Why does striking seem to be the hardest word for community pharmacy?

In December, nurses will strike in what is being labelled the biggest industrial action in their history.

Up to 100,000 members of the Royal College of Nursing union are set to strike across England, Wales and Northern Ireland on December 15 and 20, with ambulance staff also due to strike before the end of this year.

But talk to pharmacists about the word ‘strike’ and many of them shake their heads in disbelief.

Striking, it seems, is not something many pharmacists feel they can do – because they feel they are the last ones standing.

Regardless, the government seems hell bent on dragging community pharmacy into its stalemate with other healthcare professions, with ministers reportedly planning to draft in pharmacists to ease pressure on the NHS over the winter and “help break” NHS strike action.

The proposals, reported by the Sunday Telegraph on December 4, would see pharmacists given permission to diagnose minor ailments and prescribe antibiotics to reduce the demand for other health services.

So, how are pharmacists feeling about the swathes of strikes across the healthcare sector, and why are they choosing not to take such action themselves?

“The sector is already so stretched”

Gurinder Singh is a pharmacist at Boots and in a GP clinic as well as being a lecturer in pharmacy at Reading University.

For him, reports of strikes across other parts of the NHS are yet another source of stress.

He says: “Hearing about another strike in a profession so close to you only adds to the burden and at a time when the sector is already so stretched and we’re all trying to work together.

“If one goes down, then that adds to the pressure on the other sector.”

Indeed, it is not just nursing and ambulance staff that are considering downing tools.

Several unions for healthcare workers – including the Chartered Society of Physiotherapy and Royal College of Midwives – are currently balloting members over industrial action, amid ongoing pay disputes.

Industrial action can include striking, action short of a strike (for example banning working overtime), or a "lock-out", where employers stop workers from working.

Meanwhile, the British Medical Association will also open its ballot for industrial action by junior doctors in England in January.

But according to Mr Singh, many pharmacists do not feel like taking such action is an option for them.

He says: “Pharmacists always feel that the burden is on them because they’ve always been patient-facing and there’s something within pharmacy: we’re so resilient.”

“I don’t know what it is – every professional has its standards to abide by," he says. "I don’t know if it’s that the General Pharmaceutical Council has such a good way of instilling fear in us about the standards and making us feel personally accountable for upholding those for our patients.”

He explains that by the time patients come to a pharmacist they have often had to wait or be declined treatment elsewhere and are frazzled.

“We see people all the time who come to us when their nerves are fraught, they’re anxious and they’re already angry towards healthcare staff and you’re not just trying to deal with their symptoms but their emotions as well."

“This is the part that’s getting really difficult," he says.

Unfortunately, explains Mr Singh, pharmacists often feel the brunt of patients' frustration.

“Patients are not happy. They’re upset, feeling they’ve been pushed from one pillar to the next. We are a place with no appointment needed and they come whenever they want, whatever time of day, and you are their last resort and they want an answer there and then," he comments.

“They don’t want to wait because they’ve waited somewhere else for two hours."

But while the source of patients' ire may be understandable, it is important that they cut pharmacy teams some slack.

Mr Singh continues: “We should see what the patient is going through but, equally, they need to understand how we work as well and I don’t think that’s happening as much.”

“I could never strike”

A feeling of responsibility towards patients is clearly stopping some pharmacists from taking drastic measures. But there are other, more practical, reasons why pharmacists may choose not to strike.

In July, when asked by C+D about pharmacist’s rights to take their own strike action, Pharmaceutical Services Negotiating Committee (PSNC) chief executive Janet Morrison conceded that contractors could “ultimately…decide if they, too, wanted to withhold their labour at any point”.

However, this would constitute a breach of their contract, she warned.

This is something that resonates with Dimple Bhatia, superintendent pharmacist director of Tollesbury Pharmacy in Tollesbury, Essex.

He says: “As a contractor, I could never strike due to two reasons.

“Firstly, I have a contract with NHS England to provide pharmaceutical services and any breach of this service could lead to sanctions or even loss of my contract.

“Secondly, having spent over 20 years in building relationships, trust, and respect with patients, I could never let them down.”

But ultimately, Mr Bhatia points out, patients are also valued customers who pharmacies depend on to bolster their bottom lines.

“It is the patients that choose which pharmacy they use and they can change their nomination within five seconds using the NHS App,” he continues.

He adds: “In the world of postal and social media advertising by competitors, independents like us need to be even more mindful to identify, highlight and promote our unique selling point of continuity, being physically there, and providing that personal touch”.

“It’s not a job, it’s a lifestyle”

However, it's certainly not a lack of stress that is stopping pharmacists from taking strike action.

Mr Bhatia explains that the immense pressure pharmacists are under often has an effect on their home life.

“My work-life balance is rubbish," he explains. "I drive 100 miles a day, working 60 to 80 hours a week including in the pharmacy and at home.

“I have Mondays off but spend 8am to 4pm at my desk and then maybe another hour or so in the evening. I can’t remember the last Sunday that I haven’t had to do paperwork."

