BBC's Boots investigation sparks pharmacy 'self-checking' debate

The BBC's programme on staff pressures at Boots was broadcast in England on Monday, January 8
The BBC's programme on staff pressures at Boots was broadcast in England on Monday, January 8

Boots pharmacists self-check medicines in "less than 1%" of cases, the multiple has said, in response to a pharmacist's testimonial during a BBC investigation.

The BBC's Inside Out programme – which aired last night – aimed to investigate pharmacists’ concerns over “workload pressure and patient safety” at Boots, the broadcaster said in promotional materials.

The programme included anonymous testimonies from Boots pharmacists, one of whom claimed that a lack of staff “often” means pharmacists are forced to self-check medication.

Boots pharmacy director Richard Bradley said in the programme that in "less than 1% of the time, or 1% of the prescriptions that we dispense, a pharmacist will return to their own work and check that prescription themselves".

Mr Bradley told C+D this afternoon: "In quiet times, such as late at night in one of our midnight pharmacies, a pharmacist may check their own work. They have ample space and time to be able to do this."

The multiple has a standard operating procedure in place "if self-checking is required", Mr Bradley added. “It advises pharmacists on how to do this safely, including taking a mental break and stepping away before coming back to check the prescription.”

"A last resort"

According to the BBC, Boots told the programme that "pharmacists should only check their own work as a last resort".

"All of our prescriptions are checked twice before they go out," Mr Bradley stressed on the programme.

While C+D readers on Twitter stressed that self-checking is a “big no-no”, locum pharmacist Ehtisham Kiani said it is "very often the only resort" for "late-night stores and at weekends".

Sadia Qayyum, a former Boots pharmacy manager and now northern lead for the Primary Care Pharmacy Association, said: "This was a regular occurrence for me before I left management."

In last night's programme, Mr Bradley added: "If we have pharmacists who think they are in situations where they are having to [self-check] when they shouldn't, they have a professional responsibility to raise that."

He also stressed that if any Boots pharmacist "fears speaking up, they can ring me direct".

"I absolutely assure confidentiality on that, just like we do with our whistleblowing hotline," he added.

Mr Bradley told C+D that: "We have an open and honest learning culture and are always looking at how we can do things better and more safely, including listening to our colleagues about their experiences on the ground and encouraging them to share their views."

C+D asks: Are there times when self-checking is acceptable?

 

During the programme, C+D led a debate on Twitter using the #BootsonBBC hashtag, which uncovered that many of the issues raised are not just affecting staff at the multiple (see more of the reaction here).

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

25 Comments
Question: 
Have you ever resorted to self-checking when under pressure?

Arun Bains, Community pharmacist

Complete pie-in-the-sky..... Boots Pharmacists are constantly left alone during late shifts and weekends.

Lucky Ex-Locum, Superintendent Pharmacist

Seems like that programme has had the desired effect and completely deflected any blame from Boots and GPhC onto the usual scapegoat, i.e. us. Why is no-one really bemoaning the fact that the BBC didn't mention the real causes of the worst pressure any of us have ever known - targets for MUR/NMS/services etc., the erosion of our role, pay cuts, increased workload and all the other crap that has sifted down from on high over the last few years.

Self checking is not much of an issue really. I self checked for the first six years of my career as a pharmacist because Lloyds didn't see fit to provide me with a dispenser because I was 'only' doing around 200 items a day. I can't say the error rate was any worse during that time. 

 

Benjamin Leon D'Montigny, Non Pharmacist Branch Manager

I'm personally just curious where he got that percentage from - like his source material, polite answers only.

Richard Binns, Primary care pharmacist

Out of curiosity (and a slight diversion from the Boots discussion), but can anyone confirm whether or not the large supermarket chain that I stopped taking bookings for a couple of years ago, is still leaving pharmacists on there own with no support staff for at least 2 hours of their shift?

