Health CommitteeWritten evidence from London Pharmacy Workforce Development Group (ETWP 27)

London Pharmacy Workforce Development Group (LPWDG)

A network of pharmacists and pharmacy technicians delivering NHS pharmacy services across London; LPWDG represents Chief Pharmacists from NHS trusts and PCTs, and links with our community pharmacy colleagues contracted to deliver NHS pharmacy services in primary care.

The 31 PCTs and 41 NHS trusts in London employ some 1,650 pharmacists, 1,080 pharmacy technicians and 570 pharmacy assistants. In addition, a significant number of pharmacy staff work in community pharmacy. The drug spend across London (2010–11) is £1,958 million. Pharmacy staff throughout the NHS contribute significantly to ensure medicines optimisation, safe and secure handling of medicines, and to the QIPP agenda.

Summary

The overall prime concern is how to overcome the challenge of truly sharing information and reaching consensus regarding priorities for the development of the workforce delivering NHS pharmacy services, across a complex range of NHS and non-NHS organisations.

1. LPWDG is concerned that the proposals will not ensure the right numbers of appropriately qualified and trained healthcare staff (as well as clinical academics and researchers) at national, regional and local levels.

Effective workforce planning is challenging within the current arrangements; the NHS pharmacy network collects its own accurate pharmacy workforce data1 to inform workforce planning discussions, as other sources are inaccurate, incomplete or results are too collective to be meaningful. There is no evidence to suggest that there is sufficient capacity and capability within all NHS organisations to carry out effective pharmacy workforce planning; or indeed in independent providers of NHS services eg community pharmacies. Workforce planning is currently carried out in each SHA, with varying levels of expertise and dedicated resource; there is a danger that the available resource will be lost.

We know that collective pots of funding generate competition for limited resources, and sometimes the “smaller” professions have lost out (or even been left out of discussions). This evidence suggests that care must be taken to retain the ringfencing of training funds for each professional group (at post-qualification and pre-qualification level) in order to achieve this goal. It must be reviewed on a regular basis to ensure that trainee numbers are appropriate.

If sufficient staff are not available with the right skills in the right place at the right time, patient safety and clinical governance are put at risk, and expensive medicines resources are not used to optimum effect.

There is a lack of transparency within the current system and inconsistencies between professions in how education commissioning takes place and clinical placements are supported. The SIFT (Service Increment For Teaching) funding has only been available for medical and dental trainees. There is therefore little incentive to train for many professions, and the impact that trainees have on productivity is missed.

Finally, the mobility of trainees of all disciplines, both into and out of the capital must be considered holistically by HEE, as it has a significant impact on both the concentration of education and training activity and resource within the capital, and on training for the NHS as a whole.2

2. In order to ensure that training curricula reflect the changing nature of healthcare delivery, including the medico-legal context, LPWDG suggests that the required outcomes need to be clearly defined and agreed with NHS service providers.

There are already systems in place to ensure that courses evolve to ensure that this is the case; however, evidence suggests that this does not always happen as effectively as it should, and the timescale for implementation of change is often slow due to the academic accreditation process; this needs to be addressed.

3. LPWDG has evidence to demonstrate a lack of engagement with some providers and commissioners of healthcare (both NHS and non-NHS) in playing an appropriate part in developing the future workforce.

This is either because they do not have the required resources (physical, human and financial) to meet the training standards, or because they are not motivated to do so, since they currently have to pay for all their own training or access it through a non-NHS, non-SHA route (eg community pharmacies access funding to support the training of pre-registration trainee pharmacists via the Contractual Framework for Community Pharmacy Services; the pharmacy undergraduate degree is funded via the Higher Education Funding Council for England rather than via the Non-Medical Education & Training part of the Medical and Professional Education & Training levy). See also comments under 1 above. This evidence indicates that clear mechanisms must be in place to ensure full participation.

