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UPDATED: GPhC ran investigation into Boots' staffing levels

The BBC's programme on staff pressures at Boots will be broadcast in England at 7.30pm

The General Pharmaceutical Council (GPhC) ran an investigation into staffing levels at Boots in 2016, following concerns raised by an employee at the multiple.

Greg Lawton, former professional standards manager at Boots, sent the regulator a 55-page report on his “experiences and concerns” of patient safety at the multiple, “shortly before resigning in 2015”, the BBC said this morning (January 8).

The GPhC told C+D it conducted a “thorough investigation into [Mr Lawton’s concerns] and looked at evidence from a range of sources, including…from senior management at Boots, as well as information from [its] own regulatory activities”.

It closed the investigation in December 2016, and concluded that “there was not sufficient objective, independent evidence to suggest a risk to patient safety across the organisation”, according to the BBC.

GPhC chief executive Duncan Rudkin told C+D this morning that the regulator “looks into all concerns raised about pharmacy professionals and pharmacies, including any incident in which a patient is harmed by a dispensing error”.

“We take the clear view that setting the right staffing levels is best done by the people responsible for managing a pharmacy on the ground, rather than by the regulator at a distance,” he told C+D.

“We make it clear to pharmacy owners and superintendent pharmacists that they are responsible for making sure they have enough qualified staff in each pharmacy.”

The broadcaster made the allegations as part of an article published ahead of its programme this evening on staff pressures at Boots (details and broadcasting times can be found here).

Boots told C+D that it would not comment further until after the programme has aired.

C+D will be covering the BBC’s Inside Out investigation live on Twitter tonight at 7.30pm. Join in the conversation using #BootsOnBBC

Pharmacy's ongoing battle with workplace pressure

In 2016, a Pharmacists’ Defence Association (PDA) survey revealed that 55% of just under 2,000 employee and locum pharmacists at the multiples feel commercial incentives or targets compromise patient safety or professional judgement "around half" of the time or more.

The survey made international headlines after the Guardian used it as part of its allegations that some Boots managers had instructed staff to carry out unnecessary medicines use reviews (MURs). Boots said at the time that it did “not recognise” these claims.

The PDA survey and the Guardian investigation prompted the GPhC to launch a "programme of work" to address the issue of workplace pressure and discuss how best to support pharmacists.

39 Comments
Question: 
Do you feel staff pressures have ever posed a patient safety risk in your pharmacy?

Mohammed Patel, Community pharmacist

That error rate they provide cannot possibly be correct. It would suggest that you've got more chance of being beamed up into a UFO by Elvis whilst bring simultaneously struck by lightning, than experiencing a dispensing error from this company.

M Yang, Community pharmacist

The GPhC hasn't revealed how it measured Boots' staffing levels. Not only that, the regulator has previously opnely admitted that mandatory staffing levels are not enforced and it is up to individual employers to decide on what is sufficient.

The best hope for patient safety at Boots is for the BPA to become derecognised and the PDA put in place as the union of choice. Only then will pharmacists at that company be able to bring about change by collective action.

Arun Bains, Community pharmacist

#BootsonBBC It’s a shame that service pressures weren’t also addressed, MURs, NMS, Flu, target and retail pressures. And SOPs are useless if the area managers apply constant pressures or force you to work alone which forces self-check. And the bullying culture needs covering.

Paul Summerfield, Community pharmacist

I listened to the programme last night while driving and although it did through up some interesting points, I am inclined to agree with the contributors in that the programme did not address the issues such as additional services.

Rubicon Mango, Academic pharmacist

As I understand, the process is timed, for example how long it takes to dispense the common 50 items, each individual time is added including time to check and bag up the script. However, they do not take into consideration when your dispensing and checking, the phone going off, patients coming in, work fatigue, a prescription with an error that needs adjusting, blister packs, specials, these take time away.

Rubicon Mango, Academic pharmacist

Watched the programme, whilst I appreciate the efforts for all those involved with the programme, it really only scratched the surface.

However, pay attention to the number of items dispensed each year in total in the UK, and the population of this country. How that does not alarm any health professional is a mystery. First lesson in Pharmacy, drugs are potentially poisons!

We could have done more with actual coverage of why the Pharmacist is so busy, lack of breaks, long hours, demanding customers but also the issues with certain GP's who prescribe far in excess to keep their patient lists happy. Over-prescribing is a big problem in this country and it is not being addressed.

To be fair to Boots, most of the companies have poor working conditions. However, they clamour on about cuts now, what about 2012/2013 when working conditions in certain places were just as bad but no cuts occurred then?

