Community Pharmacies In England Research Articles

Evaluation of antibiotics returned for safe disposal during and after a community pharmacy antibiotic amnesty campaign.

Community pharmacies in England offer convenient and safe disposal of unwanted medicines, including antimicrobials, and better uptake of this service could limit environmental antimicrobial resistance. However, there is limited information on the extent and nature of antibiotic returns to community pharmacies. The impact of an antibiotic amnesty campaign promoting antibiotic disposal through community pharmacies was evaluated with the intention of collecting detailed information on the antibiotics returned. An antibiotic amnesty campaign was delivered by community pharmacies in the Midlands (England) with an audit of returned antibiotics conducted in 19 community pharmacies in Leicestershire. Detailed information on antibiotics returned for disposal was gathered during the month-long amnesty campaign and again 3 months later in the same pharmacies. Antibiotics accounted for 3.12%-3.35% of all returned medicines. The amnesty campaign led to a significant increase in defined daily doses of returned antibiotics compared to the post-amnesty period (P = 0.0165), but there was no difference in the overall number of returned medicines. Penicillins were the most commonly returned antibiotics in both periods (29.3% and 42.5% of packs, respectively), while solid oral dose formulations predominated. A total of 36.6% of antibiotics returned during the amnesty period were expired, increasing to 53.4% in the post-amnesty period. Amnesty conversations had a significant impact on the number of antibiotic returns but campaign posters did not. Antibiotic conversations can increase the amount of antibiotics returned to community pharmacies for safe disposal, and passive campaign materials had limited impact. More research is needed to identify the most effective interventions to increase returns.

The role of the community pharmacy work system in the enactment of pharmacists' non-technical skills.

Non-technical skills are recognised as important in various work domains, but have been the subject of debate regarding their role in ergonomics/human factors, given their focus on human behaviour itself rather than the interaction between people and systems. This study aimed to examine the relationship between non-technical skills and the work system in which they are enacted. The study setting was community pharmacies in England. Qualitative data were obtained from observation of seven pharmacists and semi-structured interviews with 16 pharmacists, and subjected to thematic analysis. Elements of their work system were found to be related to their non-technical skills; either by creating a need for the skill in the first place, or by facilitating or inhibiting its enactment. The findings highlight the importance of considering the work system that contextualises individuals' and teams' behaviour, in addition to the behaviour itself, when investigating non-technical skills.

Protocols versus practice: unravelling clinical checking variations in community pharmacies in England—a multi-method study

BackgroundStandardisation, a widely accepted concept for risk management, entails designing and implementing task-specific operating procedures. In community pharmacies, Standardised Operating Procedures (SOPs) are a mandatory requirement and are recognised as essential for upholding safety and quality.AimThis study aimed to investigate community pharmacists’ (CPs) compliance with SOPs when checking prescriptions, and the reasons for variations between standardised protocols and practice.MethodEight sets of SOPs underwent hierarchical task analysis (HTA) to generate a normative description of clinical checking execution as per protocols. Subsequently, twelve CPs were engaged in a simulated clinical checking exercise, verbalising their thoughts while checking virtual prescriptions. Transcribed data underwent content analysis, aligned with a descriptive model to uncover engagement patterns, and disparities between SOPs and CPs’ practices. Finally, a focus group discussion took place to contextualise the observed variations.ResultsHTA aided in constructing a clinical checking model with six primary subtasks and 28 lower subtasks. CPs often omitted subtasks during checks, diverging from prescribed protocols. These deviations, observed in controlled environment, reveal an ingrained aspect within the professional culture of pharmacists, where there may be a tendency not to strictly adhere to protocols, despite variations in work conditions. Contributing factors to this culture include the exercise of professional judgment, reliance on others, and prioritisation of patient preferences.ConclusionThis study highlights ongoing deviations from SOPs during clinical prescription checks in community pharmacies, suggesting a cultural tendency. Future research should delve into risk management strategies for these deviations and address the delicate balance between flexibility and stringent compliance.

