Pharmacists are disillusioned, disenfranchised and marginalised

 

Dear PIP editor,

 

Like many of my clinical pharmacist colleagues, my concerns about hospital pharmacists being forced to wear uniforms are extensive. There is nothing to suggest that the current duties of hospital clinical pharmacists in the UK give rise to increased risk of healthcare-associated infections.

 

I want to share my view on what pharmacist should or should not wear but first some context.

 

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or simply ‘COVID-19’) pandemic has drastically affected pharmacists physical, mental and social wellbeing.

 

Both pharmacists’ professional and personal identities have particularly been impacted by forced moves to non-familiar clinical areas, additional hours, full seven-day service rotas, rapidly evolving change in Public Health and NHS guidelines policy, facemasks, visors unisex uniforms/scrubs, medicine shortages, staying on top of evidence-based treatments, cancelled holidays, and personal life restrictions etc.

 

The thing that keeps many of us going, is the faith that medical intervention, in the form of a vaccine and/or prophylactic drugs, looks promising to come in the second quarter of 2021.

 

Hospital pharmacists are a very diverse professional group including specialists in aseptic preparation, medicines information, governance, formulary, clinical pharmacist’s, radio-pharmacy, production, practitioners, management.

 

The largest group being the clinical pharmacists.

 

The rationale to wear uniforms is to reduce touch contact contamination and subsequent transmissions. Staff who are required to wear a uniform are those in close physical contact with patients on a prolonged basis.

 

Pharmacists have never historically worn uniforms in the hospital or had a true need too. All pharmacists are taught at university what professional attire looks like, smart but modest, and nothing below the elbow. At this point considering the WHO 5 points of hygiene is useful in assessing risk.

 

Considering the wider pharmacy team, each member of the ward pharmacy team plays a significant, yet varying role in providing patient care. These different roles carry different levels of risk.

 

The only members of the pharmacy team that routinely enter the immediate patient area are the pharmacy assistants and technicians when assessing patients’ own medicines.

 

Modern clinical pharmacists do not routinely undertake these activities, thus are not at the same high risk as other pharmacy team members. In the absence of a fully resourced ward medicines management pharmacy team, it is not safe or physically possible for a pharmacist to run these services on their own, thus there is never a need to take that risk.

 

In addition to standard NHS infection control training precautions, pharmacists have background knowledge of aseptic and sterile production thus are well informed and practised in how to limit microorganism spread. Many of us also have specialities working with immunocompromised patients or those with infectious diseases or both.

 

The use of PPE, shielding, and precautions isn’t new to us. It is just more extensive during the current pandemic.

 

In the past pharmacists wore laboratory white coats, and these were either laundered by the hospital, or by the individual pharmacist. The issues with white coats were primarily two-fold:

 

  • By their nature, they had long sleeves, thus not ideal in the eyes of infection control.
  • Hospital budgets looked to reduce clothing and laundry costs.

 

The reasonable risk management approach was and still is to drop the white coats, and tie long sleeves, and continue with the other parts of professional dress.

 

During the pandemic, many pharmacists have either agreed to wear a pharmacy technician uniform and cover the embroidery, or wear scrubs. That was hard as the professional dress is part of the pharmacist identity for patients, other professionals and pharmacists alike. Many pharmacists, including myself, agreed to wear uniforms as a temporary measure during the pandemic out of a mixed fear from:

 

  • Managers anxiety.
  • General personal and public anxiety about COVID19.

 

These fears could be internalised and rationalised as there was an expectation of a return to normal, and restoration of pharmacist’s identity, in 12 to 18 months from the pandemic outbreak onset.

 

I can also say from personal experience that the response from professional colleagues towards pharmacists’ wearing a uniform has not been a positive one. Our teams experience is that clinical pharmacists have been taken less seriously since we started to wear ‘tabard uniforms’.

 

The centre for disease control state that the risk of catching COVID-19 from a dry surface is extremely low. This is not proven and is theoretical. It is very frustrating as there has been very little coherent approach to PPE in NHS Scotland, with many of the recommendations changing week to week being based on opinion and resource availability rather than science.

 

Some of the comments I’ve heard from senior and director level staff justifying a new uniform policy are bizarre.

 

“When I started, I was told that woman should wear a skirt instead of trousers.”

 

My reply:

 

Paraphrase ‘my grandmother went to school in a horse & cart so you must too’. Much has changed since the 1980s. It is 2020, and it is appalling for anyone to dictate to anyone else what to wear based on gender. It is equally appalling and harmful to once identity, emotional and psychological health to force people into unisex clothing.

 

“Pharmacy technicians and nurses have to wear uniforms.”

 

My reply:

 

They take a risk, with unsafe equipment, let’s make ourselves feel better by making pharmacists take an unnecessary risk. The solution is to give people uniforms that are fit for purpose if required.  The vast majority of hospital pharmacists do not require a uniform.

 

I could go on…

There is also a general concern that the role of the pharmacist has been devalued with reduced opportunities over the last 30 years. Examples include the following:

 

  • The 1990s – Exodus of pharmacists form the pharmaceutical industry in the 1990s driven by consecutive governments polices, and greed of commodity dealers. The rise of the pharmacy multiples.  This has led to generally fewer career options of pharmacists.
  • The 2000s – Multiple SOPs opening in the UK leading to an oversupply of graduates, leading to supply outstripping demand.
  • The 2010s – GPhC no longer regulate qualified persons, gradual fleecing of science from the pharmacist syllabus
  • The 2020s:
    • Dispensing errors still criminalised for hospital pharmacists.
    • Pharmacist apprenticeships (this is turning back the clock over 50 years).
    • Pharmacy Technicians to administer PGDs.
    • Removal of supervision.
    • Lack of posts for progression beyond band 7.
    • Lack of equality of banding between clinical and non-clinical hospital pharmacist roles.
    • Devaluing of prescribing, as entry grade pharmacists are planned to qualify as prescribers from year 1, without the remuneration to match.

 

My point here is the pharmacist workforce at large are disillusioned, disenfranchised, marginalised, and have reduced opportunity for career choice and progression.

 

There is the hypocrisy of our ‘leaders’ in Scotland, many of whom haven’t practised in a clinical setting for decades, and will not ever wear a uniform, earning at least double what your average clinical pharmacist does, to use public funds to take non-evidence-based decisions about clinical pharmacists’ identity without full consultation and consent from our community.

 

As you know, hospital pharmacists are classified as clinical scientists. We are not nurses or allied healthcare professionals. Thus, clinical pharmacist practise requires a professional expression to span both the art of healthcare and the science base behind the exterior.

 

The previous Chief Pharmaceutical Officer for Scotland, Professor Bill Scott, was extremely wise in realising that a unisex uniform, pulled over one’s head, is not befitting to the science or art of the pharmacist profession.

 

Put simply it is a waste of public funds.

 

Yours etc.

 

A clinical pharmacist

 

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