Before the pandemic our pharmacy was already short staffed

 

Before the pandemic, our pharmacy was already two members of staff short.

 

One team member has been on long term sick and another recently left for another job. We also have one person self-isolating because they have symptoms. Another team member helps us out but usually ends up doing three days a week. This person has now said that she doesn’t want to do any hours during this time.

 

Our pharmacy is extremely busy normally. It’s a very fast-paced and stressful environment. We never have ‘quiet times’ and often have to cover other branches who are consistently short-staffed.

 

We’ve already taken on more work because of the way our local GP surgeries have changed the way they work. It would have been great if they had discussed this with us first.

 

The changes that we have had to cope with are as follows:

 

  • Patients can no longer order medication via the telephone directly with the surgery so they come into us and we take to the surgery or they ring us – patients were not aware of this so continued to order in their usual way only for it to be ignored so we then had a period of having to do emergency supplies and inform patients of these changes.
  • Patients come to us when they have new medications or medication changes.
  • Surgeries are consistently behind with prescriptions when patients have ordered so we are continually having to chase them and deal with distressed customers and reassure them we won’t let them go without medication.
  • We ourselves are unable to call surgeries direct, we have to go through the same system as patients so when we have an urgent query, for example, an out of stock for a gold form or other CD prescribing error we cannot sort it out quickly.

 

Deliveries

 

We are already up to capacity so can’t take on any more deliveries yet we are getting people demanding, not asking, for us to deliver their medicines.

 

Understandably valid in some cases but we just don’t have the resources at the moment. However, people are being abusive about this even when we are doing our best to make alternative suggestions. The government needs to make it clear that people are still allowed to go out to collect medication or they need to provide some help

 

Staying open and for longer hours and open seven days.

 

How?

 

How are these hours going to be staffed?

 

We ourselves have children, partners who also work, older parents and relatives who will need our help. And how will Pharmacy companies be able to afford to pay the extra wages?

 

Redeploying Pharmacists

 

From where?

 

I know we don’t have spare people, even when we were in desperate need in normal circumstances

 

Impact of Doctors Surgeries and their COVID-19 protocols

 

The local Doctor Surgeries have stopped seeing patients face to face and then only emergencies we are being bombarded with concerned people.

 

They are coming for advice and with other health concerns unrelated to the virus. Things they would normally contact their GP about. We had a parent in who had a toddler with a fever who’d been refused at their surgery but were concerned about their child.

 

On top of this, we have people coming in demanding their normal medication ‘now’ because they have to go into ‘lockdown’ (actual words) or they don’t want to come out again because of the risks, etc.

 

Surgeries have not made contact with us to see how we could work together to lessen the impact for us both. They are making our situation worse by telling patients prescriptions will be ready straight away with no thought for our workload or staffing levels.

 

People are not listening to advice and equally, we are not being protected by those in government, they have not mentioned pharmacy enough.

 

  • Why do they think we have loads of spare Pharmacists and staff?
  • Why do they think that we are immune to getting COVID-19
  • Why do they think we have no people working in pharmacy who are in the vulnerable or at-risk categories.

 

We have already been supporting the NHS with the work we do day in day out – the more pressure GP’s are under the more work we are under, we have seen an increase in our work over the past year or so (not dispensing but supporting patients) people cannot get through to their surgeries so they come to us and we sort out a lot of their issues.

 

For me, this has highlighted how little the Government regards the importance of community pharmacy as part of the healthcare system. A lot of assumptions have been made about the current resources and capacity and I wonder if they are even aware of the challenges of community pharmacy before this situation.

 

And all this while I’m in remission from leukaemia.

 

Anna Mamwell works in community pharmacy, is a Patient Ambassador & Policy Panel Member at Bloodwise.org.uk (becoming Blood Cancer UK), is a patient advocate at UCL Blood & Transplant Research Unit (BTRU) and is a KnowAML Ambassador Macmillan NHS Lincolnshire Living with Cancer Co-Production Group. Anna runs a very successful Blood Cancer Blogger which you can view here.

The worst week of my pharmacy career

 

Four colleagues self-isolating.

 

Four part-timers volunteer to work every day to keep this thing afloat.

 

An ex-manager of ours who now works at the hospital stepped in to help and was a Godsend.

 

No contact from “up above”.

 

We’re basically left to it. To sort ourselves out in one of the worst weeks in pharmacy history. No-one asked us to work these extra hours. We did it for each other. The few of us who were left that is. I certainly didn’t do it for my basic minimum pay wage.

