Sort out the contradictions

By Outsider

In March the long protracted dispute between the Pharmacists Defence Association Union (PDAU) and Boots UK came concluded as pharmacists at big blue voted decisively for PDAU recognition. Cue forward looking statements about how representation would improve the working conditions of those involved, but I was startled by the claim that pharmacists might actually get lunch breaks.

How are the PDAU (or any union) going to manage that? Admittedly, in very large stores or in areas with multiple Boots pharmacies in close proximity, I’m sure this could be done, in fact I’ve seen it happen as a pharmacist shuffles around the different stores to cover each break. But that is the exception not the rule. It’s nothing to do with whether the PDAU or the Boots Pharmacists’ Association is better placed to make this happen – it needs regulatory change.

As of today the UK is still a member of the European Union, and our working conditions are protected by the EU Working Time Directive. There is the entitlement to a 20 minute break after six hours of work. Furthermore you must have a rest period of 11 hours between shifts and a continuous break of at least 24 hours per week. This was agreed by the UK Government and came into force in 2003, yet neither the subsequent 2005 pharmacy contract nor the underpinning regulations around pharmacy supervision have ever been properly revised to reflect the practicalities of that.

Every day pharmacists work from open to close without taking a substantial break, irrespective of who they work for. Every day pharmacists write up dispensing errors with an explanation that their concentration lapsed. There might be a connection. 

The 2009 Responsible Pharmacist Regulations only muddied the water. Two hours away from the pharmacy to deliver clinical services needed elsewhere? Great in theory; useless in reality. During the consultation it was made clear that for the regulations to function in practice there would need to also be adjustments to the NHS Terms of Service and a definition of supervision introduced. Neither has happened in the decade since.

In those ten years contractors have increased efficiencies to ensure their businesses stay competitive, sustainable and deliver excellent care. They have invested in checking technicians, staff training and automation. However, they are still hampered by the Government’s failure to align these three contradictory sets of legislation.

A pharmacy that invests in technicians and a dispensing robot can’t receive their wholesaler delivery out of hours as putting the stock on shelf is an activity that can only take place under the supervision of the Responsible Pharmacist. A pharmacist can’t plan to use the quiet time of day to visit a frail patient recently discharged from hospital to perform an MUR because unless they can afford a second pharmacist they will breach their NHS Terms of Service.  

An emerging integrated care system (ICS) can’t involve the local community pharmacy leaders in the development of their new primary care networks (PCNs) because when they are meeting in their protected time for learning, the pharmacies are open, even though the general practices are closed. And finally, but most importantly, the pharmacist who is tired, stressed and hungry can’t have a proper break under their protected working rights because we are still behaving like it’s 2002 and dispensing as many items as we can is all that matters.

I recognise that there are many pharmacies that give breaks to their team, and have their NHS contract hours set up to correctly reflect that. Well done! The other problems still apply to you too, though. Unfortunately, there are too many pharmacies where the pharmacist is working through their lunch break.

If community pharmacy wants to stay relevant in the rapidly changing NHS as it hurtles into the world of PCNs then we have to change. Staying open all day without a break might make a few more OTC sales but is that a justification that will sit well with a patient who has suffered harm because of a dispensing error? You need to be involved in the development of the new NHS structures around your pharmacy or you’ll be left behind. And finally, we need regulations that enable quality and excellence, not hamper it.

It’s time to change.

Outsider is a community pharmacist

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