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Targets push employees to conduct unnecessary services

Contractors say the overall results of the C+D Salary Survey 2015 show a disproportionate focus on service volume rather than quality

Thirty-one per cent of respondents to the C+D Salary Survey 2015 say they carry out irrelevant services every day to make up numbers and a further 22 per cent do so once or twice a week

EXCLUSIVE

More than half of pharmacy employees regularly conduct services they consider clinically irrelevant simply to meet targets, the C+D Salary Survey 2015 has revealed.

Of the 1,178 employees who took the survey, 31 per cent said they carried out irrelevant services every day to make up numbers and a further 22 per cent said they did so once or twice a week.

The findings came against a backdrop of high pressure to meet service targets. Thirty-one per cent of employees say they are under so much pressure that it affects their quality of work, revealed the survey, which ran from September 29 to November 11. This represented little improvement on the impact of pressures reported by employees the previous year.

Multiple differences

Of the national multiples, the effect of target pressure appeared to be most prevalent at Lloydspharmacy - of its 133 employees responding to the survey, 40 per cent reported conducting clinically irrelevant services every day to meet targets. The figure was only slightly lower among Co-operative Pharmacy employees, 38 per cent of whom conducted this volume of services they deemed unnecessary.

Lloydspharmacy told C+D it conducted its own employee survey each year and sought to address any concerns raised. The Co-operative Pharmacy said pharmacy could be a “challenging profession” but that it aimed to ensure employees were aware of how to raise any concerns through its field management, HR and superintendent teams.

Boots was the national multiple with the lowest amount of pressure reported, with a quarter of its 164 employee respondents conducting unnecessary services every day - lower than for the supermarkets (38 per cent of 120 respondents) and independents (32 per cent of 247 employees). Boots UK director of pharmacy Peter Bainbridge told C+D that the company was pleased to see the steps it had made to reduce pressure on its pharmacists and simplify its processes were “having an effect”. It would continue to focus on these issues in the future, he added.

 

Quantity over quality

Contractors said the overall results showed a disproportionate focus on service volume rather than quality. Martin Bennett, owner of Wicker Pharmacy in Sheffield, argued that targets should be “aspirational” and stressed that it “would seem wrong to just artificially [carry out MURs] in order to meet a number”. “It’s the wrong mentality. We should be talking [about] patients,” he told C+D.

Ani Patel, owner of Savages Pharmacy in Essex, told C+D it was “wrong” to set targets for services. This led to pharmacists concentrating on “number crunching”, whereas they were more likely to identify a need for services through conversations with patients, he said.

But Graham Phillips, owner of Manor Pharmacy Group (Wheathampstead) Ltd, said it was easy to “scapegoat” service targets when lack of resources was the real problem. “There’s a myth going [around] that targets are inherently a bad or unprofessional thing. But if you look at healthcare, it’s all about targets,” he said.

Pharmacists’ Defence Association director John Murphy told C+D he was concerned pharmacists carrying out irrelevant services could lead the profession into “disrepute”. “Despite the good intention of MURs, we have a situation whereby they’ve been taken over by other commercial imperatives to get them done and get money in the till,” he stressed.

 

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How have service targets affected you?

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26 Comments

S S Locum, Locum pharmacist

The percentages quoted above should be doubled. That would reflect the true figures , i think !!

S S Locum, Locum pharmacist

All the MUR and NMS forms should have the following questions at the end of the form ( FOR AUDIT PURPOSES ): WAS THIS CONSULATATION USEFUL / WORTH IT ? DID IT IMPROVE YOUR KNOWLEDGE ? DOES IT DESERVE A PAYMENT OF £28- £30 TO THE OWNER ?

Huzaifa Motala, Community pharmacist

From the code of conduct As a Pharmacy professional: You must make patients your first concern New code of conduct As a Pharmacy professional: You must make money your first concern

Balwinder Lotay, Locum pharmacist

Ha Good One and a fact!!!

Gerry Diamond, Primary care pharmacist

Again it's not the targets that are the issue, but resources are the fulcrum around which this matter has some resolution. I do not advocate lower salaries for pharmacists but if we have them then lets employ a second pharmacist at least part time to support and deliver these additional or core services i.e. NMS, MURs and so on. Perhaps it will be more pharmacists in a job and less pressure on them, therein the quality of the services would be improved and the outcomes enhanced to make substantive differences to pharmaceutical care of the patient. As an over 50 with 30 or more years experience and more qualified than the average community pharmacist I've seen my salary drop as the market moves on but it is getting by that is important.

