Type 2 diabetes
Published: 15 July 2025
This was published when the organisation was the Royal Pharmaceutical Society.
Pharmacists can play an increasing role in the prevention, early detection, care and support of people with type 2 Diabetes.
We want to see the NHS utilise pharmacists across all care settings to improve the care of people with type 2 diabetes. Pharmacists can support people with type 2 diabetes so they get the best from their medicines, improving their health and wellbeing through integrated, collaborative and personalised care services.
What we’re calling for:
To improve care for people with type 2 diabetes:
- Pharmacists should work in collaboration with other healthcare professionals to play a greater role in prevention and detection services for type 2 Diabetes.
- Pharmacists should play an active role in optimising medicines, improving the health, wellbeing and safety of people with type 2 diabetes across the NHS.
- Pharmacists in specialist and generalist roles should be given access to the most up to date education and training to support people with multiple conditions.
- NHS organisations need to establish and embed the role of consultant pharmacists in diabetes across the NHS should ensure improved outcomes in the management of people with type 2 diabetes, promote collaborative practice, multidisciplinary team working, quality improvement and research.
Further information
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Supporting the mental health and wellbeing of pharmacists
This was published when the organisation was the Royal Pharmaceutical Society. Background In June 2018, the Royal Pharmaceutical Society published a report on how pharmacists can support care for patients with mental health problems. However, as one in four adults experiences some kind of mental illness, pharmacists themselves need support in dealing with their own mental health and wellbeing (MHWB) in the workplace. We have heard from many of our members that they are experiencing pressures at work that are affecting their MHWB. Being the third-largest health profession, pharmacists deal with considerable pressures during their day-to-day practice. Pharmacists must comply with their contractual frameworks and regulatory standards. Employers can also cause pressure by insisting on targets that need to be achieved, which can sometimes be difficult with a lack of resources available. According to a King's Fund report on the workforce published in 2019, the significant vacancy problem of meeting patient demand would require recruiting at least 3,000 more pharmacists. Other royal colleges representing a variety of health professionals have also been looking at the issue of workplace pressures and how to support their members. We have engaged with other organisations within the pharmacy profession, who too have highlighted similar concerns. From these discussions, we developed some key themes that have factored in mental health and wellbeing problems in the workplace. It is important that we recognise these issues and raise awareness about the mental health and wellbeing of pharmacists. These include the individual responsibility of pharmacists, maintaining a work/life balance, changing roles for pharmacists across the NHS, pharmacy teamwork ethics and morale and staffing and recruitment. There is a need to collate more data to showcase the extent of the problem and to provide solutions to tackle it. More widely, we have been raising our concerns to stakeholders across healthcare. In 2018, a letter was sent from RPS to Steven Brine MP, the minister at the time with responsibility for pharmacy in England, calling for an investment to support the MHWB of pharmacists in a similar way to doctors. We also raised the issue of MHWB of pharmacists in introductory letters to those who have been appointed to this role since (Seema Kennedy MP and the current pharmacy minister, Jo Churchill MP). Following this, Keith Ridge, the chief pharmaceutical officer in England, asked to meet with RPS and we agreed that workplace pressures are a priority area and information to support this should be collated. Workplace pressures are similar across Great Britain, and we would welcome parallel engagement with the NHS in Scotland and Wales. There are services in England, Scotland and Wales that are designed to address the MHWB of staff in the NHS. However, these do not cover pharmacists who are not directly employed by the NHS, such as those working in the community, in care homes or in GP practices. Pharmacists and other healthcare professionals working in these care settings also deserve access to services that support their MHWB, and pharmacists deserve parity with other healthcare professionals. Doctors and dentists across England are supported by the Practitioner Health Programme, which is funded by NHS England. This is available to all doctors and dentists in whichever care setting they practice. In Scotland, for example, the Healthy Working Lives initiative from NHS Health Scotland has stressed the importance of employee mental health, stating that ‘Supporting the mental health of your employees can result in fewer days lost to sickness and absence, improved productivity and engagement, improved teamwork and lower staff turnover and recruitment costs’. NHS Wales also provides a ‘Health Working Wales’ service, which also gives key messaging regarding how to manage mental wellbeing in the workplace. The NHS Long Term Plan (England), published in January 2019, highlighted that the mental health and wellbeing of staff working in the NHS is a major concern and that it needs to be addressed. For example, page 43 of the plan states that: ‘As the largest employer (the NHS) in England, we are also taking action to improve the mental health and wellbeing of our workforce and setting an example to other employers.’ But unlike doctors and dentists under the Practitioner Health Programme, pharmacists do not have access to specific services that can help support their MHWB. The NHS in England has committed to providing support to all employed NHS staff, although the details of a scheme have yet to be published. In February 2019, Health Education England published a report looking at the MHWB of NHS staff titled ‘NHS Staff and Learners’ Mental Wellbeing Commission’. RPS called for all pharmacists to have access to the government’s new NHS mental health support plans based on these plans. Following this report, NHS England has pledged to provide better MHWB support for NHS staff as part of its ‘workforce implementation plan,’ based on the HEE report recommendations. The NHS Interim People Plan, published in June 2019, has a focus on the MHWB of NHS staff, citing that ‘the culture of the NHS is being negatively impacted by the fact our people are overstretched’. In April 2019, the General Pharmaceutical Council (GPhC) published a report from a meeting they held, focusing on safe and effective pharmacy teams, and work pressures are a core component of this report. The British Medical Association (BMA) also published their report on the mental health of doctors in the same month. RPS has discussed the MHWB of pharmacists across all three boards, and it is seen as a key priority area across Great Britain. RPS will roll out a comprehensive survey for all pharmacists to identify the extent of these issues. We hope that the findings will help us better understand the MHWB problems that affect pharmacists in the workplace. What we would like to achieve: Raise awareness of issues of mental health and wellbeing of pharmacists with employers, the NHS and stakeholders Understand the causes of mental health and wellbeing across all areas of pharmacy practice Find out how things can be improved Promote access to occupational health within employing organisations, or a similar service Lobby for a structured mental health and wellbeing service for all pharmacists across the system RPS will: Undertake an in-depth survey of its members to understand the issues affecting them around mental health and wellbeing at work from 10-31 October 2019. Produce a report following the survey with the findings. Hold a roundtable to discuss potential options to provide better support for pharmacists Work with pharmacists, employers, the NHS and Government on supporting the mental health and wellbeing of pharmacists and improving their working conditions. What we have heard from key stakeholders: We have engaged with a range of key stakeholders* and a variety of themes have emerged from the discussions we have had. * The organisations that have engaged with us are: PSNC, GPhC, Pharmacist Support, CQC, GHP, CCA, UKCPA, NHS England Key themes Individual responsibility All pharmacists must comply with the contractual framework and regulatory standards, and they have an individual responsibility to do this. However, the regulatory codes should support pharmacists and provide guidance on what they can do to avoid situations and problems occurring. Sometimes, individuals put unnecessary pressure on themselves. Some pharmacists prefer to work longer or condensed hours, sometimes due to other commitments on their non-working days or because they want to earn additional pay. Additionally, not all pharmacists are willing to delegate to other staff members working within the pharmacy for a variety of reasons. Different people have different and individual tolerance levels, so what is perceived as pressure by one person may not be seen the same way by another. Over the past two years, there have been increased concerns expressed by those working at senior levels within NHS Trusts. These concerns are mainly based on additional scrutiny of roles, particularly in the event of a merger with another Trust. Several chief pharmacists have felt that they are being unduly held to account in some areas. Wider issues of patient safety, and how health and wellbeing of staff can impact the person’s ability to do their job, as well as their physical health, need to be considered. Work/life balance Wellbeing is not just about workplace pressures, but also about having the right work/life balance. Many mental health issues can be related to anxiety and are not always work-related, but they manifest at work and then need to be supported by the workplace. Pharmacists, like all people, struggle with the complexities of life, where their priorities lie and how to balance everything. The continuing drive for extended hours and seven-day services can place pressure on family life and work/life balance, which has an impact on the desire and capacity of people to undertake post-graduate development. The profession needs to explore what the acceptable terms of workload for pharmacy are. This has a number of components. In the first instance, the issue is one of volume of work. Individual pharmacists are being asked by employers to look after more patients (beds/pharmacist ratio is rising) and deliver more services. The increased use of more medicines with more complicated monitoring profiles means that patient/medicine reviews take longer, and that length of stay reductions and increased bed occupancy mean that there are no ‘quiet’ days with opportunities to catch up. The impact of this is not related to the individual’s willingness to work hard, but the anxiety generated due to the workload experienced, and that they would or had ‘missed something’ or not seen the patient they needed to see. The work volume described also results in work overflowing into rest periods, lunches and finish times, and this is not limited to physical tasks, but also emotional burden (i.e. not being able to switch off). Finally, there is a recognition that the profession is somewhat a victim of its own success; the desire to become part of multidisciplinary teams, be integrated into primary care services and undertake extended roles has led to increased expectations from other professions and management. Changing roles Stress can be caused by external factors and organisations, such as lead time to develop and deliver new services, as well as internal factors, such as employers setting targets for service delivery. The environment that people work in can also place additional pressures on them. Pharmacists experience different pressures during their career progression. With the new roles for pharmacists, the level of support needs to be adequate so pharmacists feel competent and capable of delivering. In hospitals, pharmacists work as teams and get support from other team members. Quite often, pharmacists working in