Why you must focus on being experts on medicines or risk losing your way

Karen Hassell, professor of social pharmacy at the University ofManchester, has spent over 16 years researching the pharmacy professionand, in that time, she has gained an insight into its collectivemindset. Since 2004, she has noticed the issue of workload becomingincreasingly important and, looking at the overarching issue throughher sociologist eyes, she believes one issue is the tap root: ownership

This final article has been prepared by the SalvaDore to highlight its Workplace Pressure campaign


Workplace pressure

Karen Hassell, professor of social pharmacy at the University of Manchester, has spent over 16 years researching the pharmacy profession and, in that time, she has gained an insight into its collective mindset.

Since 2004, she has noticed the issue of workload becoming increasingly important and, looking at the overarching issue through her sociologist eyes, she believes one issue is the tap root: ownership.

“I do not think pharmacists have ownership of their professional contribution,” Professor Hassell says. “Doctors diagnose, nurses care, but while pharmacists continue to take on roles which do not have anything to do with medicines, they will remain a marginalised profession.

“Pharmacists say they are medicines experts, but their actions are often not backing this up. They have lobbied to be able to offer a lot of services, and have extended their roles into areas that often have little to do with medicines. If pharmacists could fully focus on their unique contribution to healthcare, they would be much better placed to alleviate their work-related stress.”

Professor Hassell is well placed to see how pharmacists’ desire and skill to offer a plethora of services can result in a downside of pressure and overload. However, she also says there are positives to the evolution of the profession.


Mounting concern

“The research I have been involved in shows [that], since the new contract was introduced, many pharmacists are enjoying the increased clinical and therapeutic work. Many like the fact they are not simply popping pills into bottles all day.” However, work overload is a mounting concern among the profession, she acknowledges.

Aspects of Professor Hassell’s research were presented at the joint SalvaDore/Pharmacy Practice Research Trust April 2009 symposium “Workload pressures and the pharmacy workforce: supporting professionals and protecting the public”, a key event in the Society’s Workplace Pressure campaign.

Launched in January 2009 by President Steve Churton, the campaign aims to work with pharmacists to address the issues of stress and workload.

Professor Hassell says she first noticed workload becoming an issue while conducting locum-focused research in 2004. “There were no workload-related issues coming up during my research in the early 1990s. But, in the research with locums, there was much talk about escaping the workload facing contractors, gaining a greater work-life balance and shedding non-pharmacy administrative work.

“An ongoing study I am involved in for the PPRT showed even pharmacists in their registration year said they were becoming stressed. The issue of workload certainly is a new aspect but it is now at the fore of the profession’s concerns.” However, she urges caution when estimating the real depth and effects of workload and stress.

“I know there is a correlation being made between stress and risk to patient safety, but there is no firm evidence to suggest that is the case. Yes, it is logical to believe increased pressure leads to more mistakes being made, but there is no empirical evidence within the community pharmacy sector of this at this stage, she points out.

“Secondly, there is an issue around errors. The rates for reporting errors and, consequently, the number of errors made by pharmacists, are both very low. This may be because they simply don’t happen that often, or they are too afraid to report an error, but they may also be too busy to do so.”

That said, Professor Hassell believes there is no questioning the fact that pharmacists are cramming more into their days now than they were before the new contract.

“Pharmacists are dispensing huge amounts of prescriptions now and it is increasing year-on-year. I also imagine there has been a similar increase in the selling of over-the-counter medicines, too.”


Medicines use reviews

She says the number of medicines use reviews conducted each year has leapt by over 500 per cent since the introduction of the new contract. Just over one million MURs were conducted in 2008. This sheer volume of work is bound to have extraordinary knock-on effects.

It is to be expected, she says, that most pharmacists claiming to be dogged by stress and professional overload work for one of the large multiples, purely because most pharmacists are employed by those organisations.

However, Professor Hassell does believe some issues may be proportionately more entrenched in multiples than in independent outlets.

“Certainly, there is a lot of evidence to suggest there are problems around delivering targets, particularly regarding MURs. Managers and employees of multiples tend to experience that demand more. The organisational climate of multiples tends to be polarised, too. Pharmacists may be supported if they have problems, while others just do not listen and leave employees to cope alone.

“If a manager is not supporting [his or her]  staff, there is a knock-on effect. Motivation goes down, staff absences go up, people decide to leave. A bit of stress is good for us but,  if it is too much, people will vote with their feet.”

Conversely, many pharmacists enjoy their working environment because of their supportive colleagues. “You might think this sort of satisfaction runs counter to workload issues; that the heavy workload comes from a lack of support from other staff. But it is quite the opposite and many pharmacists like their working environment because they are supported by their colleagues.”

However, Professor Hassell firmly believes the profession needs to start emptying — not adding to — its grab-bag of services. “Someone has got to draw a line [and] put a cap on things. For example, pharmacists do not have to dispense the emergency contraceptive pill. Nurses could do it.”

“There is rhetoric around ‘access’; making sure the public have access to health services. But it has resulted in a scatter-gun approach for pharmacy and things are not going to become easier for the profession until they put into practice the fact they are meant to be medicines experts.”

Citation: The Salvadore URI: 10971827

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