4. Multi-professional and multidisciplinary leadership and accountability (encompassing the full range of healthcare professions, specialties and grades) is essential if the challenges of prioritisation and decision-making for fair and equitable allocation of resources are to be met. LPWDG understands that previous attempts to review the MPET levy have proved challenging due to the dominance of the medical profession; this evidence suggests that new and innovative solutions must be devised to ensure fairness and equity for all. Evidence also suggests that a lack of a chance to input means that some professional groups have missed out on accessing funds in the past; this must be overcome if the proposals are to be fit for purpose.

A balance must be reached whereby all professional groups have a voice, either by presence or representation and effective communication mechanisms, otherwise this ambition will not be realised.

5. We have evidence that standards of education and training are not always as high and consistent as required, particularly in the workplace. The proposals offer opportunities to address shortcomings; however, significant new infrastructure, and closer partnership working with key stakeholders, including education providers and professional regulators, will be required.

6. It is critical that the existing workforce can be developed and reskilled for the future (through means including post-registration training and continuing professional development). Our evidence suggests that a lack of funding is already impeding this activity. As above, the opportunity to access post-registration and CPD funding is often lacking; sometimes professional groups/service managers do not know what opportunities are available.

Local trusts are concerned that the loss of CPD funding would impact on the quality of services. Junior staff having to pay for all of their training and CPD may result in training not taking place due to the affordability of this on a London salary. If the service does pay, this will divert money and could impact on service delivery, particularly in times of austerity.

Career pathways need to support the creation of a flexible and adaptable workforce so that professionals can move more easily across boundaries to counter imbalances between supply and demand. This whole aspect of the proposals needs to be clearly defined and prioritised; with guidance by HEE, whilst incorporating local flexibility.

LPWDG supports the proposal for open and equitable access to all careers in healthcare for all sections of society (by means including flexible career paths)

7. Evidence suggests a lack of awareness of pharmacy career opportunities by schoolchildren and students; numbers of pre-registration trainee pharmacy technician applicants are low. Promotion of and access to information on various NHS careers needs to be addressed centrally in order to avoid duplication of effort.

Plans for the transition to the new system, up to April 2013

8. Evidence from other transitions suggests that rapid transition is often associated with the loss of organisational memory and skills, competences and capability, which then need to be re-developed. A clear transition plan to ensure that these losses are not suffered is required.

The future of postgraduate deaneries

9. NB This response also covers current SHA activity.

The current evidence suggests that Deanery roles vary; some are Multi-Professional, others are not. Some cover undergraduate as well as postgraduate multi-professional activity. Some Deaneries carry out roles which are carried out by SHAs elsewhere. The variety of approaches has produced a lack of consistency, widespread confusion and inequity. The range of approaches in workforce planning, education planning and education commissioning could be usefully addressed in guidance by the proposed HEE. LPWDG supports the Government’s proposal to retain the Deaneries within the NHS.

The future of Health Innovation and Education Clusters

10. LPWDG has worked with one of the HIECs in London. HIECs have varied in their approaches. The need to respond to local demand and innovate must be retained. Again, communication and engagement have not always been as effective as required, and this must be overcome.

The role of the Secretary of State for Health in the new system

11. Evidence suggests support for this responsibility and the need for responsibility to remain within the NHS infrastructure is high, and must be retained.

The proposed role, structure, governance and status of Health Education England (including how it will take on the roles of Medical Education England and the Professional Advisory Boards), and its relationship to professional regulators and to the other parts of the new NHS system architecture

12. In its response to Liberating the NHS: Developing the Healthcare Workforce, LPWDG noted that in order to support its high level aspirations it is of paramount importance that the detail supports the aspirations of the new infrastructure as a whole. As evidenced by subsequent discussions, the notion that “the devil is in the detail” continues; and this is still of concern.

The proposed role, structure, status, size and composition of local Provider Skills Networks/Local Education and Training Boards, including how plans for their authorisation by Health Education England will address issues relating to governance, accountability and potential or perceived conflicts of interest, and how the Boards will relate to Clinical Commissioning Groups and the Commissioning Board

13. As under 4. and 12. above.

How professional regulators, healthcare providers and commissioners, universities and other education providers, and researchers will all participate in the formulation and development of curricula

14. See also under 2 above. It is important that HEE leads on such things best done nationally (eg with professional regulators on professional requirements), and that LETBs (or “lead LETBs”) collaborate accordingly where local need is being met. It is important to avoid duplication of effort as experience suggests that this is inefficient and does not support the QIPP agenda.

