Jeroen van de Pol

188 Appendices Summary Community pharmacists in the Netherlands have a unique position within the healthcare system. It is where two responsibilities meet: the safe and responsible dispensing of medicines to patients and counseling patients on ensuring safe and effective use of the medicines. A number of activities can be directly or indirectly attributed to this responsibility that can be very diverse in nature, like managing finances and personnel management, but also providing medication reviews and home visits after hospital discharge to patients. These last two are considered to be part of an activity group called cognitive pharmaceutical services (CPS). Currently, community pharmacy practice is undergoing a transitional phase in which focus is being shifted towards the provisionof CPS. The role of the community pharmacist is gradually changing by which traditional tasks, such as compounding and dispensing, are becoming less dominant. This is considered a major change for the profession, rendering change management an important concept within the profession. Kotters’ 8-step change model can provide support in this change process. This model describes eight different steps that eventually lead to change. These steps are (1) creating a sense of urgency; (2) building a guiding coalition; (3) forming a strategic vision; (4) enlisting a volunteer army; (5) enabling action by removing barriers; (6) generating short term wins; (7) sustaining acceleration; (8) instituting change. The HARM-report published in 2006 stating that half of alle hospital admissions related to medicines could have been prevented can be regarded as a sense of urgency. Next to the personal suffering that could have been prevented, costs could have been savedmounting to an annual sumof €85million. Different policymakers are convinced that community pharmacists can have a positive impact on these preventable hospital admissions. Also, rising healthcare costs are motivating healthcare policymakers to shift healthcare provision from the more expensive hospital care towards the better affordable primary care system. This increases pressure on the primary care system and also increases complexity of care that needs to be provided within the primary care system. General practitioners (GPs) play an important part in handling this shift in care provision, but are currently already experiencing a significant workload. Community pharmacist can play an important part by utilizing their expertise. By doing so, community pharmacists can further support a shift from hospital care to primary care, without reducing the quality of treatment the patient receives. Community pharmacists can therefore play an important part within healthcare. However, community pharmacists are currently being under-utilized. The Royal Dutch Pharmacists Association is aware of this situation. Several steps have been