primary care are isolated and do not have this team support. The workforce needs to be developed in the right way so there is professional support across the system. Junior staff want to progress quickly, and this can also be an issue. Undergraduate training should include more on what it is like to be a pharmacist in day-to-day practice, so students leave with the right expectations. Several generic skills might be lacking in the profession. At a personal practice level, practical training around finances, business case development and commissioning could be developed or strengthened. These are in addition to some of the ‘softer’ skills of resilience and coping strategies, assertiveness and delegation. These skills are needed to equip the modern pharmacist for life in practice. Additional training for managerial skills may also be required for those in such roles. This will prepare managers so they can recognise and help relieve workplace pressures among their staff. Pharmacy teamwork ethic and morale Consideration needs to be given to the contractor vs. employee situation, but both employers and employees have responsibilities around workplace pressures. When people work as part of a team, other team members will often notice if someone is struggling. Pharmacists may not have the same level of resilience, and this needs to be universally recognised. A lower level of resilience can lead to a reduction in confidence when things go wrong and an increase in stress. Foundation pharmacists have said that working and completing postgraduate training is stressful, but the link between the qualification and promotion meant that you had to do so, and that time was not given in work to support this training. Staffing and recruitment Overall, there are several pharmacist vacancies that are difficult to fill, and this is likely to become worse as new and exciting roles emerge across primary care. Cuts in funding to community pharmacies in England have led to cuts in services, staff or opening hours as community pharmacies struggle to maintain the delivery of essential services. This will increase demand on community pharmacy teams to deliver more without appropriate staffing levels and resources. This will add pressure on pharmacy teams, impacting their health and wellbeing as a result. Potential solutions Some of the organisations we spoke to already provided some potential solutions, and others discussed with us what they thought might help the situation: Individual support and preventive measures: there is a need to help people to help themselves, such as support via coping techniques, (e.g. just sitting still with eyes shut for two minutes etc.) There might be a role for RPS or others in signposting to good examples of support, for example, mindfulness, podcasts etc. Putting in place preventive programmes to support the mental health of pharmacists will help people manage stress and pressures on a day-to-day basis. Third-party support services organisation: The larger employing organisations have occupational health schemes in place. However, members of staff do not always feel comfortable with accessing these, as they are not anonymous and so immediately identify the individual to the employer as having an issue. There is still a stigma around mental health, so it is difficult to talk about any issues. There is a need to help people access support as well as ensuring trust and confidentiality. Third-party organisations are used by some large multiples and are available to their employees. The employee can access support from the third-party organisation without having to inform their employer. Undergraduate/postgraduate training: This could include more on coping techniques and resilience, to help support the profession to undertake risk assessments, so that, as a profession, we are more confident in risky solutions and less risk-averse. Pharmacist Support: They provide training and run workshops on combating stress, interventions and outcomes. They currently rely on funding via donations. Understanding the workforce: The workforce needs to be developed in the right way so there is professional support across the system. Also, the pharmacy workforce needs to work collaboratively across a system and avoid competition in different areas of practice Practitioner Health Programme: Initially, when the Practitioner Health Programme was being rolled out, NHS England didn’t feel that there was enough evidence base that showed substantial concerns in pharmacist wellbeing, and so the profession was not included in the service. We would want pharmacists to be included within this service delivery and be able to self-refer. Point of Care Foundation: The PoCF have not previously had anything to do with pharmacists as a profession, although pharmacists will be involved in the organisational multidisciplinary work they do. They intentionally work at a multi-professional level. The PoCF run Schwartz rounds, which are a forum for reflective practice and are open to anyone who is on the staff of the organisation. These Schwartz rounds provide an opportunity to reflect on the non-clinical aspects of work and organisational life. Further information If you would like to get any further information or help on mental health and wellbeing support for pharmacists, please visit Pharmacist Support: https://pharmacistsupport.org/ Appendix 1 Literature review: Le H, Young S. Exploring the relationship between environmental stressors, pharmacy residents’ stress and medication errors. Journal of Psychology and Cognition. 2017; 2(3):192-197. Online. There is a positive relationship between stress levels and medication errors reported by pharmacy residents. Several environmental stressors contribute to their stress and medication errors. Further research is needed to validate the role of stress on medication errors in pharmacy residents. (US study) Le H, Young S. Evaluation of stress experienced by pharmacy residents. American Journal of Health-System Pharmacy. 2017; 74(8):599–604. DOI: 10.2146/ajhp150763. Pharmacy residents exhibited high levels of perceived stress, especially those who worked more than 60 hours per week. Perceived stress was highly correlated with negative affect levels (US study) Aldhwaihi K, Schifano F, Pezzolesi C, Umaru N. A systematic review of the nature of dispensing errors in hospital pharmacies. Integrated Pharmacy Research and Practice. 