Impact of findings on practice
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There is scope for community pharmacy teams to incorporate and contribute to asset-based approaches in their localities.
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The further adoption of asset-based approaches requires a programme of enabling funding, strategic leadership, and changes in workplace culture.
Introduction
Aim and research objectives
Methods
Ethics approval
Theoretical framework
Sample and data collection
TCABA Stage | Interview questions |
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Stage 1: reframing towards assets | When you use the term asset-based approaches what are you referring to? Can you explain what you mean by asset-based approaches? Can you give any examples? |
Have you or your colleagues received any training on asset-based approaches? Do you feel that this approach is widely understood within your team/organisation/locality? Please explain | |
Are there key individuals championing asset-based approaches in your team/organisation/locality? How do they do this? | |
Stage 2: recognising assets | Can you explain what you mean by the term ‘assets’ in the context of this approach? |
How do you/people in your team/organisation/locality become aware of/identify community assets? | |
What role do you feel community pharmacies/pharmacies could have in terms of this approach? What do you feel are the possibilities with regards to community pharmacies/pharmacists in terms of adopting asset-based practices and/or becoming involved in asset-based approaches in their localities? | |
Stage 3: mobilising assets | Can you give me examples of asset-based approaches within your team/locality/organisation? |
Are you aware of any examples of asset-based approaches involving community pharmacies/pharmacists? | |
What would need to happen/be in place for community pharmacies/pharmacists to adopt this way of working into their practice and/or become involved in asset-based approaches in their localities? | |
What might be the barriers/challenges? | |
Stage 4: co-producing assets and outcomes | How do you/your team/organisation identify/evaluate intended outcomes of this approach to working with individuals or communities? |
Has this involved any collaboration/consultation with patients/customers/citizens, communities, or organisations? Please explain |
Data analysis
Results
Stage 1: reframing towards assets
Pharmacy participants largely conceptualised their current and potential involvement in asset-based approaches at the level of working with individuals or communities. On an individual level, asset-based approaches were understood as the adoption of increasingly person-centred and strength-based approaches towards consultations with patients/customers:Asset-based working is working with local people in a different way that seeks to recognise and nurture the strengths of individuals, families, and communities and to help them build independence and self-reliance (Interview 10—Policy).
At a community level, pharmacy interviewees saw asset-based working as the ‘contribution’ that community pharmacies made, or could make, to the communities in which they were situated beyond current commissioned pharmacy services. Policy and strategic leads additionally conceptualised asset-based approaches on a more systemic level, as a strengths-based philosophy that could be utilised to inform and underpin health and social care service design, structure, and delivery:Instead of looking at somebody’s weaknesses and things that they, maybe, don’t do so well, it’s having a conversation to find out where their strengths are….What is it that they enjoy doing, what is it that matters to them in life, not what I think matters but what they think matters (Interview 6—Pharmacy).
The need for increasingly collaborative relationships between individuals and communities, and health and social care services, local authorities, and policy makers was highlighted. Arrangements facilitating shared decision-making and devolvement of power were seen to be key in terms of meeting local priorities and empowering citizens and communities to have greater control and authority with issues concerning their health, lives, and local area.The overarching use of the term to me is to describe a world view where health and social care services are not done to people, where they are seen as ill and needing benevolent help, which is really a passive model. But more whereby we recognise what exists in the community, the assets that are there, and we have structures, and processes, and ways of working to harness those to support wider health and well-being (Interview 14—Policy).
The rebalancing of power towards a more equitable relational dynamic was also referenced with regards to interactions between citizens and health professionals. All participants acknowledged that this shift in perspective and practice required a corresponding change in professional identity and culture, and that this reframing could conflict with existing professional mind-sets:I think the nature of asset-based approaches is much more about shifting power into those communities and letting them and the organisations and groups that are there, determine what the best model of support looks like, that fits the needs of local people (Interview 14—Policy).
The language used by some pharmacy participants when discussing their adoption of asset-based approaches, suggested that there was a tendency to continue to frame their involvement with customers/patients from the standpoint of their role as ‘expert’. Interactions were commonly characterised as unidirectional ‘advice giving’ and professional-led ‘interventions’ as opposed to person-centred or strengths-led, suggesting a lack of understanding or coherence in the adoption and integration of asset-based values into practice:The big challenges tend to be cultural for the healthcare professionals. To move away from this mind-set that we are here to cure people, or if we can’t cure them, because it’s a long-term condition, we are here to provide that support and advice. So, it disempowers people to self-care more effectively. So, it’s that mind-set which says, this is down to an individual themselves, our role is to help them access the support that’s around them, and to think of that support much more broadly than clinical support (Interview 14—Pharmacy).
I think community pharmacists, they just do things and they just help, they just make these interventions, and they just help people out, and they just fix these problems (Interview 15—Pharmacy).
