Ah, the good old days. Everything was better back then, right? Wages were higher, workload was lower and pharmacists had time to get to know all their patients on a first-name basis. Independent pharmacies were hailed as the focal point of their communities and employees were blissfully unaware of the words “MUR targets”.
If this picture feels somewhat rose-tinted, that’s probably because it is. But it is nonetheless a view that will resonate with pharmacists who yearn for times gone by. It is easy to understand the nostalgia. Considering the recent upheavals in pharmacy and the NHS, the past can feel like the perfect antidote to the uncertainty of new commissioners, budgets and services.
There is no denying that today’s pharmacists have plenty to contend with. But it’s not necessarily accurate to paint everything in the past as rosy – to establish a full picture, you need to look at changes in the role, wages, workload, culture and career opportunities.
Pharmacy has undergone some major changes over the past few decades – and the role of the pharmacist is one of these.
In the not-so-distant past, pharmacists would spend much of their time making up medicines from scratch – a task that clearly made use of their pharmaceutical training. Martin Bennett, owner of Wicker Pharmacy, Sheffield, remembers “many hours making up liquids, ointments, and creams”.
But pharmacists who qualified in the 1970s say they felt very much limited to dispensing medicines. Sandra Gidley, chair of the RPS English Pharmacy Board, remembers feeling frustrated by the role when she qualified in 1979. She was “stuck behind a hole in the wall dispensing” and rarely had the opportunity to give out advice. “I didn’t like it. I wanted to be able to talk to people,” she says.
Tony Schofield, owner and superintendent of Flagg Court Pharmacy in South Shields, tells a similar story. He qualified in 1978 and felt he was restricted to “putting labels on bottles and handing them out to patients”.
Ultimately, this somewhat restricted remit left many pharmacists feeling dissatisfied. In fact, Mr Schofield feels practising today is “immeasurably better”. Not only have pharmacists started providing services – flu vaccinations, medicines use reviews (MURs) and smoking cessation, to name a few – but they also have more opportunities to provide advice.
Today’s patients are more health-savvy than ever before and arrive armed with information from the internet – meaning they no longer automatically “treat you with deference”. Instead, you have to earn their trust. “They still respect you if you give out information in an unbiased way,” Mr Schofield points out. And, for him, earning this patient respect makes the job worthwhile.
“I talk to pharmacists now who just survive the day – they are physically and mentally drained by the end of day. Frontline community pharmacy is not a very comfortable place to be”
There are certainly upsides to this evolving role for pharmacists. But there is one major downside: workload. As Wicker Pharmacy’s Mr Bennett can testify, life in pharmacy has always been “extremely busy”, even when the role rarely ventured beyond dispensing.
Today, pharmacies are providing services and advice without relinquishing any of this dispensing workload – in fact, prescription volumes have only increased. The number of prescription items dispensed in the community stood at more than a billion in 2014 – a 55% increase on 2004.
The trend has clearly taken its toll on the sector's people. In the C+D Salary Survey 2015, 68% of pharmacy employees reported suffering from workplace stress and a similar proportion were doing unpaid overtime every week. Kevin Noble, community pharmacy lead at NHS Isle of Wight and a former contractor, confirms that the life of pharmacists is now “much busier” than when he started out in 1986.
The retort often levelled at pharmacists who complain about workload is to make better use of the pharmacy team. It is true that pharmacists can lean on their support staff more today – Mr Noble remembers having to “count out the number of tablets of paracetamol for a patient” when he started out.
But these support staff come at a price and not all pharmacies can afford as many as they used to. Nick Hunter, secretary of Doncaster and Rotherham LPCs and chief officer of Nottingham LPC, says the “constant pressure to improve efficiency” has forced pharmacies to reduce staffing levels. Combine this efficiency drive with an increase in most pharmacies’ opening hours and ever-mounting bureaucracy, and “the pressure on frontline pharmacy is now unprecedented”. Life as a pharmacist “is constant”, says Mr Hunter.
“I talk to pharmacists now who just survive the day – they are physically and mentally drained by the end of day. Frontline community pharmacy is not a very comfortable place to be,” he argues.
