Workload in community pharmacies in the UK and its impact on patient safety and pharmacists' well-being: a review of the evidence.

New contractual frameworks for community pharmacy are believed to have increased workload for pharmacists; too much work has been implicated in high profile cases of dispensing errors leading to patient harm, and concerns about pharmacists' well-being. A review was undertaken to ascertain whether community pharmacists' workload has increased and whether links between workload and patient safety and pharmacists' well-being have been established. We searched Scopus; EMBASE; MEDLINE; PubMed; CINAHL; PsychINFO; ASSIA; E-pic, and International Pharmaceutical Abstracts for research published between 1989 and 2010 containing data on UK community pharmacy workload, and on its consequences when workload was found to be a determinant of either patient or pharmacist outcomes. Researchers assessed retrieved material against inclusion and exclusion criteria and synthesised findings using a data extraction form. Fifteen studies were retrieved that met the inclusion criteria. A number of methodological weaknesses were identified: studies categorised work tasks and workload differently making comparisons over time or between studies difficult; most studies were small scale or conducted in specific localities, or lacked sufficient methodological information to rule out bias; studies that control for possible confounders are rare. The reviewed research suggests that community pharmacists still spend the majority of their time involved in activities associated with the dispensing of prescriptions. There is some evidence that community pharmacists' workload has increased since the introduction of the new contracts in England and Wales, especially around the core activity of dispensing prescriptions and medicines use reviews. There is also some evidence to suggest a link between heavy workload and aspects of pharmacists' well-being but there is no robust evidence indicating threats to patient safety caused by their having too much work to do. More high quality research is required to examine what constitutes too much work, the impact of high workload, and associations with other work place factors.