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'Staffing levels must be taken seriously, before it's too late'

"Our pharmacists and their teams are suffering"

Staffing levels in community pharmacies must be taken seriously or risk compromising patient safety and workforce mental health, Laura Buckley warns

The old adage ‘too many cooks spoil the broth’ isn’t one that can necessarily be applied to community pharmacy. At least, I can’t imagine it has ever been tested, since many of our pharmacies aren’t staffed to meet the demands of the patients we care for. A more appropriate phrase might be ‘not enough colleagues to keep it safe’.

A lack of definition for safe staffing levels means that our pharmacists and their teams are suffering. Considering that a core role in the profession is to minimise risk, it would seem reasonable to expect that the number of staff in pharmacies would be set to a safe level.

So why is it that we still find ourselves having to campaign for more support, fighting for every additional hour of colleague time and unable to cover all staff absences? Our regulators might not have a duty of care to us, but they are mandated to protect the public from harm. With the National Pharmacy Association (NPA) reporting staffing levels as an increasing contributor to patient safety incidents, the evidence is there to underline the seriousness of the issue.

The non-exhaustive list of tasks that our staff undertake is growing, with pharmacy teams sharing the burden of work between them. But when does the burden become too much, because there aren’t enough members of the team to share it with? Excessive workloads directly impact on patient safety, and the fear of making mistakes becomes more prominent. Colleagues are spread thinly across tasks. Getting only the essentials complete to keep things ticking over is something I’ve been all too familiar with, and the lack of support then begins to affect staff morale.

And what of the consequences on pharmacists’ mental health? Community pharmacists have a unique role that bridges the sizeable gap between business and healthcare. The excessive pressures to maximise profit seem to stretch the distance further between the two entities. The pressures become insurmountable, the inability to meet business targets paralleled with the struggle to provide safe healthcare creates stress, and the inescapable feeling of not doing enough sets in. Last week, Pharmacist Support reported widespread concern about staffing levels. Earlier this year, C+D released survey results demonstrating an increase in pharmacist stress levels.

Our teams are running around in circles. They are jumping through funding hoops, while polishing their skills to provide more services. They are pushing themselves beyond what should be reasonably expected of them in a bid to keep community pharmacy afloat. The saying goes that there’s ‘safety in numbers’, but those of us at the forefront of healthcare are running short with threadbare staffing. The Pharmacists' Defence Association published a safer pharmacies charter in 2017 that outlines safe staffing as a key point, but pharmacies are still crying out for support.

The time has come for staffing levels to be taken seriously. In England, the funding cuts and reduction in category M reimbursement disincentivises contractors from providing adequate staffing. If staffed safely, pharmacy would be in a much better position to take on new roles and support the NHS with new urgent care services. If nothing is done to change the current situation, the profession can expect to haemorrhage talented pharmacists, the risk to our patients’ safety will mount, and we will fail in our attempts to progress the profession for the sake of the NHS.

Laura Buckley is a community pharmacist based in north England

C+D takes pharmacy pressures to parliament

On September 9, C+D and the charity Pharmacist Support brought together MPs, pharmacy representatives and pharmacists to discuss the rise of stress and workplace pressures among pharmacy teams.

The parliamentary event took place in Portcullis House, Westminster, and was hosted by all-party pharmacy group chair Sir Kevin Barron MP.

You can read C+D editor James Waldron’s address to the event – in which he highlighted disturbing data from C+D readers about the extent of pressures in pharmacies – as well as the key points from each speaker.

If you would like to share your experiences, please email [email protected]

10 Comments

C Hinkers, Community pharmacist

Well are moving to central fulfilment, that in itself cannot keep up. Customers are not happy, that it takes 5 days, minimum, for a Rx to be dispensed. Staff hours required, are calculated, once the shop has moved to central fulfilment,  based on figures from the previous year...so its better if you haven't made target items as you will be penalised even more. I am not clear what the Superintendant is doing, as the staff situation is making sure that SOP's are impossible to follow. They seem to be happy for each responsible pharmacist to self check at perceived quiet times, irrespective of how busy the counter may be. It takes a very brave pharmacist to close the shop from a safety perspective....Not only that, they are changing staff hours, so that everyone works every day, rather than full days...and then the staff  are finding it impossible, to get another job, to maintain their lives, with this working pattern. Unsurprisingly, they are leaving and then, its a worse case scenario, as we have less staff, and they are not trained in anything to do with the dispensary. Overall it seems that the Superintendents office are ineffective at maintaining patient and staff safety as it is the finance team that rule the roost.