The only change we can make is for people today when they walk into their branches, see what workload can be reduced. I locum the odd occasion on a weekend and in that branch, there are a lot of people on blister packs who don't necessarily need it, patients who do not need deliveries,  they use it for convenience! Young people with no learning problems on 2 tablets on blister packs, time we became a bit more ruthless! Good luck everyone!

Glyn Owens, Community pharmacist

I worked for Boots when the first wave of staffing hours cuts came in and there were many concerns then. However as a manager you tow the company line if you want to keep your job but there was no doubt about the feedback the senior managers were getting. I met Greg on many occasions during my time at Boots and he is one of the nicest, most sincere, down to earth people you could ever meet. I'm so proud of him for taking this battle all the way when so many others who knew the truth didn't even poke their head above the parapet. It's obviously taken its toll emotionally but thank you Greg.

As for the current situation, the Boots next to me has had several staff off with stress including the Pharmacist over the last year so I don't think staffing issues in Boots have been resolved yet,

Jonny Johal, Pharmacy Area manager/ Operations Manager

The error rate mentioned in the programme by Boots is selective (they just mentioned 'patients suffered harm') and possibly gives a false impression. I am sure one of the reasons why I stopped locuming for Boots, some 10 years ago now, was because of the large amount of dispensing errors I saw. There was one morning that I had to send dispensers out to patients' addresses multiple times to sort dispensing errors from the night before.

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

Jonny Johal, Pharmacy Area manager/ Operations Manager

Please be very clear, the current regime makes companies (and their superintendents) like Boots untouchable. The GPhC's policy is to police the profession through their superintendents (which I think is fundamentally flawed), the result is everytime something happens, the superintendent will sent out a memo or make amendments to the SOP, after which when a similar error occurs again the company is always absolved by 'SOP wasn't followed', thus the dispensing staff invariably gets the blame!

We must also not forget that how pharmacy is regulated was a product of consultations between the GPhC (at its inception) and the superintendents of the multiples, remember those secret meetings in the RPSGB?

The net result is the GPhC has become the de facto disciplinary department for companies like Boots and a mechanism to manage unwanted employees out of the business, why else would you think Boots just can't stop referring their own employee pharmacists to the GPhC for sanctions?

Stephen Eggleston, Community pharmacist

Whilst I don't argue this may be the best research available, it was carried out in 2013 and most of the errors were down to a single pharmacy - probably when most places (GPs and Pharmacists) were getting to grips with EPS. To be relevant, I think there needs to be new research carried out in order to give some overall context, positive or negative

Concerned Pharmacist, Community pharmacist

Whilst I agree that more research is needed, it is relevant to Note that the research paper also discusses and references a number ofother research papers in the field. All papers conclude that the error rates are way above those reported by the multiples through the current self-reporting (Datix) systems. My interpretation is not that most of the errors were down to a single phamacy, but rather that the increase in errors with EPS vs non-ETP dispensing was largely down to a single pharmacy.

 

 

 

 

Jonny Johal, Pharmacy Area manager/ Operations Manager

Clearly, a regulatory failure. The GPhC is a pure waste of time, what do they regulate? Their 'investigation' into Boots was probably a low effort exercise.

MICHAEL PARKER, Pharmaceutical Adviser

Isn't there an ex Boots director on the committee?

Jonny Johal, Pharmacy Area manager/ Operations Manager

The gamekeeper is also the poacher!

Ghengis Pharm, Locum pharmacist

Firstly, staff budgets are based on profit projections which are based on actual profits from previous years. No company is going to throw money at something unless it's within that budget.  Secondly, no mention of MUR's/NMS's/other additional services which the Responsible Pharmacist has to time-slice in between checking prescriptions accurately.  Thirdly, I've never seen a bigger bunch of fops on TV in my life trying to explain to the public what pharmacists actually have to do.

Stephen Eggleston, Community pharmacist

Watched the program. So, there was a lot of focus on patients who unfortunately died following dispensing errors, although I don't recall there being a definite link between the errors & the deaths but the program DID say (very quietly) that staffing levels were not an issue in these cases. If that is so, then why include them, other than to highlight that staff didn't follow SOPs. Then they moved on to Greg and his concerns about staffing. He raised concerns which, from what the program told us, were reviewed and some actions taken but, it appears,because Boots didn't (want to) spend £100,000,000 he then resigns and goes to the GPhC. Frankly, at the end of the program, all I could think was "How many Pharmacies will close as a result of this program" and, with it, "how many hard working staff will find themselves unemployed". Don't think it did ANY of us any favours

Farm Assistant, Community pharmacist

What would you have done in his shoes? An honest answer please.