Chemical Mistry, Information Technology

It is interesting that Gerry as up skilled himself but still his salary drops therefore you do the same job as less skilled, what is the incentive! I would urge every pharmacist to listen to a radio four podcast file on four on nurse shortage in nhs it made very interesting listening.

London Locum, Locum pharmacist

Yes. You're better off as a nurse. Much better off.

London Locum, Locum pharmacist

Dear Gerry, With rates as they are a 2nd pharmacist would be better off working in Mcdonlads.

London Locum, Locum pharmacist

Dear Gerry, With rates as they are a 2nd pharmacist would be better off working in Mcdonlads.

Gerry Diamond, Primary care pharmacist

Again it's not the targets that are the issue, but resources are the fulcrum around which this matter has some resolution. I do not advocate lower salaries for pharmacists but if we have them then lets employ a second pharmacist at least part time to support and deliver these additional or core services i.e. NMS, MURs and so on. Perhaps it will be more pharmacists in a job and less pressure on them, therein the quality of the services would be improved and the outcomes enhanced to make substantive differences to pharmaceutical care of the patient. As an over 50 with 30 or more years experience and more qualified than the average community pharmacist I've seen my salary drop as the market moves on but it is getting by that is important.

Brendon Jiang, Community pharmacist

I don't quite understand what all the fuss is about. With any given service it can be quite difficult to assess whether the outcome will be clinically important or necessary before the service has taken place. I have conducted non-targeted MURs with patients on very few medicines who have benefitted greatly from my time with them. Conversely a recent monster MUR of 15 items and multiple target groups yielded a very engaged and enlightened patient who I could only provide reassurance that they were being treated and monitored appropriately and had a solid grasp of their therapy. You can never assume that a given patient will not require an intervention until you have sat down and taken them through the service. Perhaps the survey included the other myriad services that are tacked on and targeted for growth in some chains: repeat ordering, blood pressure/CV/diabetes health checks, ventolin PGDs, EHC, supervised consumption, needle exchange, dosette boxes to name a few. In my opinion NMS and MURs are fantastic services which not only allow you to build great relationships with your patients and prescribers, but also provide a valuable service income stream. Why wouldn't the profession want to complete as many as is feasibly possible?

John Randell, Non Pharmacist Branch Manager

hi jiang you are probably a regional manager or pre-reg or dispenser.......you wont understand that customers are demanding and often think about themselves and THEIR need to talk to a pharmacist very few will wait while you are conducting a long and engaging clinical MUR on 15 items.... congratulations you have conducted that MUR and helped that patient...but on the other hand you have missed out on 5 MURs have angry customers----which will lead to customer complaints,staff.delivery drivers, all have been made to wait and are angry at you... ITS NOT THAT PHARMACISTS DONT WANT TO DO MURS....IT COMES DOWN TO RESOURCES AND SUPPORT...

London Locum, Locum pharmacist

If it was about the patient benefit there would be no cap at 400. Think about that. MURs have nothing to with patient outcomes. It's about financial outcome

Hayley Johnson, Community pharmacist

"Why wouldn't the profession want to complete as many as is feasibly possible?" - Because of that massive queue of angry, impatient people out there also demanding to speak to their pharmacist, not to mention the delivery drivers angrily waiting for you to check a huge pile of prescriptions to take the last load of deliveries out, the 20 minutes spent on hold to try and get hold of an out of stock drug etc etc etc.

John Randell, Non Pharmacist Branch Manager

CAN PEOPLE STOP refering to the gphc...the gphc is not their to baby sit pharmcists or look after them in times of need.THE GPHC IS AN INDEPENDENT BODY WHOSE PRIE FOCUS IS TO PROTECT THE PUBLIC.......NOT PHARMACISTS ALOT OF PHARMACISTS GET CONFUSED PLEASE READ THEIR WEBSITE FOR MORE INFORMATION... PHARMACISTS HAVE NO BODY OR REP TO STAND UP FOR THEM...THE BODY WE DO HAVE ROYAL PHARMCEUTICAL SOCIETY IS EMPATHETIC TO EVERYTHING AND RARELY HAS THE MEANS OR RESOURCE TO HELP.....best action will be to put your money into the hand of the royal pharmacuetical society and demand they do more to help pharmacists.

