Jeroen van de Pol

17 General introduction 1 One example of such a barrier is the current reimbursement system for community pharmacies. Currently, community pharmacists are still primarily reimbursed for the distribution and dispensing of medicines [48]. So the economic incentive still comes from these traditional activities, whereas the fees for CPS related activities are insufficient to keep the pharmacy business running [48, 51]. Concomitantly, policymakers and healthcare insurers are acting reservedly regarding (adequate) remuneration of care related services provided from a community pharmacy. This is due to the fact that the cost-effective nature of CPS in daily community pharmacy practice is still part of debate. The community pharmacy practice is confronted with a similar challenge in other countries, but these countries are already implementing solution strategies. For example, in the United Kingdom the NHS has launched the Minor Ailment Scheme . This enables community pharmacists to diagnose and treat certain minor ailments, in support of general practitioners [52]. The department of health in Australia presented the Sixth Community Pharmacy Agreement (6CPA) , enabling community pharmacists to provide more CPS [53]. Like most health care professionals, community pharmacists are being confronted with large amounts of red tape and the accompanying administrative burden [54]. The current medicine shortages, increase community pharmacists’ administrative burden even further. Logistic issues are consuming more time and further limiting the amount of time that can be spent on the provision of CPS. To get further insights into the actual time-utilization of community pharmacists, could benefit the profession in identifying possible chokepoints and providing further insights to enable the profession to focus more on the provision of CPS. Next to barriers, opportunities for community pharmacy practice should also be identified and further researched. An important potential opportunity is the needs of patients and the general public regarding services to be provided by community pharmacists. Patient demandcanact asamajoropportunity in furtherdeveloping the profession. Also, the potential benefits of CPS provided by community pharmacists as mentioned earlier is an opportunity for the profession and more insights in these benefits can help the profession in its argument to transition towards CPS. Next steps according to Kotters’ 8-step change model The first five steps of Kotters’ 8-step change model [25] have been briefly highlighted and in differing degrees, progress has been made in daily practice. The major focus within the community pharmacy profession is currently on identifying different barriers and facilitators. Simultaneously trying to overcome barriers and further enhance facilitators. After this however, a few more steps have to be made according to Kotters’ 8-step change model. These will be further discussed within the general discussion at the end of this thesis.