Increase in patient aggression due to medicines shortages

The majority of pharmacists have experienced aggression from patients due to medicine supply issues, while almost half of pharmacy teams claim abuse from patients means they are struggling to cope at work, according to the recent Pharmacy Pressures survey from the Pharmaceutical Services Negotiating Committee (PSNC).

Of the more than 2,000 pharmacy team members surveyed, one third (31%) said that they were ‘barely coping’ with workplace pressures, while 7% said that they were ‘not coping at all’.

Of ‘particular concern’ to PSNC was the fact that 45% cited patient abuse as a reason for their struggles.

And 84% said that medicine supply issues had caused patient aggression – up from 75% in last year’s survey, which also had half the number of pharmacy team member respondents compared to this year.

Pharmacists ‘at the sharp end’ of medicines shortages

Mark Lyonette, chief executive of the National Pharmacy Association, described the findings as ‘appalling but, sadly, unsurprising’.

He said that while ‘most patients and customers treat pharmacy staff with courtesy’, ‘there is a minority who fall well short of acceptable standards of behaviour’.

He said that pharmacy teams were ‘face to face with patients at the sharp end of any problems with medicines shortages’ and ‘wrongly get blamed for problems further up the supply chain’.

Mr Lyonette added that rude, intimidating or aggressive behaviour against pharmacy staff ‘cannot be tolerated under any circumstances’ and said that the NPA has discussed the issue with senior police representatives and drawn it to the attention of ministers.

Professor Claire Anderson, president of the Royal Pharmaceutical Society, agreed that pharmacy teams found themselves at ‘the sharp end’ of medicines shortages.

She said they were ‘under enormous pressure, spending hours tracking down the medicines patients need’, meaning that ‘at times’ supplying patients with their medication ‘can take a little longer than usual’.

And ‘whenever there’s a supply issue it makes patients anxious, as they rely on their medicines to stay well’, she told The Pharmacist.

However, she said that ‘no one should experience abuse or violence in the course of their working day’.

She added: ‘Pharmacy teams are an important and valued part of the healthcare workforce and have a right to be treated with respect at all times.

‘They must be able to carry out their vital work such as providing life-saving vaccinations, medicines and advice, without feeling threatened or in danger whilst at work.’

She described violence and abuse against pharmacy teams as ‘deplorable’ and urged those affected to report it to the police, ‘so they have the necessary information to build up a picture of what’s happening in local areas’.

She added that the RPS would continue to raise this topic with the NHS, government, patient groups, the police and across the profession.

Meanwhile, PSNC chief executive Janet Morrison described the results of the Pharmacy Pressures Survey as ‘distressing to read’, adding that it was ‘totally unacceptable’ that pharmacy staff were increasingly experiencing aggression from patients due to medicine supply issues.

‘Acts of abuse and violence should not even be a reality for any pharmacy staff members, and it should never be tolerated,’ she said.

What could be done about patient aggression?

Mike Hewitson, a community pharmacist in Dorset, started a petition to combat patient abuse against pharmacy teams, following an incident in which three men robbed his pharmacy and one threatened to stab him.

Responding to the survey’s findings, he called for the NHS Terms of Service to be amended to give pharmacists the right to decline to treat patients in cases of persistent or severe abuse.

Mr Hewitson told The Pharmacist: ‘It’s fairly simple. GPs have the right to deduct patients from their list, we do not have the option to refuse to dispense an NHS prescription which leaves us in a more vulnerable position.’

Schedule 4 of the NHS (Pharmaceutical and Local Pharmaceutical Services) Regulations 2013 says that an NHS pharmacist may refuse to dispense a prescription where they or other persons on the premises are subjected to or threatened with violence, or where the patient or others accompanying them commits or threatens to commit a criminal offence.

But Mr Hewitson said that this bar was ‘far too high’.

‘So, we are only allowed to refuse service if we are threatened with violence or a criminal act?’ he asked. He added that pharmacy teams could be subject to ‘repeated abuse’ that fell outside these parameters and ‘would not be able to do anything about it’.

Mr Hewitson said that he would like someone within NHS England to take specific responsibility for the safety of pharmacy teams. ‘They have a duty of care towards us and our staff who are providing NHS services in good faith,’ he added.

An NHS spokesperson said that NHS staff, including pharmacy teams, ‘should not be subject to any kind of abuse, intimidation or violent behaviour from the public – colleagues work day in and day out to provide patients with the best possible care.

‘There are measures in place that provide pharmacy teams with protection to decline to dispense medicines in certain circumstances as well as a range of resources to support them with this if it is needed.’

In a notice issued last August, PSNC told pharmacy teams: ‘If you face verbal abuse from patients, please don’t feel like you have to tolerate it. The pharmacy regulations say that if a contractor or their staff (or other people at the premises) are threatened with violence, a contractor may refuse to dispense a prescription. This also applies if the person threatens to commit a criminal offence. Obviously, refusal is also an option if any of those threats are carried out.’

Ms Morrison told The Pharmacist today that it was ‘clear more needs to be done to support our pharmacy colleagues’, who ‘should never have to deal with abuse when they’re simply just trying to do their jobs’.

She described the safety and wellbeing of pharmacy staff as ‘crucial’ and said that PSNC had been calling on the government to urgently step in and address the situation pharmacies are facing, including by supporting Mr Hewitson’s petition alongside other pharmacy organisations.

‘More needs to be done to protect pharmacy staff from the abuse that they are reporting, and we will keep pushing for other measures to help our pharmacy colleagues,’ she added.

PSNC highlighted resources including NHS materials and guidance for use by primary care staff, security advice for pharmacies during the pandemic, and key contacts for police services.

While the RPS highlighted its Be Kind campaign, tips on Managing Conflict: Dealing with Angry and Abusive Patients and advice on building assertiveness and professional relationships, as well as NHS England’s training programme: Handling difficult situations with compassion.

Ongoing issues in community pharmacy

Patient abuse has been increasingly affecting pharmacy teams, with over two-thirds of community pharmacists reporting that they had experienced abuse from the public, in the Royal Pharmaceutical Society’s recent workforce wellbeing survey.

And the issue was most prominent in the community sector, where 69% of respondents stated they had experienced abuse, compared to 22% of respondents working in other pharmacy settings.

Many community pharmacies have taken safety measures to help their staff deal with cases of abuse from the public, such as asking staff to wear body cameras and installing panic buttons that are linked to police stations.

And in September, the local Community Pharmacy Provider Board (CPPB) secured funding for safety and security measures for all community pharmacies in Greater Manchester.

While a pilot across 83 Boots UK stores found that wearing body-worn video cameras reduced violent and aggressive incidents by 45%, prompting the multiple to roll out body cams to staff in an additional 225 locations.

Patient abuse was highlighted alongside other pressures facing pharmacy teams including significant workload increases (81%), a lack of staff due to insufficient funding (48%) and staff unavailability (34%), problems sourcing medicines for patients (71%), and increases in patients requests for support (81%).