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Could a mental health service help pharmacists under stress?

C+D revealed stress levels among community pharmacists rose six percentage points in two years
C+D revealed stress levels among community pharmacists rose six percentage points in two years

The RPS has used C+D’s Salary Survey data as evidence that NHS England should fund a community pharmacy stress service. So what difference could this make to the sector?

Last month, C+D revealed that stress levels among UK community pharmacists rose six percentage points between 2016 and 2018. The Royal Pharmaceutical Society (RPS) presented the figures – compiled from the past five years of C+D Salary Survey data – to NHS England’s chief pharmaceutical officer Keith Ridge, to convince him that stress is a growing problem in the sector.

The RPS English pharmacy board chair Sandra Gidley, who handed the data to Dr Ridge in person, has told C+D that the society will use the figures to lobby the commissioning body to fund a similar programme to the GP Health Service.

This service was set up by NHS England in 2017 to “help doctors with issues relating to a mental health concern, including stress or depression”. Ms Gidley says the RPS “believes this should be extended to pharmacists and other health professionals as well”.

What is the GP Health Service?

The NHS service is designed for GPs and GP trainees in England who feel they need confidential help or treatment for mental health issues and addiction problems, “in particular where these might affect [their] work”.

The service was originally commissioned by the Department of Health as a pilot in 2007, for doctors living within the M25 area to self-refer themselves to. In 2017, the service was expanded nationally, and in October 2018 NHS England chief executive Simon Stevens announced a Practitioner Health Programme would be funded to cater for all 110,000 NHS doctors, as well as dentists, in England.

Announcing the full nationwide rollout, Mr Stevens said the service would benefit “patients and not just their doctors”. Dr Clare Gerada, medical director of the NHS Practitioner Health Programme and former chair of the Royal College of General Practitioners, said it would help to tackle “the last taboo in the NHS”: “the acknowledgement that doctors also have mental health problems, and that they are not immune to the pressures we all face”.

How did the service get commissioned?

Ms Gidley has acknowledged that “it took medics eight years to achieve” funding for the GP Health service. Lucy Warner, its chief executive, tells C+D that she and her colleagues “went on a journey to get to where we are now”.

“The short version is, given the fact that we had changes of government and changes in policy, it's been a long struggle.”

Ms Warner says the service meets a vital need – confidential support for doctors who may feel stigmatised if they seek help for mental health problems, or who don’t want to seek help from their colleagues, or someone who may be more senior, because of the impact it could have on their career.

“The reason it was initially done was because there was a fairly solid international evidence base that doctors in particular, and to a lesser degree dentists, have difficulty accessing confidential NHS care, and some evidence that doctors avoid seeking help because of the fear that the advice and support won't be kept confidential,” she says.

Has mental health support helped GPs?

Between its launch in early 2017 and its expansion in October 2018, more than 1,500 GPs were treated by the NHS GP Health Service, three quarters of whom were able to return to work.

NHS England has said that “the current service for GPs has shown itself to be highly valued”. A 2018 survey found 93% of its users were likely to recommend the service to others, while 88% said it had a positive or very positive impact on their wellbeing and 78% said it had a positive or very positive impact on their ability to continue working.

Do doctors and pharmacists face similar risk factors for stress?

It appears they do. “The problem with pharmacists [is] the [same] general risk factors that affect any health professional: they have a job with increased risks, with periods of intense stress,” Ms Warner explains.

The “increased risks” for stress-related mental health issues among pharmacists can include “very high levels of presenteeism”, and “sometimes a reluctance to trust” other healthcare professionals when seeking help. “Generally, when health professionals are ill and they do present, they receive poorly managed care or don't necessarily get the appropriate assistance,” she adds.

Another “significant factor” is “the intensely stressful work environment” in the health service, which “is getting more and more stressful by the day”.