Balwinder Lotay, Locum pharmacist

Why do we pay them annual fees? The RPS only only ever backed the Multiples and do you know how many Pharmacists faced the Statutory committee with them in the past when these multiples made us work with the minimum staff levels possible ?

Hayley Johnson, Community pharmacist

I know this is minor and petty, but please stop with the RANDOM CAPITALS. It makes your comments really hard to read.

Clive Hodgson, Community pharmacist

Hi John R. The suggestion is that there is possible fraud against the NHS with employee Pharmacists having their arms twisted to perform clinically useless services for the financial benefit of the Company. That is a matter for the GPhC. The GPhC has been happy in the past to take action against individual Pharmacists when asked to do so by these Companies when they want to send an intimidatory message to their employees.

London Locum, Locum pharmacist

Err that's the problem John many people aren't sure how independent the GPHC is. The rulings always seem to crush the individual whilst the particular multiple directing these actions repeatedly get off scot free. People are not stupid.

London Locum, Locum pharmacist

The Pope is also Catholic in case anybody is wondering. The situation is Very nicely put by previous posters. Of course Murs/Nms are in the main box ticking exercises to collect £28 for the multiple/independent. They push the individual into committing fraud with the threat of the sack hanging over them. The spoils are collected by the contractor/multiple but when it goes pear shaped the individual is hung out to dry. This so called profession is a joke and and gets worse by the day. In fact it's no longer a profession as it simply doesn't meet the necessary criteria to termed so. Pharmacists are no more professionals than a kid frying chips at McDonald's these days. Even the wages will slip behind sooner than later.

David Lewis, Community pharmacist

This is news???? Is anybody surprised to read this? We all know what's going on but for an employee to 'raise a concern' is never going to happen. I believe it's called 'performance management'.

Niall Murray, Superintendent

Clive/Graham. Accurately & eloquently put. Getting someone to understand something when their salary/career/profile depends on them not understanding it depicts the situation and relationship between gphc & corporation pharmacy. This has always been the case and to read circa 40% will behave in this way is a direct reflection on the profession not individuals. Big, big question and I have said this to a small number of key individuals at rps: who has ever, ever reviewed the quality of MURs. Ansa: no-one. Defence rests.Our 'system' is adept at turning agression and blame on individual pharmacists when it is the gphc needs regulation. Pharmacists have no space, status or structure to operate professionally or properly. We feel condemed before we start. A profession in search of a role...

Clive Hodgson, Community pharmacist

Those Pharmacists performing unnecessary or clinically useless services to meet Company targets are only doing so because of threats, of varying degrees of subtlety, from management. With the employment situation as it is, I doubt many Pharmacists will make a stand against these pressures for fear of being “performance managed” out of their job and into unemployment. If there was any justice it would be the Superintendents of some of these Multiples up before the GPhC as they are ultimately responsible for the pressurised sweatshops many employee Pharmacists are forced to work in. Specifically, could not the methods used to force employee Pharmacists to meet the compulsory 400 MURs/year target be interpreted as incitement to commit fraud against the NHS? However, I doubt we would ever see the GPhC taking action against the large Multiples. The RP regs and Company SOPs provide a firewall to protect them in situations like this. Also they have the considerable resources needed to influence behind the scenes and if it came to it they could muster a defence team that could most probably outgun the GPhC. Unfortunately, it is just so much easier for the GPhC to ignore the situation.

London Locum, Locum pharmacist

gphc and B**ts are interchangeable and can get confusing at times. Also interesting to note the 'captive employees' at B**ts are suffering from Stockholm syndrome it would seem.

Farm Assistant, Community pharmacist

Bang on the money. Maybe C&D could do a survey of how many pharmacists have actually been threatened with the sack if they don't perform? Not that it would do any good as the GPhC are bought and sold and would never do anything with the results anyway.

Clive Hodgson, Community pharmacist

C&D. Could you have a look the new post/reply function? When posting, multiple paragraphs are getting merged into one making it harder to follow. Thanks.

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