Introduction 
Pathfinder Repeat Dispensing sites involving 32 English Primary Care Trusts (PCTs) came into force in May 2003.¹ This study is an ongoing evaluation of the implementation process and outcome over 3 years at one case study PCT. The results will inform policy developments within the PCT as the initiative is rolled out for the new pharmacy contract. The purpose of year one of the evaluation was to measure the Pathfinder site against two stated objectives: a reduction in waste through improved medicines management and improved patient care. 

Method 
The formative evaluation design followed a review of the repeat dispensing studies and the PCT Pathfinder bid document. The study had Local Research Ethics Committee (LREC) approval. Of 18 pathfinder community pharmacies, 6 were sited outside the LREC boundary (the PCT boundary was not co-terminous with the LREC boundary). Of the 12 pharmacists in scope, 8 were interviewed, 4 declined. Four PCT based staff were interviewed: the PCT head of medicines management, a GP, and 3 practice managers. All interviews used piloted semi-structured schedules. Responses were manually recorded and analysed thematically. 

Results 
The scheme was planned to start August 2003. Prior to this, pharmacists and their staff were Centre for Pharmacy Postgraduate Education trained. The PCT provided training for practice staff (1hr) to which pharmacists were invited. All respondents agreed the training was useful. Practice staff said it improved communication with pharmacists. Although practice staff anticipated a slow start, there were significant problems with the GP software so by February 2004 only one of the 8 pharmacists interviewed had implemented the project. For evaluation of the objectives, we found that none of the pharmacists currently provided any form of medicine management, none of the pharmacies contained a consultation area and none of the pharmacists were measuring waste. Therefore there was no baseline data and no monitoring systems to measure change. A framework for patient referral was yet to be written.

Practice staff reported a lack of enthusiasm amongst some GPs. The GP stated that the scheme had been set up at the wrong time when there was too much change and therefore some uncertainty about the scheme’s long-term viability. None of the practice respondents could state where the responsibility for audit lay but they "believed" that changes in medicines management and waste reduction would be monitored by the pharmacists.

Discussion 
The experience of Department of Health (DH) funded repeat dispensing pilot studies in the 1990s² and policy commitments in the NHS Plan³ led to the introduction of Pathfinder repeat dispensing sites. However, the IT problems that were observed in the Birmingham pilot study² had not been resolved and led to delayed implementation. There is evidence that these problems have been replicated on a national basis.⁴ The evaluation of the first year showed that this time lapse between training and implementation caused frustration and some loss of enthusiasm, compounded by uncertainty due to the high level of background change. The key finding of the evaluation was the absence of any baseline assessment and of robust monitoring systems to measure outcomes.

References