Viewpoint: Moving towards a better balance

Firstly, there are factors that relate to the environment in which community pharmacists often find themselves working. Community pharmacy is in a period of transition as it responds to a call from government to move from a largely supply based function towards a more clinical service-based offer.  

As automation, AI and off-site dispensing start to take hold on the sector, this move is going to be essential if community pharmacy is to thrive. Transitions can often be painful, and this is no exception.

Increased prescription volumes and double working as clinical services are established alongside the more traditional supply function, combined with reduced margins and flat remuneration, mean pressure on employers and employees is inevitable and the temptation is to reduce staffing levels.  

There is clearly an onus on employers to mitigate the associated risks. However, for transitions of this nature to be successful, they require significant resource – something which has been sadly lacking in community pharmacy in recent years.

Combine that with the physical environment in which community pharmacists often work, such as cramped and cluttered dispensaries, small and often inadequate consultation rooms, reduced space for stock, being on their feet all day often with a lack of facilities for staff breaks and it means physical working conditions are far from optimal and increase the risk of error. 

Secondly, there are issues relating to individual pharmacists, which also need to be thought through.

Following Covid-19, many people have examined their attitude towards work and tried to reassess their work-life balance by asking for a reduction in their working hours, working more flexibly or working compressed hours. People now want more from their working life and are reluctant to work antisocial hours.

While this is no bad thing for the individual – and in many respects is to be encouraged – it does pose problems for employers and owners, who may want to be able to grant these requests but find the nature of community pharmacy and existing workforce shortages mean they are unable to do so. This, in turn, exacerbates the problem, with pharmacists leaving the sector for more flexible jobs in other sectors of the profession, although there are some signs that this trend may be slowing.  

Thirdly, let’s consider the work itself. Community pharmacists not only want flexibility as outlined above but they also want work they find interesting and professionally fulfilling alongside a career structure that allows them to progress and develop their skill base. While in many respects community pharmacy can offer all those things, too often it is seen as wanting, with many community pharmacists spending their time doing things they are vastly overqualified to do.  

Pharmacists want to utilise the skills they have learned and be recognised as clinical professionals. While it is hard to hear, too often the perception is that community pharmacy remains largely a supply function and is treated and remunerated as such. The nuances of medicines safety, clinical expertise and holistic professionalism are too often lost on government, media, the public and, sadly, other healthcare professionals. 

Above all else, we need to make community pharmacy an interesting and professionally fulfilling place where people want to work. This must be infinitely better than restricting choice and essentially forcing people into the sector. It can be done by making full use of a pharmacist’s clinical skills and expertise and utilising them in areas where those skills can be used to the full, in front of the patient.

The development of clinical services will take us in that direction and allow community pharmacists to flourish.  

We need to get away from additional training requirements before each individual service can offered, which can be both arduous for all concerned and demoralising, and move towards credentialling and post graduate study becoming the norm within the sector. This will also help in terms of the development of a more structured career path for community pharmacists, which is long overdue. 

“We need to make community pharmacy an interesting and professionally fulfilling place where people want to work” 

One of the well-recognised elements of good leadership is to play to people’s strengths if they are to feel valued and fulfilled. To do this, we need to be brave and unpick the dispensing process, which could be considered to consist of the clinical check, assembly, accuracy check and patient counselling.

All too often, these are seen as a single process, but by teasing these elements apart and employing appropriate skill mix from well-trained colleagues, automation and utilising hub and spoke dispensing models, we can concentrate the pharmacist’s efforts on what only they can do (i.e. the clinical check), to ensure the medicine is safe and appropriate for the individual patient and leave the rest of the process to others.  

By concentrating on that as well as face-to-face interaction with patients to deliver new clinical services that utilise independent prescribing, we can make the role of the pharmacist much more professionally rewarding. Many pharmacists will tell you that they spend a huge amount of time on tasks such as answering the phone and sourcing medicines that are in shortage. This cannot be a good use of a highly trained healthcare professional and can only lead to discontent.  

While General Pharmaceutical Council standards are there to ensure minimum standards are met both in terms of premises and individual pharmacists, we must ask ourselves if meeting the minimum is good enough or should our patients expect much more than that, particularly if patient safety could be compromised because of workforce discontent. 

It is not the role of government to make our profession interesting and professionally rewarding. That must be for employers and the profession itself – although it does of course take resource. Owners and employers cannot be expected to take all the risk when their viability depends on a monopoly commissioner.

The remuneration model therefore needs to be completely revised to reflect a reorientated work programme and modern clinically orientated premises so that employers can develop models that attract pharmacists, technicians and other staff into the sector.  

It will always be a balance in terms of patient access, which has long been one of community pharmacy’s greatest strengths and giving pharmacists the flexibility to undertake clinical roles both within and outside of the pharmacy.

If we are prepared to trust our colleagues and let go of the things that others can do just as well, or even better, then with a will and commitment from government, community pharmacy can truly become a place where pharmacists can thrive and want to work, sometimes as part of a portfolio career.

If we can get to that point, patient safety can only benefit, and we will hopefully never see the issue of deteriorating community pharmacy workforce issues being highlighted as a major patient safety risk again. 

Bruce Warner is honorary professor of pharmacy policy and practice at the University of Nottingham and a visiting professor of pharmacy practice at the University of Huddersfield University. He was deputy chief pharmaceutical officer for England from 2014 until 2023.