Special report: the stressors burning out pharmacists

Three years after highlighting a hidden pandemic of work-related stress within pharmacy, the profession’s wellbeing crisis carries on unabated.

One in four pharmacists continue to report feeling ‘very stressed’ at work in 2024 — the same proportion as 18 months into the COVID-19 pandemic in September 2021 and approximately double that in the previous three years (see Box 1).

Although the immediate stress of COVID-19 has passed, it has left other stressors in its wake, including a chronic lack of funding for community pharmacy, leaving many businesses running at a loss, with over 400 closures in England in the past year alone.

Funding and recruitment challenges within hospital pharmacy, coupled with the impact of industrial action within the NHS, has left the workforce stretched thin. And, in primary care, financial struggles within general practice, compounded by challenges with GP recruitment and an unrelenting increase in demand for appointments, mean that GP pharmacists are having to take on more duties, piling pressure on the sector.

The latest data from The Pharmaceutical Journal’s salary and job satisfaction survey, conducted between 15 April 2024 and 30 April 2024 (see Box 2), reveal that 61% of 1,243 pharmacist respondents said they feel ‘moderately stressed’ or ‘very stressed’, while 6% said they have needed to take time off work owing to stress in the past year (see Figure 1).

Higher levels of stress were most common among respondents working in the community sector, with 70% of 306 community pharmacists saying they were ‘moderately stressed’ or ‘very stressed’, compared with 64% of 397 hospital pharmacists and 49% of 208 pharmacists in general practice (see Figure 1).

The survey also revealed that 8% of community pharmacists, and the same proportion of hospital pharmacists, said they had taken time off work owing to stress in the past year.

Some pharmacists said they were able to access mental health support in the past year, with almost a quarter of 400 hospital pharmacists (23%), 15% of 306 community pharmacists and 17% of 207 pharmacists in general practice doing so.  

This support ranged from cognitive behavioural therapy, to counselling, antidepressants, mindfulness and yoga (see Box 3).

These responses tally with recent news from charity Pharmacist Support, which said in July 2024 that the number of calls to its peer support helpline for pharmacists increased by 74% in 2023, compared with 2022. It funded 876 counselling sessions in 2023, while the number of financial grants awarded by the charity also increased by 23%, totalling £193,528.

Demand

The biggest source of stress among survey respondents was demand for services, with 78% of 1,223 respondents overall citing this as contributing to their stress levels (see Figure 2) and 61% of 1,263 respondents saying it was a barrier to doing their jobs properly (see Figure 3). Demand across the health service has steadily grown in the past year. In England, data published by NHS Digital show that there were 16.4 million NHS hospital admissions recorded in 2022/2023, a 2.6% increase from the previous year.

An ageing population has played a large role in the increased service needs. According to the latest Census figures in 2021, the number of people aged 65 years and over had increased from 9.2 million in 2011 to more than 11.0 million in 2021. As the population ages, more people will need to take more medicines​​.

Community pharmacists are feeling the demand most acutely, with one respondent commenting in the survey on the “increased workload due to pharmacy closures” and another citing “increased prescription numbers, possibly due to reduced hours at some pharmacies in the locality”.

Others said demand was greater because of “inappropriate GP referrals”, which leads to “unrealistic patient expectations”.

Nearly 9 in 10 community pharmacists (89% of 304 respondents) said demand for services was a source of stress (see Figure 2), with 71% of 311 respondents citing an increase in demand as a barrier to them doing their job (see Figure 3).

Hospital pharmacists also said they feel swamped, with one respondent saying that their “health and wellbeing is out of the window”.

Another hospital pharmacist commented: “The overwhelming workload leaves me anxious every Sunday about the upcoming challenges on Monday, including the number of patients to see, managing discharges, addressing unexpected queries, covering for staff absences and handling the regular workload — it’s truly daunting!”

Almost 8 in 10 hospital pharmacists (79% of 398 respondents) cited demand for services as a source of stress (see Figure 2), and 67% said it was barrier to them doing their job properly (see Figure 3).

Workforce

The increase in demand is compounded by a lack of appropriately trained staff to cope with it across all sectors.

Overall, a lack of appropriate staff was cited by 73% of 1,223 respondents as a source of stress (see Figure 2). Two-thirds of respondents (64% of 1,263 respondents) also said that a lack of pharmacy staff was a barrier to them doing their job properly, with 35% saying a lack of other staff was a barrier (see Figure 3).

Workforce and appropriate skill mix are huge issues for community pharmacists. More than three-quarters (78%) of 304 respondents working in community pharmacy said a lack of appropriate staff was a source of stress (see Figure 2) and 74% of 311 respondents working in community pharmacy said a lack of pharmacy staff was a barrier to efficient working (see Figure 3).

One community pharmacist commented that they received “persistent hounding by [their] manager to perform services, but not enough support staff to facilitate this”.

There has been a workforce crisis within community pharmacy for some years, with the number of pharmacists and pharmacy technicians both declining. The NHS workforce plan promises to grow the pharmacy workforce but the first expanded cohort will not qualify until 2031. Skill mix is also set to change, as pharmacy technicians are poised to take on more responsibilities within the pharmacy team, including the ability to supply and administer medicines under patient group directions. A workforce strategy for pharmacy technicians is also currently being developed by NHS England to grow the technician workforce as all newly registered pharmacists become prescribers from 2026.

