My story mirrors that of Tony (How Boots went rogue, The long read, 13 April). I have been broken by Boots despite being loyal. I too have had overwhelming pressure to perform services for pure profit over patient benefit. I was set targets by my manager at times expecting 30 Medicines Use Reviews (MURs) a week. My manager showed total disregard for ethics, saying: “I don’t care how you do them but I want them done.” For a period in this store I refused to do services as I felt patient safety issues in store needed to be addressed first or a patient would come to harm. These concerns were on more than one occasion dismissed and I was threatened that if I didn’t do the services I would face disciplinary action. The manager on a daily basis would assign me to the walk-in counter in an extremely busy store with trainee staff producing a high error rate. Scripts were never ready and done on a walk-in basis despite them being in store for up to a week. Towards the end of my time in that store I had no dispenser and was facing queues and complaints on my own despite asking for help and was self-checking. The pressure was extreme and bad practices led me to take time off for stress.
My health and confidence have been affected and in my experience Boots has put MURs and NMS before basic patient care. Self-checking is expected and relied upon substantially and the common practice in most stores open on a Sunday is for a pharmacist to work without a dispenser.
I have experienced fear, disciplinary threats and pressure to go beyond patient care and return a profit. They are a force unto themselves.
Name and address supplied
I have an elderly mother requiring a lot of routine repeat medication on prescription from her GP in north-west England. She does not pay a prescription charge, but the NHS supplies the medication. It appals me that when she hands in her list of repeat drugs to Boots, with the items she needs ticked off, the pharmacist ignores the ticks and issues the whole lot. She does not require the eye drops each month, or the paracetamol, so she does not tick these items. Yet I find a stockpile of them in her kitchen cabinet rapidly nearing or past their use-by date. When I return them to the store I am told that they have been issued and so cannot be given to anybody else.
Our NHS is paid for by all of us, we should all play our part to ensure that medication is not wasted.
Lesley Foote
Brentford, Middlesex
I have been a practising community pharmacist for 15 years. During my time I have seen the pressure build up. It has now reached an unsustainable level and many are leaving the profession as a result.
More and more of those in charge of running the healthcare services are non-pharmacist managers with little idea of what they are managing. They seem to only understand figures and targets. Anything else bypasses them, which ultimately creates a vicious cycle of lower patient care due to lack of support and trained staff.
My experience has been such that the pharmacist must make a stand on a regular basis to be heard. This creates an unnecessary distraction which shouldn’t be allowed to exist if the managers were doing their job properly.
Name and address supplied
I left Boots back in 1997 to work in supermarket pharmacy for 15 years. I have been a self-employed locum since 2012. I would like to think I have always put the needs of the patient first but pressure to perform and hit targets is everywhere. At least I now have control over where I work. I think it is telling that I will not be encouraging either of my children into the profession. After completing a four-year degree then another year completing pre-registration, it seems they would be better off training and qualifying as a plumber or electrician.
Jayne Gleed
Hamble, Hampshire
Pharmacists undergo five years of training to become medicines experts. They are trained to develop clinical relationships with patients, but are thwarted from doing so by the preference of many retail-oriented non-pharmacist employers intent on them merely supplying products and commoditised services measured only by quantitative targets. MURs are sadly treated this way.
The employer benefits from the MUR fee, not the pharmacist, and in many organisations demands have engendered a culture that pressurises and sometimes bullies pharmacists to deliver.
Your article describes pharmacists being demoralised by the erosion of their professional autonomy, and finding themselves working with staffing levels that border on dangerous at times.
Today’s community pharmacy service is therefore a mere shadow of its true potential. My union has calculated that the money available to “chain” pharmacies in MUR fees would fund a cohort of about 2,000 pharmacists who could contract directly with the NHS and concentrate on delivering a clinical rather than transactional pharmaceutical care service to patients who would benefit the most. These services could be provided in patients’ homes, care homes, GP surgeries and in consultation rooms of existing community pharmacies.
This would provide patients with a more focused service, the NHS better value for money and make better use of pharmacists’ unique skills. It would also allow hard-pressed community pharmacists to concentrate on delivering excellence in the wide range of services that they are renowned for providing, making them more accessible as the source of expert advice on medicines.
John Murphy
General secretary, the Pharmacists’ Defence Association Union
The alleged abuse by Boots of NHS payments for MURs illustrates that a simplistic approach to resourcing care can be counterproductive where commercial imperatives are more powerful than professional conscience. In contrast, financial incentives for GPs have been effective in enhancing care of chronic illness. Despite its shortcomings, the overwhelming majority of GPs have engaged in the Quality and Outcomes Framework (QOF) responsibly and professionally. I suggest that this is partly because the professionals and the business leads in general practice are one and the same, and wealth-seeking behaviour is tempered by their professionalism as doctors. Furthermore, the QOF scheme was carefully designed and constantly fine-tuned by collaborative negotiation between general practice and the Department of Health to ensure both effectiveness and value.
In Boots’ case, however, there is a disconnect between business managers, who see the scheme merely as commercial opportunity, and their pharmacist employees, whose professionalism comes under huge pressure to play their employers’ game to maximise profit.
Having worked with pharmacists for years as a GP and a researcher, I know that in the right environment and with appropriate skills, pharmacists can transform the quality and safety of prescribing and medicines management. Perverse incentives such as in the current MUR scheme only serve to undermine the professionalism of pharmacists and in their present form contribute little to care. The scheme should not be abandoned, but should be restructured to promote quality and safety.
Dr Arnold Zermansky
Portfolio GP and visiting senior research fellow, Leeds
