You know those days when the queries and the problems seem endless, patients have nothing but complaints, and you've not made your MUR target? Well, according to The Lancet last week,1 if you feel you're dying to get to the end of the day – that could be literally true.

The report concludes that having a highly demanding job, but little control over it, could be a deadly combination of job strain increasing risk of cardiovascular disease by 3.4 per cent.

"Highly demanding job but with little control over it" – doesn't that sound familiar? Doesn't that sound like having to stop some of the 40,000 serious medication errors a year while answering the phone, chasing stock on quota, and juggling impatient patients with the need to do an unnecessary MUR?

We used to be able to take comfort from being reasonably well remunerated for our efforts. Like intellectual athletes, we'd push our bodies for high return – knowing we could retire in comfort before burn-out. But now even that is being threatened.

Again owners despair over the latest category M famine – and employees see ever greater demands to meet MUR and other service targets, proving that "clinically necessary" is meaningless and MUR and NMS are just exercises in marketing not medicine.

And now it seems this is extending to locum pharmacists, for whom some employers are reducing pay rates in the absence of an MUR. This could have implications for the self-determined status of a locum as self-employed, with such control by an employer possibly bringing the attention of HMRC.

Will companies offer rates that lessen each time a locum reduces their value by indulging in pleasantries and conversation or consults the BNF?

Give us a break – we’re dying for one

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