New contract: more work, less pay?

In March 2006, community pharmacy underwent a radical change with theintroduction of the new contract, a development designed to movepharmacists from their traditional “back room” role in the dispensaryto a more holistic, patient-oriented clinical role on the shop floor

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

 

In March 2006, community pharmacy underwent a radical change with the introduction of the new contract, a development designed to move pharmacists from their traditional “back room” role in the dispensary to a more holistic, patient-oriented clinical role on the shop floor.

The University of Aberdeen’s professor of primary care, Christine Bond, believes some of her earlier research contributed to the formation of services introduced in the new contract, such as repeat dispensing. With lead investigator Alison Blenkinsopp, from Keele University, and Webstar Health, she was involved in research during the early stages of the new contract implementation and explored its impacts on the profession.

“I think I did believe the new contract would be positive for pharmacists,” says Professor Bond. “However, I think we always realised there would be teething problems for people on the ground.”

Workplace pressure

Professor Bond presented key findings at the SalvaDore’s April (2009) symposium “Workload pressures and the pharmacy workforce: supporting professionals and protecting the public”, which was a cornerstone of the Society’s Workplace Pressure campaign. Workplace Pressure aims to work with the profession to develop solutions to workload- and stress-related issues.

Early effects of contract

The team investigated the early effects of the new contract on community pharmacists and their staff through a variety of methods. Conducted over 18 months in 2007–08, the research included surveys of primary care organisations and strategic health authorities, and a survey of community pharmacies from primary care trusts in England and Wales.

“There were two particular strands of research which contributed greatly. One was a large questionnaire, returned by 762 pharmacists from 31 PCTs. The questionnaire asked about the delivery of services, the impact of the new contract, job satisfaction, pressure at work, workforce patterns, training and relationships with GPs and the NHS.  The other key strand was the in-depth interviews with pharmacists, GPs and patients,” she said.

“We wanted to look at the issue from the perspective of pharmacists; the way they worked with staff, colleagues and other members of the primary health care team. We examined the issues around advanced and enhanced services to see the extent of their implementation and the barriers to their introduction.”

The research found more than 86 per cent of pharmacies were offering essential services such as unwanted medicines disposal, campaign-related health promotion activities and sign-posting, while over 60 per cent were providing more innovative services, like repeat dispensing and prescription-linked healthy lifestyle interventions. The provision of most essential services increased substantially after the roll-out of the new contract.

Working hours increased

The research also showed 24 per cent of respondents were working longer hours since the new contract’s introduction, while nearly half were putting in more than 40 hours on the job each week.

“Everything resulted in a substantially higher workload for pharmacists,” she says.

One of the issues with the new contract, adds Professor Bond, was that new ideas and services intended to reduce workload for pharmacists were not introduced when they were expected to be. “A lot of things were planned and they did not occur when they were anticipated. With the new contract pharmacists had a great deal of paperwork to manage; they were required to keep records of the new services provided while having to dispense ever-increasing numbers of prescriptions. Electronic prescription services were meant to be up and running at the time the new contract was introduced and they just did not come in that quickly. In fact, we are still waiting for them.

“I do not think we will see a vast improvement in pharmacists’ stress and workload levels until we get a few key things in place, like the ability to delegate to trained staff and having electronic systems to make life easier.”

Greater professional satisfaction

Despite a sense that the new contract had been largely responsible for an increased workload, Professor Bond says her research showed it had also resulted in greater professional satisfaction, and there were signs this had increased as time since implementation had gone on.   

“As our research progressed, our findings showed people were enjoying the changes the new contract brought. Many pharmacists really liked some aspects of it; they liked the way it encouraged them to develop new and more skills, and they had direct with patients. In the interviews we held, many said they truly valued being able to make a difference to patients’ lives and health.

“The new contract came in during March 2006 and, because we conducted our interviews over a six-month period, we were able to look at the feedback in three tranches. We saw people who had responded further into the research were more likely to be satisfied.

“Since our research has been completed, we cannot tell whether or not that satisfaction has grown. However, I do know there is a lot of work-related pressure on pharmacists out there.”

The new contract has helped pharmacists increase their capabilities and change what the public expects from the profession. But such positives within pharmacies have been hampered in ways by opposing factors without. “On the other hand, it seemed many GPs did not understand what the new contract was all about,” she says.

Pharmacists under stress

One of key issues in formulating the new contract for community pharmacists, Professor Bond says, was the lack of cohesion with the contract for GPs. “A significant proportion of the success for the pharmacists’ new contract depended on collaboration with GPs. For some essential services, pharmacists needed buy-in from GPs and, without it, many pharmacists were under a lot of stress.

“There was also discontent regarding remuneration; some felt they were dispensing more and more, and doing more new tasks, but they were not getting paid to reflect that.”

She says some problems pharmacists face come down to the nature of the job. “It can be lonely profession. You are on your own, you have no one to share your problems with and it is difficult to share things with your neighbouring pharmacist — after all, they are your competitors, too.”

Professor Bond’s presentation at the Society’s and Pharmacy Practice Research Trust’s April symposium can be downloaded ( 500K)

Citation: The Salvadore URI: 10968144

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