CAPT FX, Locum pharmacist

This is not about funding or any other excuse. It is high time we address the elephant in the room—regulation or lack of it and Pharmacy owners.

Why is it that the GPHC can have concerns about Locum Pharmacist rate and yet they are least worried about the quantity and quality of Pharmacy support staff. This article has brought out real issues here. We work with poorly trained staff and Managers who do not understand what Pharmacy management is. The pharmacist is trained to Masters degree level and then go on to have the pleasure of working with a manager who never went up to GCSE. All of this in the name of Profits, not funding. Community Pharmacy owners mourn at every turn about everything, surely if this Pharmacy contract is not worth it, why not walk away.

The GPHC claims their responsibility is to protect patient safety. Yet The legal person called Pharmacy owners is not regulated. The Pharmacy owner provides the resources, the staff and Management. They determine the quality of all these and the Pharmacist has no choice or authority over any of these aspects. Yet the Pharmacist bears the brunt of failures mostly attributable to inadequate and poor quality support. The only regulation is through Premises, and this is laughable. Why has the GPHC set minimum standards of staffing and quality thereof? Not only that but stipulate penalties for failure to meet those standards. We work in pharmacies unfit to be healthcare facilities, and yet the one time they are inspected in a lifetime they are somehow certified fit for purposes. Has any Pharmacy been penalised for failure to meet standards? No. Yet Pharmacists are penalised and traumatised for issues well beyond their authority.
The GPHC from inception should have regulated and set minimum standards for The Professionals, The technical and support staff and the persons or Companies that own Pharmacies. Somewhere in this would have come the obligation to ensure competent and qualified people adequately staff pharmacies. They would have included penalties for failure to meet this obligation. That is the human experience of the carrot and stick.
My local. MP was unimpressed with the C & D initiative, which had merit, but failed to mention in clear terms the role of Pharmacy owners in the stress on Pharmacists. This is because it is the employer who chooses staffing levels and the quality of the support staff.

How High?, Community pharmacist

It's the continual race to the bottom created by Government underfunding and businesses reacting by cutting the only overhead they can control. NVQ2 dispensers on National Minimum Wage and levels gradually eroded in line with funding.

It's now unsafe beyond what we can professionally compromise on but will anyone ever get that message across? No, because we are divided and therefore easy to defeat with imposed settlements that the lackies then tell us we're lucky to have got "as you didn't see the other offer".

As far as risk management goes, good luck with highlighting that in a multiple and getting any Superintendent to go against their senior leadership team.....

 

Alice Chew, Dispenser Manager/ Dispensing Assistant

As a community dispenser i feel if wages were more appealing to the workers we would have more dispensers who wanted to work, and therefore being able to staff more pharmacies. Most of us are either on or close to minimum wage. Honestly it's not much of a insensitive.

Mark Boland, Pharmaceutical Adviser

The number of staff required to operate safely and at a rate that is reasonable is a function of how (in)efficiently the pharmacy operates. You can work in two different pharmacies with roughly the same number of staff, one is a 400 item per day dispensary and is a breeze (rare) and the other is an equivalent 200 items and a complete nightmare (common).

This is why adding staff to a chaotically operated pharmacy often brings little improvement. Of course you can work in a pharmacy that has too few staff regardless of its operation. Now that dispensing and MDS is going off-site for many chains, the number of staff required to operate safely and at a reasonable rate is going to change.

Will they use this opportunity to improve standards and rationalise the work-load? Will they misuse the technology and continue to operate inefficiently? Or will they use the technology to reduce staff to an (unreasonably) ultra low level in the name maximum cost cutting?

Benie I, Locum pharmacist

I think you know the answer to your own question.

Alexander The Great, Community pharmacist

Since Well pharmacy has gone central, they have already cut staff hours instore. God knows how they will cope with NHS 111 referrals. Its turning out more of click and collect service you get for your groceries at a supermarket.

Leon The Apothecary, Student

Totally agree with this article. I feel pharmacies should have legally enforceable clear protocol around minimum safe working levels that are reviewed as part of inspection to ensure patient safety and staff well being.

SP Ph, Community pharmacist

""minimum safe working levels""

and a funding from the DH which is paid based on the staffing level and not based on prescription volume, for us to maintain this level.

Reeyah H, Community pharmacist

Great article Laura! It’s a real shame that the PSNC couldn’t get such a simple message across. 

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