Stage 2: recognising assets—the potential of community pharmacy
The very established physical presence of community pharmacies within local communities was seen to provide a tangible opportunity for them to act as assets within their neighbourhoods. Community pharmacies were seen to occupy a unique position in terms of the broad range of people accessing their services and the scope to undertake proactive public health work:Community pharmacy is probably the only remnant of the NHS that sits on the high street, that is part of the community, and people can go into that space not necessarily to receive an NHS service, they go into community pharmacies for all sorts of reasons […] and […] it is pretty much the only place you can walk into and, in a very informal way, have a conversation with a healthcare professional (Interview 1—Policy).
Community pharmacy’s drive towards more patient-facing services, including public health initiatives, was seen as an opportunity to further develop relationships with individuals and communities. The potential for pharmacists to expand their social value and contribution to social capital was also referenced by several policy and strategy leads. The notion of social value centred on creating and building connections with other local agencies and resources:The other advantage of community pharmacy is that the staff are far more likely to encounter the otherwise well people who wouldn’t necessarily access other health services. So, there is great opportunity to work proactively, and even to go out and work with other organisations as well” (Interview 9—Pharmacy).
Building on community pharmacies’ current involvement in public health and prevention was seen as a potential avenue to develop their patient-centred and asset-based roles. Policy and strategy leads highlighted the potential to better utilise the existing resources and skills within the pharmacy workforce, with emphasis on workers other than pharmacists, such as health champions:The thing that I am really interested in is, [community pharmacy] expanding their social value at a kind of community level…. Local pharmacies are like other businesses, but they have a particular part to play in what’s going on in a locality, have the connection to people who have long term needs, that few other places within a local community have” (Interview 12—Policy).
The potential to develop and build upon existing relationships, and repeated contact with patients/ customers, particularly those receiving repeat prescriptions, was also noted. Improved access to, and inclusion, in asset directories/mapping initiatives and resources was seen as fundamental to enabling the development of a reciprocal and dynamic awareness between pharmacy teams, other health and social care services/sectors, as assets within the community. It was thought that this would support more effective signposting from and to pharmacies.There are 9500 health champions in community pharmacies …they’re not a registered profession, they’re not pharmacists, they’re coming from the local community and they’re seen as members of that community, in touch with the community. They are going out there doing health related interventions, so I could see that there is potential there (Interview 3—Policy).
Stage 3: mobilising assets—current examples of asset-based practice
Community pharmacists provided a few discreet examples of asset-based approaches, including setting up and supporting group sessions and activities, engaging with voluntary sector projects, and applying for funding in conjunction with other organisations.Really taking advantage of the assets that a particular community may have, whether that’s a leisure centre, whether that’s a support group. It ties in quite closely with signposting from pharmacies, one of our aims is to make sure that [pharmacy staff] are aware of all of the available services, assets within an area, so that they are able to signpost people more effectively (Interview 9—Pharmacy).
The need for greater strategic direction and proactive leadership within the community pharmacy sector was noted. Some policy leads highlighted the absence of pharmacists in relevant regional and specialist networks. The need for proactive strategic representation of pharmacy in policy and decision-making forums was stressed so as to ensure community pharmacy was considered and incorporated in discussions concerning local commissioning. Funding was depicted as a key enabler in facilitating the adoption of new ways of working, particularly when this involved time away from the pharmacy premises. Policy and strategic leads highlighted the tension inherent in developing approaches to commissioning that operated at scale whilst also retaining local sensitivity:We [the pharmacy] trained one of our counter staff to become a health leader… we set up a walk every Thursday with the idea of…well the walk's healthy and that's a good thing, that was kind of the excuse, but actually it's more about …could these people set up a new kind of social network. Then we had to make that sustainable, so we managed to get one of them trained up to be the lead. Now they just meet…it's still going 15, 16 years later. They just meet in the pharmacy every Thursday. (Interview 8—Pharmacy).
The approach is not about having a standard approach everywhere, one size fits all, it’s about systematising this way of working. So that is, each locality deciding themselves which approach to use, is it local area coordinators, is it social prescribing, is it integrated pharmacy services, is it pharmacy health champions. Is it a combination of all of those? (Interview 3—Policy).
The role of healthy living pharmacies (HLP)
A way to guarantee that people engage with these things is to include them in say, quality payment. But does that necessarily mean that you will get a good service from all those pharmacies or will they just do the bare minimum to get what they need? So, it does involve regulation as well (Interview 9—Pharmacy).
Stage 4: co-production—creating an enabling climate for change
If I was doing development work with pharmacists then I’d be tempted to bring together a group of community pharmacists who want to get more involved with their local community and do a series of workshops that explored how to do it in a practical way, building on their own strengths, knowledge, data, and possibly putting some money alongside it. (Interview 12—Policy).