 

Patients not adhering to the two people in store rule and when asked to wait outside away from the ramp abusing staff.

 

Patients not standing behind the two-metre line.

 

People standing in store openly coughing.

 

I personally had a woman scream at me for her prescriptions not being ready. She said to me:

 

“What the hell have you been doing?”

 

I didn’t reply but thought: well yes, of course, we are all sat on our fat arses watching daytime TV in the dispensary love!

 

Then a couple who entered the pharmacy together were asked to wait outside as there were already two people in. The man shouted:

 

“I haven’t got the Corona. I wish I’d gone to another f$%king chemist.”

 

At which point I said:

 

“Please feel free to take your prescription to another pharmacy.”

 

And he replied:

 

“No you’re my local chemist so just do it and hurry up.”

 

He then left to wait outside, as requested and slagged us off loudly as incompetent to the rest of the patiently waiting queue.

 

A lady requested a medication that I could not supply her with due to the special measures and bein unable to do a private consultation in the tiny room. But I was directing her as to how she could get it urgently when she stopped listening, sighed loudly and said:

 

“For God’s sake, this is a f$%king joke.

 

She stormed out.

 

Her husband, who was a huge man over six feet tall and I’m sure well over 18 stone, then pushed by everyone in the queue to stand at the door and shout loudly demanding to know who just refused his wife the medication.

 

I put my hand up and tried, again, to explain how they could access it the same day by using our online doctor service where we would be sent a private prescription for it.

 

He then shouted aggressively at me, whilst pointing:

 

“You clearly don’t know how to do your job properly.”

 

Disclaimer… I actually do. I didn’t just Google this shit! As his rant was clearly not going to end I could not get a word in. I told him to leave three times.

 

He eventually left. As he was leaving he told us that we were f%&king useless.

 

Sounds shit doesn’t it? Well, let’s just top this off.

 

We had a queue outside waiting for us to open and as a member of staff, not in uniform, approached the door for us to let them in and they were assaulted for pushing in. The perpetrator claimed that it wasn’t their fault as the person hadn’t announced who they were. Yes, that aggressor left our pharmacy in a police van.

 

Our pharmacy is in an affluent suburb of an affluent city and quite frankly public, we deserve better.

 

We are snowed under. We are busier than we ever have been. We have hundreds of scripts every day for new patients who we’ve never had before. Where are they all coming from?

 

Some medications are out of stock. This again is not our fault. These strange times are scary for everyone but they are also scary for us. Every member of our team has family members who we are at risk of coming in contact with.

 

We all have small children, elderly parents, vulnerable family members and we also are stressed and worried.

 

Please be patient with us, we are risking our health to help the public. The abuse and insults affect our mental health and we take it all home with us.

 

A good 95% of our clients are lovely, supportive and patient but the ones that we take home at night and re-play in our heads are these guys that I’ve mentioned. They should be thoroughly ashamed.

 

If you go outside on a Thursday and clap for the NHS please be aware that this courtesy should adhere to every single time you come across one of us networkers in any setting.

 

This article has been published with permission from Annette. You will find her on Twitter here.

 

 

Community pharmacy cannot financially cope with the pandemic

 

Alexander Stafford MP

 

Member of Parliament for Rother Valley

 

3rd April 2020

 

Dear Mr Stafford,

 

I am one of your constituents and a pharmacist.

 

I would like to bring to your attention the plight of community pharmacy. In 2016 the Department of Health announced its intention to impose drastic funding cuts as part of a plan to reduce the number of pharmacies by 25%. This was, and still is, straight financial attrition and has forced every pharmacy in the country to reduce staffing levels and reduce services in order to survive.

 

Hundreds have closed and others are on the brink of closure.

 

Consequently, the COVID-19 pandemic has arrived when community pharmacy is in the worse possible state to deal with the increased pressures. Despite this, the sector has risen to the occasion. When it’s been virtually impossible to visit or contact a GP, pharmacies have remained open, staff have worked extra hours and urgent deliveries have been made.

 

The workload has increased enormously, protective screens have had to be sourced and fitted, additional staff employed, extra stock begged, borrowed and obtained at over-Tariff prices, emergency medication supplied, fights between customers broken up and abuse from a small minority dealt with it’s been a nightmare.

 

At the same time, the bodies representing community pharmacy have pleaded with NHS England for increased resources to cover these additional costs and to ensure that pharmacies are able to pay their bills and remain in business.