As well as NHS-wide issues, there are “standout” factors that affect pharmacists, Ms Warner suggests. “Some individual factors pharmacists [face] that also come into play for some dentists and doctor groups would be around working in isolation, and having access to certain drugs,” she says.

Could a mental health service be helpful for pharmacists?

The RPS certainly thinks so. English pharmacy board chair Ms Gidley has told C+D the society “will be working with others to try and make [a pharmacist service] a reality”. The RPS already wrote to pharmacy minister Steve Brine in July 2018, to urge him to extend the GP Health Service to tackle mental health issues in pharmacy.

“Pharmacists comprise the third-largest health profession and play a vital role in supporting patient safety and reducing the risk of medication errors,” the society’s letter stated.

“The RPS does not believe that the mental health of such an important professional group responsible for supporting patients every day should be dependent on charitable giving,” it added.

It argued that the rise in calls from pharmacy professionals to the charity Pharmacist Support’ s ‘Listening Friends’ helpline, which increased by 39% in 2017 alone, was evidence for the need for a mental health service for the profession.

In terms of numbers, Ms Warner estimates that roughly the same proportion of pharmacists could seek help from a mental health service as dentists.

“I would say pharmacists are probably closer to dentists than to medics,” she explains. “There's about a half to one per cent of the population [of dentists] accessing the service. So if you look at it from that perspective, with something like 60,000 pharmacists in the country, you could say that possibly 300 to 600 pharmacists may be needing some sort of appropriate care through the confidential accessible service who may not be receiving it at the moment.”

But Ms Warner warns there is a lack of formal evidence that pharmacists who are under stress need confidential support. “There is not currently an evidence base that I'm aware of that says pharmacists are not necessarily seeking help when they need it through mainstream means.

“It may be that they're suffering the same as [other] health professionals, but there's no evidence I'm aware of that says they have the same concerns around stigma going to their GP.

“That's one of the key factors, I think, why at the moment people aren't rushing to say: ‘Yes, we have to provide support for pharmacists’. There's nothing to say that when they need help, they don't get it.”

The provision of confidential support has made a difference to doctors and dentists. Ms Warner says that figures from NHS Resolution, which assess concerns about the performance of doctors, dentists and pharmacists, show that since the London service started 10 years ago, the number of doctors suspended or excluded from the General Medical Council register due to ill health has fallen.

In addition, “people are coming to seek help at a much earlier stage now than they were 10 years ago”, she tells C+D. “When we first started, about a third of the people who came to us had already got themselves into a mess one way or another; they were already involved in some sort of investigation or regulatory process following a complaint. And now that's far less, around 6%.

“Those factors mean obviously there is less absence that is health-related, and particularly long-term absence….and you could say there's less impact on patient care.”

But she stresses: “I don't have any data to tell me whether there would be a similar story in pharmacy.”

What else could make a difference to pharmacist stress?

Ms Warner says a mix of awareness of the support available, self-referral and policy changes could help address pharmacist stress. She cites basic cognitive behavioural therapy (CBT) techniques, as well as mindfulness and sleep hygiene strategies, which are “useful for everybody”. However, tackling the growing problem of pharmacist stress – and its root causes – will take more systemic change, she says.

“[The] more health professionals work in isolation [the] more we see stress levels building. The biggest thing that could be done is making sure that any healthcare professional has a group that they are connected to.”

This is as true for pharmacists as other healthcare professionals, she says, and so building a support network “could make a huge difference”.

“Just making pharmacists feel like they're part of a group; that they're not just working around the country, dashing here and there just to fill a gap. [That’s where] giving them a group to be connected to becomes even more important.”

What is C+D doing about pharmacy stress?

C+D created a briefing document, which was passed to England’s chief pharmaceutical officer Keith Ridge by the RPS to persuade him of the damage stress is causing to community pharmacy. Download it, and read C+D’s in-depth coverage of the data.

Let C+D know about your own experiences of stress by emailing [email protected]. Please state if you prefer your comments to remain anonymous.

