Victoria Steele: ‘There are simply not enough pharmacists working in community pharmacy’

LloydsPharmacy may be finally turning a corner.

Following four consecutive years of increasing annual financial losses and hundreds of high-profile store closures, according to accounts published in April 2022, the multiple recorded an annual financial loss of £100m.

This may still be a loss, but it is one that is 42% lower than that of the year before. The company directors gave special mention to the surge in growth of its digital offering, with LloydsDirect riding the online pharmacy wave that picked up momentum during the early stages of the pandemic.

But this step in the right direction comes with a healthy pinch of uncertainty, following the sale of LloydsPharmacy, from McKesson to asset management group Aurelius, and the chronic workforce shortages that appear to be plaguing the sector.

Sitting in the middle of all this is Victoria Steele, the multiple’s first female superintendent pharmacist. Steele was appointed in September 2020 from her previous job as deputy superintendent and head of clinical governance and professional standards at the company. She is also chair of the Community Pharmacy Patient Safety Group and a leading light in helping to reduce medication errors across the sector.

The Pharmaceutical Journal met with Steele to discuss her expectations and concerns for the future of community pharmacy, at this time of rapid change.

Over the next year, how would you like to see community pharmacy develop?

I would like to see a profession that’s truly recognised through a well-funded contract. I’d like to see the efficiencies that we’ve been promised come to fruition, so that then we can drive services forward and really get behind the hypertension services, etc. And I’d like — this is probably not achievable in a year — to see what can be done to start to allay significant workforce pressures.

How is LloydsPharmacy supporting its pharmacists to gain and then use their independent prescribing qualifications?

Our clinical career pathway is a programme called Evolve. We currently have 65 pharmacists on a clinical diploma, which will bolt on to an independent prescribing qualification at the end of that. It’s clearly very different across the countries; in Wales and Scotland, it is very easy to see your path and what services you will then provide with your qualification. England still has a little way to go in that. And that will then help for us to be able to find our way.

What about private prescribing services?

We’ve got several private services and we’re always looking in that arena. Our medicated weight service, which we’ve had in place for about 12 months now, has helped patients lose more than 20 tonnes of weight, which is an enormous number. So, from what was quite a small service that we rolled out, it’s made a significant impact to patients. And there are other services that we’re currently working on, that just aren’t ready to be released yet.

[The LloydsPharmacy press office later clarified that 19.2 tonnes of weight had been lost through the medicated weight service in the 19 months between July 2020 and February 2022.]

Given your interest in patient safety, how is LloydsPharmacy eliminating look-alike-sound-alike errors?

I challenged the business to eliminate the amlodipine/amitriptyline look-alike-sound-alike (LASA) error, in 2020, and we reduced it by 77% and all of our LASA errors by 35%. And we reduced any amlodipine or amitriptyline errors by 50%. So that remains on the error reduction program.

But, by looking at the data, I’ve looked at where I can make the biggest difference. So, we’ve added handout errors to the error reduction programme because clearly if you get the wrong thing, or don’t get your medication, there is a significant issue there. That’s where we’re focusing our attention next.

What is the number one risk that the Community Pharmacy Patient Safety Group is looking into?

I don’t know whether that’s necessarily where our priorities sit. We want to embed significant patient safety cultures throughout the whole of community pharmacy and help to raise awareness of that.

But one of the things that we’re really passionate about is supporting schools of pharmacy and their curriculums. Our reasons for doing this are two-fold.

We want to make sure that we can support the patient safety agenda in pharmacy schools with some real-life experiences of what’s happening and how broad risk is. So, we’ve all twinned with one or two schools of pharmacy, making sure that we’re their points of contact to support any appropriate lectures.

Equally, I am concerned that community pharmacy is not being seen currently as an attractive place for our graduates and that fills me with real dismay, because it’s a career that I’ve absolutely adored. To be able to make significant differences and interventions in patients’ health is an extraordinary privilege. It makes me sad that maybe our students aren’t thinking about community pharmacy, and what they can do and be as part of a critical part of the fabric of society.

What specifically needs to change to improve that image?

We’ve all got a part to play in that. I don’t like the expression ‘a clinical pharmacist’. All of our pharmacists are clinical; it doesn’t matter where their setting is. The thought that you are more clinical, if you are in a different setting, is a misnomer.

Clearly, community pharmacists, alongside other healthcare professionals, have worked their socks off for the past two years in extraordinary circumstances. And it has meant that people have made different decisions; they’ve gone onto other paths, whether that is to health boards or primary care networks. It’s publicly available that 3,500 community pharmacists have gone in the past 18 months.

Add to that the opportunities to become vaccinators over the past two years and a workforce that is choosing to retire a bit earlier because the past two years have been really hard. And then there’s significant market value now to being a locum, so there’s no need to travel as far as you used to because you’re going to get fantastic rates close to home, which then means you don’t need to maybe work as many days as you used to.

This is all now clawing away at the workforce and is predominantly coming out of community pharmacy. It is particularly challenging at the moment.

How can the profession retain those people that you’re talking about?

When people are starting to look elsewhere, to really understand what role they are going to. I believe our pharmacists are passionate and patient-focused, and get great satisfaction from helping numerous individuals on a daily basis and probably never know, sadly, how significant some of their interventions are. To go to a role where they aren’t patient facing is a big change, which really does need thinking through.

We have to create efficiencies for our pharmacists to enable them to be able to provide services, to then be able to recognise some of the significant interventions they make. So, the hypertension service — we’ve got some extraordinary case studies around the interventions that our teams have made. We’ve got a couple that only happened in the past few weeks around patients coming in with either significantly low blood pressure or significantly high blood pressure and immediate trips to A&E, which then followed with this particular patient, with low blood pressure, having a pacemaker fitted that night.

Now, these are extraordinary things that our pharmacists are doing. In another example — significantly high blood pressure in somebody with a known cardiovascular issue that was struggling to get support from GPs, they managed to have their blood pressure checked with us, an ambulatory monitor and a significant change to the medication resulted off the back of that. These examples are coming in weekly now. For our pharmacists to be able to see that and hear the feedback is exactly why we came into this profession.

In November 2021, some branches were having to reduce their hours because of workforce shortages. Was that a permanent or temporary measure?

It was in line with the temporary provision [to allow flexible opening hours for community pharmacies, which ended in March 2022]. However, there’s still a very big concern around workforce that hasn’t been resolved. It’s a worry because COVID-19 hasn’t gone away. We still have sickness levels that are not what they once were, and they are nearly wholly COVID-related.

Is there a shortage of pharmacists or is it a workforce challenge?

That’s a really good way of wording it actually. We know how many are graduating, but how many people are on the register is a very different equation. How many are working? How many are working full time? There simply are not enough pharmacists working in community pharmacy.

Some people say: ‘But there’s this many people on the register’. Yes, there is. We can’t deny that. Are they working here in community pharmacy? No, they’re not. And if we keep sucking them out into other parts of pharmacy, then we end up as we currently are. We need to see some light at the end of the tunnel for our pharmacists, but predominantly for our patients and communities.