Dealing with frustrated customers and patients is unfortunately part and parcel of the job when you’re in a public facing role. What’s not usually expected is verbal abuse and threats of violence – but new figures reveal worrying trends.
Fuelled by Covid-19 pandemic pressures, NPA members are reporting that even some regular patients who they’ve known for many years, are becoming increasingly impatient and angry due to prescription delays, covid tests shortages and increased waiting times.
Bernadette Brown, owner and pharmacist at Cadham Pharmacy in Fife, Scotland is one of those NPA members who believes the issue of abuse faced by pharmacy teams is on the rise.
“One of my staff was just screamed at over the phone the other day. It’s to do with expectations really more than anything else,” she says.
“The public are wonderful, it's just a minority of people who are not getting it. We are looking to find new ways of engaging with the public so that we can organise telephone, video or face to face appointments to manage their expectations and give everyone the time they need and deserve to get the best consultation advice, treatment or referral. We are in a new age of pharmacy.”
She revealed that some elderly people are showing aggression. “They’re really lashing out and their mental health is more acutely becoming apparent that they're not coping,” explains Bernadette.
“Before lockdown it was okay to phone the doctors but now they're being told you've got to be capable of using the internet before you order a prescription.”
A freedom of information request by Chemist + Druggist found over 26,600 reports of crime committed in community pharmacies, which included incidents of violence, were received by police forces in England, Wales and Northern Ireland during 2019, 2020 and 2021.
"There is a workforce danger arising from this and it’s not just at pharmacist level"
A rise in abusive behaviour and aggression has also been seen further north – Community Pharmacy Scotland say some owners have had to employ security guards to protect staff and their premises.
Phil Galt, Managing Director and Superintendent Pharmacist Lindsay & Gilmour is one of those pharmacies.
He says: “When our neighbouring pharmacies are closing we end up having to deal with their patients and end up getting the abuse. We’ve recently employed security guards to work in three of our pharmacies, managing queues, and customer behaviour. One of our staff was nearly assaulted, which just illustrates how bad it has become.”
Bernadette’s daughter Kara, who works at Cadham Pharmacy as a pharmacist, had to call in the police recently to deal with an aggressive patient.
“This man was sat down and was waiting on someone to approach him, which is usual for us. However when Kara came out she asked, 'Has everyone been helped'? she was met with intense aggression. He was argumentative, confrontational and didn't allow her the chance to say 'How can I help you?' or ‘What can I do for you today?’
“His prescription that he was expecting to be ready hadn't even been sent to us yet by the GP practice. That led to further aggression from this individual. In a normal circumstance we’d able to diffuse that by saying something like 'Please come into the office' or 'Let's phone the surgery.' Just so they're aware there's a fault somewhere in the system and not us. At this point she had offered to phone the surgery but the angry patient demanded he would go down and sort them out”.
“She had to call the surgery and warn them that he was on his way down,” explained Bernadette.
“He stormed back into the pharmacy and at this point she felt really threatened. She pressed the panic button and the police were there within 10 minutes. They gave him a warning.”
It’s the first time Kara had to press the panic button says Bernadette and it’s left a sour taste.
“On the days we get abuse, we question why we are still working so hard on the frontline NHS and we need to feel supported. NHS Fife have been a wonderful support and Ben Hannan the Director of Pharmacy came and personally spoke to my team which was uplifting and helps us have the motto ‘tomorrow is a new day’.”
Bernadette warns that there is a workforce danger arising from this and it’s not just at pharmacist level.
“We have technicians getting shouted at. The reception staff in particular are finding this new post-covid recovery period tough and the expectations of the public is that we are encompassing everything, for everyone. They’re expecting their prescriptions to done at superfast times. It’s taking upward three-four days now to get prescriptions to us. We don't have electronic transfer like our colleagues in England, so we need to wait on that physical piece of paper coming in which is taking longer and they suddenly think our service is rotten.
“Our role in the NHS is changing fast. We are the most accessible healthcare practitioner, especially when in Scotland every GP practice in my town is saying Pharmacy First. But this change is moving at a pace where sometimes we may no longer be that walk-in ‘accessible place’.”
Investing in training and security
Cadham Pharmacy installed a panic button more than seven years ago.
