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Revealed: The rising levels of stress among community pharmacists

Exclusive
C+D analysed pharmacists’ responses to its Salary Survey over the past five years
C+D analysed pharmacists’ responses to its Salary Survey over the past five years

As the RPS uses C+D data to try to persuade Keith Ridge of the growing issue of pharmacy stress, we ask what effect it is having on pharmacists' health

Exclusive data compiled by C+D has revealed for the first time that stress among community pharmacists has risen six percentage points over the past three years, from 68% in 2016 to 74% in 2018. These findings were so concerning that C+D summarised them in a briefing document for Sandra Gidley, English pharmacy board chair at the Royal Pharmaceutical Society (RPS), who in turn presented them to NHS England chief pharmaceutical officer Keith Ridge in a meeting earlier this month (January 10).

Following the meeting, Ms Gidley told C+D: “All of those working in pharmacy will not be surprised that stress levels have increased... Many pharmacists are experiencing a greatly increased workload, which is not great for patient safety.”

Read C+D’s coverage of the meeting between Ms Gidley and Mr Ridge, or download C+D’s briefing document.

Where did C+D get the stress data from?

For the past five years, C+D has conducted an annual survey of community pharmacists and pharmacy staff, including collecting data on stress and workload levels and their impact on services to patients.

C+D analysed pharmacists’ responses for each of the past five years (2014-18 inclusive) to questions about their stress levels at work and the effect stress has on the service they provide to patients (see below).

What does the data show?

C+D stress graph

The most recent survey, which ran throughout October 2018, found that stress-related problems affecting pharmacists included: trouble sleeping, cited by 43% of respondents; depression (27%); drinking more than usual (11%); and suicidal thoughts (6%).

It's not only the pharmacists who are affected: stress was the most-often cited factor affecting pharmacy services, with 34% of the 1,067 pharmacist respondents to last year’s survey saying it had the greatest impact on their offering to patients.

What did pharmacists say about stress?

Respondents' anonymous comments for the C+D Salary Survey 2018 paint a grim picture of the toll stress is taking on pharmacists' services and health:

  • “I have to multitask to the point of it being unsafe.”
  • “I am stressed and distressed, which is affecting my family life.”
  • “Every day is the same. No cover for holiday or sickness…new services and targets to help reduce GP workload and stress, but no one seems to care how we can do this in a climate of reduced funding.”
  • “Shifts in poorly managed branches are hell to deal with. Redundant pharmacy software, misfiled scripts, poor communication, overworked and stressed staff…and over-exploited, yet underutilised, pharmacists.”
  • “I generally do four hours unpaid overtime each week to keep stress down.”

One pharmacist described how their “health deteriorated” to the extent that their “type 2 diabetes and blood pressure is now poorly controlled”, while another said: “I have developed arrhythmia and my GP says it’s stress related.”

Other pharmacists told C+D they had suffered conditions such as anxiety, obsessive compulsive disorder and hypertension as a result of stress at work. One pharmacist wrote: “I am currently absent from work due to work-related stress and reactive depression.” Another said: “I am currently on long-term sick leave, undergoing treatment for an illness potentially triggered by the stress of my job.”

A locum told of developing “a stress-related illness” at work, while another said they had experienced “panic attacks, palpitations and dizziness”. Other pharmacists also described suffering from “fatigue” and “hair loss” due to stress.

What did C+D ask pharmacists about stress?survey

In each of the past five years, the C+D Salary Survey has asked community pharmacists questions on stress, including:

  • Have you suffered from stress in the previous 12 months?
  • Has stress affected the service you give to patients?
  • How realistic is your workload (always realistic, mostly realistic, often unrealistic or always unrealistic)?
  • How high are your stress levels (very high, high, somewhat high, somewhat low, low or very low)?
  • Which factor most affected the service you provide to patients?
What happens next?

After speaking to Dr Ridge about C+D's findings, the RPS's Ms Gidley said she wanted to see a version of the GP Health Service – set up by the NHS in 2017 to “help doctors with issues relating to a mental health concern, including stress or depression” – extended to pharmacists and other health professionals.

In the meantime, the RPS is “deciding its next steps”, Ms Gidley added, “including the possibility of a roundtable meeting with other relevant pharmacy organisations from all sectors to try and progress this”.

C+D editor James Waldron has called the findings “deeply concerning” and pledged to sustain the pressure on the government to “take firm action to address this critical issue”. Meanwhile, deputy editor Lilian Anekwe – who compiled the data – has given further insight into what she learned from analysing the Salary Survey data, and explained why C+D’s briefing document should prompt a long overdue change in the sector.

22 Comments
Question: 
How is workplace stress affecting you and your patients?

Angry Pharmacist, Community pharmacist

I'm so glad I left community for the industry. More rewarding, more pay, more benefits, more progression, more respect, and less stress. I feel for my colleagues in the community.

