The deluge of demand for healthcare items following the outbreak of COVID-19 has loaded unprecedented pressure on community pharmacies. The impact of this was inevitable – increased waiting times, enforced social distancing, and reduced opening hours.

However, the consequential spike in reports of “disgusting” abuse from patients was unexpected. Pharmacy professionals say this includes patients spitting, coughing and screaming at them.

One told C+D they had to call the police after a patient, infuriated by social distancing measures, threatened to “rip the shop apart”. Another says their pharmacist was “in tears”, while one says the COVID-19 outbreak had made abuse upon pharmacy staff “routine”.

But why do these incidents happen? A C+D survey reveals the reasons behind patient anger during the pandemic. The survey, which ran from April 1 to May 10 and covered pharmacy teams in all four UK nations, received responses from 1,018 respondents on how their business has been affected by COVID-19.

Waiting times

Longer waiting times were the primary cause of patients becoming abusive. One third (33%) of the 545 survey respondents, who say they had received abuse, say it was primarily down to patients having to wait longer to be seen by a member of staff in the pharmacy. A further quarter (26%) say the main reason for patient abuse was having to wait longer to receive their prescriptions.

Social distancing measures have lengthened waiting times as they often lead to queues. Almost one in 10 (8%) of respondents say attempts to distance people in the pharmacy were the chief driver of patient abuse.

Pharmacy professionals say:

“Our abuse has been related to increased waiting times to be served, the fact that only three people are allowed in the pharmacy to comply with social distancing results in a queue system outside the pharmacy. Repeat prescriptions are taking longer to come from the surgery – we get abuse for this as they’re not ready when patients want.”

“Patients seem to forget that everything has a supply chain. Just as they wait at supermarkets, they have to be patient at pharmacies too. They are happy to wait and buy bread and milk but seem to think their prescriptions should be at hand even when they are not urgent.”

“Most people come over as very reasonable until you tell them their prescription will take longer than usual, or they can’t get something, or we can’t deliver immediately. Then they can get quite abusive.”

“[Patients are] demanding same-day service for routine prescriptions. [They have] unrealistic expectations of a service under pressure.”

“Social distancing has led to verbal abuse – the company has employed a guard to assist us.”

“Patients are increasingly demanding. They get angry if they have to wait longer.”

“Patients are not happy with social distancing measures implemented by [the] pharmacy, in turn swearing at pharmacy staff and banging on our doors and windows because they're not happy.”

“The issue is that [patients] had such an excellent service in the past. This waiting longer and reduction in opening hours is alien to them.”

Medicine shortages

Waiting times at pharmacies are often made longer due to medicine shortages because pharmacists have to spend more time sourcing stock or calling the patient's GP to find an appropriate alternative. According to the survey, 77% of respondents say they had been affected by medicine shortages as a result of COVID-19.

This was the most-common impact of the pandemic felt by respondents. The other most pressing problems were a lack of personal protective equipment (55%), a need for COVID-19 tests for staff (50%), and reduced money from clinical services (48%).

A lack of certain products in pharmacies was also listed by respondents as a trigger for patient abuse.

Pharmacy professionals say:

“Initially, patients couldn't understand our lack of hand sanitiser, face masks and especially painkillers.”

“Patients are not happy that we restricted items, such as paracetamol and baby milk, to give everyone a fair chance! Some have been very verbal and just downright nasty.”

“The mad panic was almost unbearable from a pressure point of view. The medicine shortages and prices [issues] have compounded the issue massively.”

“Drug companies really need to sort out medicine supply issues, quotas and out-of-stocks as this is adding enormous pressure when we need to be focusing on COVID-19.”

“We are facing abuse due to medicine shortages, there is a total lack of awareness to the public or our plight.”

“Thankfully the abuse has eased but we are still getting complaints about medicine shortages.”

GP prescriptions

Many respondents have reported problems linked to GP surgeries. A common issue is patients becoming incensed after not being able to access a closed practice, before venting their frustration in the only primary care premises open to the pubic: pharmacies.

In addition, some GPs are trying to help patients by prescribing them up to three months’ worth of medicines, instead of the standard 28 days. This contravenes COVID-19 advice from the Royal College of General Practitioners that doctors should not increase the length of prescriptions as “this is likely to undermine the medicines supply chain”.

When there is a mistake with a prescription the blame falls again on the pharmacy team, who must spend time calling the GP surgery to try to fix the problem. Many respondents to C+D’s survey feel abandoned by their healthcare colleagues.

Pharmacy professionals say:

“GP surgeries appear to have increased the volume of prescriptions according to patient wishes, this knock-on effect has brought many more patients who are frustrated that medications are not available immediately.”

“GP surgeries have shut their doors and we are getting the blame for it. Patients are taking all their stress out on us.”

“GPs tell patients to go straight to the pharmacy and it will be ready – it will not.”

“GP surgeries have refused contact [with patients] leaving patients scared and confused as to how to order or manage their medication.”

“GPs have shuttered themselves in and left us to deal with everything.”

 “A lack of communication from surgeries means that patients, and ourselves, are not always clear where prescriptions are. Some scripts have been post-dated but there is no clear pattern and no advice to patients. Some patients have ended up having three months’ worth of medicines while others, maybe in the same household, are struggling to get what they need”

Although abuse of pharmacy staff has risen during the COVID-19 pandemic, it is usually a minority of patients. Many respondents to the survey noted that the rise in aggression was accompanied by an increase in gratitude – with patients gifting items ranging from chocolate to personal protective equipment. But it just takes one offensive patient to ruin the day of a member of a pharmacy team.