Pharmacist attacks Society employee with metal bar at Statutory Committee hearing, ran a headline in The Pharmaceutical Journal for 28 October (p503). Although there may be no connection in this particular case, the report about a pharmacist who reacted thus, when told he would be struck off for misconduct, prompted me to think about the issue of stress in pharmacists, about its causes and about what can be and is being done to address the problem.
As chairman of the Society’s Listening Friends scheme, I am certainly well aware of the problem of stress. The scheme was set up nearly 11 years ago to help pharmacists who were affected by stress. The idea arose because Sue Sharpe, who was then head of what is now known as the Society’s Fitness-to-Practise and Legal Affairs Directorate, told me (I was then a member of the Society’s Council and chairman of its Infringements Committee) that inspectors were increasingly coming across pharmacists who were failing to meet required professional standards through an inability to cope with increasing workload and pressures of the job. She believed that something needed to be done to help them, and that doing so would also contribute to safeguarding the public.
Little researched in pharmacists
Stress in pharmacists is a little researched topic, certainly in the UK. The only piece of specific research appears to be a study published in 1996. This found that the level of occupational stress was about the same as that of GPs and higher than the norm for health workers generally. The main concerns contributing to stress were lack of time for professional development, inflexible working hours, low professional status, constant interruptions, inability to make minor changes to prescriptions, and being the first to be blamed if a prescription was incorrect or incomplete.
A later survey of job satisfaction among health professionals in New Zealand found that community pharmacists had the lowest job satisfaction of all groups surveyed, although women pharmacists were more satisfied with their work than men. Pharmacists more frequently contemplated giving up their jobs due to work stress than all other groups.
They also felt more overwhelmed by paperwork, reported more financial concerns and high levels of frustration at bureaucratic interference. Pharmacists also had the highest proportion of cases of psychological distress.
Recently, a qualitative interview study of 30 women community pharmacists in England  explored the effect on them of increased workload with minimal increases in remuneration in recent years. Factors that emerged that led to increased stress and dissatisfaction with the job include increased dispensing volumes coupled with falling staff levels, resulting in insufficient time for patient contact and worries about compromising patient safety.
In the past 11 years stress factors in pharmacy have certainly increased. From conversations I have had with pharmacists, and cases dealt with by the scheme, it appears the new NHS community pharmacy contract is proving to be a source of increased pressure, as profits on dispensing have been reduced and funding has been redirected to clinical services that many contractors are finding difficult to provide. The contract has also introduced new clinical governance requirements, including monitoring of premises and standards by primary care trusts additional to that already carried out by Society inspectors. Additionally, the contract has increased the amount of record keeping, form filling and dealing with bureaucracy, leaving less time available for pharmacists to fulfil their professional functions.
Employees of multiples complain of being pressured by their companies to take on additional roles without an increase in either staff resources or pay. In hospital and primary care pharmacy, recent NHS financial cutbacks have increased workload, and the reorganisation of PCTs has left pharmacists employed by them uncertain about their futures.
Another source of stress reported is the perceived more hostile attitude in the past few years of the Society to its members in relation to disciplinary and fitness-to-practise matters. Concerns have also been expressed about the large increase in numbers of people studying pharmacy as a result of the expansion of intakes of existing schools and the opening of new ones, and the implications for future employment and pay prospects.
There seem to be no quick and easy solutions to these problems, although it may be believed that the Society has a responsibility to address those issues over which it has influence. While I was a member of the Council it certainly did what it could, although its power in many areas was less than members seemed to imagine. In the past few years, rightly or wrongly, the perception has grown that the Society is taking less interest in representing and looking after the interests of its members, in favour of a greater interest in regulation. Nevertheless, the Society still provides a range of welfare services through its Benevolent Fund, of which the Listening Friends scheme is one.
Since its inception the scheme has helped around 3,000 pharmacists cope with stress-related issues, although not all of these have been directly related to work. One of the recognised ways of coping with stress is to relieve the burden by talking it through with somebody else, and this is the core principle of the scheme’s operation and the basis of its success. Most of the caseload are single calls where the caller wants to get a problem off his or her chest.They then usually feel better able to deal with it themselves and do not feel the need to come back for further support, although it is always available if wanted.
The unique advantage of Listening Friends is that all its volunteers are pharmacists and therefore have an understanding of the problems being expressed to them, and can genuinely empathise with callers. In addition, they all have initial and ongoing training in listening and counselling skills, and many have additional counselling or therapy qualifications. Callers can feel secure when they contact the service because they call in anonymously to an automated line, giving only a first name (or a pseudonym if they prefer), a number and a suitable time to call back on. If they have a preference, callers can request to speak to either a male or female Listening Friend. Calls are picked up daily by a co-ordinator (one of a team of four senior pharmacists in the scheme), who then allocates them to LFs. LFs are trained to listen, and to help callers, if they want, towards finding their own solution to their problem. LFs also have a list of resources for further, more specialist help in specific situations, if they think it would be of use.
The Society may not have it within its power to resolve all the issues that cause stress for its members, and some members may even feel that it contributes to them, but it does provide effective help in coping with stress and it is only a telephone call away — on 020 7572 2442.
1. Willett VJ, Cooper CL. Stress and job satisfaction in community pharmacy: a pilot study. Pharmaceutical Journal 1996;256;94–8.
2. Dowell A, Westcott T, McLeod DK. A survey of job satisfaction, sources of stress and psychological symptoms among New Zealand health professionals. NZ Medical Journal 2001;114:540–3.
3. Gidman WK, Hassell K, Day J, Payne K. The impact of work intensification and role expansion on female community pharmacists.International Journal of Pharmacy Practice 2006;14(Suppl2):B21.