Inside Out investigation: Pharmacy feeling the pressure

The BBC’s Inside Out programme ‘Boots: Pharmacists under pressure’ has started a vigorous and impassioned debate in the profession about workload stress, patient safety and staffing levels in community pharmacy.

The BBC documentary looked at claims that pharmacists at the UK’s biggest pharmacy chain are under excessive pressure and included a former clinical governance pharmacist at the company, Greg Lawton, talking about staffing concerns he raised – with both Boots and the GPhC – before he resigned more than two years ago.

Boots told the BBC that its pharmacies are not understaffed and it has an industry-leading patient safety record. Since a spate of dispensing errors during 2012-13, some of which had resulted in the deaths of patients and whose relatives were featured in the programme, the company had invested significantly in its people, pharmacy design, technology and processes to improve safety levels, it said.

Since 2015, the company claims to have taken on 430 additional pharmacists, 360 more pharmacy technicians and around 2,700 extra pharmacy support staff.

Safety our priority

In response to the points raised in the programme, Boots UK’s pharmacy director, Richard Bradley, said the safety and well-being of its patients and colleagues is the company’s number one priority.

“Healthcare professionals across the country are facing increasing demands and 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,” he said.

“We have continually invested significantly in our business and supporting our pharmacists. 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.”

Robust approach

In a letter sent to Boots staff by chief pharmacist Marc Donovan after the programme was aired, seen by Pharmacy Magazine, he recognised that some of the sentiments raised may resonate with employees and are symptomatic of the ever-changing and increasingly high expectations placed upon the community pharmacy sector.

However, under the heading ‘Our approach to patient safety’, he said: “We are never complacent about dispensing incidents but I am confident that our approach to patient safety is robust.”

Prior to the broadcast of the BBC programme, Boots obtained comparative patient safety data across community pharmacy from a number of sources, including other multiples.

“Compared with anonymised data from the Community Pharmacy Patient Safety Group, we reported a higher percentage of incidents (reflecting our strong reporting culture) but, importantly, the percentage of those alleging harm was lower than the average of others who shared their data.

“We also know that we perform well in GPhC inspections, with around twice as many ‘Good’ outcomes when compared with the rest of the sector. Specifically, Boots has met Standard 2.1 (that mandates sufficient numbers of suitably qualified and skilled staff) on 98.72 per cent of occasions, compared with 97.60 per cent for the rest of the sector.”

Wake-up call

The Pharmacists’ Defence Association, whose director of defence services Mark Pitt appeared on the programme, said it should be a wake-up call to the Government to realise that the multinationals who run the big pharmacy chains need to be held more effectively to account for their actions. 

Commented PDA chairman Mark Koziol: “It is clear that the current regulatory regime is not putting patient safety first and we challenge the Government to urgently address this by reforming the inadequate rules under which the pharmacy regulator operates.”

Regulator defends record

In his response to the Inside Out programme, Duncan Rudkin, GPhC chief executive, said the absolute priority was to make sure people using pharmacy services receive safe and effective care.

“We can assure the public that the vast majority of pharmacies are meeting [our] standards. In the rare cases where things do go wrong, our focus is always on making sure lessons are learned to help stop the error happening again and help keep patients and the public safe.”

Referring specifically to some of the points raised in the BBC documentary, Mr Rudkin said the GPhC had 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 its own regulatory activities.

“We concluded there was not sufficient evidence overall to suggest a risk to patient safety across [Boots]. But we did use what we learnt … to inform the questions we now ask during inspections to help us make judgments on whether a pharmacy is meeting all of the standards, including in relation to staffing.”

The GPhC takes a 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, he said. 

In an email sent to PDA members, chairman Mark Koziol said the organisation “cannot agree with this approach because patient safety must always come before the commercial profits of corporate pharmacy. The approach of the GPhC allows unacceptable conflicts of interests for pharmacy employers. The regulator cannot distance itself from the one factor that can make the biggest difference to patients.”

On whistleblowing, the GPhC’s Duncan Rudkin said it was concerning that some pharmacy professionals 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.”

Pharmacy is safe, says RPS

In its response, the RPS emphasised that community pharmacy provides a safe and effective service to patients and the public, with very low dispensing error rates, and said that pharmacists do their best to provide high quality services despite the huge pressures placed upon them. “It is an incredibly tough time to be working in a patient facing role,” it said.

The Society called on the GPhC to demonstrate how it will improve the support given to pharmacists when raising public interest concerns and change the perception that nothing will change if concerns around staffing levels are brought before it. “The more we learn about why errors occur, the more we can do
to improve safety,” it said. 

Our pharmacies are not understaffed

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