This thesis is a policy analysis of the Pharmacy In A New Age (PIANA) initiative launched by the Royal Pharmaceutical Society of Great Britain (RPSGB) in 1995. It leads to an understanding of how pharmacy services develop as a part of the Welfare State. The chosen interpretation was to explore the pharmacy policy sub-system using the Advocacy Coalition Framework (ACF), the Systems Approach and the dimensions of power associated with decision-making. The PIANA initiative identified five areas where pharmacists' input into future healthcare systems would be valued: o the management of prescribed medicines; e the management of long-term conditions; the management of common ailments; the promotion and support of healthy lifestyles; and, advice and support for other healthcare professionals. Research was conducted using both qualitative and quantitative methods to ascertain pharmacists' perceptions towards the implementation of the PIANA initiative. From the interviews it was determined that isolation, remuneration, skill mix and competitive retail environment were factors thought to impede the implementation of new pharmacy services in the community setting. Hypotheses were generated and subsequent questionnaire based research explored pharmacists' views relating to the development of the extended pharmacy services and which organisations were trusted to influence the policy process. The study group comprised 2359 pharmacists living in Great Britain who were registered With the RPSGB on March 12 th 1999. The response rate was 50.1 % (n= 1182). Statistical analysis demonstrated that the management of prescribed medicines was ranked most important role and that pharmacists employed in GP surgeries were thought best placed to carry out this role. The author suggests that clinicallytrained pharmacists based in GP surgeries would be best placed to manage prescribed medicines. Community pharmacists ranked the management of common ailments as their second most important role and were perceived to be best located by all pharmacists. Hospital ranked the advice and support of health care professionals as the second most important; community pharmacists ranked this as the fifth most important. The conclusionsd raw on the literaturea ssociatedw ith implementationT. he author considers that the methods employed, were appropriate to analyse the pharmacy policy process. The analysis identified that the RPSGB was unable to unilaterally influence the policy process and that the plethora of pharmacy organisationsm ay be detrimentatl o policy implementationT. he authorc oncludes that local leadersw ho are associatedw ith severalp harmacyo rganisationsfu rther compromise the situation. Employees of Primary Care Organisations were found to possess the triple dimensions of power associated with decision-making and are key policy brokers for emerging pharmacy services. Future policy implementation research should focus upon this group. The majority of pharmacists were unable to identify a legitimate organisation to support the local implementation of pharmacists' non-dispensing roles, this may impede the implementation process. The majority of pharmacists agreed that they would have to change the skills that they used in order to survive. Educators and trainers should ensure that pharmacists develop competencies to the expected professional standards required to develop and deliver new roles. 16

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