Ava Denuff, Locum pharmacist

I haven't worked for the said chain (every little helps) for some time (by choice). I do recall an instance when i was told I was going to have work alone for an hour whilst the member of staff I had was on lunch break. I contacted customer services to get me another staff member . They duly tried but told me there was no-one available. I carefully explained my position as a locum and that I wasnt ableto feel satisfied with the safety. Unbelievably, the manager accepted my points and we closed teh pharmacy for a period so that both she and I could take breaks. I was so not ready for that ! 

It almost sounds like I am defending them, but I would wager that this happens rarely if ever. But I would encourage anyone in that position to put a case forward to close on safety grounds. If these big chains are so concerned with genuine safety issues, they will agree to close......won't they :-)

Ava Denuff, Locum pharmacist

Hahahahahahahaha..... realised how deluded my last sentence was.....

Lucky Ex-Locum, Superintendent Pharmacist

If that chain is the one beginning with T ending in O and with ESC on the middle then, yes when I last did a shift for them several weeks ago, I was on my own for the final two and a half hours of my shift from 8pm. The morning shift is also alone for at least an hour and a half so thats FOUR hours every day where the pharmacist is home alone. That is in direct contravention of their written policy which is to always have one trained dispenser on duty with the pharmacist at all times. 

Chris Pharmacist, Community pharmacist

Without the name of the chain how would anyone know?

But if a pharmacy is open until 11pm, a member of support staff may not be needed after say 8pm in many quiet pharmacies

Richard Binns, Primary care pharmacist

why? does the pharmacy not accept scripts for dispensing after 8pm, nor offer EHC consultantions where the pharmacist is required see the patient in the consultation room, nor supervised methadone........

My point being that surley there should be no instance in community pharmacy where it is routinley acceptable to have an individual working on their own, unless in an unexpected emergency?

Chris Pharmacist, Community pharmacist

Having worked in many supermarket pharmacies my experience is that after 8pm, sometimes earlier it is incredibly quiet... rarely an OTC sale or Rx, never done a EHC consultation or supervised consumption...

...of course it depends on the pharmacy. Some can still be busy and if so of course support staff should be there but some are quiet, sometimes the whole supermarket is quiet.

It does also depend on the capability and experience of the pharmacist at the branch in question. I see you are a primary care pharmacist and perhaps don't need to sell your skills and capability to secure bookings compared to a full time locum and perhaps that does account for your opinion.

Richard Binns, Primary care pharmacist

Hi Chris, thanks for the reply.

Just for the sake of clarity, yes my current role is Primary Care based, however at the time of my experience with the Pharmacy chain we are discussing, I was in the process of relocating and was between permanent positions (the post I had just left was that of Superintenent of a 100 hour pharmacy), hence forth my income at the time was dependent on community locum bookings and the cancellation of 3 months worth of shifts with one particular chain did have a potential significant impact on my earnings for that period.

without going into specific details about the incidnet, I found myself in a position where I had to make quite a significant and time consuming intervention with a particularly vulnerable patient, which required my full attention for a time period lasting over an hour. In my opinion this was complicated greatly by not having a second member of staff present to man the pharmacy counter and manage the angry gathethering of customers who felt I was ignoring them.

My feeling is that yes most of these late night opening pharmacies are virtually deserted, however the workload and circumstances we are facing on these shifts we work are not predetermined before we accept the shifts, hence we don't know what we may encounter.

A hundred hour pharmacy is open on the basis that it is contracted to provide NHS services for the duration of its opening hours and to do so adequate support staff surley must be inplace. My view is that this is important to safe-guard both the patients recieving these services and the professionals providing them.

I know its easy to assume because things have been ok previously then it is ok to continue an action, but what the documentary (and other high profile cases surrounding dispensary errors, one of which with this very chain), must surley highlight is that one day we all have to be prepared to accept something has gone very wrong and we may be called upon to defend ourselves infront of a coroner or a magistrate. Is the acknowledgment that we wilfully undertake these duties without support staff present defensible?

