Changes to community pharmacy practice during the COVID-19 pandemic: a cross-country documentary analysis
Authors: Barry H E , Cadogan C A , O’Reilly E , Patterson S M , Fitzell C , Hughes C M 
Published: April 2022

Abstract

Introduction
Community pharmacy has played a frontline role during the COVID-19 pandemic (1,2). Governments and professional organisations in the United Kingdom and Republic of Ireland (RoI) have acknowledged the need to support and maximise community pharmacy to maintain delivery of patient care. However, the pandemic’s impact on day-to-day changes to community pharmacy practice has not been comprehensively examined across the island of Ireland.

Aim
To identify changes as communicated by policy and professional bodies to community pharmacy practice across the island of Ireland in preparation for and/or response to the COVID-19 pandemic, and to compare identified changes in Northern Ireland (NI) and RoI.

Methods
Government, health service, regulatory and professional organisation websites in both NI and RoI were searched using relevant search terms (e.g. pharmacist, COVID-19). Any document (e.g. official publications/reports, website pages, circulars) containing information relating to changes to community pharmacy-related infrastructure, funding/resourcing, legislation, guidelines or policies in preparation for, and/or response to, COVID-19, published between 1st January and 31st October 2020 was included. Guidelines on clinical use of medicines were excluded as this was considered a separate topic. Initial screening of each website was undertaken by one reviewer. Brief details of potentially relevant documents were collated in a spreadsheet. Following removal of duplicates, full-texts of identified documents were assessed for inclusion by two reviewers independently, with discrepancies resolved through discussion. A content analysis was undertaken.

Results
In total, 253 documents were identified. Following removal of duplicates and screening, 98 documents were included in the analysis. Most documents were published in the first three months of the pandemic (March-May 2020). A key theme related to medication prescribing and supply, with changes implemented to ensure continued access to medicines. In both NI and RoI, significant changes were made to emergency supply arrangements (e.g. increase in allowable duration of supply at the request of patients). In RoI, legislative changes were made to recognise Healthmail as the national electronic prescription transfer system and to temporarily extend prescription validity. In NI, many community pharmacy services (e.g. Minor Ailments Service, Medicines Use Review) were ‘stood down’ during initial months of the pandemic. Much of the communication in NI and RoI related to operational changes to ensure business continuity. In both jurisdictions a temporary register of pharmacists was introduced to allow previously registered pharmacists to contribute to the health service response. Additionally, in NI, General Dental Practitioners were redeployed to assist with community pharmacy response. Other areas of focus across both jurisdictions included infection control within a workplace setting, dealing with situations where staff were affected by COVID-19, and the use of personal protective equipment during pharmacy service provision.

Conclusion
This study examined changes in community pharmacy practice across two jurisdictions during the COVID-19 pandemic. Whilst our searches were limited to publicly accessible documents only, the overlap in identified changes reflects the similarities in challenges faced by community pharmacists in adapting and responding to COVID-19. The cross-country comparison may help pharmacists and policy-makers to identify optimal approaches for responding to any future public health crises.

Reference
(1) Cadogan CA, Hughes CM. On the frontline against COVID-19: community pharmacists’ contribution during a public health crisis. Res Soc Adm Pharm. 2021; 17(1): 2032-2035.
(2) Maidment I, Young E, MacPhee M, Booth A, Zaman H, Breen J, Hilton A, Kelly T, Wong G. Rapid realist review of the role of community pharmacy in the public health response to COVID-19. BMJ Open. 2021; 11(6): e0500043