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‘There’s no escape from it’: How stress is pushing contractors to the limit

Results from the C+D Salary Survey 2022 reveal the devastating effect years of funding cuts, rising costs and increasing workload are having on community pharmacy contractors’ wellbeing

With more demands on our time than ever before, it sometimes feels as though the whole world is stressed.

The rise in mobile technology means that the ability to check our emails is only ever a few taps away, making it increasingly difficult to delineate between work and home life. And most people are feeling the pinch as energy prices and inflation continue to bite.

None of this is news to community pharmacy contractors. With a litany of stressors to contend with, many respondents to the C+D Salary Survey 2022 reported feeling battered and bruised by the challenges they faced last year.

Their responses paint a worrying picture of a profession headed for burnout, citing problems such as financial worries, untenable workloads and the looming threat of pharmacy closures.

 

Stress “a daily occupancy”

 

According to the survey, which ran between October 25 and January 20, stress is a chronic problem for contractors. More than half (54%) of 30 respondents report “very high” stress levels, while 20% say their stress levels are “high” and 23% say they are “somewhat high”.

One respondent says that stress is now a “daily” occurrence for them, particularly at month-end when their wholesaler bills are due.

Another reports that the pressures have become so severe that they have “become rather numb to [the] effects of high stress” – to the point where they are “past caring, if you will, to keep my own sanity”.

“That effectively means I've gone past ‘very high stress’. It's [a] sad time for community pharmacy and its future,” they say.

Read more: Quarter of pharmacy workers suffered depression due to work over past year

It’s unsurprising that so many contractors are feeling the strain. After years of flat funding, pharmacy bodies have warned that many will be unable to stay in business unless the government injects more money into the sector.

Pharmacists’ Defence Association (PDA) director Paul Day tells C+D that while owning a business can have its upsides “in good times”, things can be more challenging during “some periods of an economic cycle”.

“The general cost-of-living crisis plus poor government funding in England in particular at this time have created challenges for pharmacy business owners and made it harder to succeed,” he explains.

Read more: ‘Concerning but unsurprising’: 10% say their pharmacy never has safe staffing levels

Although funding woes are nothing new, some contractors believe the cumulative pressures they are currently facing have made their jobs more difficult than ever before.

“I have never seen this amount of stress in my 26 years as a community pharmacist,” Dimple Bhatia, superintendent pharmacist at Tollesbury Pharmacy in Maldon, Essex, tells C+D.

Workforce issues, stock shortages and “regulatory red tape” are only heaping more stress onto contractors' plates, he says. “And all this while trying to meet patient demands in a system that is broken.”

 

Inability to switch off

 

Despite the rise in pressures, contractors have no choice but to present a friendly, professional outward image to their patients, which often only adds to their stress levels.

One contractor who responded to the Salary Survey complains that stress levels in community pharmacy are “unbelievable” at the moment.

They say: “We are expected to see our patients face to face and remain professional, understanding, calm and giving of time we simply don’t have with increased workloads, overtime and more and more services being redirected to pharmacies.”

Rachael Patel owns Sabel Pharmacy, which has three branches in London, with her husband, Sam.

She “definitely” believes that stress in community pharmacy has only grown in recent months.

Read more: Six in 10 independent pharmacies cut staff to ‘limit costs’ in 2022

“I know for a fact that my husband’s a lot more stressed at the moment than he has been over the years,” she explains.

Although she and her husband are “both quite resilient”, with issues including money, clinical services and staff to worry about, there have been times where it’s all felt too much, she tells C+D.

“You just have to keep thinking, well, it hopefully will get better,” she says.

With so much to worry about, stress can easily tip over into contractors’ personal lives as well – a problem made even easier by technology.

“Even on weekends and evenings when the pharmacy is shut, the online world doesn’t allow you to escape, with e-mails [and] instant messages still coming through with queries and sometimes complaints,” says Mr Bhatia. “There is no escape from it.”

 

Unrealistic workloads

 

And data from the Salary Survey suggests that the load is only increasing for contractors.

Among 29 respondents, (90%) say their workload has increased over the past year.

And four in ten (41%) of 29 respondents say their workload is “often unrealistic”, with a further 24% saying it is “always unrealistic”.

Ms Patel tells C+D that she finds “the most stressful thing” is sourcing medications, with the added worry that the Drug Tarriff price may not match what the pharmacy is paying for certain items.

“And you’ve got your rent and you've got your heating and you've got your staff bills [to pay],” she adds.

Read more: Dispensing at a loss is absurd – enough is enough

Financial worries are a common theme raised by contractor respondents to the Salary Survey 2022. One respondent says that last year marked the first time in their 40 years of pharmacy ownership that they were forced to arrange tens of thousands of pounds in overdraft arrangements “to keep my business afloat”.

“Every month I am having to find more money. [I] don’t know how long I can continue,” they add.

Other respondents tell of having to use money from their personal savings to “top up” their pharmacy due to chronic underfunding. 

Ms Patel says that an overhaul of the drugs reimbursement system would go a long way to alleviating stress.

“Just an increase in fees or just to get paid for what we’re getting charged for the medication would be a first step,” she says.

 

Threat of closure

 

With even large pharmacy chains weighing up closing a number of of their branches, many independent owners are understandably worried for the future of their businesses.

Over a third (36%) of 28 contractor respondents to Salary Survey say one of more of their pharmacies is at risk of closing in the next year, with one respondent explaining that "closure is imminent in the next six months...if funding does not improve". 

This worrying trend is reflected in recent data released by the Company Chemists' Association, which reveals that more than 700 pharmacies have permanently closed in England since 2017.

Read more: CCA: At least 720 English pharmacies permanently closed since 2015

But even if the majority of pharmacy businesses can continue to weather the storm and remain open, the UK's pharmacy network faces a different threat as contractors consider whether they want to remain in pharmacy at all.

Of 26 respondents to the Salary Survey, 69% would not recommend a career in pharmacy. One respondent says that there is "no future for contractors", while another comments that they have dissuaded their children from taking up the profession. 

And of 27 respondents, 41% say they they are "disillusioned with pharmacy", with a desire to sell their business and move away from pharmacy.

For the PDA's Mr Day, a way forward would be for the pharmacy sector to pull together.

“Everyone's wellbeing is important, including owners, managers, employees and locums,” he says. “It is better if everyone can be open, communicate and work together to tackle the causes of difficulties faced by the sector, just as in better times the upside of the situation should be shared, too.”

Read more: Petition to 'save our pharmacies' tops 1.8k signatures in one day 

And it seems as though the sector is coming together to drive change, with leaders currently spearheading a campaign to lobby the government for sustainable pharmacy funding in England.

It remains uncertain as to whether the government will bow to increasing political and public pressure to improve the situation, but it is becoming increasingly clear that without immediate and radical change the UK's pharmacy network faces total collapse as community pharmacy contractors head for burnout.

The C+D Salary Survey 2022 ran between October 25 2022 and January 20 2023 and was completed by a total of 1,480 pharmacists and pharmacy staff.

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