Staffing levels at Boots have led to concerns over workplace pressures and patient safety, according to a BBC investigation that aired last night (8 January).
The 30-minute Inside Out investigation, ‘Boots: Pharmacists under pressure’, explored the alleged workplace pressure placed upon pharmacists working for the health and beauty giant and how this could potentially lead to dispensing errors.
With 2,400 pharmacies, Boots is the biggest pharmacy chain in the UK, providing crucial NHS services in locations across the country.
Following the airing of the programme, Boots UK pharmacy director Richard Bradley told The Pharmacist: ‘We have an industry-leading approach to patient safety and today we employ more pharmacists in the UK than ever before, which demonstrates how we value and support their vital role.
‘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.’
Here’s the pick of what The Pharmacist learnt from the BBC’s investigation.
- Boots’ dispensing errors are rare
Between 2016 and 2017, there were 901 reported accidents where patients were harmed due to pharmacy dispensing errors.
With more than 220 million items dispensed every year, Boots argued that it has one of the lowest levels of errors compared to other pharmacy chains.
Mr Bradley said that ‘all prescriptions are checked twice before they go out’.
But some Boots pharmacists interviewed for the investigation claimed that these safety procedures aren’t always followed because ‘the amount of work can’t physically get done safely without either working longer hours or after the store closes’.
A Boots pharmacist who wished to remain anonymous said: ‘Often you’re in a situation where you got no staff at all and you have to dispense medications and self check the medications.’
In an interview for the programme, Mr Bradley said that one dispensing mistake ‘is one mistake too many and my absolute assurance is, despite having our industry leading record [on dispensing errors], we will continue to minimise the chances of it happening again.’
- Boots refused to reveal how many staff it needs
There is no regulation around the number of staff a pharmacy needs to have working at any one time to keep patients safe.
To calculate the workload in each of its branches, Boots uses its own complex model, which includes the time it takes to dispense various prescriptions, according to the investigation.
The BBC claimed the company refused to reveal this figure, saying it is ‘commercially sensitive’.
Greg Lawton, a former clinical governance pharmacist at Boots UK who was interviewed for the programme, believes that Boots ‘wasn’t giving pharmacies enough money for [adequate levels of] staff’ and the staffing model could put patients’ safety at risk.
He said: ‘Pharmacists are working very hard to protect patients but they are really stretched trying to keep patients safe.
Mr Bradley told The Pharmacist: ‘We have an industry-leading approach to patient safety and today we employ more pharmacists in the UK than ever before, which demonstrates how we value and support their vital role.’
- A regulatory problem?
In the programme, Mr Lawton questioned the current regulatory approach towards pharmacy staffing levels.
He said: ‘The regulation around pharmacy is inadequate. We need regulatory standards to specify what the staffing levels must be in pharmacy.’
He also claimed that he had raised concerns about staffing levels at Boots with the regulator, which the GPhC subsequently confirmed in a statement released after the programme aired.
Duncan Rudkin, chief executive of the GPhC, said: ‘First and foremost, our sympathies go out to the families featured in the programme who lost their loved ones as a result of dispensing errors. I can assure them that we investigate all concerns raised with us, including any incident in which a patient is harmed by a dispensing error, and our focus is always on making sure that actions are taken to help prevent a similar error happening again.
‘We have already carried out a robust and thorough investigation into all of the concerns raised by Mr Lawton and looked at evidence from a full range of sources, including evidence provided by Mr Lawton and from senior management at Boots, and our own regulatory activities. After carefully reviewing all the available evidence, we concluded that there was not sufficient evidence overall to suggest a risk to patient safety across the organisation.
‘But we did use what we learnt through that investigation into Mr Lawton’s concerns, to inform the questions we now ask during inspections to help us make judgements on whether the pharmacy is meeting all of the standards, including in relation to staffing.
‘We take the clear view that setting the right staffing levels is best done by the people responsible for managing a pharmacy on the ground, rather than by the regulator at a distance. It’s our role to provide assurance to the public that standards are met. If they are not, we take steps to ensure the necessary improvements are made.
‘The staffing levels needed to provide safe and effective services will vary significantly between pharmacies depending on the context in which each individual pharmacy is operating, including for example the services it provides and the number of prescriptions it dispenses. Later this year we will be publishing new guidance for pharmacy owners that emphasises what they are expected to do to make sure they have a safe and effective pharmacy team in every pharmacy.
‘It is concerning that some pharmacy professionals are reporting they don’t feel able to raise concerns about pressures. We make clear to pharmacy owners in our standards that there must be a culture of openness, honesty and learning across all of their pharmacies.
‘Employers, employees, the representative bodies, the unions and we as the regulator all need to work together to make sure that everyone working in pharmacy feels able to raise concerns, so that action can be taken where necessary and we can make sure that patients and the public receive safe and effective care.’
- Pharmacists under pressure
Mark Pitt, assistant general secretary at union the Pharmacists Defence Association (PDA), claimed in the programme that Boots pharmacists it has spoken to are ‘finding increasingly that there are less staff available and that’s make their job more difficult and pressurized.’
‘They do an excellent job but often in very difficult circumstances. Considering it [Walgreens Boots Alliance] is the largest pharmacy company in America and Europe, it shouldn’t be like that.’
Mr Bradley told The Pharmacist: ‘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. We have continually invested significantly in our business and supporting our pharmacists. Every single one of them is a professionally qualified, highly-trained individual and they have one priority when they come to work – to look after people.’