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BBC investigation into Boots pressures 'didn't scratch surface'

One C+D reader said she is “afraid of making a mistake every day”
One C+D reader said she is “afraid of making a mistake every day”

The issues uncovered by a BBC investigation into staff pressures at Boots extend beyond the multiple, according to C+D readers.

A BBC television programme – which aired last night – aimed to explore pharmacists’ concerns over “workload pressure and patient safety” at Boots, the broadcaster said in promotional materials.

The BBC claimed Boots pharmacists had told it they are so overstretched that many are forced to “take shortcuts”, including self-checking medicines.

Reacting to the programme on Twitter, pharmacy professionals said the show “didn’t scratch the surface” of the pressures that pharmacists and their teams are facing every day, and the issues are not only a concern at Boots.

Whistleblower praised

Greg Lawton, former professional standards manager at Boots turned whistleblower, who appeared in the programme, raised concerns with the multiple and the General Pharmaceutical Council (GPhC) in 2015.

In the programme, Mr Lawton said: “I wrote a paper for the superintendent's office which set out...concerns, explained the issues with the staffing model and how that could put patient safety at risk.”

Mr Lawton – who at one stage in the programme was seen to get visibly upset over his concerns for patient safety – was praised by C+D readers on Twitter.

Boots pharmacy director Richard Bradley told C+D this morning: “Healthcare professionals across the country are facing increasing demands and we are committed to doing all we can to support our pharmacists and ensure our pharmacies are always well-staffed and resourced to meet these needs.”

Catch up with last night's episode of Boots: Pharmacists under pressure? on BBC iPlayer here.

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

James Mac, Community pharmacist

It seems fair to assume that people won't disclose their ommisions, e.g. self checking, even anonymously unless they're pretty disgruntled. I personally know of several branches (multiple businesses) where self checking is the norm mcdonald.

Stephen Walsh, Community pharmacist

Interesting statement on the programme from the RPS. Doesn't mention Boots by name once. 

Alternative Pharmacist, Community pharmacist

It was informative that yesterday Boots were forcing all Staff to sign a Declaration that they would not speak about the Broadcast!

Ilove Pharmacy, Non Pharmacist Branch Manager

God forbid the truth migh slip out!

CAPT FX, Locum pharmacist

There were a few serious inaccuracies in this report. They said fatalities due to dispensing errors are extremely rare. That is incorrect. They should have said known and reported fatalities are rare because these are grossly underreported.

Most multiples suppress this information and remember reporting these brings negative publicity. Look at how the Boots spin doctor played down everything which was being reported.

But for me all roads lead to the GPHC door. Why didn't they publish details of their investigation. Issues like the tools they used, if they used a professional investigation team, their results and conclusions. This would have been reassuring to the public they claim to protect. Their outright bland dismissal of 55 pages of concern was always expected but still very disappointing. There is need to urgently and completely revamp the GPHC to protect the public. How can a body that claims this very role be so out of touch and play catch up when issues are published. The Guardian story, and two BBC stories and all issues which their inspectorate should pick up in their travels.
Why is it that from it's birth they have not even cautioned one Multiple? If only they can see what's happening on the shop floor, errors and even fatalities are being managed and swept under the carpet. After their reaction to the BBC concerns no registrant will bother to engage the GPHC on anything , no matter how serious. It's an absolute waste of time.

Honest- Pharmacist, Community pharmacist

I have mentioned on other platforms that I feel a major component missing from last nights documentary was any mention of former boots employee Alison Stamps who felt her only choice was suicide and in the end made this choice.

Pressures can pose a risk to patient safety but also to the workforce too. A loss of a  life is a loss of life regardless who it is. It is important to have protective measures in place for both and to follow them through.

It strikes me that these matters can be overlooked. Your work force does not work for the business.. it is the business. You should protect this part of the business.

I also have a problem with the terminology 'industry leaders'.... is this based on profit? or number of stores? Or the best at healthcare. Number of stores does not make you the leaders, it means a bigger portfolio of number of stores. A huge profit does not necessarily make you leaders, it could mean you compromised elsewhere ie service. The best at healthcare can not really be measured can it as it is a matter of opinion.

I am not prepared to take the the terminology at industry leaders at face value.