“I would encourage every local pharmacy to get to know the community cops and have a very good relationship with them, so if they do have an incident and press the panic button, they are there within 10 minutes,” explains Bernadette.
“We've put the Perspex up so it makes you feel you have a bit of security between you and the customer but they can still literally just walk three steps and empty the dispensary if they wanted.”
Overall Bernadette believes “prevention” is key and it is better to invest in training and technology to help prevent bad behaviour. She got her team trained in verbal skills to deal with aggressive patients via some local community police officers.
"Some of that training is not saying 'We are a zero tolerance NHS premises'. Most of the time we don't realise we could be making a situation worse by saying something like 'Please don't talk to my staff like that'. The minute you say something like that who's already talking aggressively, this just winds them up more. The community police came and taught my staff on how to dissolve a situation and bring someone down from a high level of anxiety. That is a skill in itself and not all of us have got that naturally.”
She also thinks technology can help to get the right messages out to patients and reduce those expectations.
“Mass texting for example, every pharmacy should be able to text every customer they have a mobile phone number for with an immediate, quick and concise message, that just keeps honing in on message like 'It may take more than two days for your prescription because we are in a pandemic'.”
Bernadette has also prosecuted some people who were caught on their CCTV cameras.
“We now have a very well behaved addiction clientele. We have four cameras outside, cameras at the back door and we've got cameras in reception too, so it’s very obvious to the public that they’re being filmed. We've prosecuted two people, which sent a huge message to that cohort of clients, that if you mess with me and my team, we will prosecute you. Prevention is best but you have to follow through too.”
Ivor Saunders, CEO of Semieta, a software security company and NPA Business partner which advises pharmacies on how best to secure the premises, says it is essential that pharmacy owners take all necessary steps to protect their work force in the light of the increased threat level.
He says: “Be vigilant, train your staff to look for early signs of potential bad behaviour, install CCTV, and make all people aware that the site is filmed.
“Pharmacy owners should also provide a safe space for staff to retire to, install panic buttons and protect the parameter of the site from easy unauthorised access.”
NPA Insurance support
Paul Coleman, Managing Director of NPA Insurance says it’s been a challenging time for the sector and his team has been drawing on its extensive in-house legal expertise and knowledge of community pharmacy, both to protect members against the more familiar risks faced within their usual daily environment, as well as to identify and mitigate emerging risks such as abuse and violence by members of the public, associated with the pandemic.
He says: “COVID-19 required our claims team to respond dynamically and empathetically to the rapidly evolving operating environment pharmacists found themselves in.
“We know that pharmacy staff are experiencing abuse, disorder and even violence at the hands of some members of the public they are trying to help. NPAI’s Pharmacover policy can cover NPA members in the event of damages to their premises, theft of goods or assault.
“We understand that receiving a claim for damages is extremely challenging, both professionally and personally. Our in-house claims team is staffed by highly experienced, qualified lawyers who are able to provide expert legal advice from the very first call to the conclusion of the claim, ensuring our customers receive the best service and support when they need it the most.”
For further information contact the claims team on 0800 4960426.
The National Police Chiefs Council (NPCC) with the help of the NPA and other pharmacy bodies has created some resources for pharmacy teams to combat abuse and violence.
“Policing is working hard to understand the challenges and associated criminal opportunities in order to provide support and help manage those risks through positive engagement and regular provision of crime prevention advice,” an NPCC spokesperson told InPharmacy.
“We are encouraging all local police patrol routes to include pharmacies where possible, and for local neighbourhood policing teams and Controlled Drugs Liaison Officers to be proactive in engaging.”
Some tips from NPCC include:
- Staff - Train, support and talk to your staff about the information in the NPCC document
- Take a note of every incident no matter how small and report crime to the police
- Assess the security of your premises, inside and out and have an up-to-date premises security risk assessment
- You can seek further advice from the Master Locksmith Association and Metropolitan Police Service
- Signage - set clear rules and make it clear which are staff only areas
- Advise staff to lock unused rooms and be vigilant
- Follow pre planned open & close routines
- Ensure drugs are locked away in a security rated cabinet and behind several layers of security.
To read the full NPCC advice to pharmacies go to: www.npa.co.uk/information-and-guidance/covid-19-crime-prevention-advice-for-pharmacies/