Pharmacists are facing stress and burnout to such an extent that many are counting down the days until they can leave the profession altogether. Costanza Pearce investigates the causes of this crisis and what can be done to improve conditions

'When I first qualified, there were walk-in prescriptions, there were no deliveries to prepare, paperwork was minimal and there weren’t any services  to promote apart from dispensing,’ says  Al Patel, contractor at Lee Pharmacy in south-east London. ‘Those were the best years of my career.’

Skip forward 22 years and the pharmacy profession is now very different. With funding cuts, multiple services to provide and mounting piles of scripts to contend with, the pressures are mounting. When asked what makes him stay in pharmacy when there are so many burdens, Mr Patel hesitates before replying: ‘What else would you do instead?’

Although there are different roles in the sector across the community, hospitals, GP practices and even teaching,  he explains that ‘doors are quite difficult to open’ without experience in a specific role. ‘You are really trapped in a way. I’m not  at an age where I can retire straight away so I’ve got to carry on. It’s one of those things where there’s no hope,’ he says. ‘You just  plod on.’

Mr Patel’s story is all too familiar. According to a major new survey of primary care professionals by The Pharmacist’s parent company Cogora, pharmacists are  at breaking point, with half of contractors thinking of leaving the profession. A staggering 70% of contractors surveyed said they were considering selling their pharmacy
and nearly half (46%) of the superintendent pharmacists surveyed agreed, with an average of 9% across both groups having  sold up already.

The worrying findings are presented in Cogora’s sixth Primary Concerns report, The State of Primary Care 2018, which surveyed 2,300 GPs, practice managers and practice and community nurses at the end of 2018  and this year also included pharmacists  for the first time. The consequences of a mass exodus from pharmacy would be devastating. So why are so many pharmacists thinking of leaving the profession and, crucially, what needs to be done to make them stay?

Lack of support


Taking a closer look at the data from the State of Primary Care survey shows that there’s a real problem in community pharmacy. More than a quarter (27%) of contractors said their morale was ‘very low’ – the highest figure of all the professions surveyed – and contractors and superintendents were the groups most likely to need time off work because of stress and burnout. Among contractors, almost a third (62%) had taken time off sick or thought it was likely that they would need to in the next year, while superintendents were feeling the strain at 71% – more than any other group surveyed.

Nearly one in five contractors (19%) had already been forced to take time off for this reason, but for some, this wasn’t even an option. One pharmacist respondent said they were showing symptoms of stress but could not afford to take time off because they owned their business. ‘My staff can, which puts greater pressure on me and the other staff,’ they added.

Pharmacists also blamed their low morale on verbal and sometimes physical abuse from patients. The vast majority of all pharmacists surveyed (79%) had suffered verbal abuse, while 10% of the 185 respondents had experienced written abuse. A total of eight pharmacists had encountered physical abuse in the past year and – shockingly – one had been the victim of sexual abuse.


‘Unprecedented levels of stress’


Faced with all of these stresses, some pharmacists are choosing to leave  for pastures new. While almost a quarter of contractors (23%) had thought of retiring because they were due to, even more in that group (27%) wanted to turn their back on the profession for reasons unrelated to retirement.

‘For the last year I have been putting in so many extra hours to provide NHS services that the time will soon come when I will have to say, “no more”,’ said one respondent. One contractor summarised the problem – ‘everyone expects everything, immediately and for nothing’ – while another agreed they were expected to do ‘more and more for less and less’.

Ongoing medicines shortages were yet another source of pressure for pharmacists,  a situation described by one respondent as  ‘a daily battle’. Almost all (97%) of contractors, superintendents and employee pharmacists reported that shortages had affected their pharmacies throughout 2018. Responding to the survey, one contractor said shortages had made it a struggle to keep patients. ‘It has been very difficult this year,’ they said. ‘I have been practising for 30 years and can honestly say this year has been the roughest and toughest.’

