Community Practice Environment Initiative

Shared Accountability in the Delivery of Patient-Centred Healthcare in Community Pharmacy

The Community Practice Environment Initiative is aimed at understanding confirmed and potential barriers to professional autonomy and patient safety in community pharmacy through thoughtful, respectful and meaningful collaboration and engagement with pharmacy stakeholders.

The first phase of this initiative will focus on developing a set of essential shared accountability principles. It is expected that these principles will guide the development of specific solutions and strategies for the sector to further strengthen the quality and safety of pharmacy care, and help position the profession for ongoing success as pharmacy plays an increasingly important role in the health and wellbeing of Ontarians.

To move this work forward, the College has initiated preliminary stakeholder communication and begun the work to formally establish a Community Practice Environment Advisory Group that will comprise community pharmacy owners/operators, association representatives, Designated Managers, staff pharmacists and pharmacy technicians and patients/caregivers.


Over the past few years, the College has conducted a number of engagement activities with registrants including Regional Meetings and open consultations and informally through direct communication and dialogue related to various key initiatives and programs designed to promote safe, quality pharmacy care. One of the common themes in the feedback the College has consistently received through these engagement activities is related to the community pharmacy practice environment.

Specific concerns that have been raised by registrants include workload and other pressures to meet operational expectations and the impact this has on professional autonomy and registrants’ ability to meet practice expectations. This feedback is now being expressed in nearly every consultation exercise.

Along with this feedback, medication safety data anonymously reported by pharmacy professionals through the College’s Assurance and Improvement in Medication Safety (AIMS) Program is providing important insights into various causal factors that may be contributing to errors and near misses. In the first AIMS data snapshot published last September along with the inaugural expert bulletin, staffing, workload and environmental factors were the single most commonly noted contributors, comprising 23.6% of the 4,426 incidents reported by onboarded community pharmacies. The availability of this data and the ongoing feedback being expressed by registrants makes it evident that workload and staffing related challenges are top-of-mind for many community pharmacy professionals.

Patients, too, have provided us feedback through our public engagement activities about their ability to access care in increasingly busy pharmacies and the need for adequate staffing as expanded scope of practice for Ontario pharmacists is being considered.

Safe patient care is everyone’s business, and ensuring the safety and quality in pharmacy at all times is a shared accountability

The practice environment must enable and support the provision of safe, quality patient-centred care at all times and that any barriers to achieving that goal must be addressed collaboratively. As the College considers the ongoing roll out and maturity of its AIMS Program, the implementation of important quality improvement initiatives and the evolution of pharmacist scope of practice in the province, it believes very strongly that shared accountability within pharmacy is more important than ever.

While the College is aware of the limits of its authority over business practices in pharmacy, it is fully committed to acting appropriately and effectively within its legislated mandate and objects through existing regulatory mechanisms designed to protect the public. This includes ensuring that owners/operators of pharmacies, including Designated Managers and those who exert any control over pharmacy operations, understand and are held accountable to their responsibilities and obligations under the Standards of Operation, just as pharmacy professionals are held accountable to the Standards of Practice.

Professional and stakeholder engagement

The College completed recruitment for the Community Practice Environment Advisory Group in March 2020. An open-call was made for pharmacists, pharmacy technicians, patient and caregivers between February 28th and March 13th.

The Community Practice Environment Advisory Group (the Advisory Group) will consist of community pharmacists, community pharmacy technicians, patients/caregivers, pharmacy owners (chain, franchise and independent) and association representatives. This Advisory Group will develop essential principles of shared accountability intended to guide the development of specific solutions and strategies for the sector in order to further strengthen the quality and safety of pharmacy care in the province, and position it for ongoing success as pharmacy plays an increasingly important role in the health of our community and performance of our health system.

The work of the Advisory Group was set to start in April 2020, and is the first phase of the broader Community Pharmacy Practice Environment Initiative. In recognition of the pressures community pharmacy professionals are experiencing because of COVID-19, the first meeting has been postponed to Fall 2020. In the meantime, work will move forward this summer on engaging pharmacy patients and caregivers to learn about their experiences accessing pharmacy services within the community practice environment

Community pharmacy professionals, the public and other pharmacy stakeholders will have opportunities to provide input as the principles of hared accountability in community pharmacy are developed.