Evidence submitted by the Royal Pharmaceutical
Society of Great Britain (WP 50)
SUMMARY
Key features of the pharmacy workforce:
— The majority of pharmacists, whilst
delivering services on behalf of the NHS or to NHS patients, are
employed in the private sector, working for either large publicly
quoted companies or for small and medium sized enterprises.
— More than a third of pharmacists
working in community pharmacy are locums, some work regularly
for the same pharmacy combining community practice with teaching
and sessional work in general practices.
— More than half of pharmacists working
in community pharmacy are working part time (which is defined
as less than 32 hours per week).
— Around 10% of pharmacists are multiple
job holders undertaking part time work in up to three different
sectors.
The RPSGB working with the Department of Health
and Welsh Assembly Government has developed and tested the first
workforce planning model for the profession that covers the NHS
and major private sector pharmacy providers. This has demonstrated
an emerging gap between demand and supply; highlighted areas of
risk of over and under supply of pharmacists in a number of policy,
demographic and technological scenarios over a 10 year period
and allowed recommendations to be made to manage the emerging
risks.
The RPSGB has opened a voluntary register for
pharmacy technicians and is awaiting legislation to make this
statutory. This, together with proposals in the Health Bill which
will define the extent to which pharmacists may delegate certain
activities to technicians under supervision and where pharmacy
technicians might supervise certain activities in place of the
pharmacist, will allow proposals around skill mix to be developed
where appropriate.
An area of particular concern, arising from
the expansion in pharmacy student numbers (44% since 1998) and
the demographic profile of the current workforce, is the lack
of planning and capacity development amongst the academic workforce—this
is being investigated further but a capacity development programme
wil be needed. The RPSGB has recently re-launched its PhD Studentship
programme in response to the growing problems.
BACKGROUND
The Royal Pharmaceutical Society of Great Britain
(RPSGB) is the professional and regulatory body for pharmacists
in England, Scotland and Wales. It also regulates pharmacy technicians
on a voluntary basis, which is expected to become statutory under
anticipated legislation. The primary objectives of the Society
are to lead, regulate, develop and represent the profession of
pharmacy.
1. The RPSGB is concerned to ensure that
the profession has the capacity (in terms of numbers and skills,
knowledge and attitudes/values) to deliver high quality services
that, above all else, are safe for patients and in which the public
can have confidence. It is from this perspective that the RPSGB
takes forward its portfolio of work relating to workforce and
education policy.
2. The primary practice responsibility of
the pharmacy team is to ensure that patients, their carers and
the public achieve their desired health outcomes, primarily through
the safe and effective use of medicines. These responsibilities
are delivered through the provision of up to date, safe and cost
effective pharmaceutical services, information and products. The
teams work in partnership with patients (and their carers) and
other members of the wider healthcare team in order to discharge
their professional responsibilities. An increasing number also
undertake teaching and training responsibilities for students
and trainees in pharmacy and more widely within the healthcare
team.
3. However, it must be recognised that for
a number of pharmacists and technicians, who work primarily in
industry and academia, whose practice responsibility relates more
widely to the discovery and development of medicines themselves
and covers research, development, regulatory affairs and production
amongst other functions—whilst their practice is not focussed
on direct patient care their activities contribute to the wider
purpose of the profession of pharmacy.
4. Based on results from the 2003 Workforce
Census, carried out by the RPSGB, the pharmacist workforce is
distributed as follows:
5. Key features to note are as follows:
— The majority of pharmacists, whilst
delivering services on behalf of the NHS or to NHS patients, are
employed in the private sector, working for either large publicly
quoted companies or for small and medium sized enterprises.
— More than a third of pharmacists
working in community pharmacy are locums, some work regularly
for the same pharmacy combining community practice with teaching
and sessional work in general practices.
— More than half of pharmacists working
in community pharmacy are working part time (which is defined
as less than 32 hours per week).
— Around 10% of pharmacists are multiple
job holders undertaking part time work in up to three different
sectors.
6. The pharmacy team also includes pharmacy
technicians and other support staff; technicians are currently
able to join a voluntary register at the RPSGB which it is anticipated
will become a statutory register in due course. There are currently
2,770 technicians voluntarily registered with the RPSGB. Detailed
workforce data is not yet available for technicians, once a statutory
register has been established it will be possible to undertake
a census and to establish a similarly detailed picture of the
technician workforce.
7. The RPSGB, working with the health departments
in England, Scotland and Wales, has recently completed the development
of a computer based workforce planning model for pharmacists[133]
which is designed to assess the impact of different policy options
on the risk of either over or under supply of pharmacists. The
information provided below is based on the background work underpinning
development of the model and outputs from it.
8. How effective has workforce planning
been and how should it be done in the future? Until the work
described above was commissioned in 2002-03 no attempt had been
made to undertake a profession wide workforce planning exercise
for pharmacy. The size of the workforce in pharmacy has been essentially
market driven with no centralised planning as seen in for example
medicine and dentistry. Overall supply has kept pace with the
demand with existing schools of pharmacy increasing student numbers
and new schools of pharmacy opening—there has been an overall
increase in student numbers of 44% since 1998. The recent modelling
work indicates that there is now a gap between supply and demand,
especially in some sectors of the workforce and, most worryingly
for the long term, in the academic workforce.
9. Many of the large private sector employers
in pharmacy have traditionally undertaken quite detailed planning
for their own workforce needs. The NHS has monitored its workforce
with regular surveys for many years identifying shortage areas
and vacancy rates as indicators of undersupply—no central
view of workforce demand has been available.
