Background
Schemes designed to improve the process of managing repeat medicines are frequently used in general practice and community pharmacy. Previous evaluations have provided useful data on such schemes, however, there has been little empirical evidence available about the impact on skill mix in community pharmacy. Repeat Dispensing (RD) was piloted at 89 pathfinder sites around England and is now an essential service in the new community pharmacy contractual framework. The aim of this study was to investigate the impact of this new service on community pharmacy, and to determine the extent and nature of support staff involvement in dispensing activities.

Methods
A non-participant observational study was carried out in a purposive sample of 13 community pharmacies around England. A researcher observed and documented the activities of pharmacy staff when processing prescriptions and tracked the dispensing pathway for both RD and 'normal' prescriptions serving as a control. Data were analysed using STATA 8 software. Simple descriptive statistics were used to describe the number of prescriptions observed, and regression analysis was used to examine differences between the staff groups engaged in each stage of the dispensing process. The analysis controlled for clustering of prescriptions at different sites, acknowledging the different systems in operation amongst different pharmacies. A p-value of p<0.05 was used to indicate statistical significance.

Results
2043 dispensing episodes were observed in total, involving 842 (41%) RD and 1201 (59%) normal prescriptions. Support staff were involved in all stages of the dispensing process for both groups. Overall, pharmacists undertook the majority of dispensing tasks and there were few significant differences between groups of staff undertaking dispensing activities between RD and normal dispensing. Overall, however, pharmacists delegated proportionately fewer RD than normal dispensing tasks. Where support staff were involved, the majority of tasks were undertaken by those with NVQ level 2 or medicines counter assistant qualifications.

Discussion
This study provides an example of how re-organisation of a routine pharmaceutical task, i.e. dispensing, impacts on the skill mix involved, and the patient interface in community pharmacy. The new Health Bill makes provision for changes to working practices, including the delegation of certain dispensing activities to support staff. Evidence from the RD scheme is therefore pertinent both to a more thorough understanding of current dispensing practices and also in providing baseline data against which future developments may be measured, whether through RD or other community pharmacy initiatives.