2016; 5:1-10. eCollection 2016. DOI: 10.2147/IPRP.S95733. The most frequent dispensing errors reported were dispensing the wrong medicine, dispensing the wrong drug strength, and dispensing the wrong dosage form. The most common factors associated with dispensing errors were: high workload, low staffing, mix-up of look-alike/ sound-alike drugs, lack of knowledge/experience, distractions/interruptions, and communication problems within the dispensary team. The majority of these studies focused on the investigation of dispensing error types with no mention of contributing factors or strategies for reducing dispensing errors. Boyle T, Bishop A, Morrison B, Murphy A, Barker J, Ashcroft D, Phipps D, Mahaffey T, MacKinnon N. Pharmacist work stress and learning from quality related events. Research in Social and Administrative Pharmacy. 2016; 12(5):772-83. Epub 2015 Oct 24. DOI: 10.1016/j.sapharm.2015.10.003. In an environment where financial rewards are not always possible, ensuring that pharmacy staff feel respected and encouraged in providing safe care may help enhance quality-related event (QRE) learning. Given the importance placed on organisational reporting of, and learning from, QREs in many jurisdictions in North America, the findings from this study suggest that a number of working conditions and perceptions of blame culture and organisational safety need to be explored before such processes can become entrenched in workflow. (Canadian study) Family H, Weiss M, Sutton J. A diary study of community pharmacists' mental workload. Abstracts of Papers Presented at the Health Services Research & Pharmacy Practice Conference, 16‐17 April 2015, Riddel Hall, Queen's University Belfast. DOI: 10.1111/ijpp.12186. Mental Workload (MWL) peaks for many community pharmacists (CPs) at specific times of the day, and part‐time CPs experience significantly less MWL compared with their full‐time colleagues. However, the effect size of this difference was small. The diary ratings also suggest that time pressure and mental and physical demands are the primary sources of MWL that CPs experience. This initial study highlights the impact working patterns have on MWL and has implications for the times of day that safety-critical tasks are carried out by CPs. Chui M, Look K, Mott D. The association of subjective workload dimensions on quality of care and pharmacist quality of work life. Research in Social and Administrative Pharmacy. 2014; 10(2):328-40. Epub 2013 Jun 20. DOI: 10.1016/j.sapharm.2013.05.007. Allowing community pharmacists to concentrate on tasks and limiting interruptions while performing these tasks are important factors in improving the quality of patient care and pharmacist work life. The results have implications for strategies to improve patient safety and pharmacist performance. (US study) Johnson S, O'Connor E, Jacobs S, Hassell K, Ashcroft D. The relationships among work stress, strain and self-reported errors in UK community pharmacy. Research in Social and Administrative Pharmacy. 2014; 10(6):885-895. DOI: 10.1016/j.sapharm.2013.12.003. Analysis of the data revealed that pharmacists reported significantly higher levels of workplace stressors than the general working population, with concerns about work-life balance, the nature of the job, and work relationships being the most influential on health and well-being. Despite this, pharmacists were not found to report worse health than the general working population. Self-reported error involvement was linked to both high dispensing volume and being troubled by perceived overload (dispensing errors), and resources and communication (detection of prescribing errors). (UK study) Family H, Weiss M, Sutton J. The effects of mental workload on community pharmacists’ ability to detect dispensing errors. Pharmacy Research UK (PRUK) final report. 2013. Online. Our research, and research of other aspects of pharmacy work, have shown that distractions and interruptions can lead to significant reductions in patient safety. Mental Workload (MW) has been shown to be an important issue for pharmacists and one which they feel they have to manage in their day-to-day work. MW was not found to predict performance on the accuracy checking task, but other mood states and cognitive factors were found to be related to improved performance on this task. The most important finding of this study is the impact that distractions have on pharmacists’ ability to detect dispensing errors. These findings have implications for the development of a pharmacy safety culture, the training and regulation of pharmacists, pharmacy policy and the design of pharmacy environments in the future. (UK study) Jacobs S, Hassell K, Johnson S. Managing workplace stress to enhance safer practice in community pharmacy: a scoping study – Pharmacy Research UK (PRUK) final report. 2013. Online. The literature review provided evidence of the effectiveness of a range of organisational interventions for the prevention and management of workplace stress (UK study) Jacobs S, Hassell K, Ashcroft D, Johnson S, O’Connor E. Workplace stress in community pharmacies in England: associations with individual, organisational and job characteristics. Journal of Health Services Research & Policy. 2013; 19(1):27-33. DOI: 10.1177/1355819613500043. Community pharmacists reported significantly higher levels of stress than other healthcare workers for seven out of eight work-related stressors. Long working days, being a pharmacy manager and working for large multiples were associated with higher reported levels of stress across several work-related stressors, including work overload, control and the job itself. However, self-reported measures of workload (such as dispensing volume) were not associated with higher stress levels. The growth in corporate ownership of community pharmacies, which is associated with more stressful working environments, together with current economic pressures, could have consequences not only for the future wellbeing of pharmacists but also for patient safety. (UK study) James K, Barlow D, Bithell A, Hiom S, Lord S, Pollard M, Roberts D, Way C, Whittlesea C. The impact of automation on workload and dispensing errors in a hospital pharmacy. International Journal of Pharmacy Practice. 