Nottinghamshire Local Pharmaceutical Committee (LPC) chief officer Nick Hunter agrees that the ongoing supply issues have  a big part to play in the ‘unprecedented’ levels of stress he’s seeing in pharmacists  at the moment. ‘As the final supplier, the buck stops with the pharmacy so they’re getting the brunt of the frustration coming from patients and GP practices,’ he says.

Mr Hunter has also found that no cheaper stock obtainable (NCSO) prices are often  ‘a trigger point’ for pharmacists. A striking 100% of contractors said they believed shortages had led to an increase in their workload and 85% believed Brexit will only make things worse.

As a National Pharmaceutical Association (NPA) spokesperson says: ‘Pharmacy teams work extremely hard to meet the evergrowing demand for healthcare, but there are limited resources in the system, and this can create immense pressures.’


No easy answers


While it’s clear that something has got to give for pharmacy professionals, it’s difficult to find a simple way forward. In January 2017, NHS England launched  a £19.5m nationwide support service for GPs as part of its commitment to improve their access to mental health help.

The Royal Pharmaceutical Society (RPS) pledged to write a letter to the then pharmacy minister Steve Brine urging for pharmacists to receive the same level of stress-relief funding as  GPs in June last year, but so far – except for  a meeting with England’s chief pharmaceutical officer Keith Ridge – little progress has been made.

It’s no wonder that feeling undervalued by the Government was another recurring theme for pharmacists in the survey, with one respondent saying the profession ‘has never been appreciated for what it brings  to the table’. Mr Patel believes more funding and new legislation that makes clear what is required from pharmacists are the only things that will change pharmacy for the better.

With the Pharmaceutical Services Negotiating Committee (PSNC) currently thrashing out the next community pharmacy funding contract with the Government, it’s possible that this, at least, could be a reality in the near future. So what makes these battered and bruised pharmacists stay in the profession?

One anonymous contractor tells The Pharmacist that they suspect the dissatisfaction in community pharmacy is ‘representative of  a more widespread malaise’. ‘Society is losing our sense of value for the most vulnerable people. Seeing those “left behind” makes you want to fight for them,’ they explain. They add that while, superficially, many stay in the profession  to meet life and financial commitments, ultimately, ‘community pharmacy  defines us’.


A confusing system


In Nottinghamshire, the LPC is being approached more and more by pharmacists seeking pastoral care. Mr Hunter says contractors are increasingly contacting him late at night and at weekends because they ‘don’t know where to turn and what to do’. ‘Sometimes they just want to be listened to and vent – and for that individual that is their coping mechanism’, he explains. Nottinghamshire LPC is considering running workshops with charity Pharmacist Support, which provides a helpline service for those who are struggling. The charity received 463 enquiries this year between January and April. Many are employment related, concerning disciplinary proceedings, terms and conditions, bullying, whistleblowing and workplace stress. Pharmacist Support has provided The Pharmacist with its top tips for busting stress.

Mr Hunter blames a ‘general confusion  of the system’ as well as the wider economy and political environment. Different commissioners behind services and separate reporting systems for each one makes for  a complex web to navigate for contractors. ‘I think if the local environment that we operate in could be simplified, that would help,’ said Mr Hunter, who believes that primary care networks (PCNs) could complicate matters.

‘It’s another layer in the commissioning environment and we cannot afford as a sector to not be engaged with them, they’re absolutely crucial to the way forward’, he adds. However, for Mike Maguire, chair of the Cumbria and North East Local Professional Network (Pharmacy), PCNs offer pharmacies the hope that they need.

In his opinion, PCNs will give pharmacies an ‘opportunity... to make a difference to the whole system’. He says: ‘All of a sudden we’re elevating pharmacy, which has always worked in isolation, to be a key partner in the multidisciplinary team and be recognised as one. It’s something that hasn’t really been recognised before — that’s the exciting part.’

With networks will come funding, as well as a greater focus on the clinical skills of community pharmacists. Let’s hope collaborative working will finally bring the freedom for contractors to really show what they can do. It’s certainly time for change.