 

Stefan Krykant, Community pharmacist

The big chains provide the locum with totally inadequate staff levels, at least that is what I have observed and experienced myself. They know about this, I am sure, because it saves then money. After all, they are a company so the only thing the company cares about is making as much money as possible to feed back to the shareholders and pay the installments on the CEOs yacht.

Healthcare professions should not be seeking to capitalise and make profits on a persons health, or lack of,, and should be there to help and assist the public in anyway possible. We are supposed to be caring about the health of our patients, not selling lipsticks to make up for the M category clawbacks.

Pharmacy has been infiltrated by predatory companies who want to squeeze every minute out of your working day to perform pointless activities which just create further resentment. Nobody wants an MUR, apart from lonely old grannies who don't get much chance to have a conversation with anyone.

Which means I have to spend 10 minutes listening to an 80 year old talking about the fact that her cat may or may not have hives. Oh well, at least my employer is getting 28 quid for it, whilst I get nothing. How can we find the time to do all our work and services on top with no additional staff?

The simple answer is that we cannot. And we are rolling the dice with pur patient's health, as a result. If I refused to self check, I would never get any bookings and end up broke and homeless.

I just cannot see how an independent pharmacy can turn a tidy profit, when these huge companies are hoovering up your customers with free delivery. Whilst all the time the profits are being funneled back to Zurich!

But as is usual in this industry, nobody actually does anything about it ,so of course further cuts will follow because we don't have the power of a collective voice or union.

The hole we find ourselves on is happpening because pharmacists don't get together, we rarely protest, and we never strike. Compare that to our doctor friends, who don't stand for this absolute ****.

On well, I should have listened to the career's advisor at school. But at least I can advise my children about a profession they should never go into.

Meera Sharma, Community pharmacist

I'm amazed that the BBC did not think to simply walk into a Boots store and just record on their iPhone what is going on in reality. As a former Boots employee, self-checking is a regular occurrence when you're the sole pharmacist covering dispenser day-off, late evenings, weekends when there were breaks and during odd occassions during the day. Not to mention the immense pressure placed by the silly dispensary design which has you dispensing medication in front of the patient, so that if you finish and put it aside to give yourself a mental break (as per SOP!), you have a screaming patient! Would Mr Bradley like to refute all these scenarios?? One only has to look at the volume of scenarios sitting on PDA's desk to see this resonates practically with every pharmacist within the last 5 years at least. Furthermore, what this filming will also highlight is how many times the pharmacist gets interrupted during their so-called checking time - queries, phonecalls, MUR opportunity, patients who have a complaint - simply because the store has no extra staff to deal with all the tasks. The BBC documentary scratched the surface of the problem, could have really done a lot more justice to this topic. More importantly, the causes of the tragic deaths were not really highlighted - it's all very well saying staffing/pressure was not a factor, but what was the factor that played a role, and what has Boots done about these? Once again, Mr Bradley stated that extra pharmacists etc have been employed, but if staff pressures were not the problem, why were extra pharmacists then employed? Very weak investigative journalism, you can do better BBC.

Graham Morris, Design

This whole scenario of self checking could be solved by the GPhC deciding that self checking by the pharmacist, except in the most exceptional of circumstances (e.g. After hours call out) be declared unprofessional conduct. Employers would then be duty bound to ensure adequate staffing levels throughout the working week. Secondly, a pharmacist should be expected to take an adequate lunch break away from the dispensary. Oops, sorry, I was just dreaming, as when profit is involved, safety may be a secondary consideration.

Ilove Pharmacy, Non Pharmacist Branch Manager

impossible when the GPhC are in tandem with multiples. It's like asking the son to police his father.

Alternative Pharmacist, Community pharmacist

I was self checking in a Boots Store yesterday due to Staff shortage!