2013; 21(2):92-104. Epub 2012 Sep 11. DOI: 10.1111/j.2042-7174.2012.00238.x. Study findings suggest that automation improves dispensing efficiency and reduces the rate of prevented dispensing incidents. It is proposed that prevented dispensing incidents frequently occurred during periods of high workload due to involuntary automaticity. Prevented dispensing incidents occurring after a busy period were attributed to staff experiencing fatigue after‐effects. (UK study) James K, Barlow D, Bithell A, Hiom S, Lord S, Oakley P, Pollard M, Roberts D, Way C, Whittlesea C. The impact of automation on pharmacy staff experience of workplace stressors. International Journal of Pharmacy Practice. International Journal of Pharmacy Practice. 2013;21(2):105-16. Epub 2012 Aug 6. DOI: 10.1111/j.2042-7174.2012.00231.x. The findings suggest that automation had a positive impact on staff experience of stressors, improving working conditions and workload. Technicians reported that ADS devalued their skills. When installing ADS, pharmacy managers must consider the impact of automation on staff. Strategies to reduce stressors associated with automation include rotating staff activities and role expansions (UK study) Chui M, Mott D. Community pharmacists' subjective workload and perceived task performance: a human factors approach. Journal of the American Pharmacists Association. 2012; 52(6):e153-60. DOI: 10.1331/JAPhA.2012.11135. This study set out to measure various aspects of pharmacist subjective workload using a model derived from a human factors approach, and to determine the relationship between subjective workload and community pharmacists' perceived performance on three tasks associated with dispensing medications. Regardless of the task pharmacists are currently focusing on, their comprehension of the interactions and events unfolding in the pharmacy appears to impact their confidence in performing task-specific activities. Pharmacists were less confident performing tasks when their attention was divided or when they worked in a rushed environment. The feeling of being rushed is a common feeling among pharmacists, as more than 70% of pharmacists experience role overload. Our results suggest that pharmacists should not be interrupted, have their attention divided or be rushed, specifically when conducting profile reviews and providing medication consultations. No one solution will improve pharmacist performance on tasks, since solutions need to consider how pharmacists' specific work environments impact work demands. (US study) Lea V, Corlett S, Rodgers R. Workload and its impact on community pharmacists' job satisfaction and stress: a review of the literature. International Journal of Pharmacy Practice, Wiley Online Library. 2012; 20(4):259-271. DOI: 10.1111/j.2042-7174.2012.00192.x. While there is a clear perception that the type and amount of work output expected from individual community pharmacists has been changing and increasing over the past few decades, pharmacists are viewed as continuing to remain based in the dispensary. The impact of such changes to the practice of community pharmacy in the UK is poorly defined, although links have been made to increasing levels of pharmacist job dissatisfaction and stress. (UK study) Hassell K, Seston M, Schafheutle E, 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. DOI: 10.1111/j.1365-2524.2011.00997.x Community pharmacists' workload has increased since the introduction of their new contract. What constitutes too much work is ill‐defined. Evidence indicates that pharmacists are feeling stressed due to the volume of work. No robust evidence is available to confirm heavy workload is directly harming patients. Clarity about how much work is too much, and studies examining associations between workload and other workplace factors, such as the availability of support staff, are recommended. (UK study) Gidman W. Increasing community pharmacy workloads in England: causes and consequences. International Journal of Clinical Pharmacy. 2011; 33:512. DOI: 10.1007/s11096-011-9498-x Workloads have increased in community pharmacy, and the work environment has become increasingly stressful. Consideration of the factors shaping community pharmacy points to continued workload increases. This is likely to have a negative impact on pharmacists and, conceivably, the services they provide. Skilled support staff, supportive management and appropriate resourcing are required to maintain high-quality services (UK study) Phipps D, Ashcroft D. Psychosocial influences on safety climate: evidence from community pharmacies. BMJ Quality and Safety. 2011; 20(12):1062-8. Epub 2011 Jul 5. DOI: 10.1136/bmjqs.2011.051912. The safety climate in community pharmacies is influenced by perceptions of job characteristics, such as the level of job demands and the resources available to meet these demands. Hence, any efforts to improve safety should take into consideration the effect of the psychosocial work environment on safety climate. In addition, there is a need to address the presence of work-related stressors, which have the potential to cause direct or indirect harm to staff and service users. The findings of the current study provide a basis for future research to improve the safety climate and well-being, both in the pharmacy profession and in other healthcare settings. (UK study) Schafheutle E, Seston E, Hassell K. Factors influencing pharmacist performance: a review of the peer-reviewed literature. Health Policy. 2011; 102(2-3):178-92. Epub 2011 Aug 10. DOI: 10.1016/j.healthpol.2011.06.004. Pharmacist performance may be affected by multiple factors, including personal characteristics such as age, gender, ethnicity, place of primary qualification, factors associated with the workplace, and mental and physical health problems. The evidence is not unequivocal, and gaps in the literature exist, suggesting that pharmacist performance is an under-researched area. Eden M, Schafheutle E, Hassell K. Workload pressure among recently qualified pharmacists: An exploratory study of intentions to leave the profession. International Journal of Pharmacy Practice, Wiley Online Library. 