Last week, the Guardian published a long read about the pharmacy chain Boots, detailing allegations from staff of how the business pressures its chemists to milk the NHS for cash, compels them to sacrifice professional ethics for demanding business targets and to work in conditions that they believe pose a threat to patients.

The sharpest change, in the eyes of Boots’ own staff, began in 2007, when the company was bought by private equity firm KKR and billionaire Monaco tax exile Stefano Pessina. In our report, employees and experts alleged that the new owners had changed, almost beyond recognition, both the priorities and the culture of what had once been a family run, Methodist firm. Boots denied all the allegations, saying: “Offering care for our colleagues, customers and the communities which we serve … is an integral part of our strategy.”

Boots is a British institution, the country’s biggest pharmacy – and here were its own staff charging it with sucking money from the public purse, endangering patients and harming employees.

Within hours of publication, the Guardian was flooded with emails, many from pharmacists. The letters editor believes this may be the largest haul of mail he has ever received about a single article. Others rang in.

Some may have been invited to write in by their trade union but the letters are not pro forma – they’re from Boots, non-Boots and ex-Boots pharmacists, and they give their individual experience and opinions. Some stress the point made in the piece that smaller rival pharmacists are now adopting some of the same practices.

Among this unprecedented slew of mail, none accuse the piece of exaggeration. Indeed the opposite.

The fear of reprisals runs deep and wide. The overwhelming majority of correspondents wanted their details withheld: “Please I would like to stay anonymous as I can’t afford to risk a jobloss [sic] as I have a family to feed.” One long-serving Boots pharmacist wrote: “I shared your article on Facebook and was telephoned immediately by my manager and told to delete it.”

The letters are an extraordinary firsthand testimony from a profession under acute pressure.

Here, we publish extracts from just a few of them. These are the voices never heard, from people rarely seen – literally, the backroom staff of medicine. Respecting the writers’ wish for anonymity, we are keeping their details private. But they are sounding the alarm on what they see as a crisis at Boots, and in healthcare.

Patients put in danger

• “I think that Boots has now reached a state where things are becoming dangerous. I often worry that I have missed something and there will be a dispensing error, sometimes it stops me from sleeping.”

• “Last year alone, my manager specifically asked me to work in a very busy store all week on my own ... She made it clear that she had discussed this with the area manager and that was the right decision. When I challenged her on the potential risk it was to patient safety and my own personal health. She replied I ‘always use patient safety as an excuse to get out of jobs’.”

• “Patient safety is severely compromised as pharmacists are asked to clinically check prescriptions while ensuring people are being served at the tills, taking phone calls, giving advice to patients, handing out prescriptions, re-ordering medication for patients, texting patients, storing prescriptions, recording clinical information, etc. Self-checking, which should only be done as a ‘last resort’ is actually done on a daily basis. Having two people involved in the dispensing and checking of a prescription is a fundamental hallmark of safe dispensing, which Boots is not taking seriously. Under pressure to meet several targets … in a Boots pharmacy it is extremely difficult to counsel a patient fully on how to use their medication correctly and how to get the most out of their medication, there is simply not a time provision for this.”

Milking the NHS

The investigation uncovered evidence that Boots managers were directing chemists to give medicine-use reviews (MURs) to customers who didn’t need them, for company profit. The NHS pays £28 for each MUR, which is supposed to give patients professional advice on health, diet and how best to manage their medicines. Each pharmacy is limited to 400 per year, but many branches of Boots (and, it is alleged, other chains) take that as a target – in order to squeeze the maximum out of the public purse.

• “I strongly agree that MURs are being abused as a way to make money rather than their primary purpose to help patients. Pharmacists are under huge pressure to do 400 a year. Professional autonomy is being crushed.”

• “I no longer work in pharmacy sector but can confirm that Boots was amongst the most aggressive in pressurising its pharmacists to do a certain number of MURs per day. I recall many occasions when as a locum I would have area managers (often with no clinical/medical training) calling branches to ask how many MURs had been done and if a certain number hadn’t been met why not and that it wasn’t good enough.”

• “We dream MURs, we have nightmares about MURs. Trying to justify the pressure by saying we need to do this for our patients is a load of rubbish. Yes, the idea behind them is great and we should be doing them – for free when needed as our moral, ethical and professional standing demands.”

• “A few months ago I told my area manager we had been doing extremely well with our stop smoking service, and his response was, that’s brilliant but we need to push MURs and NMS [new medicine service] as they are pure profitable services whereas with stop smoking, it is not as profitable when you take into account the products we are providing to our patients.”

Pharmacists under pressure

• “Working for Boots is making people ill. They have an anonymous survey of staff opinions and I am sure people tell them; I certainly have, but nothing ever changes. Profit appears to matter much more than health and safety of customers or duty of care toward staff. I have had many sleepless nights worrying about the safety of the patients. If you complain you are seen as a trouble maker, or inadequate, and basically told to get on with it! I have sat and cried because of the stress and worry many times. At one point I even considered suicide because I could not see any way out of the situation. I know of others who have said they felt the same.”

• “I lasted 20 months [at Boots]. I worked myself into the ground, lost weight and for a large part of it I survived on anti-depressants and sleeping tablets, having had no significant health problems in the past. The lack of sleep was very profound and by far the worst symptom, as this undermined my stamina, concentration, emotional stability (I was crying at the drop of a hat) and general ability to function. It was the constant pressure to ‘perform’, meet targets, and fill ‘expectations’ all dressed up to make everyone ‘Feel Good’.”

• “I joined Boots after my university studies … and found out how it was the worst place for me to work for. I did a professional medical degree, not a sales degree, but felt I was only appreciated if I hit the targets ... Some of the customers don’t even need the services but the pharmacists feel so pressurised that they do it just to hit the targets, despite compromising patients’ health. I always worked in an understaffed environment ... I felt constant pressure and eventually had to leave due to depression.”

• “I am not allowed to just BE a pharmacist – what I have trained for and used to love so much. I am a money-making object.”

• “I am a passionate pharmacist and love doing my job so that I can help patients and provide a brilliant service to them. However with the ongoing, worsening and unrealistic budget cuts, we are working on skeleton staff every day just battling to survive. We can no longer give even a half decent service even if we wish to. What is worse is that staff are taken away and more is expected of you in terms of targets, services! How can you cope? They are setting you up for failure even before you have begun. I wake up in the morning dreading work.” [signed “A disappointed, tired and stressed Boots pharmacist”]

• “I was proud to work for Boots as a pharmacist and as a manager across many stores from 1981 until 2004. My patients and my people came first – before commercial targets – and I was valued, as was my profession. I returned to employment with Boots in 2009 and found a massive change in priorities. One of the most significant drivers in the change of culture at grassroots level seemed to be the move from employing pharmacists as senior managers to the current situation where many managers are unqualified, have lower levels of education and are obviously employed at lower cost. The difference in priorities makes it almost impossible for professional and ethical concerns to be considered appropriately in the face of profit targets.”

• “After Boots was bought [in 2007 by Pessina/KKR], the staffing was radically reduced and I was constantly having to self check. I lost a well-trained dispensing assistant who also covered the medicines counter, in favour of a general sales assistant with no medicines experience. So my day was spent dispensing, answering the phone, offering advice, all whilst listening to what the new counter girl was selling and having to intervene on a regular basis. Oh yes, I forgot to mention the relentless targets for everything whilst having insufficient support staff and a consultation room at the opposite end of the shop to the pharmacy.” [Resigned in 2014 after working in a Boots branch for 11 years]