Pressure, distraction, stress! Pressure distraction, stress! Constantly racing to catch up and end the day with at least something completely done. Unflaggingly vigilant when dispensing or checking others. Supervising sales either personally or with an all-hearing, all-seeing sixth sense. Forever feeling for any unhappy staff murmurings, and all the while muttering to oneself under one's breath. Pressure, distraction, stress!
Rummaging through the month's prescriptions to answer a query. Distracted for 10 minutes then finding the inquirer has rung off. Thumbing through Martindale or the British National Formulary to solve a query from a medical colleague. Spilling a half-filled Nomad tray, and all the time a never-ending sea of impatient patients scowling through the dispensary window. A quiet cup of tea in the rest room? Impossible for the single-handed pharmacist. Pressure, distraction, stress!
Few middle-aged community pharmacists have not heard the Tempter whispering to them seductively: "Retire now. Be a locum. Take the reduced pension and top it up with part-time work. No paperwork.
No staff problems. No rota. No company rules and targets to meet. And no company representatives to haggle with over bonus parcels. Weekday golf. Holidays whenever you choose. Easy-peasy!"
The nearer that the pharmacist is to retirement, the greater the pressure weighs. Increasing bureaucracy from the Government and the National Health Service, eroded profit margins, collecting and dispensing prescriptions (often for people with more spare time than the pharmacist), the temptation to stay after hours to catch up . . .
The whispering becomes louder: "Arrive after the shop has opened. Supervise the computer-skilled dispenser. Buy biscuits for the trained staff and chat over the hot, freshly percolated coffee. Exchange pleasantries with the fascinating local customers. After a nice lunch in the local pub and a quiet afternoon, leave promptly so that the efficient staff can cash up, shut down the computer and set the alarms."
Beware! Thirty or 40 years ago, these conditions might have existed. Most pharmacists had ample staff and an experienced dispenser. In a large shop, the dispenser would act like a senior non-commissioned officer, a fount of all pharmaceutical and operational knowledge, and also the go-between of staff and management. Even a busy dispensary then was was less complicated than one of today. Handwritten labels identifying "The Tablets" or "The Mixture" were passed to a more patient and trusting public. No stuttering computers, endorsers, printers, electronic tills or bleeping fax machines to interfere with normal conversation.
A certain distortion by nostalgia? Possibly. By the standards of today, most retail premises were freezing in winter and often poorly lit. Assistants' wages were fairly low and longer hours were worked. Fewer holidays were allowed and, except for the large companies, there was no standard training.
Today, retail working conditions have improved immensely. Most pharmacies are warm and well lit. The public are better informed on medical matters, bombarded as they are by the media with education about disease and drug treatment. They are also frightened by scare stories in the same media. They rightly expect the pharmacist to allay these fears and act as the first line of defence against illness.
Unfortunately, training assistants costs money, and as the pharmacy has lost its counter trade to the supermarkets, the resulting loss of profit is often directly proportional to staff reductions. Many pharmacies are now operating with dangerously inadequate staff levels, especially during staff holiday and sickness periods.
Pressure, distraction, stress!
Why change the comfortable working regime built up over so many years? The young career locum may work for an agency which will not rebook if conditions are not right. They may act solely for one company, with identical procedures in each shop. The full-time locum can also come into work knowing what went on yesterday.
Thinking of semi-retiring? Take care! The odd day may provide all the pressure, distraction and stress of a whole week of regular work. It may be that the strange pharmacy has no dispenser or staff member familiar with the computer. The dispensary may be laid out in a lunatic pattern only decipherable by the owner. The acute shortage of managerial pharmacists (especially in the south of England) can mean that a different locum is in charge each day. Not all of them remember to leave explanations for the benchful of incomplete prescriptions. The strange computer program, the printer that jams after five labels, the missing CD cupboard key, inadequate staff and no proper lunch break result in a scenario fraught with danger . . . and a sleepless night worrying about possible dispensary slips.
Of course, there are many well-run, well-staffed pharmacies and the erstwhile locum must seek them out before burning the NHS contract. Visit colleagues to see if they would like a regular day off. Have a look around the dispensary layout. Ask for a demonstration of the computer and other electronic gadgets. Meet the staff and notice how efficient and numerous they are. To become part of the team, even just once a week, is pleasant and not too demanding for the less agile.
A semi-retired locum may not want to be tied by a regular position, however. Dangerous! Beware that telephone call on a Sunday night in the middle of Morse. A half-familiar name desperate for a day next month. A hurried glance at the pocket diary while watching the television will result in a double booking or an irate family member abandoned on a promised excursion. Solution? Promise to ring back later.
Vital questions need to be answered: Is there a computer-literate dispenser? Are the staff able to open and lock up without setting off alarms at the local police station? Lunch break? Car parking? Oh, and what is the locum fee and how will it be paid? Of course the locum will renew his own indemnity insurance, obtain receipts for fees and keep meticulous records for the taxman.
Pressure, distraction and stress are a necessary evil of modern community pharmacy, unfortunately. But at least the part-time locum, having found the ideal pharmacy, can spread the burden by the days off in between and can enjoy a stimulating and financially rewarding experience. He or she can enjoy the luxury of retelling old experiences and anecdotes to a new audience, long after the nearest and dearest have died of boredom!
What the Tempter does not whisper is that to be a locum is like looking after someone else's children . . . often more trouble, less disciplined and more worrying that coping with one's own. But once the shop is closed, there is a certain smug satisfaction for the locum in that a colleague has enjoyed the security of time off without worry and can open in the morning with a clear bench and no left-over problems.
Celia Evans is a pharmacist in Southampton