Super-pharmacists or pseudo-doctors?

The short answer to your question is for adequate staff to be available in every pharmacy. This is unlikely to happen unless the owners are compelled to provide them. The reasons why this is unlikely to happen are obvious to anyone who actually works in a pharmacy.

I’m beginning to think in terms of extreme pharmacy rather than super-pharmacists or pseudo-doctors. In extreme sport the general idea seems to be to go further than you thought you could in order to gain an adrenaline rush even though such activities are often more than acceptably dangerous. This seems to have been extended lately to include anything different from what the majority of people think is a sensible activity. 

Extreme pharmacy should be easily defined. At first I thought it would be when one has to do something out of the ordinary like carrying on through the floods to provide a service, or coping with a flu pandemic or working amid the chaos of a store refit. Those activities might give you a buzz but they rarely require you to risk your life. Then I realised that the definition is much more worrying. Anyone who actually works in a pharmacy will recognise extreme pharmacy straightaway. It has become the way we work everyday.

Pharmacists have taken on many new roles. At the time I think those who greeted the changes believed that pharmacists were moving away from the dispensing part of the job to take on a more clinical role. At last, we thought, we would be freed from the repetition and routine of the dispensary and be able to make use of all the training and experience we have gained to help our patients. 

We would run campaigns to promote health and healthy lifestyles such as smoking cessation and weight loss. We would provide tests for blood pressure, detecting diabetes, controlling cholesterol levels, checking INR, chlamydia and even, just lately, we have heard the suggestion that pharmacists could collect the biometric data required for passports and identification cards. We would spend our time reviewing patient’s medication, ensuring they take their medicines safely and for the best effect. The list grows almost daily. It hasn’t worked out quite as planned yet.

The main problem is that the new ideas and plans intended to reduce the dispensing part of our workload have not been introduced. All sorts of people, usually academics and administrators incidentally, pushed pharmacists into what they called ‘a new age’ without thinking for one moment how what they refer to as ‘the people on the ground’ would cope. 

We needed to be able to delegate some of our responsibility to trained staff. While there are some accredited checking technicians coming through now, it is a slow and patchy process. The electronic transmission of prescriptions was supposed to ease our workload but it hasn’t happened yet. Most of us are still waiting for the system to be up and working properly. The majority of companies either cannot or will not employ more staff to do the work. To do so, they say, would increase costs too much. 

Then we were told that repeat dispensing systems were going to help us plan ahead but in many ways they just added to the paperwork. In fact adding to the paperwork has been the greatest change to our workload so far. Most pharmacists have ended up taking on the extra roles in addition to also dispensing an ever growing number of prescriptions. 

The majority of practicing pharmacists are employees of the large chains or work as freelance locum pharmacists, mainly for these few companies. I have worked as a locum for all of them except Superdrug. There isn’t one in my area. As there are very few pharmacists involved in the day to day running of these huge companies our influence at head office is slight. Financial controls rule the day. Company-speak covers head office while leaving the ‘people on the ground’ exposed to the pressure. 

One of the biggest costs of running any business is that of staff salaries. The easiest way to reduce your costs is to cut the number of your staff. Obviously therefore one of the greatest pressures on pharmacists and other managers is the need imposed by head office to reduce staff costs as much as possible. The result of this policy is a demand to employ fewer staff and sometimes less experienced or trained staff who won’t cost as much. 

Although the quality of dispensing training available nowadays has never been better, such is the pressure in the workplace that one is rarely allowed to replace experienced, competent pharmacy staff as the years go by. 

So companies want cheap staff but on the other hand the companies want to make as much money as possible as well. To make more money for their companies, pharmacists and their staff have to take on more of the new roles. The pressure from head office to perform more and more of these jobs and claim the maximum funding available gets greater by the day. It is not uncommon for middle managers to threaten pharmacists with lost pay rises or withheld bonuses if they don’t find a way of claiming the full amount of these funds. My old boss warned me years ago that we would become well-trained chimpanzees existing on ever fewer bananas. He was right.

Certainly those who take part in extreme sports risk serious injury if not their lives for a moment or two of ecstasy. However as extreme pharmacy becomes the norm in most companies the adrenaline rush is fading fast and the lives at risk are those of our patients.