Patient experiences of their current asthma care and their views toward providing support for patients with asthma in community pharmacy: A Qualitative study

BackgroundAn estimated 300 million people live with asthma globally. In England, a significant percentage live with poorly controlled asthma symptoms. Community pharmacists might be able to play a role in filling gaps in asthma care as they have the expertise and are in regular contact with patients with long term conditions. This study described patients' experiences of the management of their asthma in the general physician (GP) practice and community pharmacy settings and explored patients' views on providing support for them in community pharmacy. MethodThis is a descriptive qualitative study. Thirteen adult asthma patients were recruited from a GP practice in the Northwest of England. Semi-structured qualitative interviews were conducted face-to-face or by telephone. The interviews were recorded, transcribed and analysed using a thematic analysis approach. Ethics approval was obtained before the study commenced and all participants gave informed written consent to participate. ResultsWe identified challenges in the current asthma care provided to patients with asthma including lack of continuity of care, inability to book an appointment and other experienced differences in the quality of asthma care provided to them and/or access to annual asthma reviews across different GP practices. Additionally, there is lack of awareness of services provided in community pharmacy. These challenges along with having comorbidities alongside asthma may negatively affect asthma patients' engagement with their asthma appointments and their behaviour toward their asthma. ConclusionsPatients showed trust in community pharmacists same as other HCPs to support them with their asthma care. Patients thought that being provided with regular asthma care including reviews in community pharmacy might be a suitable approach to respond to patients' needs and preferences in terms of their asthma management because of ease of access to community pharmacy. Pharmacists could be involved in the provision of community pharmacy-based asthma interventions that involve more than inhaler technique education. Further research should focus on developing structured approaches for asthma patient education that can be implemented consistently in the context of community pharmacy in England.

A qualitative study exploring the opportunities and challenges of providing digital community pharmacy services for older people in England

Abstract Introduction Digital healthcare can be an innovative, cost-effective solution for the growing healthcare needs of an ageing population, enhancing service accessibility.[1] Older individuals tend to rely more on community pharmacy services, supported by research indicating positive health outcomes.[2] However, scant evidence exists regarding the impact of digital community pharmacy services on this demographic, emphasising the need for crucial investigations into their effectiveness. Aim Identify challenges and opportunities in delivering digital pharmacy services for older population in community pharmacies in England, from perspectives of policymakers and pharmacy service providers. Methods Between November 2022 and May 2023, online/telephone interviews were conducted with stakeholders including policymakers/commissioners and pharmacy service providers. Recruitment involved purposive and convenience sampling, with commissioners sourced through networks and pharmacy providers via gatekeepers in industry associations. Topics covered the current state of digital pharmacy services in England, implementation opportunities and challenges, and suggestions for enhancement. Audio-recorded interviews were transcribed verbatim and analysed using both inductive and deductive thematic approaches, assisted by NVivo 12 Plus. Themes comprised challenges and solutions in digital pharmacy service delivery and factors influencing user acceptance. Deductive analysis shaped the coding framework based on Davis’s Technology Acceptance Model (TAM). Results Twelve interviews (three policy makers/commissioners [PM], four senior managers of community pharmacy [SM], five front-line community pharmacists [CP]) were completed. One of the interviewees was a female and all others were male. Their length of relevant employment in the field of community pharmacy ranged from three to seventeen years. The key findings indicated challenges in implementing digital pharmacy services to older populations may be due to unclear health policies and limited financial support for digital reforms to community pharmacy: “as a pharmacy we’ll take care of that, but we need to know that there will be funding for that before we go and do it all. I think there’s amazing things that can be done, but at local, small level, like a little community pharmacy, they just can’t afford to do the development” [SM1], and “so the majority of independent pharmacies, … they have paper prescriptions, so they’re not as technology based. I believe one, that’s because it’s money, so it’s funding. They get less funding” [CP4]. Interviewees highlighted that community pharmacists facing high workloads and time constraints, often prioritise other responsibilities over adopting new technologies: “unfortunately, there are a fair few demands on pharmacy team’s time at the moment, so where does promoting a digital priority fit on that long list of priorities and probably quite low down” [PM3]. They also expressed a need for additional technical training to effectively navigate digital pharmacy services. Conclusion This study provides insights into challenges in implementing digital pharmacy services for older people through diverse stakeholder perspectives, offering practical considerations for policy decisions, service design, and implementation strategies. Nevertheless, this study observes a deficient emphasis on deploying digital pharmacy services for older people. It is orientated towards a broader demographic, while those with specific medical conditions may receive pharmacy services more precisely. The applicability of this study may be limited, requiring region-specific research. Further research would be focusing on those over 50 in Greater Manchester aligns with the local community’s emphasis on ageing-related research, technology, and innovative ideas supported by academic institutions.

