The vast majority of pharmacists feel under pressure to hit service targets, so what – or who – is to blame, and what can you do about it?
The case of Eleisha Watson has sent an unseasonal shiver down the spines of pharmacists. As a 27-year-old pharmacist working at a Boots branch, she admitted to – and was suspended from the register for – falsely claiming to have conducted more MURs than she had. She wasn't motivated by financial gain – indeed, she received none – but instead, she said, by the "enormous pressure" to meet MUR targets.
While the GPhC found Boots had not put her under improper pressure, Ms Watson is not alone in feeling the heat – a C+D poll of almost 130 readers found that just 6 per cent of them never feel under pressure to meet service targets. And while stress is nothing new for community pharmacy, there is a sense that MURs are the straw in danger of breaking the pharmacist's back.
Callers to charity Pharmacist Support often cite MURs as a problem. "The main issue raised is pressure on pharmacists to meet MUR targets, causing stress," says a spokesperson. "Some callers have said that they think their workplace does not have sufficient staff to provide a safe service and meet MUR targets."
More on MUR targets Targets and harrassment: where you stand
For one pharmacist, a manager for 28 years who wishes to remain anonymous, the problem with MURs is that they are viewed "in cash terms". "It is a service that is remunerated on a quantity basis, not quality."
One organisation that has been vocal on the subject is the Pharmacists' Defence Association (PDA). Director John Murphy believes that pharmacists face a stark choice when trying to meet targets. One option is to maintain their "professional autonomy" and decide whether an MUR is genuinely required for each patient – potentially resulting in "a threat to their job" or a "reduction in their locum fees". The alternative is to "keep everybody happy, and find yourself in front of the General Pharmaceutical Council".A multiple problem?
But our anonymous pharmacist does not feel that everyone in the sector faces this dilemma. The view among his colleagues is that "the excessive pressure to meet targets for MURs is largely confined to the multiples". "There may well be ‘indies' who put pressure on managers or locums, but I am not aware of any," he says.
So is this simply a case of big business looking after its profit margins at the expense of its employees? Graham Phillips, owner of Manor Pharmacy Group (Wheathampstead) Ltd, Hertfordshire, agrees that some pharmacists are being put under "undue, target-driven pressure", but warns that "it's very easy to vilify the large multiples".
"In many ways they are simply responding to an operating environment," he says. "But I think they are doing it in an unempathetic way. [Pharmacists] are being asked to do too many things with too little resources. It seems to be worse where there are non-pharmacist managers, and they just don't get the pharmacist's view of things."The profession gap
This use of non-pharmacists as managers seems to be at the heart of the debate over target-driven stress. Pharmacist Support says callers have complained that these managers "do not understand the role of the pharmacist and the pressure they are under".
Another objection is that they have "different targets and priorities and so their demands on pharmacists can cause additional pressure". C+D readers certainly agree, with the topic prompting fervent debate online and three quarters of more than 200 respondents to a poll believing that non-pharmacist managers struggle to manage pharmacy teams effectively.
Unsurprisingly, this view isn't shared by the supermarkets. Sainsbury's superintendent pharmacist Chris Perrington is "proud" of the number of MURs it has conducted. "We believe the combination of pharmacist and non-pharmacist manager working together has been key to this success," he says.
Asda superintendent pharmacist John Evans says the supermarket has tried to address the gulf in experience between the two roles. "Our non-pharmacy managers... are not as qualified as pharmacists and they understand that. We teach our non-pharmacists processes that they can understand to support our pharmacists."Individual responsibility
But Mr Evans doesn't agree that all the blame can be laid at the door of managers. "A pharmacist is a professional... If he thinks someone is making him do things that aren't reasonable, he should tell that person. And if they don't get any joy, they should see their superintendent."
Noel Wardle, a partner at legal firm Charles Russell, echoes Mr Evans' comments. "If the pharmacist is concerned about the imposition of targets, then I think it is incumbent upon the pharmacist to raise that with the employer," he says.
The message is that pharmacists shouldn't suffer in silence, but should voice their concerns if they genuinely feel that unreasonable targets are having an impact on their professional conduct.
