: Nearly all community pharmacies in England participated in PQS, with income received via the scheme being an important motivator. Interviewees were consistently in agreement with policy-makers about the purpose of PQS being patient safety, patient experience, and clinical effectiveness. Beyond these core dimensions, interviewees identified consistency of service provision, sustainability, and wider system integration as important. Nevertheless, while PQS was largely viewed as impacting positively, interviewees felt that increasing workloads across the sector made it challenging to focus on quality; they felt that there was a lack of feedback and that impacts were not always visible; they felt that the rationale for annual changes in the PQS criteria were not clearly understood; and in particular, independent (1-5) pharmacies found PQS workload burdensome and complex. In addition, stakeholders often referred to multiple sources of guidance, leading to duplication/confusion. Frontline pharmacists viewed PQS as challenging to measure, and they were often not aware of published evidenced of PQS impacts.

Conclusion: The primary incentive for PQS engagement revolved around income stability for employers, with some positive impact achieved, but obstacles persist concerning resource implications and sustainability. As concerns rise about the viability of community pharmacy services and the importance of increasing the scope of pharmaceutical services, these implementation barriers should lead policy-makers to question whether different means of incentivising quality are more appropriate.