2010; 17(3):181-187. DOI: 10.1211/ijpp.17.03.0009. Early-career pharmacists can become disillusioned because the pressure to perform routine tasks often results in a lack of time to provide new pharmaceutical services. Increased job satisfaction levels are seen when more opportunities for clinical input are afforded to pharmacists. This could be achieved through the use of clear guidelines on staffing levels and, more importantly, the provision of adequate support staff. (UK study) Holden R, Patel N, Scanlon M, Shalaby T, Arnold J, Karsh B. Effects of mental demands during dispensing on perceived medication safety and employee well-being: a study of workload in pediatric hospital pharmacies. Research in Social and Administrative Pharmacy. 2010; 6(4):293-306. Epub 2010 Feb 11. DOI: 10.1016/j.sapharm.2009.10.001. Pharmacists and pharmacy technicians reported high levels of external and internal mental demands during dispensing. The study supported the hypothesis that external demands (interruptions, divided attention, rushing) negatively impacted medication safety and employee wellbeing outcomes. However, as hypothesised, increasing levels of internal demands (concentration and effort) were not associated with greater perceived likelihood of error, adverse drug events, or burnout, and even had a positive effect on job satisfaction. (US study) McCann L, Adair G, Hughes C. An exploration of work‐related stress in Northern Ireland community pharmacy: a qualitative study. International Journal of Pharmacy Practice, Wiley Online Library. 2010; 17(5):261-267. DOI: 10.1211/ijpp.17.05.0002. Developments in professional practice can be positive; however, commissioners and policy‐makers need to consider whether community pharmacists have the infrastructure in terms of environment, personnel and multi‐professional support to deliver what is required of them. The main themes that emerged in relation to job‐related stress were workplace issues, issues regarding professional expansion, recognition and responsibility, and a demanding public. Bohand X, Aupée O, Le Garlantezec P, Mullot H, Lefeuvre L, Simon L. Medication dispensing errors in a French military hospital pharmacy. Pharmacy World and Science. 2009; 31(4):432-438. Epub 2009 Mar 21. DOI: 10.1007/s11096-009-9290-3. The results showed that a wide range of errors occurred during the dispensing process. A check performed after the initial medication selection is also necessary to detect and correct dispensing errors. In order to decrease the occurrence of dispensing errors, some practical measures have been implemented in the central pharmacy. But because some dispensing errors may remain undetected, there is a requirement to develop other strategies that reduce or eliminate these errors. The pharmacy staff is widely involved in this duty. (French study) James K, Barlow D, McArtney R, Hiom S, Roberts D, Whittlesea C. Incidence, type and causes of dispensing errors: a review of the literature. International Journal of Pharmacy Practice, Wiley Online Library. 2009; 17(1):9-30. DOI: 10.1211/ijpp.17.1.0004. In general, the incidence of dispensing errors varied depending on the study setting, dispensing system, research method and operational definitions. The most common dispensing errors identified by community and hospital pharmacies were dispensing the wrong drug, strength, form or quantity, or labelling medication with the incorrect directions. Factors subjectively reported as contributing to dispensing errors were look‐alike, sound‐alike drugs, low staffing and computer software. High workload, interruptions, distractions and inadequate lighting were objectively shown to increase the occurrence of dispensing errors. (UK study) McCann L, Hughes C, Adair C, Cardwell C. Assessing job satisfaction and stress among pharmacists in Northern Ireland. Pharmacy World and Science. 2009; 31:188. DOI: 10.1007/s11096-008-9277-5. Any developments in professional practice need to be considered in the context of the wellbeing of the health professionals who implement and are affected by the changes. Unless stress in pharmacy is recognised and reduced, pharmacists and patients may be at risk. (UK study) Teinilä T, Grönroos V, Airaksinen M. A system approach to dispensing errors: a national study on perceptions of the Finnish community pharmacists. Pharmacy World and Science. 2008; 30(6):823-33. Epub 2008 Jun 24. DOI: 10.1007/s11096-008-9233-4. A heavy workload and the similarity of drug packages were considered as the most important potential causes of the dispensing errors in the structured statements. (Finnish study) Gidman W, Hassell K, Day J, Payne K. The impact of increasing workloads and role expansion on female community pharmacists in the United Kingdom. Research in Social and Administrative Pharmacy. 2007; 3(3):285-302. DOI: 10.1016/j.sapharm.2006.10.003. Findings suggest that although community pharmacists enjoy aspects of their new roles, their work environment has become increasingly pressurised, resulting in decreased job satisfaction. Additionally, this study found some evidence that increasing workloads resulted in decreased health and wellbeing. Consideration of the factors shaping community pharmacy points to high-pressure working environments becoming commonplace. This is likely to have a negative impact on pharmacists and, conceivably, the services they provide. (UK study) Bond C, Raehl C. Pharmacists' assessment of dispensing errors: risk factors, practice sites, professional functions, and satisfaction. Pharmacotherapy. 2001; 21(5):614-26. DOI: 10.1592/phco.21.6.614.34544. Nine job satisfaction variables were strongly associated with the risk of dispensing errors (rs = between −0.3 and −0.422, p<0.001), as were prescription volume, practice site, staffing, training, pharmacist functions, and professional organisation membership. (US study) Peterson G, Wu M, Bergin J. Pharmacist's attitudes towards dispensing errors: their causes and prevention. Journal of Clinical Pharmacy and Therapeutics. 1999; 24(1):57-71. DOI: 10.1046/j.1365-2710.1999.00199.x. The principal contributing factors to high dispensing errors were: high prescription volumes, pharmacist fatigue, pharmacist overwork, interruptions to dispensing, and similar or confusing drug names (Australian study).