The implications of a more diverse provider market within the NHS

15. We have evidence that this can be detrimental where “niche”, highly specialist training is essential, and the trainee numbers are small; for example with a number of courses ceasing to be viable, and access being an issue for NHS service providers. Care must be taken to ensure that service providers can develop their staff to meet service needs, in an accessible manner (curriculum content, delivery design and geography).

How the workforce requirements of providers of NHS and non-NHS healthcare will be balanced

16. We have evidence that non-NHS organisations which deliver NHS services are unwilling to share workforce information. This will challenge the ability of the future proposals to meet this objective and must be overcome, perhaps by incorporating into service contractual arrangements. If information exchange is successful, there must be careful consideration and guidance form HEE if balance is to be achieved.

The role and content of the proposed National Education and Training Outcomes Framework

17. The preliminary outline seen by LPWDG is laudable and supported; as HEE develops the framework it will be important to engage with all key stakeholders in order to ensure that it achieves its objectives.

The role of the Centre for Workforce Intelligence

18. The CfWI’s current activity is insufficiently resourced/focused to provide sufficiently detailed, accurate data and guidance to support workforce planning and education commissioning; capability has also been lost. Its capability needs to be developed considerably if it is to fully support the new infrastructure, in collaboration with appropriate professional groups and networks.

The roles of Skills for Health and Skills for Care

19. Skills for Health has demonstrated achievement of consistent standards and benefits from economies of scale; this must be incorporated into the new systems.

The role of NHS Employers

20. No comment.

How funding will be protected and distributed in the new system

21. Evidence shows that current arrangements are inconsistent and confusing (see under 4 and 9 above). Clear guidance from HEE is essential.

How future healthcare workforce needs are being forecast

22. Our evidence shows that forecasting ranges from “How many did you have last year? Same again?”, to considering numbers of NHS posts, vacancies and forecasts, to considering workforce demand aligned with care pathways, which is extremely challenging eg the pharmacy workforce is involved in every care pathway where medicines are involved, but to accurately consider required input and pool that information to define overall activity, where and when it is required, to inform accurate workforce planning is difficult. Again, a consistent and properly informed approach is required.

The impact of people retiring from, or otherwise leaving, healthcare professions

23. Our evidence suggests that this is not considered in current pharmacy workforce planning activity. We understand that it is an important issue which needs to be fully understood if it is to be properly addressed.

The place of overseas educated healthcare staff within the workforce

24. Nationally, the vacancy rate for newly-qualified Band 6 pharmacists was over 20% two years ago. Although this has improved, the use of overseas pharmacists, particularly in London, has facilitated service provision. Our evidence indicates that a change to reciprocity arrangements (albeit some years ago) with our Antipodean colleagues led to a “crisis” in delivering NHS pharmacy services across London. We have evidence to indicate the challenges of mobility of the professional workforce where their command of English is an issue. The ability to obtain work permits and duration of these arrangements is also an issue. All of these issues need to be carefully considered.

How the new system will relate to healthcare, education, training and workforce planning in the other countries of the UK

25. The LPWDG has members who link with the UK-wide NHS Pharmacy Education & Development Committee. Our evidence suggests economies of scale and consistent standards can be achieved by information exchange and collaboration; this must not be lost, especially where professional requirements straddle country boundaries. However, it is important to acknowledge that policies and funding arrangements in the different countries are becoming more “stand alone”. Consistency across England would be helpful.

How the public health workforce will be affected by the proposals

26. Many pharmacists have public health roles, ranging from a strategic remit, to the community pharmacist supporting smoking cessation. An ability to incorporate all of the activity, in collaboration with PHE as well as private contractors for NHS services is important if holistic workforce development is to be achieved.

December 2011

1 www.nhspedc.nhs.uk

2 King’s Fund Report In Capital Health? 01 July 2003 and interim report 13 May 2005.

Prepared 22nd May 2012