Reports that pharmacy employers are setting commercial targets for employee pharmacists to conduct clinical services are not news to the pharmacy profession. Since the early days of medicines use reviews (MURs), which were introduced more than ten years ago, there have been reports from employee pharmacists, mainly from large chain pharmacies, that they are expected to complete the upper limit of 400 MURs each year, or that they have been set weekly or monthly targets. These targets are seemingly put in place to ensure that the pharmacy receives the maximum revenue available from the NHS. Moreover, there are frequent claims that inadequate resources, including qualified support staff, are provided in order to carry out these services.
Pharmacy managers (some of whom are not pharmacists), perhaps because of a lack of understanding about such services, put pressure on pharmacists, not taking into account whether the pharmacist had the time to conduct MURs while keeping the pharmacy running safely or whether the service was clinically appropriate for patients. Bullying tactics, intimidation and threats of disciplinary action or no pay rise have been cited by pharmacists claiming to be under pressure to deliver services (
The Pharmaceutical Journal 2013;291:137).
Locum pharmacists are not immune. Many pharmacy chains now expect locums to be accredited to conduct clinical services and may set targets for their shifts. If these targets are not reached, the locum pharmacists may find themselves receiving a lower rate of pay or not being booked for future shifts.
The issue has now been highlighted by national newspaper The Guardian
, which published a damning report — focusing on Boots, the largest pharmacy chain in the UK — on the toxic culture it claims has been created around conducting clinical services for profit and the pressure placed on employee pharmacists to meet service targets. But Boots is not the only pharmacy accused of doing this – the problem is far more widespread.
A community pharmacy safety survey conducted by the Pharmacists’ Defence Association (PDA), a not for profit organisation that supports individual pharmacists, was completed by nearly 2,000 employee and locum pharmacists who work for multiple chain pharmacies. Almost 55% of survey respondents said commercial incentives or targets had compromised the health, safety and well-being of patients and the public, or the professional judgement of staff at least half of the time. More than 63% of respondents reported that there were not enough suitably qualified and skilled staff to provide safe and effective pharmacy services for at least half the time. Moreover, just 20% said their employer arranged to provide staff cover most of the time or all the time when there was a planned or unplanned absence of staff from the pharmacy.
Some of the comments made by survey respondents make for worrying reading, and include: “We were told not to tell the General Pharmaceutical Council inspector that we did not have enough staff”; “The work situation has lead me to have regular sickness absence from work due to anxiety and depression”; and “If you highlight concerns you will be alienated and branded a nuisance”.
Mark Pitt, assistant general secretary of the PDA Union, a trade union for pharmacists, describes the survey results as a “damning indictment on corporate business behaviour towards pharmacists”.
Data from UK charity Pharmacist Support paint a similarly bleak picture of workplace stress and conditions within community pharmacy. The percentage of enquiries to the charity regarding employment issues increased from 26% in 2011 (107 calls) to 31% in 2015 (256 calls). In the first quarter of 2016, terms and conditions, disciplinary issues and workplace bullying made up 72% of all employment enquiries at the charity, compared with 49% in 2015 and 36% in 2014. A Pharmacist Support survey conducted in 2012 sought to understand stress levels among pharmacists. More than 800 people responded, 60% of whom were community pharmacists. Almost 50% reported that they felt stressed often and, of these, 84% said their stress was mainly or completely related to work.
It is normal practice for managers to set commercial targets for employees so that staff performance can be measured and to ensure that business objectives are met. And financial incentives to drive good practice have their place. But clinicians, including pharmacists, must be confident that their professional activities are always in the best interests of patients. If they are pressured into conducting services or offering products that are inappropriate or unnecessary for patients, or are placed in a pharmacy where there’s inadequate staffing levels or unqualified staff, patients’ needs will not be met or, worse still, they could be harmed.
It is also in the interests of employers to ensure that the professional autonomy of pharmacists is protected. Managers need to trust employee pharmacists to select and conduct appropriate clinical services for patients since this is the only way that such services are effective and can be sustained.
The General Pharmaceutical Council (GPhC), the pharmacy regulator, is now investigating the allegations of unnecessary clinical services and poor staff conditions, but it should not have taken an article in The Guardian to prompt it to do so. The problem has been around for years and, since it is the regulator’s job to protect patients, the GPhC should have taken action earlier. When commercial interests get in the way of pharmacists’ professional judgement, patient safety is compromised, and it is up to the GPhC to ensure that this does not continue.