Stephen Eggleston, Community pharmacist

Well, since none of us have all the information, that's a tricky one. Would I have gone to the GPhC? Possibly but that implies a complete lack of mutual respect within the company - and since I don't work for them, I am not in a position to comment on that. All I can say, with any certainty, is that, on those occassions when I have felt the need to raise an issue with my line manager, there has been a useful discussion and an outcome that everyone can feel comfortable with is reached.

The other thing I am unsure of is - what did he actually want to achieve, whether it be by writing the report in the first place, going to the GPhC or speaking to the BBC?

As an aside, why were the actors wearing white coats? If it was to represent the Boots Pharmacists who did speak to the BBC, I can't think of the last time I saw a white coated Pharmacist in Boots.

Angela Alexander, Academic pharmacist

I emailed the Producer of the programme about the representation of the two pharmacists by actors and she responded "The decision to use a white coat was an attempt to make it straightforward for the audience to identify at a glance which interviewees were speaking pharmacists’ words but represented by actors. It was, in effect, set dressing and intended to appear somewhat stylised to be as transparent as possible with our audience that these were not real pharmacists but speaking their words."

Myke Kofi, Locum pharmacist

Good for you Angela in conatcting the producer. Through no fault of their own, I felt that the two "actors" came across as inauthentic and therefore insincere. It would have been a far more powerful testimony had the account of what led to the dispensing errors had come directly from the pharmacists involved. However, I commiserate with their need for anonymity.

Jonny Johal, Pharmacy Area manager/ Operations Manager

I agree. I also found myself disagreeing with many pharmacists who appeared in the programme.

Farm Assistant, Community pharmacist

The love of money is the root of all evil. I have just watched the programme and Greg (I hope you read this) made me proud of the human race. On the other hand the company spokesman made me ashamed of being a pharmacist. EVERYONE in the profession and I mean EVERYONE knows the truth, even the lost souls in Canary Wharf who sit in judgement of us. Where do we go from here? The only way anything will ever change is if the govenrment were to press a charge of corporate manslaughter but that is not going to happen now that we have the lovely responsible pharmacist escape route. I hope this programme is the start of a gathering storm as nearly every pharmacist I speak to wants out.

H.N. BURDESS, Community pharmacist

Farm Assistant: Your comments are a perfect piece of prose and you summed up the situation very well - you are in the wrong job! The G.Ph.C. will not do anything- it has neither the guts nor the money.

 

 

Ilove Pharmacy, Non Pharmacist Branch Manager

Nothing will happen. Boots have too many allies( C&Dincluded who will remain mute or dismiss it completely. Even as we speak Waldron is employing deflection techniques(on Twitter) by stating he has heard these ‘stories’ by non Boots pharmacists. Lol.

Ilove Pharmacy, Non Pharmacist Branch Manager

Investigation. Lol. 

Meera Sharma, Community pharmacist

Following the last farce by the GPhC (after the Guardian expose), I did write in to the PSA - guess what? Not even an acknowledgement - almost a case of  nobody wants to tackle this. Best thing is as Rubicon has suggested, there needs to be a petition of "no confidence" in the GPhC - its very obvious that they "cherry-pick" what gets investigated and what doesn't, with no transparency as to what criteria are used.

John Smith, Locum pharmacist

The GPhC “conducted a thorough investigation into” Mr Lawton’s concerns, Mr Rudkin added, and came to its conclusions “after carefully reviewing all the available evidence”

What was the nature of this investigation into the concerns raised? What form did it take? Was it thorough and objective? What was the outcome? Can the GPhC release any resultant reports?

Do you, Mr Rudkin, understand that this singular issue is of the utmost importance in regard to the safety of the public?

Do you understand that placing responsibilty for staffing levels with the very same people who are instructed to constantly increase and maximise profits is a serious conflict of interest? Can you see that it represents a dereliction of duty on behalf of the GPhC who are charged with the very serious duty to protect the public from harm?

Do you acknowledge that the GPhC has the power to initiate steps thatt would compel pharmacy owners and superintendents to adequately staff pharmacies?

A Hussain, Senior Management

“We take the clear view that setting the right staffing levels is best done by the people responsible for managing a pharmacy on the ground, rather than by the regulator at a distance,” he told C+D.

What a cop out and a joke! The best person to control the speed of a car is the driver, but the regulator (the police) still have to do their bit for those who don't obey the rules.

Ilove Pharmacy, Non Pharmacist Branch Manager

GPhC or Keystone cops. Take your pick.

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