Strengthening Pharmacy Governance (Supervision)
Policy position statement RCPharm believes that supervision legislation is needed to protect the public. We advocate for changes to the current legislation to enable progressive, safe and effective pharmacy services within a modern and advancing NHS. RCPharm supports the principle of moving specific components of legislation to regulation. Any changes should be supported by clear professional guidance. The following eight principles should apply to any change: Pharmacists and the pharmacy team should be accessible, approachable and available in a reasonable timeframe for patients Supervision by a pharmacist and delegation of activity should be decided by the Responsible Pharmacist (RP), supported by regulation to ensure appropriate pharmacy services can continue in their absence Pharmacists must be enabled to expand their professional and clinical services for better patient outcomes Pharmacy technicians, as registered professionals, must be enabled to take increasing responsibility for managing technical tasks such as routine dispensary processes A pharmacist can only be the Responsible Pharmacist (RP) for one pharmacy at any one time Digital opportunities should be harnessed to enable pharmacists to undertake more professional roles from pharmacy premises A shared understanding and interpretation of supervision legislation is needed. This should be supported by clear up-to-date professional guidance while maintaining a focus on patient safety and wellbeing Any changes to legislation should lead to improved patient care, not lead to an increase in risk to patient safety, and any changes in workload must be considered Pharmacists and the pharmacy team should be accessible, approachable and available in a reasonable timeframe for patients. Community pharmacists are among the most accessible healthcare professionals. This accessibility and approachability mean that pharmacists can provide patients with medicines advice and support when needed. The pharmacy team have the skills and knowledge to help support patients and escalate queries appropriately for the pharmacist's attention within a reasonable time. With pharmacies offering more services which require time in a consultation room, the expectation of access needs to be managed carefully. Supervision by a pharmacist and delegation of activity should be decided by the Responsible Pharmacist (RP) and supported by regulation to ensure appropriate pharmacy services can continue in their absence. The current legislation allows pharmacists to be absent from the pharmacy for up to two hours. However, during this time, patient care is currently impacted in terms of the supply of medicines and access to professional advice. Change required Legislation change is needed to enable appropriate medicines that have been clinically checked, dispensed, and accuracy checked, to be given to a patient or their representative when the pharmacist is signed in as RP but absent. This would require that a pharmacist has approved the medicines are suitable to be given to the patient with no planned further intervention by the pharmacist. Given to the patient includes being handed out by trained pharmacy staff when the pharmacist is not present, being delivered by a delivery driver, or being put into a vending machine. In all three scenarios, arrangements must be in place to enable the patient to ask for a consultation with the pharmacist, using technology or in person, within a reasonable time. There should be no change to the sale of Pharmacy (P) medicines as it is important that the pharmacist can intervene when these medicines are sold. This category is important to allow patients access to certain medicines without the need for a prescription. Any change in the need for a pharmacist to oversee P medicines sales and be able to intervene could affect future POM to P switches and have a detrimental effect on patients' ability to self-manage appropriate conditions. Supply of P medicines via NHS services, such as Pharmacy First and Common Ailment Services, requires a pharmacist to be present. These services have achieved equity of access for deprived populations and therefore, a change to permitting the sale of P medicines without a pharmacist present would introduce a new inequity. Pharmacists must be enabled to expand their professional and clinical services for better patient outcomes. It is essential to future-proof the supervision arrangements to ensure community pharmacists can provide an expanding range of professional services for patients. This includes regular, planned and ad hoc patient consultations in consultation rooms within the pharmacy premises and the provision of symptom assessment, advice and/or treatment. Therefore, patients need access to a pharmacist, and long periods of absence from a pharmacy are undesirable. This must be balanced against the provision of the current services, which may require an occasional home visit by a pharmacist to ensure a patient is fully involved in decisions about their medicines. Pharmacists need to be able to make professional decisions to support the best care and outcomes for their patients. It is not possible to plan for every eventuality, and professional decision-making is a skill; this must be encouraged and supported by robust record-keeping. Change required Successful provision of all professional roles can be achieved through a combination of a good skill mix in pharmacies and clear interpretation of the current supervision legislation. Pharmacists must have the confidence to delegate to pharmacy technicians and other staff according to their skill set and competencies underpinned by clear frameworks for establishing competency in pharmacy staff. Appropriate staffing