Table 3.

Pharmacist quote sample in relation to suboptimal practice increase in the last 5 years.

Has Suboptimal Practice Had Increased in New Zealand over the Last 5 Years?
Framework	Major Theme	Sub-Theme	Pharmacist Quote
Software	Leadership and Corporatisation	Lacking leadership Service direction Continuing education Stock Supply issues Ownership regulations Lack of recognition Effective control Compliance adherence Profitability Competition Marketing/Image Lack of responsibility Electronic prescribing Remuneration Cost pressure	“I think pharmacy owners feel they are under increasing financial pressure with the rise of discount chains and their response is often to look to the wage bill for savings. Reducing staffing levels hugely impacts the ability of pharmacists to work in the higher levels of their scope of practice and at it’s worst is more than suboptimal it is dangerous.” (32) “The pharmacy profession at large has faced a flux of change with the introduction of Corporates and the changing face of community pharmacy. This has a downstream effect on hospital practice. I have observed a loss of faith in the practical need for Post Graduate qualifications in practice and for professional development.” (230)
Hardware	Funding	Under resourcing Lack of resource commitment	“Lack of funding—this leads to us not being able to provide the services we need to as we need to spend time being money into shop. Staff unhappiness has increased due to higher work demands, less pay, more pressure: (24) “The health sector keeps wanting us to provide more services, more treatment, and store more information on site. This includes COVID-19 vaccines but there isn’t enough staff to be able to treat patients at the level that they deserve.” (40)
Environment	Workload pressure	Staffing pressure Growing needs Service provision	“Large chain pharmacies who offer “free” prescriptions but have huge wait times is putting massive pressure on their pharmacists, many of which are young and relatively inexperienced. Also COVID-19 has added an element of stress to pharmacies, increasing workload and changing how prescriptions are received. It makes it more difficult to prioritise prescriptions as you now have no idea when a person will be calling to collect their prescriptions. Customers are also more anxious and stressed and often take this out on staff members” (62)
Liveware	Work Culture	Stress and burn out Short cuts Anxiety Professional dissatisfaction Attitudes Social media	“There have been complex shifts within the age bands and ethnic diversity of the profession some have added and enriched practice whilst others have created a mismatch and muddling of shared values.” (230) “Obviously I am not a user of health services, but I have conversations with many who are. What I regard as standard level of practice is apparently not what is offered universally. I hear from patients who have seldom (if ever) had medicine or health related conversations with pharmacists. Additionally, locum’s and pharmacists I have employed have also commented on the different level of service we provide.” (119)
Liveware–Liveware	Relationships	Lack of support Multi-disciplinary teams Public Generational gap Health Providers Bullying	“Co-payments not streamlined across the board: serious ramifications including pharmacy seen as a ‘cheap supermarket service’ AND untrustworthy as causes confusion and plants suspicion in pharmacies that still need to ‘charge’ despite being a government fee. Scope of practice: as previously mentioned, pharmacists are capable of so much more as they come out of University. In part, this may be due to the cheap service that’s provided which is only heightened by the fact that pharmacies are no longer medicine-only focused. Due to the need for a retail-heavy model, trust from the general public also wanes.” (135)