Unsurprisingly, the immense workload takes its toll on many pharmacists.

Mr Bhatia continues: “It’s not a job, it’s a lifestyle. My family are used to it and accept it.

“I never turn off and sometimes wake up at 3am to order a medicine that I had forgotten to order or for a private prescription I have had emailed to me during the night."

Mr Bhatia finds it difficult to turn his thoughts away from work, even when taking well-earned time off.

“On my first holiday in three years in July, I asked the hotel to bring me an iMac so that I could process pharmacy orders every afternoon as so many things were out of stock, so I could support my team," he recalls

“I am not special but typical of most independent contractors up and down the country that just get on with it because we have a responsibility to our patients, staff and our families.”

“There is massive fatigue among pharmacists”

The pressure to keep pharmacies open and ready to tend to patients is clearly taking its toll on teams.

“Across the sector at the moment, there’s a lot of sickness," Mr Singh says. "But the worry is that I’m seeing pharmacy professionals turn up to work while sick.

“So they’re getting through the day when they probably shouldn’t be there purely because they know that the pharmacy might close because there’s not enough staff out there to cover their sickness.”

And the problems don't disappear even when pharmacists do take sick leave, he warns.

"Going in after your sickness the next day, the workload has doubled or increased so there are people out there that are turning up to work who aren’t in a good position themselves either emotionally mentally or physically who are getting through day by day. But eventually, that will come and bite them," he says.

“Either you make a mistake or your illness increases.”

These are sentiments that will be shared by legions of healthcare workers, forming part of the reason why so many are considering strike action.

“There is massive fatigue among pharmacists and healthcare workers," says Mr Bhatia.

“The after-effects of COVID-19 are still being felt. With inflation, fuel costs, utility prices, rents and mortgages, and food costs, the pressure is on.

"But healthcare workers have a choice they can leave and work elsewhere. Unfortunately, independent contractors cannot unless we sell up.”

“How long can we survive?”

But when it comes down to it, will pharmacists bite the bullet and decide to strike?

As Mr Bhatia points out, pharmacists can strike – especially employed pharmacists with Pharmacists' Defence Association union membership.

“But pharmacists have never been unified and because they have so many different paymasters the effects of pharmacists striking will be disjointed and ineffective,” he says.

Both Mr Bhatia and Mr Singh agree that COVID-19 has had a huge effect on pharmacy.

Mr Bhatia says: “Work levels are sky high [and] COVID-19 is still being used as an excuse by other healthcare providers as to why they can’t do things but [patients are advised to] try the pharmacy."

“Pharmacy paid a massive price over COVID-19…we were the only healthcare professional with our doors open," he continues.

And all of these extra pressures is only adding to workforce issues in community pharmacy.

“We lost three to four members of staff who just couldn’t face pharmacy, we lost good regular locums to general practice who couldn’t face community pharmacy," Mr Bhatia says.

In October this year, NHS Business Services Authority data revealed that the number of community pharmacies across England had dropped to its lowest figure since 2015, with 11,522 open in 2021/22. This marks a 3.6% decrease on 2015/16 levels, when there were 11,949 community pharmacies.

Mr Bhatia continues: “We are severely understaffed and cannot recruit trained pharmacy staff even paying above the odds because people just do not want to work in pharmacy full stop.

“Pharmacy is on its knees with poor funding, dispensing at a loss every day, rising fuel costs for delivery, rising staff costs, record high locum costs – how long can we survive?”

Next steps

With tensions reaching fever pitch, PSNC has ramped up discussions with the government to address the “critical situation facing many community pharmacy businesses”.

According to PSNC's director for legal, Gordon Hockey, the measures it has requested include allowing pharmacies to close for certain hours of the day to help manage workflow, “similar to the provisions that were in place during the pandemic”.

Other options it has mooted include not answering patient phone calls; asking patients to book slots for advice, rather than on a on a walk-in basis; and charging for or stopping the provision of some unfunded services such as medicines deliveries.

While discussions remain ongoing, “we are pushing hard for [a] resolution as soon as possible”, he says.

But although these measures signal recognition that pharmacies cannot be expected to endure the current pressures without more support from the government, they do not constitute strike action.

“The actions that some contractors are taking are not strikes," Mr Hockey says. "They are measures that reduce provision of some services which they may offer under the Community Pharmacy Contractual Framework, but don’t have to,” he adds.

However, further change may be afoot. PSNC is seeking the views of contractors over a series of online events this month to discuss these “serious steps” and consider what further measures may be taken.

“Our events will allow for that honest conversation – so that contractors consider, and the government and the NHS appreciate, what remains possible within the current limited funding”, Mr Hockey adds.

Whatever the outcome of those discussions, it's clear that pharmacy teams are reaching breaking point and that drastic measures may have to be taken if the government refuses to listen to the sector's concerns. Whether or not this will ultimately constitute strike action remains to be seen – breach of contract or not.