Carbon Reduction Impact from Synchronising PrescriptionS (CRISPS): A pilot study

Abstract Introduction Synchronising the dates of patients’ repeat prescriptions can reduce monthly community pharmacy visits or home deliveries, which may improve patients’ adherence to medicines.[1] It should also reduce carbon dioxide (CO2) emissions associated with avoidable travel, but previous research does not appear to have determined the potential size of this reduction. This pilot study therefore attempted to do so using routinely collected data. Aim To estimate potential carbon savings from synchronising repeat medicines for a sample of patients from one community pharmacy. Methods All patients who had prescriptions dispensed four times per month or more from a single medium-sized (approximately 2,500 items dispensed per month) urban community pharmacy in England were identified from the pharmacy’s home delivery application. The threshold of four deliveries per month was selected to increase the likelihood of this frequency being due to asynchronised prescriptions. Data were collected (August 2023) for deliveries in June 2023 as there were no public holidays or events to affect prescription ordering. Data included patients’ postcode, delivery dates, and using the Patient Medication Record, the pharmacist collecting the data determined acute or one-off prescription items, that neither the patients nor the repeat medicines were new, and where deliveries were made to supply medicines owing. The pharmacy was selected because it efficiently managed stock to minimise items owing. The distance that would have been travelled was calculated as if the medicines had been collected from the pharmacy as a dedicated journey to and from the patient’s home address instead of being delivered. The saving in miles and CO2 emitted for different vehicle types was modelled by assuming that for each patient, all deliveries that were not for acute items or medicines owing could have been reduced to a single delivery if prescriptions had been synchronised. UK Government conversion factors were used to calculate CO2 emissions.[2] Results Data were collected for 59 patients, of whom 7 patients had 8 deliveries, 4 had 7 deliveries, 6 had 6 deliveries, 16 had 5 deliveries and 26 had 4 deliveries. The total number of deliveries to these patients was 269 but would have been 80 deliveries if the repeat prescriptions had been synchronised (70% reduction). The distance travelled would have been reduced from 842 miles to 241 miles (71% reduction). This would have resulted in a 71% reduction in CO2 emissions, although the reduction in volume in kilograms of CO2 emitted would have varied (by an estimated 137 Kg CO2 or 51%) depending on whether e.g., a small diesel car was used or a large petrol car (reduction of 133kg versus 270 kg CO2). An average diesel car was estimated to have reduced CO2 emissions by 163 kg. Conclusion The findings demonstrate that potential carbon savings from medicines synchronisation can be modelled from routinely collected data, but with limited accuracy, especially as patients receiving home deliveries may not be representative of all pharmacy users. Challenges remain in how to measure actual carbon savings of prescription synchronisation and overcoming barriers to widespread implementation of clinically appropriate synchronisation.

What's age got to do with it? A study of the implementation of the discharge medicines service for paediatric patients.

The discharge medicines service (DMS) was introduced as an essential service for all community pharmacies in England through the Community Pharmacy Contractual Framework (CPCF) in February 2021. This study aimed to describe the implementation of this service for paediatric patients and to identify any barriers to referrals. The study was undertaken in a 24-bed paediatric ward in a District General Hospital from September 2022 to February 2023. All paediatric inpatients on long-term medications were eligible for inclusion. Out of 169 eligible participants, 149 were referred. Community pharmacists accessed referrals through PharmOutcomes® and could accept, complete, or reject referrals on this platform. Of the 149 referred patients, 24 (16.1%) were accepted but not yet actioned; 63 (42.3%) were fully or partially completed; 19 (12.8%) were rejected, and 43 (28.9%) there was no response (remained as referred). Younger children (<2 years) were more likely to have their referral rejected than older children (6 years and older). The feedback from parents was overwhelmingly positive (93.5%) and two families reported that they believed the DMS service prevented readmission to the hospital for their children. No children were involved in the community pharmacist consultation. Barriers to referrals included patients not having a nominated pharmacy and a lack of confidence in completing paediatric referrals. This study demonstrates the value of completing referrals for paediatric patients. More research is required to explore how community pharmacists can be supported to complete paediatric DMS referrals.

Workforce development in community pharmacies in England: Opportunities and tensions for a private sector provider of NHS services.

