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Wendy Gidman is a pharmacist from the Workforce
Academy at the School
of Pharmacy, University of Manchester
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An ageing population, increased morbidity, new technologies and higher
patient expectations have led to an increased demand for health care
and pharmaceutical services. In fact, the number of prescriptions dispensed
in the UK has risen by 42.9 per cent over the past decade. Moreover,
pharmacy workforce planners and analysts predict that this trend will
continue.
Although demand for pharmaceutical services has escalated, the number
of community pharmacies in England has remained static and the number
of pharmacists working in the UK community sector has decreased. Consequently,
workloads within community pharmacy have risen.
In the US, workforce shortages have resulted in substantial increases
in pharmacists’ salaries. However, in England, the Government’s
attempts to contain health care and specifically medicine-related costs
have eroded unit remuneration levels within community pharmacy. In fact,
the professional fee per prescription item dispensed dropped from £1.42
in 1991 to 99p in 2001. Furthermore, between 1991 and 2001 Government
funding for community pharmacy services within England and Scotland has
only increased by 4 per cent. Community pharmacists’ salary data
in the UK is scarce, but it seems reasonable to suppose that pharmacists’ salary
levels will reflect reduced payments to contractors. Thus, it would seem
that more prescriptions are being dispensed in the community sector with
minimal increases in funding.
New community contract
In addition, English health care policy has aimed to improve access
to health care services and decrease GP workloads — policy initiatives
reflected in the new English community pharmacy contract. The new
contract provides the incentive for community pharmacists to expand their role.
With additional training, community pharmacists are able to provide
a range of advanced or enhanced services. Common examples of services
include minor ailments schemes, emergency hormonal contraception services
and blood pressure monitoring. This allows patients to access a number
of services in community pharmacies that were formerly only available
from GPs. Similar role extensions are reported in the US.
Role expansion is common in the health care setting. Typically, this
has meant that individuals are taking on tasks previously performed by
more qualified, senior staff. On a positive note this can be seen to
enhance professional status, increase autonomy and potentially increase
job satisfaction. Indeed, pharmacists in England were overwhelmingly
in favour of the new contract. In reality, however, this may result in
increased workloads, increased levels of responsibility and increased
risk of litigation and exploitation.
Role expansion acts to increase workloads in community pharmacy in two
ways. First, it involves additional, potentially time-consuming, unscheduled
consultations with patients. Secondly, it necessitates extra training,
which might have implications for pharmacists and those employing them.
Anecdotal evidence suggests that some pharmacists, particularly those
working as locums, have experienced difficulties in gaining accreditation
to provide advanced services, such as emergency hormonal contraception
under patient group
directions.
It is interesting to note that changes in the English community pharmacy
contract have acted to reduce the workload of GPs in England, while increasing
that of pharmacists. Are community pharmacists more vulnerable to exploitation
by “work intensification” than other health professions,
such as GPs? Commercial pressures
Employment research suggests that work intensification can arise from
increased competition, with organisations cutting back on staff in
response to market pressures. It is likely that the recent changes
to the English community pharmacy contract, with the expansion of corporate
pharmacy chain stores and the demise of resale price maintenance, have
increased commercial pressures.
Technological and structural changes within employment environments
can result in work intensification. Within community pharmacy, technological
advances have the potential to erode the pharmacist’s position — specifically,
automated dispensing and internet pharmacy. Work intensification has
also been associated with a decrease in union power and an increase in
the use of temporary agency workers. The community pharmacist workforce
is without a union and freelance locum work is common.
Work intensification has also been linked to job insecurity. Not surprisingly,
workers who feel less secure in their jobs are more likely to be prepared
to work harder for the same or less remuneration. At first, this would
not seem to be applicable to pharmacy, which has experienced workforce
shortages. However, there is some evidence that community pharmacists
are moving from locum posts to permanent positions, at least in part,
as a consequence of perceived job insecurity.
Pharmacists’ perceptions of their employment prospects may have
altered as a consequence of the evolving community pharmacy environment.
Importantly, in the past decade, key aspects of the community pharmacist’s
role have been devolved to other less skilled employees: accredited technicians
can now check prescriptions for accuracy. Critically, the pivotal supervisory
role of the pharmacist is now under review. The current legislative framework
requires the presence of a registered pharmacist in a community pharmacy.
If this situation alters, in accordance with the Health Act 2006, it
could dramatically affect the status of community pharmacists. Moreover,
the number of UK registered pharmacists is set to rise due to the opening
of new schools of pharmacy, while opening of the labour market to Central
Europeans has led to an influx of overseas pharmacists. An over-supply
of pharmacists may be imminent. It seems that community pharmacists could
justifiably be concerned about their employment prospects and, data suggest,
susceptible to pressure to increase workloads without compensation.
It is worth considering how work intensification affects community pharmacists
and the services they provide. Emerging data from a study, conducted
in the Workforce Academy in Manchester, suggest that workloads in community
pharmacy are high. Specifically, community pharmacists found it logistically
difficult to balance new roles with existing responsibilities. In some
cases a lack of management support and staff shortages exacerbated the
effects of work intensification. Furthermore, this study adds to the
evidence suggesting that pharmacists perceive that increased workloads
affect the standard of their work and put patients at risk. Impact on health and wellbeing
Another interesting point to consider is the impact of work intensification
on community pharmacists’ health and wellbeing. Previous research
suggests that high workloads lead to increased levels of stress, associated
with decreased levels of health and wellbeing and, in some cases, decreased
job satisfaction. Evidence indicates that community pharmacists are
increasingly citing stress as the reason for leaving an employer. It
is of concern that published employment research indicates that individuals
do not adapt to work intensification. It is also important to consider
the likely impact of work intensification on the female workforce:
it has a greater affect on women, possibly due to women contributing
more to the domestic workload.
Work intensification and role expansion have the potential to put greater
pressure on community pharmacy, and negatively affect job satisfaction,
health and wellbeing. High pressure working environments look to become
common place. Workforce planners and health care policy makers should
consider the impact of recent policy changes on pharmacists and the services
they provide. |
The
Pharmaceutical Journal