levels, competencies and clearly defined processes which trigger appropriate referral to the pharmacist when necessary, are key to delegation and freeing up time for clinical care achieved by appropriate workforce planning. This would enable the pharmacist to leave the pharmacy premises for short periods, for example, to undertake a home visit, while still being contactable if advice is required urgently using technology. If absences were short and infrequent, this would avoid reduced access to services provided directly by pharmacists. Therefore, a clearer interpretation of legislation around the pharmacist being able to intervene in a medicines or advice supply situation is required. Workforce planning is needed in each country to ensure continuity of workforce for pharmacists and pharmacy technicians, and that staffing levels are of a sufficient level to avoid a reduction in pharmacy services and face-to-face access to a pharmacist when desired. Pharmacy technicians, as registered professionals, must be enabled to take increasing responsibility for managing technical tasks such as routine dispensary processes. RCPharm recognises the important roles of pharmacy technicians as registered professionals who are accountable for their responsibilities and should be encouraged to work to the top of their competencies. Recognising and enabling the roles of pharmacy technicians to lead on the technical processes/services within the pharmacy, and undertake accuracy checking where appropriate, will support pharmacists to fully maximise the opportunities in the current legislation. Defined career pathways for pharmacy technicians would support retention and recruitment into the profession. More frameworks for quality assurance, which enable pharmacy technicians to develop, are needed within pharmacy. A pharmacist can only be the Responsible Pharmacist (RP) for one pharmacy at any one time. It is essential to have professional oversight by a pharmacist in every community pharmacy. RCPharm is opposed to remote supervision and believes that patients require access to a pharmacist, in person if desired, and long periods of absence from the pharmacy are undesirable. Some pharmacies will require more than one pharmacist on site to safely deliver the range of medicines supply, clinical and public health services required by the NHS. Digital opportunities should be harnessed to enable pharmacists to undertake more professional roles from pharmacy premises. Digital systems need to be safe, efficient and fit for purpose to support clinical decision-making. Better use of digital technology, such as remote and asynchronous consultations, can be used to provide patients more choice and access to pharmacists where they are unable to travel to the pharmacy. Digital developments should also be maximised, so pharmacists can engage virtually with local multidisciplinary team meetings and multi-professional patient consultations without leaving the pharmacy premises. Advances in technology will mean robotics and artificial intelligence will improve clinical decision-making; opportunities for near-patient pharmacogenomic testing and treatment monitoring will widen. We do not support the use of digital technology to allow remote supervision of a community pharmacy. A shared understanding and interpretation of supervision legislation is needed. This should be supported by clear, up-to-date professional guidance while maintaining a focus on patient safety and wellbeing. It's important that NHS bodies, the General Pharmaceutical Council, and pharmacy contractors apply supervision legislation in a consistent manner to ensure equity of access to pharmacy services for patients. Consistency in the interpretation of supervision legislation across all pharmacies would also enable pharmacists and pharmacy teams to work in the same way to provide truly person-centred holistic care, offering a full range of services in all locations. Pharmacists acting in good faith, putting their patients' needs first, should feel supported to do so without being hindered by legislation. Change required NHS bodies, the General Pharmaceutical Council, and pharmacy contractors must agree a consistent interpretation of supervision legislation. Pharmacists and pharmacy teams must be educated on what supervision legislation means to ensure they can apply it in a way which allows them to provide a person-centred service enabled by quality systems, processes and risk assessments. RCPharm will provide updated professional guidance, toolkits and supporting documents, supported by the GPhC, on how to interpret the guidance in practice to assist pharmacy teams. Any changes to legislation should lead to improved patient care, not to an increase in risk to patient safety, and any changes in workload must be considered. The priority must remain to provide the most effective and safe care for patients. This means any changes to legislation should not result in an increased patient safety risk or a reduction in accessibility to a pharmacist when a patient needs it. With ever-increasing clinical commitments in community pharmacy, employers must establish suitable working conditions and provide the right environment for pharmacists to be able to focus on their clinical roles and the right skill mix to allow pharmacy teams to manage the technical workload. RCPharm believes pharmacists should embrace new ways of working to shape what pharmacy will look like in future: the opportunities within the existing supervision legislation should be used to their full potential, alongside the changes described above, to achieve this and ensure pharmacists and pharmacy teams maintain and deliver high standards of clinical and medicines governance.
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