Workforce is also a challenge within hospital pharmacy, with lack of appropriate staff the most common source of stress, cited by 85% of 398 respondents (see Figure 2), while 84% of 405 respondents said a lack of pharmacy staff is a barrier to them doing their job properly (see Figure 3). One respondent noted a “massive increase in workload and reduction in appropriately trained staff”, while another stated that “we have recruited some [band] 6 and 7 but they are very inexperienced in hospital with new training models and coming from other sectors”.

Within primary care, a shortage of appropriately trained staff is less of an issue — although this was cited by 54% of 205 pharmacists in general practice as a source of stress — compared with the lack of understanding from colleagues about their role within this setting.

One pharmacist said that there is a “lack of knowledge from colleagues about what primary care network pharmacist role is… not a prescription monkey who just issues repeat or replacement prescriptions”.

Another said there is a “misunderstanding of role/capabilities”, which means they “often get treated/used like a GP if there are no GP appointments”. Another PCN pharmacist said there are “unrealistic pressures from GPs” and a “lack of professional respect from GPs”.

Medicines shortages

Medicines shortages, which have been hitting the UK headlines since early 2022, are another significant source of stress for pharmacists in all sectors, but particularly so within community, where most prescriptions are dispensed.

Almost three-quarters (72% of 304) of community pharmacists cited medicines shortages as a source of stress (see Figure 2), with a similar proportion (74% of 311) saying that dealing with shortages and sourcing alternatives are barriers to them doing their job properly (see Figure 3).

It is not surprising that medicines shortages were a significant source of stress for the sector, given that a staggering 75% of 311 community pharmacists said shortages had put patients at risk in the past six months (see Figure 4). Over half (54%) of community pharmacist respondents said they were spending between 2 and 5 hours per week trying to sort them out, while 4% were spending more than 15 hours per week (see Figure 5). Three-quarters of community pharmacists (75%) were unable to supply prescription items to, on average, 6 or more patients each week (see Figure 6).

Although fewer pharmacists in general practice cited medicines shortages as a source of stress (see Figure 2), a higher proportion — 80% of 210 respondents — believed they have put patients at risk in the past six months and 59% spent between 2 and 5 hours per week on activities related to medicines shortages. The proportion of hospital pharmacist respondents who said medicines shortages have put patients at risk in the past six months was also high, at 68% of 405 respondents (see Figure 4).

Funding

Underlying the high demand, workforce crisis and medicines supply chain issues is a chronic lack of funding for pharmacy and the NHS more widely.

With an NHS funding gap of billions of pounds, it is not surprising that 46% of 398 hospital pharmacist respondents specified funding as a contributing factor to their stress levels (see Figure 2). One respondent cited a “lack of funding and resources in [the] trust to manage clinical cover and medicines information enquiries”, as well as the increasing pharmacy student numbers and “insufficient funding from NHS England tariff/university”, the “NHS financial position”, “lack of funding” and “NHS resource constraints” as barriers to doing their jobs properly.

The community pharmacy sector is also in dire need of adequate funding. According to the Department of Health and Social Care, as of January 2023, community pharmacies in England have lost out on £1.6bn in funding since 2015/2016, owing to increases in inflation combined with static funding from the government.

The financial shortfall has been met, in part, with a government investment of £645m for the Pharmacy First scheme in England, which launched on 31 January 2024. Nevertheless, years of underfunding have led to a net loss of over 1,000 pharmacies in England since 2015, with closures commonly occurring in more health-deprived areas.

Pharmacies that have managed to keep their doors open are having to stop providing some advanced and locally commissioned services or reduce their hours. An analysis of NHS Business Services Authority (NHSBSA) data, published by The Pharmaceutical Journal in March 2024, found that more than a fifth of community pharmacies in England had cut their opening hours by an average of 10.5 hours during 2023.

Just over a third of community pharmacists — 37% of 304 respondents — cited lack of funding as a source of stress (see Figure 2).

Community pharmacists wrote about “unrealistic targets” imposed on them to help pharmacy owners “ease their financial squeeze” and “lack of investment” by the large multiple owner, meaning “no accredited checker but pressure to provide services so checking does not get done”. Others highlighted the “lack of overall appropriate funding to cover basic costs”, adding that “businesses operating at a loss cannot be successful”.

Abuse, bullying and isolation

Other sources of stress that came out of the survey strongly for community pharmacists included physical or verbal abuse by patients (55%) and professional isolation (39%) (see Figure 2).

Hospital pharmacists painted a distressing picture of the workplace, with respondents detailing “terrible senior leadership”, “workplace politics”, “microaggressions”, “bullying, harassment and racism by pharmacy senior leadership” and “lack of support from so-called management”.

For pharmacists in general practice, 40% of 205 pharmacists said that professional isolation contributed to their stress levels, partly because of “unpleasant working relationships with partners” and a “lack of teamwork from the multidisciplinary team”.

New government, new hope?

What the new Labour government’s ten-year plan for the NHS will mean for pharmacy is still unclear. The party’s general election manifesto included plans to set up a “community pharmacy prescribing service” and a broad aim to “shift resources to primary care and community services”. But clear expectations for pharmacy have yet to be articulated. 

However, pharmacy’s expectations of the new government are high, with leading pharmacy organisations writing to the new health secretary Wes Streeting on the day he was appointed calling for reform and investment in pharmacy, and Community Pharmacy England seeking “early meetings” with the government to discuss the new contract.

The Guild of Healthcare Pharmacists is calling on Streeting to “recognise the vital role pharmacy teams play in secondary care” and “put pharmacy at the forefront of its health agenda”.