When it comes to workload, Ms Gidley concedes that the profession “had it better back in the good old days”. “We were busy, but we never felt that we didn’t have enough staff, and were well-supported,” she explains.
These high workplace pressures may explain why, over the decades, multiples have become ever-more dominant. Mr Hunter says it is “not surprising” that weary independent contractors are selling up to big corporations.
Mr Noble is one of these contractors. He sold his second pharmacy business in 2001, and found that multiples had the greatest appetite for acquisitions. “If a multiple wants to buy you now, you’ll probably sell to them. They’re the only people who can afford to buy,” he explains.
As a result, multiples are now dominant in UK pharmacy. In 2013-14, multiples – classified by the government as businesses with more than five branches – made up 60% of the sector.
With this dominance has come a more corporate way of working. Employee pharmacists now have to be much more mindful of commercial pressures, and targets have become a way of life. Like many, Ms Gidley is unsure whether this approach benefits patients. “The focus has gone away from customer service. For example, if you haven’t done two MURs a day, and you’re dealing with customers complaining about having to wait, you still have to tick the company’s checklist box,” she explains.
Mr Hunter also expresses concerns over the impact of this corporate mindset. Multiples must adhere to rigid procedures that can “restrict choice” and the ability to tailor services to local needs, whereas independent pharmacies are “quicker and more flexible”, he says.
“Back in the day, you’d buy a run-down business and develop it and make it work. For young pharmacists, these opportunities have diminished.”
Owner and superintendent, Flagg Court Pharmacy, South Shields
The life of a pharmacy graduate has changed beyond recognition over the past few decades. Wages are not what they were – the oversupply of pharmacists has forced down the average hourly locum rate, which reached a seven-year low of £20.85 in the C+D Salary Survey 2015. This trend has dashed graduate hopes of buying their own pharmacy at a young age.
As Flagg Court Pharmacy’s Mr Schofield can testify, it was easy to become a contractor in the 1970s. “Back in the day, you’d buy a run-down business and develop it and make it work,” he points out. “For young pharmacists, these opportunities have diminished.”
But it’s not all doom and gloom. There are new roles and opportunities for the freshly qualified. One of these opportunities comes in the form of the £15 million NHS England pilot to employ 250 more pharmacists in GP practices.
GPs appear to be enthusiastic about the scheme, which – if successful – could lead to even more practice pharmacist positions. LPC chief Mr Hunter believes this is indicative of greater scope to work outside the traditional community sector. “There are more roles in primary care... and greater opportunities to use clinical skills,” he says.
NHS Isle of Wight’s Mr Noble is proof that today’s NHS environment can open up new possibilities. He spends several days a month working for a “social enterprise” that was set up to remove barriers between healthcare commissioners. In this role, he ensures pre-registration graduates have an understanding of the new commissioning environment and organises placements for them in CCGs and public health teams.
Each generation of pharmacists will have felt disillusioned at some point – and today’s workforce is no exception. But Mr Schofield is keen to highlight that there are just as many opportunities for the profession now as there have ever been.
This is especially true in today’s NHS environment. As Mr Schofield says, cash-strapped commissioners are “looking for solutions” and pharmacy may well form part of these. “If we can raise the profile of the profession among young pharmacists, we can put together solutions, and it may well be in partnership with other health professionals,” he argues.
It is up to the profession to seek out these opportunities, though. Mr Hunter is concerned that the sector is “busy waiting for someone else” to come to them. “Rather than trailblazing, they would [prefer to] hide in the dispensary,” he says.
He urges pharmacists to take a more proactive approach. “The ball is in our court as a profession. Nobody’s going to give it to us. We have to seek it and take it,” says Mr Hunter.
The RPS’s Ms Gidley agrees that “the potential for the profession is huge”, but it is “undervaluing itself”.
It seems the profession has everything to play for. And this is perhaps what pharmacists need to keep in mind when the future seems hopeless and the past takes on a rose-tinted hue. After all, there is nothing wrong with nostalgia, as long as it doesn’t blind you to the opportunities that exist in the present.
Mr Bennett sums it up well: “At any time, people say ‘things used to be better’– it’s human nature. The reality is the past is just different.
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