Background: All changes in the regulation of pharmacies have an impact on the work carried out in pharmacies and also on patient safety, regardless of whether this is the intention or not.

Objective: To compare staff apprehension regarding some aspects of patient safety and quality in community pharmacies prior to and after the 2009 changes in regulation of the Swedish community pharmacy market.

Methods: Questionnaires targeted at pharmacy staff before and after the changes in regulation (in 2008, 2011/12, and 2012/13 respectively) used four identical items, making comparisons of some aspects possible.

Results: All four items demonstrated a significant decrease in the first survey after the changes as compared to before. In the second survey significant differences were found on the two items representing safety climate whereas the items representing team climate and management showed no significant differences.

Conclusions: The comparison carried out in this study indicates a negative effect in Swedish community pharmacies on safety and quality issues, as experienced by pharmacy staff. It is recommended that the possible effects of healthcare reforms are assessed before implementation, in order to counteract conceivable decline in factors including patient safety and working conditions.