Thoughts go out to Alison Stamps and her family and the bravery of Greg Lawton is no small act either.

 

Honest Pharmacist, Community pharmacist

Well said Raj, I was also waiting for them to mention Alison Stamps, sadly over this last 16 months I have been able to relate to how she must have been feeling, and I don't say that easily or flippantly.

These multiples need to be exposed for what they are, and they wouldn't know the first thing about 'patient care' if it hit them in the face. All they care about is money and profit, and forget that they even have a 'duty of care' to their staff.

I applaud Greg Lawton, I respect him for having the real integrity that these multiples have never displayed. We need more people like Greg, and we need less people like the Boots guy, Richard Bradley.

I also can never get my head around the fact that the GPhC, as our regulator, is not an independent body and has fellows from all of these multiples. This should not be allowed, the GPhC should not have the Superintendents from these multiples sitting at the same table as them - how are they ever going to treat pharmacists fairly when the leaders of these multiples are also on the board?! This needs addressing immediately or else we'll always have the doors slammed in our face - no matter how much we whistleblow! 

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

Clive Hodgson, Community pharmacist

If I may advance a few observations from the crop of public exposés alleging malpractice and disturbing working conditions in certain of our Pharmacy Multiples. A shame the BBC “Pharmacists under Pressure” could not have gone into more depth regarding the many other pressures faced daily by many Pharmacists that can adversely affect their performance and impact patient safety. It is not just about staffing levels, important as they are.

Individual Pharmacists come out of these investigations well. Arguably victims of the situation. Take Pharmacist “Tony” who featured in the Guardian “When Boots went Rogue” investigation by Aditya Chakrabortty.

As a pharmacist Tony was shown to be very experienced, knowledgeable and caring. Everything a good Community Pharmacist should be. Many Pharmacists however will identify with his position, that of being relentlessly ground down professionally, physically and mentally by the working conditions that were forced on him and over which he had no control.

Following on from this is how the status of Pharmacists has plummeted over the last decade or so within these Multiples.

In the not too distant past Pharmacists dominated the management structure both at branch and territory level in the Multiples. Not now. They are now marginalised with the situation that highly experienced Pharmacists are subordinate to (cheap) managers who last year were employed as dispensing assistants or selling mobile phones (I know of both). They are expected every day to sign on as Responsible Pharmacist whilst in practice have almost no say regarding facilities, staff hours or staff qualifications in their branch.

Performance is judged by how many MURs that can be churned out in a week and meeting all the other commercial targets that are set without fail. There is absolutely no professional career structure. Can anyone think of any other working environment where decades of experience and accumulation of so many additional skills and qualifications can count for so little?

Very depressing.

Ilove Pharmacy, Non Pharmacist Branch Manager

Yes it is. Blame the multiples and their cheerleaders.

David Moore, Locum pharmacist

Would Greg consider publishing his paper?

Amy McNellis, Academic pharmacist

I'd be more interested to see these academic papers that supposedly show that pharmacies with higher staffing levels have more dispensing errors to see if firstly, Mr Boots has interpreted his information correctly and secondly, whether they actually bother to account for the fact that pharmacies with higher staffing levels are more likely to have a higher volume of prescriptions, distractions etc

Concerned Pharmacist, Community pharmacist

Without adequate staffing levels, and with the very lengthy Datix/NRLS error reporting forms, it is only the higher staffed pharmacies that have time to report their errors. 

Error reporting should be made much simpler (we don't need to know the ethnicity, sexual preference, and shoe size of the patient in every near miss) and also entirely anonymous. Until this happens there will always be gross under reporting especially in those most work-stressed stores.

 

C A, Community pharmacist

Yes, it would be very interesting to see if it was interpreted correctly or if there was some form of survivor bias -

For example if you give people that are already multi-tasking another process/task it wouldn't be surprising to see productivity go down - especially when more pressure is associated with their performance in the original tasks. 

Conversely if you take tasks off people or allow them to delegate and ask them to report any errors, you are likely to see an increase in reporting.

 

Remember just because you call it multitasking doesn't mean it isn't really task-switching, and moving back and forth between several tasks reduces productivity, because your attention is expended on the act of switching gears.

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