The intention to more effectively mobilise and integrate the capabilities of the community pharmacy workforce within primary care is clearly stated within National Health Service (NHS) England policy. The Pharmacy Integration Fund (PhIF) was established in 2016 to support the development of clinical pharmacy practice in a range of primary care settings, including community pharmacy. This study sought to determine how PhIF funded learning pathways for post-registration pharmacists and accuracy checking pharmacy technicians enabled community pharmacy workforce transformation, in what circumstances, and why. Realist evaluation. We identified two main programme theories underpinning the PhIF programme and tested these theories against data collected through 41 semi-structured qualitative interviews with community pharmacist and pharmacy technician learners, educational supervisors, and community pharmacy employers. The data supported the initial programme theories and indicated that the learning pathway for post-registration pharmacists had also provided opportunity for pharmacists to develop and consolidate their clinical skills before pursuing an independent prescribing qualification. Employer support was a key factor influencing learner participation, whilst employer engagement was mediated by perceptions of value expectancy and clarity of purpose. The study also highlights the influence of contextual factors within the community pharmacy setting on opportunities for the application of learning in practice. When designing and implementing workforce transformation plans and funded service opportunities that require the engagement of a diverse range of private, for-profit businesses within a mixed economy setting, policymakers should consider the contextual factors and mechanisms influencing participation of all stakeholder groups.

Facilitating self-care through community pharmacy in England

In England, almost all the population are within a short walk of a community pharmacy. This network of pharmacies provides a range of services, most of which are commissioned and remunerated through a nationally agreed contract with the National Health Service (NHS). Over time this contract has seen funding move from the traditional core service of dispensing medicines, toward patient-facing clinical services. All of these services have elements of self-care built in to the service specification, which pharmacists are mandated to deliver. These services significantly expand the role of the community pharmacist beyond facilitating self-care by supplying “over the counter” (OTC) medication. The increased public health role, where promotion of healthy living and prevention of disease is now seen as an essential activity by and for pharmacists. Changes to UK health policy, where the focus has been on delivering care closer to the patients' home, means community pharmacists have an increasing role in the effective management of acute and long-term conditions. The most recent contract afforded to pharmacy has now started to integrate pharmacy services with medical services, in both primary and secondary care, in attempt to provide greater continuity for the patient. It is very likely that self-care activities provided by community pharmacy will expand further, especially around the management of long-term conditions as the pharmacy workforce transitions in to having prescribing rights for medicines other than non-prescription medicines.

A pilot study to assess the impact of the Discharge Medicines Service for paediatric patients

Abstract Introduction The Discharge Medicines Service (DMS) was introduced as an essential service for all community pharmacies in England through the Community Pharmacy Contractual Framework from February 20211,2. Aim The pilot study aimed to evaluate this service for paediatric patients and to identify if there are any barriers to referrals. Methods The study was undertaken in a 24-bed paediatric ward in a District General Hospital from September 2022 – February 2023. All paediatric in-patients on long-term medications were eligible for inclusion. Out of 169 eligible participants, 149 were referred. Community pharmacists accessed the referrals through PharmOutcomes, and can accept, complete, refer, or reject referrals on this platform. A survey was also sent to community pharmacists, through the Local Pharmaceutical Committee, to better understand how comfortable community pharmacists felt completing referrals for paediatric patients. The study was deemed as a service evaluation by the Clinical Audit Department and Research and Development Department and therefore did not require ethical approval. Results Out of the 149 referred patients, 63 (42.3%) had completed referrals, 19 patients (12.8%) had their referrals rejected, and the remaining 67 patients (44.9%) either had their referrals accepted or referred. Younger children (less than 2 years) were more likely to have their referral rejected compared to older children (6 years and older). The feedback from parents was overwhelmingly positive (93.5%), and two families reported that they believed the DMS service prevented readmission to the hospital for their children. No children were involved in the community pharmacist consultation and only nine community pharmacists (42.9%) survey answered as either somewhat comfortable or very comfortable about completing a referral for a paediatric patient. In addition, one community pharmacist reported they did not know how to complete a referral for a paediatric patient. Discussion/Conclusion This pilot study demonstrates the value of completing referrals for paediatric patients as well as the potential barriers. Barriers to referrals included patients not having a nominated pharmacy and a lack of confidence in completing paediatric referrals. As this was a pilot study, the number of patients included was small, and a larger scale study is required to further investigate the implications of DMS referrals for paediatric patients and reasons for non-completion of referrals. Although the numbers of respondents to the community pharmacist survey were very small, this did give an insight into how community pharmacist colleagues felt about receiving paediatric referrals and potentially highlights the need for ongoing training and support. More research is required to explore how community pharmacists can be supported to complete DMS referrals for paediatric patients.

Pharmacy users' perceptions, awareness and future expectations of community pharmacy in England: a focus group study.