For support and advice on mental health and wellbeing, visit the Pharmacist Support website here. For specific stress and wellbeing support, contact the charity’s ‘Listening Friends’ scheme here.

16 Comments
Question: 
What action would you like to see sector leaders take to combat stress in community pharmacy?

Tohidul Islam, Locum pharmacist

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A Rashid, Locum pharmacist

Everyday stress/anxiety/depression etc worsens when the feeling of isolation or loneliness increases. Being a pharmacist is definitely the most isolated profession ever. That’s where the stress is. 

Jack Ponting, Design

nice

Leon The Apothecary, Student

Would be better if we eliminated the factors causing the stress in the first place.

Michael Achiampong, Community pharmacist

Spot on Leon as usual. It's rare that I work with another pharmacist in community pharmacy but it has happened on a few ocassions. The constraints of community pharmacy funding is an obvious issue, but surely the time has come for proper co-working to get on top of the immense daily workload. Also, it's imperative to maximize the knowledge, skills and capabilities of community ACTs, dispensers and counter assistants.

 Working together, we can ultimately serve patients more effectively and efficiently. This way everyone will stress less!

Interleukin -2, Community pharmacist

ha ha ha ha ha ha ha ha ..............teeeeaaaarssss!

Angry Pharmacist, Locum pharmacist

We don’t need a mental health service. We just need a COMPETENT regulatory body that’s stands FOR us and our rights to proper and fair working conditions rather than AGAINST us. 

Reeyah H, Community pharmacist

I don’t think we need a special phone number to call in the middle of the night because we are suicidal. Adequate funding would be a good preventative measure. I fully agree with Graham. We have become the laughing stock of health professionals. I had a guy sell me lots of toilet paper today, and even he knew that pharmacies are struggling big time and mentioned ‘Pharmacies are concentrating more on retail’. Shame. I didn’t do my degree to sell toilet paper and get excited about it. I make more selling per outer of that than a dispensing fee. 

Chris Locum, Locum pharmacist

Community pharmacy needs to be funded so that mental health service is not necessary. Everyone working there already knows they are part of a special group. There is no need to inform them that they are a bunch of talented, overworked and underappreciated fools.

Graham Turner, Non Pharmacist Branch Manager

Instead of treating the symptoms, why don't you try and cure the disease? This would mean taking steps to try and make sure pharmacists are allowed proper breaks, branches are adequately staffed, and pharmacists are not called at home on their days off or holidays. And no, when you're on your break you should not be pestered to check "just one script because she's in a hurry" - a break should be a break. Personally, I think that if this happens, then the break should be reset back to zero so that the pharmacist can enjoy an uninterrupted rest period.

Telling pharmacists at the end of their tether about CBT, "sleep hygiene" and "mindfulness" is quite frankly insulting, and likely to do nothing good at all. Create a more healthy working environment, and pharmacists and patients will both benefit.

The combination of a very target-driven workload with a constant lack of staff, pressure to go in when you're ill, and many more jobs than you could ever finish in your shift is enough to make anyone depressed.

In the last 15 years or so, pharmacists have been asked to "add":

- MUR

- NMS

- Flu jabs

- EHC services

- Travel "clinic"

- Chamlydia consultation

- Dealing with locum agencies

- Conference calls

- myCPD or online training requirements

- Staff reviews

- Collating MUR info for submission (takes hours)

- Back to work meetings for sick staff

- Dealing with script collection/delivery issues

- Attending regional meetings

- Attending local CPD events

- Checking and replying to various emails

- Dealing with smartcard issues

- Dealing with ETP problems

- Dealing with advertising for staff

- Dealing with customer complaints

- Politely dealing with very verbose customers who want a specific item that you can't get

