Work-related stress: the hidden pandemic in pharmacy

Pharmacists have had to cope with an extraordinary couple of years — and the cracks are beginning to show.

Results from The Pharmaceutical Journal’s annual salary and job satisfaction survey show a significant rise in the proportion of pharmacists reporting severe stress in 2021, and it is clear that this is having a damaging effect on morale.

In this infographic, we look at the depth of the problem and what has contributed to this trend. We also ask those in power what they are going to do about it (see Box 1).

A quarter of pharmacists (25%) report being “very stressed at work”, a significant increase on previous years

There has been an approximate doubling of pharmacists reporting feeling very stressed compared with previous years (see Figure 1). There are significant proportions of pharmacists with severe stress in most sectors, with community pharmacists appearing to be the most affected.

This matches trends observed in other parts of the health service. A study of almost 3,000 NHS workers published in The British Journal of Psychiatry in April 2021 revealed that severe stress jumped from 11% to 46% during the first wave of the pandemic. Then, in September 2021, the British Medical Association’s (BMA’s) survey on the impact of COVID-19 on doctors was published, which suggested that 67% of GPs and 52% of hospital doctors are suffering from depression, anxiety, stress, burnout or emotional distress relating to, or exacerbated by, their work.

Despite the higher stress levels within pharmacy, the proportion of pharmacists taking time off work because of stress has remained at a constant low of around 4% over the past four years.

So many times, I felt I needed to take time off during too much stress and exhaustion, but the workload is too much

Community pharmacist

I try to help all the time but there’s only one me. Feels like I’m a pharmacist, dispenser, customer adviser and floor staff in a day — just burnt out

Community pharmacist

Staff shortages and demand for services during the pandemic have made workload unsustainable for some

Demand for services and staff absence are cited most often as sources of stress (see Figure 2).

Workforce issues are a recurring theme, with 78% of pharmacists saying that a “lack of staff” is creating a barrier to them doing their job effectively (n=991). There have been reports of shortages of pharmacists across all sectors and pharmacists were added to the Home Office’s shortage occupation list in March 2021.

Many pharmacists who responded to our survey say that supporting the rollout of the COVID-19 vaccine programme and changing the way they work, because of the pandemic, has put additional pressure on them.

Additional work created by the vaccine programme, which we had to accommodate over and above our day-to-day jobs, has caused stress. This was easier during the lockdown as a lot of other hospital activity, meetings etc. were stood down, but much more challenging now

Hospital pharmacist

Learning to work remotely and consulting patients remotely, especially if they have a language barrier

Primary care network pharmacist

The daily unpredictable workload, increased demand, shortage of staff, not enough GP appointments, lack of support and so many other reasons have left me doing many tasks at one time, while under pressure and stress and in a rush

Community pharmacist

Almost a quarter of pharmacists (22%) say they “always work outside of their contracted hours”

Taking time away from work is a recognised way of reducing stress levels, but our survey shows that working hours have increased over the past year for almost half (46%) of pharmacists (n=1,035).

Almost half of hospital pharmacists (46%) always or very often work outside of their contracted hours, followed by 36% of community pharmacists, 35% of GP pharmacists and 19% of primary care network (PCN) pharmacists (see Figure 3).

One in six (14%) pharmacists never take their contracted breaks, with a further 28% only taking them infrequently (up to a quarter of the time) (n=1,032). Community pharmacists are least likely to always take their breaks (see Figure 4).

Despite working outside of their contracted hours, 77% of pharmacists are not always paid for working overtime (n=1,035).

There is an inability to take breaks, even to eat or hydrate, due to workload and meetings

Hospital pharmacist

When at home there are constant out-of-hours phone calls and emails from work, so you can never have time to yourself to even relax and recover physically

Community pharmacist

Physical and verbal abuse has been a problem over the past year, with 42% of pharmacists saying it has increased

Community pharmacists appear to be bearing the brunt of the abuse, with almost three-quarters (74%) saying abuse has increased over the past year (see Figure 5). Reports of increased abuse in community pharmacy have grown by 17 percentage points since our 2020 survey. Only 7% of community pharmacist respondents said they have not experienced abuse within the past year.

These reports of a rise in abusive behaviour towards pharmacists are supported by data from pharmacy employers and organisations. In April 2020, the Pharmacists’ Defence Association published survey results showing that more than 90% of 1,200 respondents had witnessed abusive or aggressive incidents in their pharmacies during the preceding month, and 80% of respondents thought abusive or aggressive incidents had increased compared with normal levels.

In early 2021, as a result of increased violence in its pharmacies, Boots began providing body cameras to its employees — including pharmacy staff — working in 60 stores.

GPs also feel they are under attack. A BMA survey of more than 2,400 doctors carried out in July 2021 found that 46% of GPs had experienced one to five incidents of verbal abuse, with roughly one in five (19%) receiving threats, in the previous month. Two-thirds (67%) of GPs had witnessed violence or abuse directed at other staff in their workplace in the past year, while 37% said these abusive instances had increased significantly on the same period 12 months ago.

Patients frustrated with their doctor’s practice take their anger out on us and our teams

Community pharmacist

Rudeness, verbal abuse and even threats of physical abuse

Community pharmacist

Rude, uncaring customers. No concept of infection avoidance. Pandemic denial

Community pharmacist

Mental health support is available, but some pharmacists struggle to access it

Most pharmacists (71%) say that mental health support is available from their employer (n=1,018), but this varies by sector. Hospitals are most likely to offer mental health support to pharmacists (85%), whereas only 54% of community pharmacists say support is available.

Indeed, one in five hospital pharmacists have accessed mental health support (not necessarily from their employer) during the past year, compared with around one in six of community pharmacists, and around one in ten GP practice and PCN pharmacists (see Figure 6).

The NHS has introduced additional mental health and wellbeing support for NHS staff during the pandemic, including helplines and access to counselling (see Box 2).

However, one in six hospital pharmacists have wanted to access mental health support but not been able to, with lack of time a common reason (see Figure 7).

There is stigma associated with accessing mental health services and I feel guilty that it is exaggerating

Hospital pharmacist

I keep planning to access help, but I just don’t have time

Hospital pharmacist

When at work there is literally not a second free to even think about my own mental or physical wellbeing

Community pharmacist

Rising stress is having a corrosive effect on the morale of pharmacists

The most disturbing finding of the survey has to be the long-term effect of high stress levels on the morale of the profession. Overall, morale is low or very low for 45% of respondents (n=1,019), with a higher proportion of pharmacists in all sectors experiencing low morale compared with 2020. Community pharmacists have seen the biggest increase, from 35% in 2020 to 59% in 2021, followed by hospital pharmacists (from 32% to 47%), GP practice pharmacists and PCN pharmacists (up from a combined figure of 20% to 28% and 24%, respectively) (see Figure 8).

This low morale translates to many pharmacists feeling that the profession is no longer the career for them. Some two-thirds of community pharmacists have considered leaving the profession within the past 12 months (see Figure 9).

Poor management and poor communication of constant changes and poor communication of plans, lack of support from managers, low staffing levels in general, other staff being stressed leading to strain and poor morale

Hospital pharmacist

Morale is at its absolute lowest. We are constantly having to deal with inappropriate referrals from other healthcare staff

Community pharmacist