To explore pharmacy users' perceptions of current and future provision of community pharmacy services in England. Qualitative, reconvened focus groups were conducted with community pharmacy users. An initial focus group explored preliminary views. Participants were then given an evidence brief describing community pharmacy before a reconvened focus group two weeks later. Transcripts were analysed using inductive thematic analysis. Eleven individuals participated across two reconvened focus groups. Participants valued community pharmacies and staff, but lacked awareness of their services and roles: '… I don't think the general public is aware of all of this … it gives you a very different perspective'. Urgent care and long-term conditions management were identified as suitable for future development, facilitated by training, closer collaboration with general practices, shared access to health records, and premises with more space and confidentiality: 'I still think of it as a retail space more than as a health service'. Concerns were expressed about working conditions in community pharmacy and unplanned closures: 'doesn't sound like a great place to work'. Participants anticipated greater use of technology but did not want this to replace face-to-face contact with pharmacy staff: 'I am not saying it's inaccurate, it is so remote and impersonal'. Pharmacy users would value a greater role for community pharmacy in addressing the challenges currently faced by the health service in England, provided that their concerns on a range of issues are addressed.

Validation of the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q); a Behavioural Science-Underpinned Tool for Identifying Non-Adherence and Diagnosing an Individual's Barriers to Adherence.

To validate the Identification of Medication Adherence Barriers Questionnaire (IMAB-Q) as a tool to guide practitioners to identify patients who require support to take their medicines as prescribed, their key barriers to adherence and select relevant behaviour change techniques. Adults prescribed medication for cardiovascular disease prevention were recruited from nine community pharmacies in England. Participants completed the IMAB-Q comprising 30 items representing potential barriers to adherence developed from our previous mixed methods study (scoping review and focus groups) underpinned by the Theoretical Domains Framework. Participants also self-reported their adherence on a visual analogue scale (VAS) ranging from perfect adherence (100) to non-adherence (1). A subgroup of 30 participants completed the IMAB-Q twice to investigate test-retest reliability using weighted Kappa. Mokken scaling was used to investigate IMAB-Q structure. Spearman correlation was used to investigate IMAB-Q criterion validity compared to the VAS score. From 1407 invitations, 608 valid responses were received. Respondents had a mean (SD) age of 70.12 (9.9) years and were prescribed a median (IQ) 4 (3, 6) medicines. Worry about unwanted effects (n = 212, 34.5%) and negative emotions evoked by medicine taking (n = 99, 16.1%) were most frequently reported. Mokken scaling did not organise related IMAB-Q items according to the TDF domains (scalability coefficient H = 0.3 to 0.6). Lower VAS self-reported adherence correlated with greater IMAB-Q reported barriers (rho = -0.14, p = 0.001). Test-retest reliability of IMAB-Q items ranged from kappa co-efficient 0.9 to 0.3 (p < 0.05). The IMAB-Q is valid and reliable for identifying people not adhering and their barriers to adherence. Each IMAB-Q item is linked to a TDF domain which in turn is linked to relevant behaviour change techniques. The IMAB-Q can therefore guide patients and practitioners to select strategies tailored to a patient's identified barriers.

A qualitative study to investigate community pharmacists' perceptions about identifying and addressing inappropriately prescribed analgesia.

Inappropriate prescribing, particularly for analgesia, is a recognised global problem. This leads to increased morbidity and mortality and presents a significant challenge for patients and the healthcare system. There is a need to identify strategies that best identify inappropriately prescribed analgesia (IPA). This study aims to explore the perspectives and experiences of community pharmacists (CPs) about addressing IPA. Semi-structured interviews informed by the Behaviour Change Wheel model and the Theoretical Domains Framework (TDF) were conducted with consenting community pharmacists. Transcripts were coded using a capability, opportunity, motivation model of behaviour (COM-B) model. The COM-B components were mapped to the TDF and behaviour change techniques (BCTs) were identified to address these. A total of 12 pharmacists who work in community pharmacies in England were interviewed between March and May 2021. COM-B components were identified through analysis and mapped to nine TDF domains. Component 1 referred to 'Capability' of CPs to be involved in addressing IPA (knowledge). Component 2 pertained to 'Opportunity' to identify IPA (e.g. social influence). The 'Motivation' component linked to five TDF domains (e.g. goals). Seventeen BCTs were identified to support CPs in addressing IPA (e.g. environmental context and resources domain mapped to 2 BCTs 'restructuring the physical and social environment'). CPs expressed mixed perceptions about their involvement in the deprescribing of IPA as part of their daily practice, but they stated that social and environmental barriers needed to be addressed to facilitate their involvement. The identified BCTs provide evidence-based strategies to help the involvement of CPs to identify IPA.

