Supporting the mental health and wellbeing of pharmacists
In June 2018, the Royal Pharmaceutical Society (RPS) published a report on how pharmacists can support care for patients with mental health problems. However, as one in four adults experience some kind of mental illness1, pharmacists themselves need support in dealing with their own mental health and wellbeing (MHWB) in the workplace.
Here at the RPS, 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 Kings Fund report on workforce published earlier this year, the significant vacancy problem of meeting patient demand would require recruiting at least 3,000 more pharmacists2.
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 ethic and morale and staffing and recruitment.
There is a need to collate more data to showcase the extent of the problem and how to provide solutions to tackle them.
More widely, we have been raising our concerns to stakeholders across healthcare. In 2018, a letter was sent from the 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 that which doctors can access.
We also raised the issues 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 MHWB of staff in the NHS. However, these do not cover those pharmacists who are not directly employed by the NHS, such as those working in the community, those working in care homes or GP practices for example.
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 health care 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 dentist 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 too 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 as 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 have 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’. The 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’.3
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 into the mental health of doctors in the same month.
The RPS have discussed the MHWB of pharmacists across all three boards and it is seen as key priority area across Great Britain. The 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, NHS and stakeholders
- Understand the causes of mental health and wellbeing across all areas of pharmacy practice
- Find out how thing 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
The RPS will now:
- 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 range of themes have emerged from the discussions we have had.
* The organisations who have engaged with us are: PSNC, GPhC, Pharmacist Support, CQC, GHP, CCA, UKCPA, NHS England
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 as the same by another.
Over the last two years, there have been increased concerns expressed from those working at senior levels within NHS Trusts. These concerns are mainly based around 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 on the person’s ability to do their job as well as their physical health needs to be considered.
Wellbeing is not just about workplace pressures but 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 and where their priorities lie and how to balance everything.
The continuing drive for extended hours and 7-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 means that there are no ‘quiet’ days with opportunity to catch up. The impact of this is not related to the individual’s willingness to work hard but the anxiety generated that due to the workload experienced they would or had ‘missed something’ or not seen the patient they needed to see.
The work volume described also results in work over-flowing 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 are somewhat a victim of their 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.
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 to deliver.
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.
A number of 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 amongst 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 wasn’t given in work to support this.
Staffing and Recruitment
Overall, there are a number of 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 a cut in services, staff or opening hours as community pharmacies struggle to maintain the delivery of essential services. This with increase demand on community pharmacy teams to deliver more without appropriate staffing levels and resource. This will add pressure on pharmacy teams, impacting their health and wellbeing as a result.
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 2 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 and 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 immediately identify the individual to the employer as having an issue as they are not anonymous. There is still a stigma around mental health, so it is difficult to talk about any issues. There is a need to help people to 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 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 Program 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 to attend. These Schwartz rounds provide an opportunity to reflect on the non-clinical aspects of work and organisational life.
Additional websites for support:
If you would like to get any further information or help on mental health and wellbeing support for pharmacists please check out the Pharmacist Support Website: https://pharmacistsupport.org/
 NHS England (2018) About mental health www.england.nhs.uk/mental-health/about/