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The good old days

We’ve all heard stories of how great pharmacy used to be. But was it really better in the past?

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.
 

Role satisfaction

  Yesterday

  Today


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”

Nick Hunter


Workload

  Yesterday

  Today


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. 
 

Corporate culture

  Yesterday

  Today


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.”

Tony Schofield

Owner and superintendent, Flagg Court Pharmacy, South Shields


Graduate opportunities

  Yesterday

  Today


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. 
 

Sector opportunities

  Yesterday

  Today


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.

How do you feel about your working life today? Take the C+D Salary Survey 2016 to benchmark your pay and conditions with those of your peers

14 Comments

Farm Assistant, Community pharmacist

It is the utter viciousness of those in charge that makes me despair of the human race. Just a few more years thank God. And every time you think it cannot possibly get worse it does.

Anonymous Anonymous, Information Technology

I'm so ecstatic to have such great "role satisfaction" - being shouted at because the GP will take 2 days to send us a prescription for someone who has forgotten to order their medicines for the umpteenth time! Having to work like a robot and walk the tightrope of customer service balanced against professional responsibility. I'm so pleased that my workload has increased exponentially. That I'm told by someone that probably has no GCSE's that I "must do more MUR's or face disciplinary action". I'm so over the moon that locum (and permanent) wages have been the lowest they've probably ever been in real terms. As well as the constant thought that one of the conveyor belt universities will be able to supply a poorly trained pharmacist to undercut my wages. And I'm overjoyed when I read the comments from the so-called 'enthusiastic' GPs about the use of "phoctors" over on Pulse!

Paul Samuels, Community pharmacist

So true!!-- it does make you wonder why so many schools of pharmacy produce such poor quality graduates. Like some respondents I have been qualified well over 45 years but for some perverse reason I still get some minimal job satisfaction.

Farmer Cyst, Community pharmacist

Because it's the University of Hertfordshire

Paul Dishman, Pharmaceutical Adviser

I qualified in 1976, ran my own business from 1985 and retired last year. I enjoyed my time as a pharmacist and relished the responsibility of running my own business. What killed it for me in the end was the flood of paperwork imposed on us by people with nothing better to do than sit in offices and dream up stupid ideas.

Angela Channing, Community pharmacist

I agree. I blame all the problems of today on SOPs, the multiples taking over, too many pharmacy schools and the 'new' pharmacy contractual framework that brought such joys as MURs, that have been destroyed as a clinical service by turning them into a money-spinner.

London Locum, Locum pharmacist

Today you would not wish Community pharmacy on your worst enemy.

Arun Bains, Community pharmacist

Sometimes I really do wonder who the people who write these stories are talking to. Because it certainly isn't to the huge majority of pharmacists who seem to be overworked, underpaid and under appreciated. It seems any honest feedback about how the majority feel gets labelled as 'negative' or just gets swept to one side.

Lancelot Spratt, Accuracy checking technician

All of the names of the people who were spoken to are in the article. Hope this helps.

John Schofield, Locum pharmacist

45 years ago my father said to me when I was at a difficult point in deciding which degree to do, having found that my first choice wasn't for me, said: " You should consider pharmacy, you will be lucky if you get rich, you may find it repetitive and boring, but it will provide you and your family with a comfortable lifestyle, secure employment and you will have the chance to buy your own shop and be your own boss." Every word of that was true, but today it isn't. I always advise anybody considering pharmacy to think again and look very hard at other degrees. Admittedly we now have many more professional opportunities, but what is the point of these if you can only do them for an employer. I hear many horror stories about multiples these days, the profession I joined was a profession fit for gentlemen and women; nowadays I'd rather be a skilled tradesman and earn more than most pharmacists and have many more opportunities. In my opinion the destruction of pharmacy as a proper profession can be laid at the door of control of entry. I retire from the register this year with absolutely no regrets.

Philip Sealey, Locum pharmacist

I am the same age as John, and am too retiring from the register this year. My career began as. Saturday boy with Timothy Whites & Taylors as a Saturday boy. Drams, fluid ounces, scruples, scales and measures, not to mention corks. I thus fell into pharmacy by default. OK, I derived a comfortable living, but would not have chosen this career path. Pharmacists are the estate agents of health care: no inherent skills, but are positioned between the drugs industry and the medical profession. Their inherent skills have been swept away by the Medicine Act 1968, and they are now left with nothing to build upon. Anyone asking my advice about becoming a pharmacist is actively discouraged. SOooh pleased to be finishing this year.

London Locum, Locum pharmacist

Estate Agents? Much more professional I'd say, Estate Agents that is.

Anonymous Anonymous, Information Technology

Ha! My estate agent drives a Mercedes C63, has an Omega watch and has several flats in London to his name. And he's 34... Now tell me who should feel more satisfied!

Farmer Cyst, Community pharmacist

Yeah but did he clear up Mrs Smythe's rash that was all over her arse and giving her 'major grief'? It's swings and roundabouts in life, mate.

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