Victoria Steele: “There just aren’t enough pharmacists working in community pharmacies”

LloydsPharmacy may finally be turning the page.

After four straight years of mounting annual financial losses and hundreds of high-profile store closures, according to accounts published in April 2022the multiple recorded an annual financial loss of £100 million.

It may still be a loss, but it’s a 42% lower loss than the previous year. Company executives mentioned in particular the strong growth of its digital offering, with LloydsDirect riding the wave of online pharmacies that gained momentum at the start of the pandemic.

But with this step in the right direction comes a fair amount of uncertainty, following the sale of LloydsPharmacy, McKesson to asset management group Aurelius, and chronic labor shortages that appear to be plaguing in the area.

Sitting in the middle of it all is Victoria Steele, the multiple’s first female pharmacist superintendent. Steele was appointed in September 2020 from her previous position as Deputy Superintendent and Head of Clinical Governance and Corporate Professional Standards. She is also the chair of the Community Pharmacy Patient Safety Group and a leader in reducing medication errors in the industry.

The Pharmaceutical Journal met with Steele to discuss his expectations and concerns for the future of community pharmacy in this time of rapid change.

I would like to see a profession that is truly recognized by a well-funded contract. I would like to see the efficiencies that we were promised happen, so that we can then move the services forward and really step back from the hypertension services and so on. And I’d like — it’s probably not achievable in a year — to see what can be done to start easing the significant pressures on the workforce.

How does LloydsPharmacy help its pharmacists acquire and then use their independent prescribing qualifications?

Our clinical career path is a program called Evolve. We currently have 65 pharmacists with a clinical qualification, which will turn into an independent prescribing qualification upon completion. It is clearly very different from country to country; in Wales and Scotland it is very easy to see your background and the services you will then provide with your qualification. England still have a long way to go. And that will then help us to find our way.

What about private prescription services?

We have several private services and we are always looking into this area. Our medicated weight service, which we have been running for about 12 months now, has helped patients lose over 20 tons of weight, which is a huge number. So from what was a fairly small service that we rolled out, it had a significant impact on patients. And there are other services we’re working on right now that just aren’t ready to release yet.

[The LloydsPharmacy press office later clarified that 19.2 tonnes of weight had been lost through the medicated weight service in the 19 months between July 2020 and February 2022.]

I challenged the company to eliminate the LASA error (amlodipine/amitriptyline look-alike-sound-alike) by 2020, and we reduced it by 77% and all of our LASA errors by 35%. And we reduced amlodipine or amitriptyline errors by 50%. So it stays on the error reduction program.

But, looking at the data, I looked for where I could make the biggest difference. So we added documentation errors to the error reduction program because it’s clear that if you get the wrong medication or you don’t receive your medication, there is a significant problem. This is where we focus our attention next.

What is the number one risk the Community Pharmacy Patient Safety Group is looking at?

I don’t know if that’s necessarily where our priorities lie. We want to embed meaningful cultures of patient safety throughout community pharmacy and help raise awareness of this.

But one of the things we are really passionate about is supporting pharmacy schools and their curricula. Our reasons for doing so are twofold.

I am concerned that community pharmacy is currently not seen as an attractive place for our graduates and this fills me with consternation

We want to make sure that we can support the patient safety curriculum in schools of pharmacy with real-life experiences of what is happening and the magnitude of the risk. So we are all paired with one or two schools of pharmacy, making sure we are their points of contact to support the appropriate conferences.

Likewise, I am concerned that community pharmacy is currently not seen as an attractive place for our graduates and it fills me with dismay, as it is a career that I love. To be able to make meaningful differences and interventions in patient health is an extraordinary privilege. It makes me sad that our students may not be thinking about community pharmacy and what they can do and be part of an essential part of the social fabric.

What specifically needs to change to improve this image?

We all have a role to play in this. I don’t like the expression ‘a clinical pharmacist‘. All of our pharmacists are clinical; no matter where their frame is. The thought that you are more clinical, if you are in a different setting, is a misnomer.

Clearly, community pharmacists, alongside other health care professionals, have worked hard over the past two years under extraordinary circumstances. And that means people made different decisions; they have taken other routes, whether to health boards or primary care networks. It is publicly available that 3,500 community pharmacists have left in the last 18 months.

Add to that the opportunities to become vaccinators over the past two years and a workforce choosing to retire a little early because the past two years have been really tough. And then there’s now a significant market value to being a locum so there’s no need to travel as far as before because you’re going to get fantastic fares near you which means you don’t have maybe no need to work as many days as before.

All of this now eats into the workforce and comes mostly from the community pharmacy. It’s particularly difficult right now.

How can the profession retain these people you’re talking about?

When people start looking elsewhere, to really understand what role they are going to play. I believe that our pharmacists are passionate and patient-focused, and derive great satisfaction from helping many people every day and unfortunately probably never know how important some of their interventions are. Going to a role where they are not patient is a big change, which really requires some thought.

We need to create efficiencies for our pharmacists so that they are able to provide services, and then be able to recognize some of the important interventions that they do. So the hypertension department — we have amazing case studies around interventions that our teams have done. We have a couple that only happened in the last few weeks with patients with very low blood pressure or very high blood pressure and immediate trips to the ER, which then followed up with this particular patient, with a low blood pressure, having a pacemaker fitted that night.

These are amazing things that our pharmacists do. In another example – significantly high blood pressure in a person with a known cardiovascular problem who had difficulty getting help from a GP, she managed to have her blood pressure checked with us, an outpatient monitor and a major change in medication resulted from the back of this. These examples are coming in every week now. So that our pharmacists can see this and hear the feedback, which is exactly why we entered this profession.

This was in accordance with the temporary provision [to allow flexible opening hours for community pharmacies, which ended in March 2022]. However, there is still a very large labor concern that has not been resolved. This is a concern because COVID-19 has not gone away. We still have disease levels that aren’t what they once were, and they’re almost entirely COVID-related.

Is there a shortage of pharmacists or is it a manpower challenge?

That’s a pretty good way to put it actually. We know how many are graduating, but the number of people on the register is a very different equation. How many work? How many work full time? There simply aren’t enough pharmacists working in community pharmacies.

Some people say, ‘But there are so many people on the register.’ Yes there is. We cannot deny it. Do they work here in community pharmacy? No they are not. And if we keep sucking them into other parts of the pharmacy, we end up like we are now. We need to see some light at the end of the tunnel for our pharmacists, but especially for our patients and our communities.

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