10. In relation, specifically, to the longstanding
involvement of major private pharmacy providers it should be noted
that for private sector employer's workforce planning data are
intrinsically linked to the business plans of the organisations
and, as a result, are commercially sensitive. In conducting its
work the RPSGB utilised an independent research team to collect
information and to maintain confidentiality. The need to protect
commercially sensitive information and to respect commercial confidences
was quite unique in pharmacy at the time the RPSGB project was
undertaken. However similar concerns will increasingly impact
on how and indeed whether workforce planning can be undertaken
for other professional groups if the use of private sector providers
in the NHS increases.
11. The workforce planning model now available
for pharmacy will support all the stakeholders interested in analysing
the pharmacy workforce. However, for the data to be useful in
terms of ensuring that supply and demand are broadly aligned,
joint working will be needed at a strategic level—the StLaR
initiative between DH & DfES offers a useful model which has
progressed discussions about academic workforce and career development.
12. How should the effects of technology,
policy, changing demographics and private provision be taken into
account? Impact of these factors on both demand and supply
should be considered separately and then combined to assess overall
impact on workforce—this requires identification and verification
of measures that reflect current workload and determination of
attitudes to work amongst the workforce in order to predict impact
on supply.
The workload measures used for pharmacy are
as follows:
— Community Pharmacy: prescription
items per pharmacist hour.
— NHS Hospital Pharmacy: Whole
time equivalent pharmacists per 1,000 FCEs (Finished Consultant
Episodes).
— NHS Primary Care Pharmacy: Whole
time equivalent pharmacists per GP Partnership.
— Industrial Pharmacy: weighted
demand based on a function of the average number of new medicines
introduced per year plus a proportion of the number of new medicines
in Phase 3 clinical trials + a proportion of the number of GP
Partnerships.
— Academic Pharmacy: Undergraduates
in Schools of Pharmacy per pharmacist.
Three sets of career anchors have been identified
and used to predict the likely impact of policy, technology etc
on the supply of the pharmacy workforce. The following three attitudinal
profiles (career anchors) predict the propensity of the workforce
to leave jobs, sectors or indeed the profession or to reduce working
hours:
— Improving people's well-being and
making a contribution to society.
— Ensuring long term employment and
financial security.
— Balancing and/or integrating work
and life outside work.
As the nature of the workforce changes in terms
of socio demographic, gender and ethnicity these profiles are
likely to vary across different cohorts within the workforce and
need to be monitored and updated regularly to maintain the model.
13. To what extent can and should demand
be met? A range of approaches can be used to bring supply
and demand back into balance—a combination has been proposed
to address the emerging gap between demand and supply in pharmacy.
[134]Care
has to be taken in deploying demand side solutions as many will
have impacts (often negative) on supply factors—a balance
has to be struck and trade offs made regarding timescales to implementation
in order to manage expectations and avoid negative impacts on
supply side features. This suggests that a significant amount
of work is needed to develop a long term view of workforce needs,
especially where the training pipeline is relatively long (for
pharmacists this is five years to initial registration and up
to 10 years for some specialist and advanced areas of practice).
Initiatives in retention with recruitment should be carefully
balanced to avoid alternating and damaging periods of over and
under supply.
14. There is a gap between demand and supply
in the pharmacy workforce and anecdotal evidence suggests that
this is covered in a number of ways:
— Working longer hours (the attitude
survey indicates that pharmacists work an average of four hours
a week longer then their contracted hours).
— Dealing more swiftly with scripts
at a rate above the official safety levels.
— Cutting back on non-core activities
and back-up activities.
— Some reduction in service provision
(eg out of hours work; vacancies left unfilled).
— Extending the role of pharmacy technicians
and assistants, and others, to substitute for pharmacists.
15. Thus whilst there are no outward signs
that the service is failing to meet demand and expectations of
patients going forward, there must be concerns over the safety
and sustainability of the emerging picture. Recognising this a
series of policy recommendations have been made by the Pharmacy
Workforce Planning and Policy Advisory Group—a number of
which have already been set in train.
16. How should workforce planning be
undertaken? For small professional groups, especially those
with long training pipelines and whose practice depends on a high
level of technical/clinical skill and/or specialist knowledge,
a case can be made for an element of centralised planning. As
acknowledged previously supply and demand have stayed largely
in balance in pharmacy with expansion in student numbers keeping
pace with increased demand—this has occurred through the
responsive market in higher education and without any centralised
planning. However, the emerging problems with academic workforce
are a consequence which can realistically only be addressed at
a national level. A planned expansion, similar in process to the
recent expansion in medical education, would have allowed a more
strategic approach to funding and capacity development.
17. Of itself workforce planning for any
professional or managerial group will not prevent under or indeed
over supply of clinical and professional groups, realistically
workforce planning enables those with power to increase recruitment
and retention or to manage demand to assess risks and make choices.
Unless there are clear lines of accountability to allow appropriate
and timely action to be taken the risks identified cannot be managed
or minimised effectively.
Dr Sue Ambler
Royal Pharmaceutical Society of Great Britain
March 2006
133 The model was developed and the underpinning
research undertaken by The Human Resource Management Research
Group, Department of Management, King's College, London, under
the leadership of Professor David Guest. Back
134
Future Pharmacy Workforce Requirements: Worforce modeling and
policy recommendations-Report of the Pharmacy Workforce Planning
and Policy Advisory Group, chaired by Judy Hargadon-in press. Back
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