Alternative Pharmacist, Community pharmacist

I was self checking in a Boots Store yesterday due to Staff shortage!

"Mr Bradley told C+D that: "We have an open and honest learning culture and are always looking at how we can do things better and more safely, including listening to our colleagues about their experiences on the ground and encouraging them to share their views.""

If I complained my Area Manager (Non-Pharmacist) would destroy me!

Ilove Pharmacy, Non Pharmacist Branch Manager

Exactly and if you werent afraid of being sacked you would use your real name. But obviously that is not a realistic option despite the li*s pedalled on the programme

Fiona Roberts, Community pharmacist

Moving to New Zealand I have been most concerned here that the Pharmacy Techs I work with find second checking a pharmacist a very odd idea. OK the shop I work in is pretty quiet compared with where I worked in the UK and was run by the same owner/pharmacist for the last 30 years so any "new" concepts are difficult to accept but I'm making progress.

enrique montes, Community pharmacist

Bottom line of this issue is that at the end of the day SOPs are a weapon to be used against pharmacy staff to avoid company’s liability if mistakes happen. What this BBC report didn’t show is how bad as a pharmacist we feel when we make a mistake and how concerned we are for our patients’ safety day in and out, copping with huge amount of pressure and with stretched teams that makes our job more and more unpleasant. The way community pharmacy is being driven by both NHS and big companies is ludicrous.

Concerned Pharmacist, Community pharmacist

What was that ridiculous self-reported error rate that Boots quoted? 0.00something%

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

This study showed an error rate of 6.8%,that's more than 1000 times Boot self reprted rate. The rate was even worse with electronically transmitted prescriptions.

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

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.

Concerned Pharmacist, Community pharmacist

and the rest!

Ava Denuff, Locum pharmacist

Did i hear correct that they dispense a total of approx 220 million scripts/year? So if 1% are self checked "as a last resort"...doesnt that mean 2.2 million items are self checked? Thats an awful lot of last resorts isn't it? Is Mr Bradley aware of the huge risks associated with this massive amount of self-checking? 

Concerned Pharmacist, Community pharmacist

and the rest!

 

Told Youso, Pharmaceutical Adviser

So….Richard Bradley, the Boots Superintendent, doesn’t “recognise” the situation described by Greg Lawton (because, of course, Greg left 2 years ago and his concerns are not “relevant to Boots today”). Well…perhaps I should direct Mr Bradley to a Boots optician to get his eyes tested…although they under investigation for allegations it misled customers over 'gadget glare' …..perhaps Specsavers instead eh?

The programme was meant to be about pressure amongst the pharmacists and yet no mention was made of the additional workload caused by MUR, NMS, flu jabs, smoking clinics etc etc

My biggest issue is SOPs. Time and time again there was reference to the pharmacy team having deviated from the SOP (referred to by the BBC as cutting corners) and thus the blame was squarely at their feet rather than at Boots’. The police used to teach a system of driving (Roadcraft: the Police Drivers Handbook) in which, in theory, it was impossible to have an accident since every eventuality would be considered by the qualified driver. If an accident occurred the officer would appear in front of a panel at which, at some time, he would be asked…”did you deviate from the system?” to which he would be compelled to answer “Yes” since perfect adherence to the system meant there could not have been an accident and thus……. The police could always point to the driver having broken his SOP (the system). This seems to be Boots’ approach. Perhaps Boots pharmacists should, after tonight’s programme, work to rule (or work to SOP)!! No deviation whatsoever. No locum will lift a finger until he/she has read all the SOPs and induction documents. Let’s see how the business runs then.

Let us test this “open and honest culture” Mr Bradley spoke of and ring him (as he invited us to do) every single time you are in a Boots dispensary, alone, on a Sunday, and have to self-check every single prescription that comes in be it a couple or a hundred! Oh no!!!! He doesn’t work Sundays does he? With such an inability to see the reality of things I wonder he doesn’t go into politics.

 

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