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Table 2 Always and Never Events and Acute Consultations

From: “What counts can’t always be measured”: a qualitative exploration of general practitioners’ conceptualisation of quality for community pharmacy services

Theme Always Never
Introduction/name/role “introduce yourself, always make it clear who you are, what your role is, so that there is no misunderstanding with the patient as to what the limits of your ..experience are” (S2)  
Competency – being aware of own competency “it’s about being aware of...recognising your limits of competence” (E14) “shouldn’t be done by untrained individuals ...never working outside your competence” (E11)
Pharmacist involvement “it’s not appropriate for someone other than a very experienced pharmacist to actually conduct that consultation ...and it probably needs to be run more like a proper consultation” (S5) “I think it should be done by the pharmacist and not by other staff in the pharmacy” (E19).  
Information gathering -history taking “they [the patient] need to be given a minute..to actually tell their story rather than be asked a lot of direct questions” (S5) “always take a history” (E16) “making sure that and accurate history is taken, especially your allergy history” (S4) “getting a history of co-morbid conditions and concomitant medications” (S1) “self-prescribed medication and GP-prescribed medication” (E9) “the pharmacist should always have access to notes,,,it’s impossible to grasp a full history from a few minutes with the patient” (E11) “jumping straight into prescribing a medication without understanding the context, particularly in terms of current medication, pre-existing ill health” (E12) “just selling ...without a history and without and explanation” (E19) “we never have any consultation without first of all establishing who the patient is and getting their background” (E18)
Diagnosis “always listening to the patient and exclusion of..anything more significant with any particular symptoms” ..(E17) “never be dismissive of patient’s concerns” (E20)
Safety – Red flags “the pharmacist needs to have the ability and the training and the knowledge to ask specific questions and exclude any red flags” (S5) “exclude red flags relating to the condition” (E20) “ideally not miss a red flag”
Safety – safeguarding “anything from an adult protection, vulnerable adults or child protection, ...follow GMC guidance on ..examining patients” (S8)  
Privacy “always have privacy” (S5) “things that pertain to people’s health ....should never be done in a public place” (S5)
Confidentiality “the confidential nature of the consultation is really important” (S1) “you’ve got to have confidentiality” (S 3) “there should always be confidentiality” (S8) “share information inappropriately” (S3)
Information/advice provision “as simple a treatment plan as possible, keep it as simple and straightforward as possible ..ideally I would want some form of teach back or checking the patients has understood” (S 1) “get the right medication; always need to be explained to the patients exactly what to do” (S 5) “patients should never be given things without people fully understanding they fully know how to take them” (S 5) “they [the patient] should never go away from the pharmacist ..pharmacy..without knowing where to go if things get worse” (S 5)
Commercialism   “they’re sold a specific product that is significantly more expensive than perhaps another product that would do the same thing” (S4) “unnecessary prescribing expensive medication that has no benefit (E12)