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Table 3 Higher order and related categories identified by qualitative content analysis—lived experience

From: Bridging the gap between healthcare professions’ regulation and practice: the “lived experience” of community pharmacists in Ireland following regulatory change

Higher order category/theme

Related categories/themes

Illustrative quotes

Disciplinary provisions

PSI approach

“We are presumed guilty until proved otherwise….without regard for the years of good a pharmacist has given”

“very punitive, creating an atmosphere of fear”

Mediation

“I feel that the lack of use of mediation is a huge problem”

Time delays

“I’ve been through a fitness to practice process…..The process dragged on for 5 years and hearings for 4 months”

Pursuit of minor matters

“I sat for a number of years on the Conduct Committee and far too many trivial cases were brought forward that would have been easily dealt with via mediation…..”

Inspection/enforcement

Inspection approach/inspectors

“I feel they look at us as the bad guys they have to protect the public against.’’

“Inspectors seem to keep looking until they find something, they are not happy with”

 

Pharmacy Assessment System

Effectiveness/repetitive

“I don't know of a single pharmacist who doesn't just copy and paste their previous efforts. This is just an administrative waste of time….’’

’It was good the first, and, perhaps, the second time…but it loses its benefits after a few repetitions.. needs to evolve…’’

Diverts from patient care

“I find it a form filling exercise and something that interferes with providing a service to our customers…’’

Training and education

Integrated MPharm Programme

 

4- and 8-month blocks of practical training

“…anybody who hasn't had a full year of exposure with increasing responsibility during it, will find it difficult to assume full responsibility for pharmacy on registration”

“new system…rushes the learning process”

Wider experience of practice

“The new system gives students a broader experience of practice compared to the older 12-month…system “

Decision-making skills of recently qualified pharmacists

“…they’re afraid to practice. They’ve been browbeaten during their training into upholding the “rules” at all costs…are unwilling or even afraid to actually think or make a judgement call”

CPD

 

Effectiveness

“Only positive change I have seen in 30 years.…”

‘’The ePortfolio doesn't actually reflect what learning is done by pharmacists…”

’I doubt the ability for it [Practice Review] to actually highlight pharmacists who lack competence and it's an over intrusive, anxiety-inducing requirement for those who are competent already’’

Convoluted

“I find the ePortfolio confounding. It’s too hard to use. I shudder to think of older pharmacists’ experience’’

“time-consuming”

“overly onerous record-keeping involved”

Practice review

“Someone may be competent in day-to-day practice but have a difficult experience at the practice review given that it is exam conditions…not sure how fair a process it is to be re-examining people who have a professional qualification”

“Waste of time and money for all involved…absolutely ridiculous- would any other medical professional be asked to do the same and all at their own expense? NO!!

‘’…should only be used in cases where there is reason to suspect that a Pharmacist is not "up to the job"

Personal experience of regulation and regulator

Disconnect

“The requirement to be 100% compliant can occasionally give pause to the decision-making process…. The Pharmacy Act needs to acknowledge that pharmacists should be given a certain amount of autonomy”

“Standards in the act….direct pharmacists to operate in a health system that is black and white…..healthcare doesn’t operate like that and the opportunity to use our professional judgment and experience isn’t appropriately considered”

 

Administrative burden/detrimental to patient care

“Too much mindless paperwork is keeping me from practicing real patient-led pharmaceutical care”

 

Overregulation

“Whilst I’m a firm believer in the regulation of my profession and understand the regulator’s societal duty of care, I feel there’s a clear and present danger of the overregulation of community practice”

“Overregulation is now utterly endangering the safety of dispensing”

 

Career disincentive

“….I am aware of at least one colleague who retired before he’d intended as a direct result of the manner by which he was treated during a CPD audit”

“I absolutely hate being a CP because of the regulations”

“The pressure and strain the PSI put on pharmacists is immense…Any young pharmacist should leave the profession if they have any sense coz [because] of the appalling way in which the PSI treats pharmacists”

Fear

“I find young pharmacists are fearful and lack the confidence to make real-time professional interventions on patients’ behalves due to the regulations and their enforcement”

“Many of our professional decisions are now made under a culture of fear of serious PSI sanctions rather than always in the best interest of the patient”

“culture of fear and intimidation”

Pharmacist working conditions

“Pharmacist working conditions needs to be better regulated…..it's not safe to allow pharmacists to work 11 h shifts with only a 5 or 10 min break all day. Excessive workload is one of the biggest risks to patient safety and it doesn't seem to be regulated by the PSI at all’’