"MUR targets are pretty common in the industry now," says Mr Wardle. "Having that sort of target isn't necessarily improper pressure. I think most pharmacists would agree that, in a reasonably busy pharmacy, there should be scope to provide MURs."
For Mr Phillips, the real issue is not the targets, but "what's available to help pharmacists meet the targets". "If the pharmacist isn't meeting the targets when they've got all the resources to support them, it's entirely fair for an employer to... have a serious conversation," he says.
Mr Murphy agrees that adequate resourcing is one part of the solution, but he believes that MURs need to become a "professional decision, not a commercial one". The PDA has proposed that services such as MURs should be delivered by "autonomous contracting pharmacists", who would have the final say about which patients need an MUR.
Whether this is the solution is up for debate, but there's one thing that isn't, as Mr Phillips puts it: "There is definitely a problem out there waiting to be solved."
"If the pharmacist has a concern about a non-pharmacist manager's conduct conflicting with the pharmacist's professional standards, we would suggest they seek advice from their union or professional body," says a spokesperson from charity Pharmacist Support.
A PDA spokesperson agrees that professional advice should be your first port of call. "Unfortunately our experience shows that attempts at informal resolution in such disputes can be counter-productive and employers use discussions to brush matters under the carpet," he says.
"Our advisors would formulate a strategy to deal with the problem based on the facts and any relevant legislation."
And Graham Phillips, owner of Manor Pharmacy Group (Wheathampstead) Ltd, believes that talking things through with someone can give pharmacists more confidence to address the issue. "Pharmacists work in very isolated settings and sometimes it is an empowerment issue," he says. "My advice would be: talk to a colleague, talk to one of the professional bodies."
But he adds that non-pharmacists need to be able to "look at the world through the eyes of a pharmacist". "Not all pharmacists are great communicators," Mr Phillips explains. "I do think there is some onus on the employee [pharmacist] to paint a picture [of their role]."
Step 1: Have an informal chat "If a pharmacist feels they are under too much pressure to meet targets and wants to raise it with their employer, we would refer them to our employment adviser," says a spokesperson for charity Pharmacist Support. "Normally their advice would be to attempt to resolve the issue informally with their line manager."
Step 2: Put it in writing "If this fails the pharmacist has the option of raising a formal written grievance. There is a process set out in the ACAS code of practice (acas.org.uk) on disciplinary and grievance procedures."
Step 3: Check your employer's policy "Organisations have a clear role in ensuring there are suitable policies in place. Many large employers have a policy on dignity at work, with a procedure to follow should there be any difficulties."
Step 4: Appeal The ACAS code of practice advises that if an employee feels their grievance has not been satisfactorily resolved then they should appeal. It states that you should let your employer know the grounds for your appeal "without unreasonable delay and in writing".
Struggling with stress? To speak to a Pharmacist Support Listening Friend, call 0808 168 5133Your shout
There patently is pressure from companies to conduct MURs – some phone the pharmacy every day to check the number you have done. They don't want to know how the patients are doing but what money the business is earning. Mike Harvey, community pharmacist What constitutes unacceptable pressure and how will it be not tolerated? There is a clear deficiency in the law and pharmacy regulations to allow us to act as professionals and stand up to/amend/review targets without falling victim to the ever-increasing demands for profit. This deficiency brings the profession into disrepute from the get go. Who will address this? A Pharmacist, community pharmacist We are not so naive [as] to believe pharmacies are charities, especially in these times – we need to capitalise on possible income streams. I personally enjoy doing proper MURs/NMS and see patient benefits in numerous cases. However, there is no negotiation or flexibility of targets put upon us. The 400 figure is the NHS-imposed limit, ie maximum. In some pharmacies this is quite achievable. However, it has been made a minimum target for most companies, with no regard to script volume, staffing resource and expectations on the pharmacists. The national speed limit is 70mph; that doesn't mean we must drive at this speed and no less, regardless of road conditions. Stephen Riley, pharmacist
Comments posted at chemistanddruggist.co.uk