Workforce pressures and medication risk: time to act?

Workforce pressures are nothing new for most pharmacists and pharmacy teams. As such a familiar feature of NHS life, they almost blur into the background and we have become accustomed to talk about “winter pressures” across all seasons. Staff are expected to absorb vacancy gaps with goodwill, flexibility and neverending stamina. However, from a medication safety perspective, these pressures can translate into patient risk. 

One of the greatest contributors is cognitive load. The ‘NHS Patient Safety Strategy’, published in 2019, highlights that high workload and frequent interruptions are contributors to medication errors^​1​. Pharmacy staff are often expected to clinically screen, respond to queries, cover dispensary slots, train new staff, and troubleshoot prescribing or administration-related issues — all concurrently. It is no surprise that decision-making becomes more vulnerable to ‘slips’under these conditions^​2​. 

Ensuring medication safety relies on cognitive work, and cognitive work needs space. Yet NHS staff, including pharmacists and pharmacy teams, rarely get uninterrupted time. When service pressures intensify, thinking time is often the first thing lost and multitasking becomes the norm. Without thinking time, even the most skilled clinician will struggle to process complex regimens and calculations, identify drug–patient interactions or navigate chaotic digital workflows.

Multidisciplinary team under strain

It is often not acknowledged that the pharmacy workforce does not operate in isolation when it comes to maintaining medication safety. Medication pathways are only as safe as the multidisciplinary team (MDT) surrounding them. When nursing and medical colleagues are under similar strain — and we know that they increasingly are — the risk is amplified across the entire system^​3,4​. 

A 2010 study by Westbrook et al. found that each interruption during medication administration tasks increased the error rate by up to 12.1%, with interruptions occurring as frequently as every two minutes^​5​ — confirming what practice has long shown. 

Nurses are often responsible for medicines rounds spanning complex patients, with multiple tasks to complete, and temporary staff working alongside them. Studies show that high nursing workload is associated with increased omissions and administration inaccuracies^​6​. 

Similarly, workforce pressures play their part. Junior doctors working beyond contracted hours or covering multiple wards have higher rates of prescribing errors — a trend reflected in the EQUIP study, which found up to 8.9% of prescriptions contained an error, often linked to fatigue or unfamiliarity^​7​. Many prescribers rotate frequently, joining new organisations with little time to familiarise themselves with local medicines policies or electronic prescribing systems. When the medical team is stretched, timely medication reviews, discharge prescribing and complex decision-making (such as those required for high-risk medicines) become more error prone.

These pressures accumulate across the MDT and inevitably impact on pharmacy teams. We observe increases in unclear or incomplete prescriptions, gaps in medication histories, dose omissions and more prescribers seeking rapid advice because they are dealing with back-to-back clinical demands. This often leads to medication errors. 

Training is another casualty of an overstretched workforce. Pharmacy relies on robust induction, supervision and competency building. More time for education and training is often one of the most cited actions and recommendations from medication incident reviews. This is not just in pharmacy. Nursing preceptorship programmes are often routinely compressed; junior doctors commonly receive minimal medicines specific inductions owing to multiple other competing mandatory training modules. The result is the fragmentation of collective confidence with medicines across the MDT and, as this increases over time, potentially leads to inconsistent safety practices from staff who are trying their best. 

Perhaps the most worrying aspect is that these pressures have become normalised. When every day feels stretched, stretched begins to feel normal. When staff routinely stay late to “finish safely” or “get the work done”, the late finish becomes routine. When interruptions are constant, uninterrupted time feels indulgent. The risk does not go away just because we have adapted to it. 

What action can be taken?

The government plans to publish a ten-year NHS workforce plan in 2026^​8​. With the ten-year health plan^​9​ calling for strategic shifts in how we operate and treat patients, the workforce plan will hopefully guide us towards having the right people, in the right roles, with the right skills. While solving workforce shortages requires some careful planning and national solutions, we can reduce medication risk through practical, system-level changes. Some examples to consider and actions to adopt include:  

1. Protecting cognitive time: Think about introducing protected time for critical tasks that require concentration, or finding ways of completing tasks with a single focus to help minimise frequent interruptions to workflows. Often as policymakers, we have a perception of how people work within the system — known as ‘work as imagined’ — and yet, ‘work as done’ (how things are done in the ‘real’ world), often looks very different to this.
2. Treating training as nonnegotiable: Structured induction, supervised practice and electronic prescribing and medicines administration (ePMA) training should not depend on whether the department is busy. In fact, high-pressure environments make these functions even more essential. 
3. Improving MDT communication flow: Clear escalation routes, single points of contact, and joint clinical huddles and ward round attendance reduces opportunities for miscommunication and prevents medication tasks from being squeezed into rushed margins of the day.
4. Acknowledging workforce pressure as an explicit medication risk: Some trusts embed staffing indicators into their risk registers. This transparency is vital — medication safety cannot be divorced from workforce reality. 

Medication safety will always rely on skilled professionals, but professionals cannot compensate indefinitely for depleted staffing, rising demand and compressed training. Workforce pressures do not just influence medication risk — they drive it. Until organisations recognise this connection at every level of policy and practice, we will continue to see the same patterns, the same incidents and the same avoidable harm occurring. However, in the meantime, while we wait for the ten-year NHS workforce plan to be published, it is essential that you ask: What can you do within your organisations to challenge this status quo? 

This article is brought to you as part of a collaboration with the UK Clinical Pharmacy Association (UKCPA). 

The views expressed in this article are those of the author and are not attributed to any organisation. 

The UKCPA is a member association for clinical pharmacy practitioners that encourages, supports and promotes advanced practice in pharmacy. 

To discover expert-led training, resources for clinical pharmacy practice and access ongoing support from our community of practicing clinical experts visit the UKCPA website or contact via email.