More than half of pharmacists responding to a snapshot survey conducted by The Pharmacist have suggested they would consider strike action or withdrawing their services.

Of the almost 200 pharmacists working across the UK in community or practice settings who responded to the survey, 71% thought their pay was inadequate.

And half of community pharmacists responding to the survey reported working overtime every week or nearly every week.

In general, respondents reported good morale and felt valued by their employer or team, but not as much by the government or NHS.

Concerningly, around three-quarters of pharmacists, including those working in community and general practice, said they experienced abuse from patients at least once or twice a month.

Pharmacists responding to the survey suggested that a desire to take industrial action was based on ‘less than ideal’ income, ‘excessive workload’, and a desire for ‘better or pay incentive for successful service provision’.

Others cited medicines shortages, a desire to ‘draw a line’ on dispensing at a loss, a lack of work-life balance, ‘too high’ patient expectations and staffing issues.

But other pharmacists suggested that striking was not an option for pharmacy contractors.

‘Striking makes no sense when 90% of income is NHS dependent. The national multiples will not strike. Far better to refer patients into NHS system to increase pressure elsewhere,’ one pharmacist suggested.

And another commented: ‘Working to rule is a much better idea – just providing services required under contract and the relentlessly refer all patients outside of contract services to their GP or A&E.’

Work-life balance

Over half (52%) of the 187 pharmacists that responded to the survey across community and general practice settings said they valued work-life balance the most, above salary (26%) and patient satisfaction (22%).

But nearly a quarter (23%) said that they worked longer than their contracted hours (or longer than a 40-hour working week) every week, with almost a third (29%) working overtime nearly every week.

A further 16% said that they worked overtime about half the time, 13% about one week in every month, 7% several times a year, 10% occasionally, and just 1% said that they never worked overtime.

The proportion of respondents working overtime every week was highest among community pharmacy owners and lowest among locums and pharmacists that worked in both community pharmacy and general practice.

Pharmacists most commonly used their overtime hours to prepare or check medicines, followed by business growth or researching new opportunities, delivering patient services and researching medicines prices or ordering stock.

Morale

Just under a quarter (24%) of pharmacists across all settings surveyed said that morale among pharmacy teams was very good, while 38% said that it was good, 22% said it was OK, 9% said that morale was bad and the remaining 7% said that it was very bad.

Reported morale was highest among practice pharmacists or those based in primary care networks (PCNs), of whom 77% said that morale was good or very good.

Community pharmacists reported lower morale, with 63% of employed community pharmacists, 57% of locum community pharmacists and 54% of community pharmacy owners reporting good or very good morale among pharmacy teams.

When compared to those working in general practice or PCNs, pharmacists working in community also reported lower levels of feeling valued by their employer or team, by the government or the NHS, by other healthcare professionals, by patients and by the general public.

The survey also highlighted frequent levels of patient abuse received by pharmacists in both community and general practice.

Within the last year, 18% of respondents said they had experienced abuse from patients on a daily basis, 31% once or twice a week, 26% once or twice a month and 16% on occasion. Just 9% of the 187 respondents said that they had not faced abuse from patients within the last year.

Jay Badenhorst, vice-chair of the National Pharmacy Association, condemned ‘aggressive behaviour towards dedicated pharmacy staff, who give so much of themselves in the service of their communities’.

‘They deserve to feel safe at work and should never be subjected to intimidation or violence of any kind,’ he added.

He said that many pharmacy owners and pharmacy staff were ‘thoroughly down at heart because of a perfect storm of underfunding, cost-pressures, workforce shortages and disruptive medicines shortages.’

But he added: ‘It’s still a great privilege to be a community pharmacist serving my local community and there are significant opportunities ahead for the whole sector.’

Dr Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies (AIMp) suggested that the close relationship that many independent pharmacy operators had with their patients and staff would have a positive impact on morale.

But she said that contractors were facing a ‘very difficult situation’, including funding cuts to the sector, medicines shortages and abuse from patients, with many investing in security apparatus such as cameras.

She added that it was hard for contractors to plan for or invest in the future, saying that their focus at the moment was ‘purely about survival’.

However, Dr Hannbeck suggested that strike action would be ‘difficult’ for the community pharmacy sector, as it is made up of several different operators. ‘If everyone is not on the same page, it wouldn't really work,’ she said.

And she added that despite ‘terrible’ funding and pressures on pharmacies, AIMp would not encourage strike action due to the impact on patients.

‘We don’t think that the public should be punished for that,’ she said.

‘I think we have a good rapport with our patients, a good rapport with the public, I don't think strikes would help that,’ she added.

And Malcolm Harrison, Company Chemists' Association (CCA) chief executive also suggested there was a difference between 'what people say and what they do', adding that strike action was 'definitely not something that community pharmacy should be thinking about'.

However, he said he understood the pressure that pharmacy teams were under.

He recognised they were 'stretched very thinly' as costs and demand for medicines and services increased, without a rise in funding to employ more people to share the workload.

And he added: 'If the NHS could find a way to make supply of medicines equitable, so we're not supplying at a loss, so businesses aren't losing money, then they'll be able to start to afford to invest in more in staff, in staff training, in facilities, which they haven't been able to do.'

James Davies, director of the Royal Pharmaceutical (RPS) Society in England, responded to The Pharmacist’s findings: ‘The entire pharmacy workforce has faced enormous pressure for several years, significantly impacting individuals’ wellbeing.’

A recent workforce wellbeing survey conducted by the RPS and Pharmacist Support found that 88% of pharmacists surveyed were at high risk of burnout.

While individuals were being urged to prioritise their wellbeing and minimise personal burnout risks, Mr Davies said that many factors contributing to stress and burnout ‘stem from systemic issues within the workplace’ and therefore ‘must be addressed at the systemic levels rather than placing the burden on individuals’.

‘Employers, regulators the NHS, unions, charities and pharmacy teams must work collectively to support pharmacists’ wellbeing and reduce potential risks to patient safety,’ he told The Pharmacist.

Janet Morrison, chief executive at Community Pharmacy England (CPE), commented that the ‘immense pressures’ faced by community pharmacy teams were ‘not acceptable and not sustainable’.

‘Most pharmacies are working at well beyond full capacity and pharmacy owners are having to take drastic action such as cutting back on services and reducing opening hours just to make ends meet,’ she added.

And she said that CPE was doing everything it could to get the additional £645m funding – promised for the sector in the primary care recovery plan – ‘flowing into pharmacies as quickly as possible’.

‘We are doing everything within our power to make that happen, but the negotiating process has involved a complex process of cross-governmental sign-off and we also need to make sure that we get to the right answers as the outcome of these negotiations will have far-reaching implications for the sector,’ she told The Pharmacist.

She also said the CPE’s recently launched Vision for Community Pharmacy would help the negotiator showcase the sector’s value to government and the NHS, ‘helping secure a better future for community pharmacy’.