{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T23:03:58Z","timestamp":1791759838473,"version":"4.3.4"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NHS England","award":["C75805"],"award-info":[{"award-number":["C75805"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Main study objectives<\/jats:title>\n<jats:p>To evaluate implementation and impact (at pharmacy and system level) of the pharmacy quality scheme (PQS), a pay-for-performance quality incentive scheme in community pharmacies in England since 2017.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Mixed-methods evaluation. Three linked datasets for 2021\/22 (n\u2009=\u200910,135) were analysed for impact of pharmacy size, type (independent, chain, supermarket), location, prescription volume, and region on PQS participation, domains completion and payments. Forty-one qualitative interviews conducted with pharmacists, employers and representative bodies explored views and experiences of PQS implementation and impact. Harrington et al.\u2018s conceptual framework for evaluating community pharmacy pay-for-performance programmes guided qualitative data analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Nearly all community pharmacies in England participated in PQS, with differences identified between chains (99% participation) and independents (16.5%), with income via PQS being an important motivator. Interviewees agreed with policy-makers about the purpose of the PQS being patient safety, patient experience, and clinical effectiveness. Beyond these core dimensions, consistency of service provision, sustainability, and wider system integration were considered important. While PQS was largely viewed as positively impacting pharmacy teams, clinical practice, and patient care, interviewees felt that increasing workloads across the sector made it challenging to focus on quality. They felt that there was a lack of feedback, that impacts were not always visible, and indeed frontline pharmacists were often not aware of published evidence of PQS impacts. Multiple sources of guidance lead to duplication and confusion. Particularly independent pharmacies found PQS workload burdensome and complex.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The primary incentive for PQS engagement revolved around income stability for employers, with some positive impact achieved, but obstacles concerning resource implications and sustainability persist. Considering concerns about the viability of community pharmacy and the importance of increasing the scope of pharmaceutical services, these implementation challenges should lead policy-makers to question how best to incentivise quality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0319215","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T17:45:57Z","timestamp":1744825557000},"page":"e0319215","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Do pay-for-performance schemes improve quality in community pharmacy? A mixed-methods study exploring stakeholder perspectives on implementation of the nationwide Pharmacy Quality Scheme (PQS) in England?"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7072-0888","authenticated-orcid":true,"given":"Ellen Ingrid","family":"Schafheutle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidan Akira","family":"Moss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali Mawfek Khaled","family":"Hindi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jon","family":"Gibson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6158-6408","authenticated-orcid":true,"given":"Emma","family":"Lovatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Robinson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Jacobs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,4,16]]},"reference":[{"issue":"692","key":"pone.0319215.ref001","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.3399\/bjgp20X708185","article-title":"Regional variation in practitioner employment in general practices in England: A comparative analysis","volume":"70","author":"S Spooner","year":"2020","journal-title":"Br J Gen Pract"},{"issue":"8","key":"pone.0319215.ref002","doi-asserted-by":"crossref","first-page":"e005764","DOI":"10.1136\/bmjopen-2014-005764","article-title":"The positive pharmacy care law: An area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England","volume":"4","author":"A Todd","year":"2014","journal-title":"BMJ Open"},{"issue":"6","key":"pone.0319215.ref003","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.sapharm.2013.02.005","article-title":"Defining professional pharmacy services in community pharmacy","volume":"9","author":"JC Moullin","year":"2013","journal-title":"Res Social Adm Pharm"},{"issue":"1","key":"pone.0319215.ref004","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s40545-023-00626-0","article-title":"Global landscape of community pharmacy services remuneration: A narrative synthesis of the literature","volume":"16","author":"R Hussain","year":"2023","journal-title":"J Pharm Policy Pract"},{"issue":"10","key":"pone.0319215.ref005","doi-asserted-by":"crossref","first-page":"e017843","DOI":"10.1136\/bmjopen-2017-017843","article-title":"Organisational and extraorganisational determinants of volume of service delivery by English community pharmacies: A cross-sectional survey and secondary data analysis","volume":"7","author":"M Hann","year":"2017","journal-title":"BMJ Open"},{"issue":"9","key":"pone.0319215.ref006","doi-asserted-by":"crossref","first-page":"e0204304","DOI":"10.1371\/journal.pone.0204304","article-title":"How do organisational configuration and context influence the quantity and quality of NHS services provided by English community pharmacies? 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