Unsupported and over stretched pharmacists: is there a role for the regulator?

Karen HassellEllen Schafheutle

The Centre for Pharmacy Workforce StudiesManchester Pharmacy SchoolMarch 2014

The presentation

• Pharmacists/pharmacy in brief• Evidence about work related stress

– sources– which pharmacists– organisations

• Employers responses• GPhC

Pharmacy in GB (i)

• Third largest HC profession: > 47,000 pharmacists• Culturally complex and diverse workforce (and student body)• 26 Schools of Pharmacy in GB; 10,599 students (2011)• Most pharmacists employed in retail pharmacy

– Self-employed small business owners– Locums– Employees

Pharmacy in GB (ii)

• Large and varied network of community pharmacies:– ~12,000 pharmacies– Includes independently-owned businesses– And (inter-)national chains, supermarkets

• New contract in 2005• Community pharmacies play a key role in healthcare systems:

– Essential services (eg, dispensing)– Advanced services (eg, Medicines Use Reviews (MURs))– Locally commissioned services (eg, Minor ailments schemes)

Pharmacy in GB: workload increasing

• 473 million items dispensed in 1995; 1000 million in 2012

• 17,745 locally commissioned services in 2005/6; 29,526 in 2009/10

• 152,854 MURS in 05-06; 2.43 million MURS in 2011-12

Hassell K, Seston E, Schafheutle EI, Wagner A, Eden M. Workload in community pharmacies in the UK and its impact on patient safety and pharmacists’ well-being: a review of the evidence. Health and Social Care in the Community, 2011; 19,6: 561-575

Stress a growing concern

• Evidence suggests that growing workloads are leaving pharmacists feeling unable to cope:– new contract; more roles; paper work; MURs– Unpredictable nature of work– Being under-utilised or under-valued– Target driven culture– Lack of resources (eg, inadequate staffing)– Long days without rest breaks

Stressors and type of pharmacy

ALL pharmacy types Independent Small chain

Medium multiple

Large multiple

Supermarket

ANOVASig.

Work stressors

Work relationships 20.19±7.61 17.37±6.92 17.59±7.86 18.65±6.36 21.96±7.49 22.03±7.44 p<0.001

Work-life balance 12.62±4.71 12.76±5.24 11.24±4.83 11.73±4.66 12.70±4.34 13.91±4.72 p<0.001

Overload 13.26±4.85 11.70±4.46 10.75±4.46 11.5±4.40 14.69±4.74 13.64±4.54 p<0.001

Job security 12.32±4.29 11.49±4.22 11.94±4.67 13.03±4.27 12.52±4.11 12.94±4.38 p<0.05

Control 13.66±5.20 10.66±7.90 11.32±4.76 12.95±4.23 15.58±4.77 14.07±4.47 p<0.001

Resources and communication

11.64±4.55 9.77±4.46 10.51±4.57 12.18±4.26 12.52±4.39 12.57±3.97 p<0.001

Your job 26.03±7.08 23.38±6.56 22.63±7.09 23.51±6.29 27.93±6.70 27.91±7.10 p<0.001

Pay and benefits 3.16±1.56 2.55±1.45 2.94±1.50 3.24±1.49 3.45±1.53 3.28±1.51 p<0.001

Well-being and type of pharmacy

All pharmacists Independent Small chain

Medium multiple

Large multiple

Supermarket

ANOVASig.

Well-being

Physical health 12.75±4.22 12.56±4.22 11.90±4.18 11.53±3.94 13.00±4.24 13.54±3.35 p<0.05

Psychological well-being 22.13±7.63 21.87±7.58 20.11±7.58 20.00±6.74 22.67±7.80 23.66±7.80 p<0.01

Stress interventions: what are employers doing?

•Return to work schemes

•Counselling services

•Coaching

Individual level

•Appraisals

•Improving communication/engagement

•Conflict resolution

Interface between individual and their

organisation

•Encourage rest breaks

•Have appropriate staffing levels

•Improve physical environment

Organisational level

Discussion: what should/can GPhC do?

Standards

GPhC standards of conduct, ethics and performance: the seven principles

1. Make patients your first concern

2. Use your professional judgement in the interests of patients and the public

3. Show respect for others

4. Encourage patients and the public to participate in decisions about their care

5. Develop your professional knowledge and competence

6. Be honest and trustworthy

7. Take responsibility for your working practices.

GPhC standards for registered pharmacies: five principles• The governance arrangements safeguard the health, safety and wellbeing

of patients and the public.• Staff are empowered and competent to safeguard the health, safety and

wellbeing of patients and the public.• The environment and condition of the premises from which pharmacy

services are provided, and any associated premises, safeguard the health, safety and wellbeing of patients and the public.

• The way in which pharmacy services, including the management of medicines and medical devices, are delivered safeguards the health, safety and wellbeing of patients and the public.

• The equipment and facilities used in the provision of pharmacy services safeguard the health, safety and wellbeing of patients and the public.

Leverage of new approach to inspection

• Eg: GPhC standards for registered pharmacies– Purpose: to create and maintain the right environment,

both organisational and physical, for the safe and effective practice of pharmacy

– The standards are a clear indication of GPhC’s commitment to improvement in pharmacy practice

• Effective regulation can and should be enabling & can be used as a lever for improvement in pharmacy services

• Aspiring to excellence – professionalism

Work with the professional body (the RPS)

• Professional empowerment:– Help improve culture around

raising concerns – Management training– Raise awareness among

employees about relevant legislation

– Resources– Physical environment– Rest breaks

Stress and poor well-being: the evidenceStudy publication

Locum study Shann P and Hassell K. Flexible working: Understanding the locum pharmacist in Great Britain. Research in Social and Administrative Pharmacy; 2006; 2; 3: 388-407

Work patterns of female pharmacists

Gidman W, Hassell K, Payne K, Day J. The impact of increased workloads and role expansion on female community pharmacists in the UK. Research in Social and Administrative Pharmacy; 2007; 3,3: 285-302.

Barriers to learning study

Noble C, Hassell K. Informal learning in the workplace: what are theenvironmental barriers for junior hospital pharmacists? International Journal of Pharmacy Practice, 2008: 16: 257-63

Leavers study Eden M, Schafheutle ES, Hassell K. Workload pressure among recently qualified pharmacists: an exploratory study of intentions to leave the profession. International Journal of Pharmacy Practice; 2009; 17: 1-7

Job satisfaction study

Ferguson J, Hassell K, Ashcroft DA. Qualitative insights into job satisfaction and dissatisfaction with management among community and hospital pharmacists; Research in Social and Administrative Pharmacy; 2011, 7: 306-16

Pharmacy workforce censuses

Seston L Hassell K. British pharmacists’ work-life balance – is it a problem? International Journal of Pharmacy Practice; 2013:

Workplace stress survey

Jacobs S, Hassell K, Ashcroft DA, et al. Workplace stress in community pharmacies in England: associations with individual, organizational and job characteristics. Journal of Health Services Research and Policy 2014, 19: 27-33