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'The BBC focused on deaths over pharmacy pressures'

Richard Bradley claimed Boots has enough staff working in its pharmacies (Credit: Boots: Pharmacists under pressure?)
Richard Bradley claimed Boots has enough staff working in its pharmacies (Credit: Boots: Pharmacists under pressure?)

The BBC documentary raised awareness of the pressure pharmacists are under, but deputy news editor Annabelle Collins questions whether it got to the heart of the issue

The journalistic trope ‘If it bleeds it leads’ sprang to my mind when watching the BBC’s Inside Out documentary on pharmacists under pressure. The half-hour programme, which aired last night (January 8), pledged to investigate patient safety and staffing levels in pharmacies – namely, Boots – but the immediate focus appeared to be on the fatal harm caused by rare, but regrettable, dispensing errors.

While rightly highlighting three incredibly tragic cases where patients had died as a result of medication errors by Boots pharmacists, the documentary also made clear these specific cases were not due to a lack of staff working in the pharmacies at the time. So how would the programme link staffing levels and patient deaths?

The short answer is that it didn’t. But it did raise some important issues facing the sector – and not just those specific to Boots.

However, if I were an average viewer with no knowledge of what goes on on the other side of the counter, I would have been alarmed. The picture it painted of community pharmacy suggested a fatal dispensing error is more commonplace than in reality. This made me question the aim of the documentary makers – was it to highlight the daily, industry-wide pressures faced by pharmacists to a wider audience, or was it to comment on tragic individual cases, and specifically to criticise Boots?

The story of a whistleblower, former Boots clinical governance pharmacist and professional standards manager Greg Lawton, was woven in with the patient case studies. It was explained that Mr Lawton felt staffing levels in the health and beauty giant's stores were too low to be safe.

Mr Lawton later described how he was “terrified” that a patient might be harmed or even die due to inadequate staffing levels. His interview was emotional and heartfelt – he felt discouraged from whistleblowing by Boots, yet was compelled to meet the General Pharmaceutical Council (GPhC) in 2015 to discuss his concerns.

The testimonies from anonymous Boots pharmacists were unfortunately marred by the use of white, male, middle-aged actors wearing white coats, playing up to a stereotype that anyone who has set foot in a pharmacy knows is no longer true. But the description of how they feel stretched to breaking point to keep patients safe will resonate with many. Also, the need for the actors highlighted the stigma around whistleblowing at the multiple.

Boots' director of pharmacy, Richard Bradley, was given ample opportunity to respond to the allegations. Mr Bradley emphasised repeatedly that Boots has enough staff in its pharmacies, and all staff have a professional responsibility to speak out about any patient safety concerns. But his suggestion that Mr Lawton’s staffing concerns are not relevant today – as he left the company two years ago – came across as unconvincing.

It was disappointing that the government’s brutal pharmacy funding cuts in England were not mentioned until halfway through the programme, and that the legislation which will decriminalise inadvertent dispensing errors was only given an offhand mention. The documentary failed to explore whether funding cuts will further exacerbate staffing issues.

The fear expressed by some pharmacists on social media – that the public will lose faith in pharmacy after watching this documentary – is legitimate. Millions of patients rely on their community pharmacist to safely dispense essential medication, and in the overwhelming majority of cases, this is done safely. The programme may not have been able to provide any concrete answers to the staffing level problem – it ended rather abruptly – but it has brought the issue of the pressures pharmacists and staff are under to a wider audience, many of whom would otherwise have little idea what goes on behind the counter.

Boots: Pharmacists under pressure? aired at 7.30pm on January 8 on BBC One. Catch up on iPlayer

Annabelle Collins is deputy news editor of C+D. Email her at annabelle.collins@ubm.com or contact her on Twitter at @CandDAnnabelle.

9 Comments
Question: 
What did you make of the BBC's documentary?

James Mac, Community pharmacist

Boots is far from uniquely mendacious. To me, the problem is the huge demand for pharmacy resource and so the very high profitability, if you can keep costs down. Part of the cost control has to be keeping staffing levels as low as possible. I can recall AMs trying to hide their delight that a dispenser wasn't returning from maternity or was retiring etc. One less mouth to feed! Also that Bradley guy deserves a medal for services to corporate cuckoldry... "Of course it's safe, we're making it even safer", in the line of a Soviet Commisar, "of course Siberia is warm, we're making it even warmer"