 

On the 31 st March an extra £300m of funding was announced and we all breathed a sigh of relief. That is until we read the mall print. This is not additional funding it’s merely an advance payment on the money we would be due to later in the year. It’s a loan to prop up the sector until the worst of the pandemic is over when the advance will be reclaimed accelerating the closure of pharmacies to that magic “3,000 closures” that the DHSC and NHSE would like to see.

 

I urge you to take up our cause and fight for adequate remuneration for community pharmacies. The extra funding must be made permanent and not reclaimed. This pandemic has demonstrated already what an important part of the local community pharmacies are. There is far more that we can do, but not with inadequate funding.

 

Yours sincerely,

 

Martin Bennett MBE

 

 

COVID-19 should drive a renaissance of pragmatism

 

As the COVID-19 pandemic gains momentum, we’re all going to find ourselves either much busier or stuck at home. Over the next few weeks, I intend to publish a series of short articles, to provide some coffee break sized learning for clinicians on the front line.

 

If you have any COVID questions of your own, please send them to me.

 

These posts will not be heavily referenced, if at all. We are in the very early stages of gathering evidence and the risk with early evidence is that it can be very misleading for various reasons.

 

Much of what is coming out from this crisis is a renaissance of pragmatism.

 

That pragmatism is born out of necessity but is based in the common sense and experience of the clinicians who look after children. Together we can figure out what’s truly important and cut through the evidence, without ignoring it.

 

The first question is as follows…

 

Should we recommend the use of ibuprofen for symptomatic relief in a child with a respiratory tract infection?

 

France’s health minister, Olivier Véran created a great deal of anxiety for both clinicians and the public when he said that people should avoid using ibuprofen because it may make COVID-19 infection worse. This prompted a variety of responses from organisations around the world.  Some recommended against using ibuprofen and some stated that there was no evidence that it made COVID-19 infection worse.

 

Why was there such a disparity of recommendations? 

 

The answer is that your view will depend on your perspective.

 

Is there a possibility that ibuprofen could make COVID-19 infection worse? 

 

Yes.

 

There is a hypothetical risk because the anti-inflammatory properties of ibuprofen include some elements of the immune response.

Is there any evidence that this biochemical effect has any clinical effect? 

 

No.

 

There is no clinical evidence that ibuprofen actually makes COVID-19 infection worse.

 

So with hypothetical harm and no evidence that it is real, what should you recommend? 

 

That depends on whether you think that being able to take ibuprofen is important. If not, then you may as well avoid it. I would argue that there are plenty of reasons to think that avoiding the use of ibuprofen is harmful in children with respiratory tract infection.

 

It is arguable that the single greatest risk of avoiding Ibuprofen is unnecessary exposure to infection.

 

Children with uncomplicated respiratory tract infections are best managed symptomatically. Although parents often seek a clinical assessment, this rarely adds anything other than reassurance in the child who has no respiratory distress, signs of sepsis or dehydration. In normal circumstances, the clinical assessment itself is low risk. These times are not normal circumstances.

 

Any healthcare setting is currently extremely high risk for acquiring COVID-19 infection, so anything that brings you to the doors of a hospital or community clinical environment is itself dangerous.

 

It, therefore, follows that anything that avoids this attendance is protective.

 

Analgesia is a good way of helping a child with a respiratory tract infection to feel well and behave in a way that lets the parent know that they are not dangerously unwell. It is also a good way to give the child the best possible chance of hydrating orally, by resolving their sore throat, sore ear or general malaise.

 

It is interesting that the initial flurry of recommendations against the use of ibuprofen was followed by a steady stream of statements that there was no evidence for such avoidance and a series of retractions and clarifications. I think that the about-turn was brought about by an alliance of evidence-based medicine purists and front-line pragmatists who recognised that symptomatic relief is under-rated and has a genuinely important role in these times.

 

Even if you have genuine anxieties about the use of ibuprofen in children with potential COVID-19 infection, I would suggest the following principle:

 

 

While avoiding ibuprofen may feel safe, my opinion is that ibuprofen may be useful as a way to keep children and the adults who care for them safe by avoiding unnecessary clinical contact.

 

Edward Snelson

@sailordoctor

 

You can check out Edward’s excellent blog by clicking here.

 

 

 

 

Abuse from the public in community pharmacy has finally broken me

 

It has finally hit me.

 

I’m lying in my daily long bath, crying and can’t stop.

