Stress and workload for hospital staff

We are being inspected to death, says Andrew Alldred, who has been a hospital pharmacist for over 18 years

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


We are being inspected to death, says Andrew Alldred, who has been a hospital pharmacist for over 18 years.

In this case, “we” is the Harrogate and District Foundation Trust, one of the many NHS healthcare organisations that is struggling to balance the needs of their patients with the compliance costs heaped on them by bureaucrats.

“We are probably at the stage where the governance aspect of our role is so great that we spend too much time doing paperwork. While we recognise the importance of the governance framework, we just want to get on and do our job”, he says.

Workplace pressure

Mr Alldred is currently director of pharmacy at the foundation trust and also the Guild of Healthcare Pharmacists practice committee chairman, a role that allows him a critical insight into the developments affecting the profession.

Issues high on his agenda include the new professional body, the impact of Department of Health policy on hospital pharmacists and the many consultation responses relating to new policies.

In many aspects, the guild’s concerns reflect Mr Alldred’s own. Much of the guild’s work around reducing stress and campaigning for changes in the profession is in harmony with the SalvaDore’s Workplace Pressure campaign, launched in January 2009. This aims to combat workload and stress issues affecting pharmacists.

One of the guild’s most energetic campaigns centres on the decriminalisation of dispensing errors. The law, Mr Alldred says, jars with current practice.

“The law, as it stands, is tied up with section 64 of the Medicines Act, which does not fit with the ‘no blame’ culture of the NHS. It is crucial we have a culture which supports reporting of errors and learning from events, while still dealing with poor performance. This is vital to ensure public confidence in what we do, particularly around the safe delivery of medicines to our patients.

“I doubt there are any pharmacists out there who have not made an error at some point in their careers. In the main, these relate to system and process failures and human error, and the focus should be on improvement in these areas. The ramifications of making a dispensing error, in relation to criminal prosecution, are huge, regardless of whether you are a locum, community or hospital pharmacist,” he says.

The potential for errors is heightened by the lengthy shifts pharmacists complete. “In hospital pharmacy, we potentially have stress issues occurring when people are in clinical areas, dispensing for longer periods of time than is ideal. People’s stress may be compounded by a lack of rest-breaks,” he explains.


Vacancies and recruitment

Constantly high vacancy rates in clinical pharmacy are a direct knock-on from the stress of being part of a stretched public service. “If you take Band 6 and 7 pharmacists, you will see there is a steady 16 to 30 per cent vacancy rate throughout the NHS — this has a great impact on our ability to deliver services. The guild is currently looking at a national recruitment premium for trainee and specialist pharmacists in order to minimise this on-going problem,” Mr Alldred says.

Currently, it is difficult to find the “perfect fit” for some hospital pharmacy roles. “We can seek locums and train them but locums are often not from hospital backgrounds. Alternatively, we end up with high-grade pharmacists in roles more suitable for junior staff,” he says.

The allure of a profession dedicated to handling medicines has, Mr Alldred believes, bloomed in the past five years: “There are lots of opportunities, but with those come, quite rightly, added responsibility. The focus of hospital pharmacy is medicines safety — we are medicines experts and patient safety is paramount with high-risk medicines.”

The pressure and responsibility, coupled with the opportunity to work in a leading-edge field, means hospital pharmacy is a tempting career choice, he adds.

“Hospital pharmacy is very rewarding, though the expectations from the NHS, the public, the profession and the Government have become more demanding — and exacting. With the public purse as it is, the drive for cost-efficiency in the public sector is constant.

“Financial pressures on the NHS mean we at Harrogate are expected to make a five per cent cost improvement, year on year. Over five years, that is 25 per cent. This puts constant pressure on us to be innovative because we need to provide the best possible service without cutting out aspects that add value.

“It is a double-edged sword. There are huge opportunities for us to drive forward services but how do we do that with fewer staff and cost improvements? This will be a real challenge for all NHS staff over the coming years,” he says.

Mr Alldred also says the decreasing flow of public finances has been made starkly apparent by the public’s ever-growing use of NHS services. “[More] patients are accessing services without the appropriate growth in resources. The [number] of patients making use of our foundation trust has grown 30 per cent in the past five years, but the funding we have received has not been comparable — it is more like five per cent.”

In addition to attracting the right mix of staff, Mr Alldred would also like hospital pharmacy to use technology with more vigour over the coming years: “Uptake of automation needs to be improved. There certainly needs to be better capital investment in things like electronic prescription services. Improving the tools pharmacists have to hand will, in turn, result in patients receiving a higher standard of care.”

“We are focusing on the quality of the patient experience. One aspect of this is focusing on medicines reconciliation, and making sure the first prescription is accurate and complete. Not only does this help pharmacists use medicines more effectively, it gives us the chance to work with patients to make sure they have a better understanding of their treatment,” he says.

Casting his mind back over the past 18 years, Mr Alldred sees some distinctly positive changes to the profession. “The whole agenda for hospital pharmacy has moved on. Issues like medicines safety have been pushed to the fore. We have also seen the advent of prescribing pharmacists and the forming of a new professional body and regulator for pharmacy, the General Pharmaceutical Council.

“Remuneration, on the whole, has improved. But there are significant pockets where things have not gone so well, especially in terms of pharmacists being under-graded.”

Hospital pharmacy needs to be able to thrive or, as Mr Alldred puts it: “We need to make sure regulation does not stifle innovation and new service models of care.”

Citation: The Salvadore URI: 10964060

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