Amal England, Public Relations

Every party involved in this documentary had their own agenda - the BBC needs to attract viewers and ensure people are left with some sort of lasting memory, hence focus on deaths. The Boots executive needs to limit damage otherwise the Boots share price will plummet and he will be out of a job, hence Richard was not being honest. In the picture Richard is sitting in a pharmacy, which is a calculated publicity stunt to reassure people- it won't work. From my experience the staffing situation is worse than 2 years ago as Walgreens Boots Alliance is cutting costs to make the company attractive to investors and pay off debts. Greg on the other hand came across as concerned for the patient. And the patient should be worried after watching this documentary, very worried because the multiples first concern is the shareholder not the patient. Prescriptions are being dispensed and checked at such speed and without sufficient attention, such that there is a huge number of errors, a reality Richard is ignoring or just cannot see it because it is unreported. One thing that can be cleared up, those staff who were involved in the 3 deaths, was there sufficient staff at that moment in time and or was there too much work on the table? It would help if you could respond .......anonymously.

Chris Locum, Locum pharmacist

Is it any surprise the BBC focused on 'deaths' and not 'work pressures'? Millions lead what they would describe as life under some kind of stress at home and work. Whether the BBC can report impartially is another matter - that is not what is at stake here. Putting professionals in a terrible working environment will lead to tragedy. Perhaps some pharmacists should leave and retrain as a film crew! We will never get the exposure we want until it is far too late to save community pharmacy. I think we have moved beyond the point of no return. The "Good old days" are long gone...

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

Would an anonymous feedback system through an external system promote a better culture of reporting and honest visibility without a fear of perhaps unfair repercussion?

Amal England, Public Relations

I believe most pharmacists, pharmacy staff, managers and certainly superintendents' know the various reasons why errors and near misses occur, the information has already been collected over many years. What needs to happen now is all relevant parties need to get together and change the way pharmacies practice and make it legally binding, which will reduce errors. Who are these relevant parties- GPhC, SIs, PDA, NPA, etc. But in my view the GPhC and the SIs have lost credibility and I would exclude them from such talks- if I had the power.

Hannah Darling, Community pharmacist

Is the Boots pharmacist recruitment advert below ironic?

M Yang, Community pharmacist

"While rightly highlighting three incredibly tragic cases where patients had died as a result of medication errors by Boots pharmacists, the documentary also made clear these specific cases were not due to a lack of staff working in the pharmacies at the time. So how would the programme link staffing levels and patient deaths?"

Fatal dispensing errors come about because of gross negligence - in which the pharmacist is simply incompetent - or workplace pressures which causes increased stress, less time to work properly/safely and contribute to mistakes being more likely to occur.

 

DAVID MACRAE, Pharmacy owner/ Proprietor

Did Richard Bradley's body language suggest he was not telling the truth ?

Concerned Pharmacist, Community pharmacist

Boots suggest their (self-reported) error rate causing harm is 0.00041%.

However the best research available suggests a far higher rate - see http://qualitysafety.bmj.com/content/23/8/629.full.pdf%20html

This study showed an error rate of 6.8%,that's 17,000 times Boots reported rate, although admittedly not all will have caused harm. The rate was even worse with electronically transmitted prescriptions.

Boots quote 1% self checking; I suspect this is underestimated but regardless it still equates to 2.2 million items self-checked. The other items are dispensed with constant interruptions and potential for error.

Lets have some honesty here. Boots pharmacists don't have time to report using the onerous NRLS reporting systems, and they would be afraid to report as any error means they "haven't been following the SOPs".

If they reported just 10% of the anticipated errors according to the research paper above then they could anticipate disciplinary action.

No-one is perfect. we are all human and can make errors; workplace pressures increase the risk of that happening.

All of the 3 leading multiples, Boots, Lloyds and Well should just stop pretending that the blame lies with the branch employees.

Well Pharmacy have suggested today that pharmacist report their concerns, I suspect that Boots and Lloyd's have done the same. However there is a fear of reporting as to report may be to jeopardise employment or further worsen relationships with management.

This is why I am using the pseudonym and why the BBC had actors in your documentary.

The simple fact is that there is increasing pressure from all the multiples to make profit regardless of ethics. Services such as MURs are regarded as a commodity and bullying tactics are used to ensure that every branch delivers maximum income. The workplace pressures increase as a result of this bullying and the rsisk of errors increases. Morale is as bad as I have ever seen.

The government cuts are not the reason for this pressure but they don't help the employees. Corporate greed means that the profit must be maintained at any cost; the last things the owners care about is patients
or employees. Of course they run the risk of losing custom and perhaps that is the only glimmer of hope that there is a limit to the pressure.

How about the businesses encourage anonymous feedback from employees. I suspect there is widespread concern currently suppressed.

Concerned.

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