H.N. BURDESS, Community pharmacist

I remember decades ago when one could read employment adverts in the P.J.  -"pharmacist  wanted as manager  for quiet branch. Good supporting staff and no paperwork. Salary negotiable." Ah the good old days .

John Blake, Retail Management

A prescription charge for everyone makes sense.  In Spain, everyone except the very poor pay 10% of the cost of the drug.  It all gets worked out at the till with up to date software utilised.

I am sure that ot does act as a deterrent to those who would stockpile medicines just because they are free.

Roy Sinclair, Community pharmacist

How I wish we were back to the old days. Tablets came loose in large containers. Bottles and caps for dispensing had to be matched up for each item. Labels had to be hand-written in copperplate script or later typed and then glued safely to the container.  If it was pre-1972 we simply called the item 'The Tablets' or 'The Mixture' and if anyone asked about it we would spend ten mintes fending them off and referring them back to the GP. If a patient asked 'How long a prescription would be,?' then the rquirement was that it should take less time than speaking that sentence.You handed out the items as a reply!  Everything else was manual - annotating, recording and filing the script, re-ordering etc. not to mention the number of items we prepared from scratch - 1% Dithranol in Lassars Paste in les than 10 minutes! There would be phone calls through to surgeries, speaking to the unreceptive receptionist and sometimes a dodgy prescription. Yes - we could easily manage 250 items a day with just a dispenser and manage the rest of the shop as will and go home happy knowing we were on the local 24 hour emergency call out. We knew we would be paid something in 2 installments in 3 months time (we had no real way of checking the payments) so all was well. Those really were the happy days !! Gosh it really was so easy and so rewarding in those days!

Lucky Ex-Locum, Superintendent Pharmacist

I used to manage 250 items a day WITHOUT a dispenser plus run the medicines counter and it was still less stressful back then. No MUR, no NMS, no flu vaccine, no 'services' generally, compounding was  FUN, less prescription volume, better stock availability, people who were actually prepared to wait for longer than 30 seconds wothout moaning, better staffing levels because there was more money to share, yes, it really was better back then.

Stuart Reeve, Community pharmacist

 

Reduce the stress by reducing the paperwork. We we all do 12 monthly safety reports, One annual safety report, Two audits and reports, Six pieces of CPD, Four NHSBSA MUR reports, Four NMS reports. Two SLAs needle ex. and Substance misuse.  Three declarations of  competence. Two pieces of CPPE for the new contract. Premises audit, fire risk assessment, disability access  assessment, MDS pre-assessments, Staff Appraisals. CD Register checks, fridge temperature recording, MHRA safety notices, staff levels of competancy assessment, interview forms, employment forms. Etc. Etc. 

I am sure I did not sign up for this when I became a pharmacist. 

 

 

 

 

Ronald Trump, Pharmaceutical Adviser

I left community pharmacy partly because of stress.Too many prescriptions to check, too many services you are forced to offer people (many of whom do not really want or need but are coerced into a tiny room) which have little evidence base or value for money for the NHS, too little support staff, too much pressure from management. Many pharmacists are trapped in their job by the financial burden of a mortgage, family, bills etc. It's a sad state of affairs.

Regards,

Ron

Graham Turner, Non Pharmacist Branch Manager

Me too, the bullying and inappropriate pressures from the area managers made the job impossible. Better to leave before you become that patient on several antipsychotics. It's not worth losing your health over.

Leon The Apothecary, Student

Expectations on community pharmacy in it's current state is unsustainable and unrealistic. Modernisation alongside simplification is a solution but not if its coupled immediately with reduction of resources as seems to be what is happening.

Prime example, why is eRD not already mandatory? Where it has been implemented, why is it administrated poorly?

Why doesn't the UK have a universial prescription ordering system? Why do we have the ability to order via phone, text, email, skype, carrier pidgeon and paper?

Why do we have prescription charges? Under 10% of people pay. We could all pay a little amount or none at all and the savings would be made just through reduction of adminstration.

Many questions, and I suspect simple answers.

Stuart Reeve, Community pharmacist

I agree but eRD is a poor system.

Lucky Ex-Boots Slave, Primary care pharmacist

Answers are not that simple I'm afraid.