- Interviewing candidates

- Dealing with constant IT issues 

- Dealing with staff "disputes" which can be VERY time consuming

- Staff rotas

- Logging dispensing incidents caused by locums

- Booking locums

- Dealing with phone calls from locums who have not been paid

- Supervised consumption

- Needle exchange

- Spending hours checking product constituents for a vegan patient's script

- FMD (lol)

- Yearly audits

- CPPQ data collection and submission

- Dealing with inspector visits

- Dealing with senior management visits

The list is never ending. And some pharmacists are checking almost a thousand items a day as well as these jobs, it's quite frankly amazing that anyone is able to do all this work without being stressed out. I know people who work in the finance industry who have nothing like this crazy list of jobs to do, and earn several times a pharmacist's salary in their bonus alone.

Quite clearly, CBT is not going to be much help, unless it can help you to grow another pair of arms.

So the answer to the question posed as the title of the article would be yes, it "may" help some pharmacists who are really suffering. But it would be papering over the cracks, when you need to replaster the wall.

I just hope that in the future, when pharmacy errors start becoming a major, MAJOR thing, that the people who currently have the power to make things better for pharmacists are held accountable. Pharmacy is in such dire straits, I hope that the regulator is held accountable for the next avoidable death.

Pharmacists do not have a say right now, they have mortagages to pay and mouths to feed. So where is the regulator right now? Sitting in Canary Wharf eating biscotti with their coffee?

In doing nothing they are endangering the public, working conditions in a UK pharmacy are an absolute disgrace, it would be incromprehensible to most people that there is a body in London wasting so much money whilst supposedly being mandated to protect the public.

Any harm caused by dispensing errors should be the fault of the regulator, not the pharmacist, because the regulator is totally and utterly incompetent, and despite that they know full well what is happening, they are doing nothing.

The GPhC has failed to regulate the industry, and we now have a situation where pharmacists are working in such high pressure and dire circumstances, errors are inevitable.

GPhC - why are you not protecting the public? If you are not doing the single thing that you are mandated to do, then why are registrants paying their fees? I think you should refund them because you are a complete and utter failure.

At least on the high street, if you buy something which turns out to be fake or garbage, you can go back and ask for a refund. What can pharmacists do about this regulator? UK consumers have alot of legal powers in their corner, but what powers do pharmacists have when they are forced to pay a fee to an organisation which does absolutely nothing? A complete and utter disgrace in this day and age.

We need a new regulator - one which doesn't sqaunder your money and actually knows what it's doing, and certainly one which does not propogate clandestine relationships to the detriment of the very people who pay for their existence.

It's funny how modern society expects transparency within big companies and regulatory bodies, yet the GPhC is about as opaque as you could possibly get. You can't find out what they are doing because they only publish so few hearings.

Does anyone fancy going for an "intelligence-led ", "patient-centred" and "outcomes-based" coffee and a piece of cake? It'll cost you £241, hope you like it.

Stuart Reeve, Community pharmacist

Well said Graham. Where is patient safety? We are drowning in workload and paperwork.

Benie I, Locum pharmacist

I think you mean prevention .

Graham Turner, Non Pharmacist Branch Manager

No, because we already have the disease of awful, high-stress, working environment, too late for prevention.

Benie I, Locum pharmacist

If anything affects your health to that extent you have to leave. WIth community phamacy that should a be a relatively easy decision as the pay is pants..

have to behave like your support staff who walk out for better pay and conditions at starbucks.

Graham Turner, Non Pharmacist Branch Manager

There are so many amazing support staff out there. And some fantastic pharmacists who provide a genuine benefit to their customers and community. It's just a massive shame that the employers would rather have you sell something useless to the patient instead of giving them some genuine advice about their lifetstyle and medication for free. Pharmacy in the UK has been monetised, the role of pharmacist can no longer be considered healthcare, but ruthless retail to make as much money as possible for the boss living abroad on their yacht.

Benie I, Locum pharmacist

IRONY ! Community stress serrvice! What will the targets be ? 2 consults a day ? And what if you don't hit the targets......

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