1. Unsupported and over stretched pharmacists: is there a role for the regulator? Karen Hassell Ellen Schafheutle The Centre for Pharmacy Workforce Studies Manchester Pharmacy School March 2014

2. The presentation Pharmacists/pharmacy in brief Evidence about work related stress –sources –which pharmacists –organisations Employers responses GPhC

3. 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

4. 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)

5. 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

6. 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

7. Stressors and type of pharmacy ALL pharmacy typesIndependentSmall chain Medium multiple Large multiple Supermarke t ANOVA Sig. Work stressors Work relationships 20.19±7.61 17.37±6.9217.59±7.8618.65±6.3621.96±7.4922.03±7.44p<0.001 Work-life balance 12.62±4.71 12.76±5.2411.24±4.8311.73±4.6612.70±4.3413.91±4.72p<0.001 Overload 13.26±4.85 11.70±4.4610.75±4.4611.5±4.4014.69±4.7413.64±4.54p<0.001 Job security 12.32±4.29 11.49±4.2211.94±4.6713.03±4.2712.52±4.1112.94±4.38p<0.05 Control 13.66±5.20 10.66±7.9011.32±4.7612.95±4.2315.58±4.7714.07±4.47p<0.001 Resources and communication 11.64±4.55 9.77±4.4610.51±4.5712.18±4.2612.52±4.3912.57±3.97p<0.001 Your job 26.03±7.08 23.38±6.5622.63±7.0923.51±6.2927.93±6.7027.91±7.10p<0.001 Pay and benefits 3.16±1.56 2.55±1.452.94±1.503.24±1.493.45±1.533.28±1.51p<0.001

8. Well-being and type of pharmacy All pharmacistsIndependentSmall chain Medium multiple Large multiple Supermarke t ANOVA Sig. Well-being Physical health12.75±4.2212.56±4.2211.90±4.1811.53±3.9413.00±4.2413.54±3.35p<0.05 Psychological well-being22.13±7.6321.87±7.5820.11±7.5820.00±6.7422.67±7.8023.66±7.80p<0.01

9. 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

10. Discussion: what should/can GPhC do?

11. Standards

12. 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.

13. 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.

14. 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

15. 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

17. Stress and poor well-being: the evidence Study 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 the environmental 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