The main issue is money. The country is poor, the government is poor, the NHS is poor and even 9 out of 10 poorest areas in Northern Europe are in the UK! And for the private contractors (e.g. large chain pharmacies) they only care about the profits and never about patient care. Please don't tell me mur and nms and flu jabs are about patient care because they never are! No one is willing or able to invest more money to improve the systems and because the NHS is simply a bottomless black hole which will suck up all the money invested in and the country is just too poor to keep pouring money into it!

eRD sounds like a good idea to reduce workload, but is it? Don't forget eRD comes with all sorts of limitations, firstly you need to identify the right patients for it. Imagine if someone has 10 meds which are all out of sync, think about how much effort will it take to put everything back in sync before you can issue 12 months' of eRD! And how about those meds which are not supposed to be taken long-term like diazepam and zopiclone? How about those needing frequent monitoring e.g. DMARDs and lithium and without bloods done we are not supposed to issue anymore until they have done it for safety reasons? And what if the patient got admitted to hospital at some point and some meds got changed and some don't? How about those meds to be taken only when required - most likely these are never in sync anyway? Also what about those meds which come in specific pack sizes that can't be split and however long they are going to last depends heavily on how mcuh and often they are used e.g. insulin test strips and needles, ventolin, creams and ointments? And what about those patients who are going through a dose reduction regime e.g. weaning off prednisolone, gabapentin or in the middle of swapping over from one antidepressant to another? By doing eRD under these circumstances are literally creating even MORE workload for oneself, and I am pretty sure more than half of the patients in this country fall into one or more of these categories!

Prescription charge - Having everything for free only happens in utopia but in reality it simply doesn't work unless the country is super rich to afford all those expensive meds, hiring healthcare staff, buying all the equipments  and maintaining them etc.! Wales and Scotland have been setting up really bad examples for providing everything and anything for free. Bare in mind there is a cost to everything and by offering all for free people will simply take it for granted, abuse it, and demand for even more! I have seen people bringing back 30 boxes of unopened rivaroxaban, 20 boxes unused Trelegy inhalers, or 10 packs of insulins saying they don't need them anymore. I am literally fuming and so heartbroken to see all these meds go into the doop bin but because of safety reasons none can be reused, and ths is literally pouring down hundreds or even thousands of pounds down the drain! Because everything is for free people do not give a sxxx to what they are ordering and how costly the drugs are as they get everything for free anyway! Instead of scrapping prescription charges I would rather see a 'prescription item charge' for maybe 50p per item regardless of whatever exemptions people have got so people will think twice before ordering anything. The idea is very similar to the 5p plastic bag charge to reduce abuse and as you can see plastic bag sales has dropped 86% since the introduction of the charge! I don't expect to see the same percentage with drugs. I will be more than happy to see just 10-20% reduction in med wastage!

Stuart Reeve, Community pharmacist

I agree with your 5p plastic bag charge. I have been saying this for ages. It will make them think 'Do I need this medicine this time or am I getting it because it's free'? Then I can get back to 'Real Pharmacy'. You know the one where you have time to speak to patients! 

 

 

Leon The Apothecary, Student

Flat fee definitely the way to go - as it stands 80p would actually give the NHS additional funding as well as savings. There's no strong argument against it!

Mark Boland, Pharmaceutical Adviser

I agree Leon, why not approach it from an intelligent solutions point of view. National ordering system that is responsibilty of the patient and surgery. Remove the need for labelling medicines and start full pack dispensing, continental Europe does just fine this way. Get rid of prescription charges in England.

Leon The Apothecary, Student

Speaking of which, the rollout of Pharmacies no longer ordering on patient's behalf seems to have slowed down somewhat, hasn't it? I've always thought it's not the remit of a pharmacy to order medicines, just to dispense them.

Lucky Ex-Boots Slave, Primary care pharmacist

Get rid of prescription charge? You are kidding me aren't you? Do you want to see even more abuse on the system? You do realise there is a cost to everything don't you 

Joan Richardson, Locum pharmacist

Increasingly patients are complaining when their medicines are not available for collection as expected usually due to volume of work so the script may be in the pharmacy but not yet dispensed.  Those on managed repeats are complaing that the re-ordering of  their items is not happening on time.  All of this contributes to stress for the whole pharmacy team.

Chris Locum, Locum pharmacist

I find literal interpretation is a problem with many patients and their ETP script. "It says on the surgery website that my prescription is ready. Explain why it is NOT ready!"

Pharmacy Career, Design

The amount of times you hear the same questions, such as 'Where is my prescription?' On repeat, there should be a brief video explaining pharmacy procedures, volume and how long it takes. Especially as many order late and come in too early

Lucky Ex-Boots Slave, Primary care pharmacist

No one gives a single sxxx about the pharmacy procedure. All they want is walk in, hand in script, pick up then walk out all done within 5 mins. 

Leon The Apothecary, Student

Also known as "The Amazonisation of Pharmacy"

Got to say, given the choice as a young male of breeding age, I would rather order online and have it delivered to my door. The multiples are trying to work this out at the moment, it won't be long before you see it commonplace.

There are even rumours of thought-dead companies getting involved with it if you follow the movement of management from companies.

Graham Turner, Non Pharmacist Branch Manager

Yep, and they do NOT want MURs, NMS etc!!!

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