 

I cannot face the public today with their selfishness and abuse. I swear I might lose it with the first person that moans today. (I know I won’t though!)

 

I love my job. I always have.

 

It has never been this hard and all because 50% of the public are actually behaving terribly.

 

I’m heading to work at 7am every morning because I want to. I am trying to support community pharmacy teams who are exhausted, who have given everything, who are working like mad, who are barely speaking to their families and who are under unbelievable pressure.

 

And yet the abuse still comes.

 

I work for a company that have completely pulled out all the stops to support us. They are trying to give us staff, they are trying to ensure we take breaks, restricting the hours that we are open to the public, taking the professional hit with unpopular decisions and just generally trying to ease the pressure.

 

They can’t do any more.

 

But the public can.

 

My gentle appeal to the general public is to please stop being selfish. We are now playing the toilet roll game with medicines. Get what you need, when you need. Think of your neighbour.

 

Instead of standing outside my shop moaning about the wait, moaning about why we don’t have stock, wanting the prescription that you don’t actually need for another three weeks, right now.

 

Please also don’t have a social media rant about how shit pharmacy is. Don’t ring three times a day to see if your non-urgent script is here.

 

Please just don’t be that person.

 

Let us, who are truly frontline, prioritise the vulnerable, the elderly, the isolated. We know you are scared, we know you are panicking. Be assured we will help you. We are scared too but we can’t help you if you don’t help us.

 

We will get the backlog done, be understanding, be patient, be pleasant. And if you can’t, then take a look hard look at yourself because you should be ashamed.

 

Rant over.

 

The tears have stopped.

 

Please don’t feel sorry for me and my rant. Feel sorry for those who caused it. They need your sympathy. I’m away to work, I’ll see you in 12hrs.

 

The author of this article wishes to remain anonymous. 

 

 

 

The Italian community pharmacist on the COVID-19 front line

 

I’m an Italian pharmacist and I have enjoyed working there in community pharmacy for many years. A number of years ago I worked in the UK as a pharmacist so have some insight into your system.

 

Community pharmacy used to be normal there. Until recently that is. A few short weeks ago all our lives in Italy changed and the professional implications are serious.

 

The situation in Italy is chaotic.

 

In recent days I have read lots of posts about the situation in the UK. I have seen that many people are confused about the COVID-19 outbreak. They don’t know what to think and pharmacists are nervous about the impact on them and their workplace.

 

Concerningly most people are underestimating the severity and impact of the situation. This is exactly what many countries, including Italy, did at the beginning.

 

It’s not time to argue or to lose time.

 

You may not have the benefit of waiting for the guides from the Government. Instead, you may need to act to protect yourselves and your patients.

 

Put a notice on at the entrance of the pharmacy. Find hand sanitiser and tissues (like Kleenex). Write notices on the doors of your pharmacy like this one:

 

“Please clean your hands before entering, use a tissue if you’re coughing or sneezing and throw it in the bin. Maintain a distance of at least one metre at least and enter just two people at a time”.

 

I have been wearing a mask and gloves to protect ourselves and your patients at work. I suggest you do similar. And when you go to the supermarket or in any shops do not think that you look weird. Instead, try to think about your health, the health of your family and the health of the rest of the population.

 

In our pharmacy in Italy, we now put a plexiglass divider on the counter. We constantly wear masks and gloves. If you can’t provide a divider, put a plastic transparent glasses on the counter. Do something. It’s not comfy wearing a mask as it’s hard to breathe but a necessary step.

 

Please learn from the Italian experience and tell elderly relatives to stay at home and isolate themselves.

 

One thing that working as a community pharmacist in Italy has demonstrated to me is that the situation is critical.

 

This is real.

 

I never thought I would be wearing a mask in the way we have been doing. The vents that began in December in China feel so far away from our home.

 

Please do not make the mistake of doing nothing. Denial is tempting. Remember Italy and go and wash your hands. Keep that gap.

 

Please do not remain complacent in light of the oncoming tsunami that is COVID-19.

 

Wash your hands.

 

Use hands sanitiser very often.

 

DON’T TOUCH your mouth, nose and eyes.

 

Don’t shake hands.

 

Keep at least a metre from another person even if you’re wearing the mask.

 

Try to find a huge amount of masks because soon all Europe is gonna be like Italy, and will be hard finding some just like in Italy.

 

The author of this article is a pharmacist who runs a community pharmacy in Italy. He wishes to remain anonymous.