Predicting the potential value of the new discharge medicines service in England

Abstract Objectives In 2021, community pharmacies in England were commissioned to support patients post-discharge through the discharge medicines service (DMS). Past studies described the benefit of DMS in avoiding readmissions. This study aimed to estimate the impact of DMS in this respect, projecting the maximal benefit if all areas mirrored the most active region. Methods A retrospective observational study, including modelling, using DMS claims data from March 2021 to February 2022, obtained from the NHS Business Services Authority (data from all community pharmacies in England for patients discharged where hospital clinicians referred them to community pharmacy). The impact of DMS on reducing readmission during this period was estimated using previous study data and estimated maximal benefit from full implementation of the service across England. Key findings In the study period 65 634 completed DMS claims were made. Claims at Integrated Care System (ICS) area level varied from 509/10 000 admissions to &amp;lt;1/10 000 admissions. Combining data from past studies provides a relative risk ratio of 0.756 (95% CI 0.678 to 0.843) for 90 day readmission (DMS versus normal care). DMS is estimated to have resulted in 8393 (95% CI 7061 to 9564) fewer readmissions after 30 days reducing to 5869 (95% CI 3774 to 7740) after 90 days. If all-ICS areas were as active as the highest performing area, DMS would avoid estimated &amp;gt;29 000 readmissions at 90 days each year. Conclusions DMS has significant potential to reduce readmissions. DMS implementation is currently variable and full implementation across all-ICS areas could increase the benefits five-fold.

Community pharmacies made 89p in profit per item dispensed in past year, claims government

There was a small drop in the profit that community pharmacies in England made on dispensing in 2021/2022, compared with the previous year, show government figures. This is despite reports from pharmacy contractors that pharmacies are making “huge losses” through dispensing, owing to increasing medicine prices and issues with the price concessions system. In September […]

Number of community pharmacies in England falls for fifth year in a row

Number of community pharmacies in England falls for fifth year in a row

Community pharmacies to start directly referring patients for cancer screening from January 2023

Forty community pharmacies in England will begin directly referring patients with possible signs of cancer for scans, as part of a pilot service from January 2023, The Pharmaceutical Journal has learned. The pilot was first announced by NHS England in June 2022, with pharmacists expected to spot signs of cancer — such as a cough that […]

Evaluation of the England Community Pharmacy Quality Scheme (2018–2019 and 2019–2020) in reducing harm from NSAIDs in older patients

IntroductionNon-steroidal anti-inflammatory drugs (NSAIDs) are widely used for their analgesic and anti-inflammatory action, but the gastrointestinal (GI) adverse effects are a known cause of preventable harm. A medication safety audit...

Community pharmacies lose £1.6bn in eight years owing to inflation, government figures show

Community pharmacies in England have lost £1.6bn in funding since 2015/2016, owing to increases in inflation, government figures have revealed. In December 2016, the government announced plans to cut pharmacy funding by £208m over two years, from £2.8bn in 2015/2016 to £2.592bn in 2017/2018. However, figures published by the government, in answer to a written […]

Ant colony optimisation of a community pharmacy dispensing process using Coloured Petri-Net simulation and UK pharmacy in-field data

There are 11,619 community pharmacies in England which dispense over 1 billion prescriptions each year, providing essential primary care to NHS (National Health Service) patients. These pharmacies are facing pressure from a number of sources including funding cuts and high demands on services, while trying to deliver the highest standards of care. This paper presents an optimisation of a Coloured Petri Net (CPN) community pharmacy simulation model using an Ant Colony Optimisation (ACO) method. The CPN method was proposed by Naybour et al . Quantitative data from UK community pharmacies was collected by the authors and incorporated into the CPN simulation model. The optimisation is made up of a choice of how many staff to employ, which prescription checking strategy to use, and which staff work pattern to implement. This method aims to provide decision makers with a set of optimal pharmacy configurations at different cost levels. This can help to support pharmacy safety, efficiency, and improve decision making processes. It has been demonstrated how reliability modelling techniques traditionally used in safety-critical industries, can be used to carry out safety and efficiency analyses of healthcare systems, such as dispensing processes in community pharmacies, illustrated in this contribution.