Health CommitteeWritten evidence from the Royal Pharmaceutical Society (ETWP 51)

The Royal Pharmaceutical Society (RPS) is the professional body for pharmacists in Great Britain. We are the only body that represents all sectors of pharmacy in Great Britain. The RPS leads and supports the development of the pharmacy profession including the advancement of science, practice, education and knowledge in pharmacy. In addition, we promote the profession’s policies and views to a range of external stakeholders in a number of different forums.

Summary

The RPS believes that there is a need to ensure that provision of education, training and professional development mirrors the patient journey and that emphasis is placed on service delivery across the sectors of care. It is vital that workforce planning and development accounts for the entire workforce delivering services in the NHS including small providers, private providers and self employed healthcare professionals as well as considering the numbers of healthcare professionals needed for other roles such as regulation, academia and industry.

The NHS is attempting to make large efficiency savings whilst the demand for health services is increasing due to an ageing population and associated health burden and increasing complexity of medicines and rising number of prescriptions dispensed year on year. In taking these factors into account alongside the Government’s proposals, we have concerns about the pace of change and how the demands of the proposed timeline will be managed.

The RPS supports the principles of further integration of workforce, financial and service planning. However we believe that there is insufficient detail and clarity on how workforce provision will meet healthcare demand. We have concerns regarding long-term planning and how service integration will occur. We also feel that there is a lack of clarity about advocacy and engagement with Local Education and Training Boards.

The RPS welcomes the opportunity to respond to the Health Committee’s invitation to submit written evidence: education, training and workforce planning. The evidence we submit follows the structure of the Health Committee’s terms of reference and call for evidence.

Key Themes

Ensuring the right numbers of appropriately qualified and trained healthcare staff at national, regional and local levels

There is evidence that workforce planning needs to be more consistent across professions and organisations. Also, roles and responsibilities at each level currently lack clear definitions.

Current Government proposals describe the role of healthcare professional regulators however it is also important to consider the role of the professional bodies such as the RPS in planning the workforce. More robust workforce planning at regional and local levels may be supported by workforce and capacity planning being aligned to professional standards.

The RPS has evidence of a decline in the number of pharmacists involved in pharmacy undergraduate courses and we believe that this is part of a wider decline in the number of clinical academics and teaching staff on healthcare courses. Appropriately qualified and trained pharmacists need appropriately qualified and trained pharmacists to educate them in order to ensure a workforce for the future.

Although there have been improvements in workforce planning in the healthcare system, more needs to be done, especially with respect to long term workforce planning, given the long lead time it takes to train pharmacists (four years MPharm degree followed by one year pre-registration training year = five years). There is insufficient evidence as to how Government proposals will support this. We are also anxious that a more market based approach will risk workforce imbalances in future.

Ensuring that training curricula reflect the changing nature of healthcare delivery, including the medico-legal context

More attention needs to focus on linking training curricula to robust career pathways that produce high quality professionals but are also flexible and adaptable so that professionals can change direction if necessary in order to counter mismatches between supply/demand, comply with new medico-legal structures or the changing nature of healthcare delivery. Greater consideration is also needed of the impact of technology on training curricula eg centralised robotic dispensing and its impact on the education of community pharmacists. The RPS has an important role, working with specialist pharmacy groups to develop professional curricula for post-registration development that are focussed on clinical outcomes and that promote excellence in practice.

Ensuring that all providers and commissioners play an appropriate part in developing the future workforce

The RPS still needs to be assured of the full engagement of both NHS and non-NHS organisations in the proposed new system. Reassurance is also required about preventing conflicts of interest and that appropriate checks and balances are in place within a market of commissioning, funding and delivery of education and training.

Ensuring multi-professional and multi-disciplinary leadership and accountability at all levels

This is critical if an equitable distribution of funding is to be achieved and therefore smaller professions such as pharmacy should be included in the leadership of the new education and training system. It is also an opportunity to develop multi-professional leadership capabilities. The RPS would welcome more detail about leadership and accountability (across the professions, specialties, grades and levels) to be assured that the governance and function of the new system is appropriate.

Ensuring high and consistent standards of education and training

Current budgetary restrictions and the fragmented nature of the proposed new system put this at risk. Employers and education providers need to be given further incentives to work closely together to deliver high quality training. There is evidence that employers seeking to achieve short term financial savings may be inhibited from providing clinical placements. Pre-registration pharmacists’ needs for clinical placements must be considered alongside other healthcare professions and therefore a multi-professional approach is to be welcomed. However, we are not convinced that problems already existing with finding sufficient pre-registration trainee pharmacist placements (currently funded by the MPET levy (for NHS employers) and the community pharmacy contract) will be alleviated by the proposals. Smaller employers may find it difficult to provide the required infrastructure for clinical placements.

Ensuring that the existing workforce can be developed and reskilled for the future

Recent years have indicated that Continuing Professional Development funding streams have become more difficult to access and many professionals are unaware of options for professional development. Considerable progress has been made in pharmacy with skill mix and ensuring support staff are appropriately trained—it is not clear how the proposals will sustain this approach, indeed we are concerned that there will be much less support for developing support staff who are important for freeing up professionals’ time.

Ensuring open and equitable access to all careers in healthcare for all sections of society

Greater confirmation of joined up thinking is necessary between the Government’s proposals for developing the healthcare workforce and the higher education reforms which concentrate on traditional entry into Higher Education via A-levels. There needs to be an equal focus on other routes so that access from all sections of society is improved.

With the above key themes in mind the RPS welcomes the opportunity to comment on:

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

Experience from previous NHS reorganisations remind us that the transition period will need to be well resourced and managed with considerable care so that organisational memory is retained.

There is a danger that there will be a lack of integration between different parts of the system and a shortage of people with the right skills to do the job effectively.

The future of postgraduate deaneries

The RPS believes that the future of postgraduate deaneries must be to move to multi-professional within the NHS ie not just medicine and dentistry—evidence is lacking that this is currently the case.

The future of Health Innovation and Education Clusters (HIECs)

More needs to be known about the work of HIECs and their success in terms of outputs. The RPS would welcome a review of the HIECs continuing role and purpose within the healthcare system.

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

The RPS supports the proposal that it must be an explicit duty for the Secretary of State to maintain a system for professional education and training as part of a comprehensive health service.

The proposed role, structure, governance and status of Health Education England (HEE) and its relationship to professional regulators and to other parts of the new NHS system architecture

The creation of HEE is a good idea but the balance between local and national oversight is of critical importance to ensure success. The new framework for planning and developing the workforce includes professional regulators but does not include professional bodies. The RPS, as the professional body for pharmacy, is best placed to lead on professional standards for education and training and professional development.

There may be a role for HEE to commission national training programmes for the pharmacy workforce to ensure delivery of services can be maintained across geographical boundaries. We support the remit of HEE as a multi-professional body and we believe it will be important for HEE to be given responsibility for the education budget.

The proposed role, structure, status, size and composition of Local Education and Training Boards

It is unclear what the impact will be on private providers (such as community pharmacy) of Local Education and Training Boards especially how they will be funded and costs, including administrative costs, be allocated and shared. The line of accountability between Local Education and Training Boards and HEE are not apparent. Authorisation of Local Education and Training Boards by HEE to address issues relating to governance, accountability and potential or perceived conflicts of interest, and how Boards will relate to Clinical Commissioning Groups and the Commissioning Board needs further work.

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

National accreditation and standards will need to be in place to ensure that the pharmacy workforce can move between geographical areas whilst still maintaining delivery of services. We also believe that it will be important to forge closer links between healthcare providers and academia and the proposals need to support this process. Healthcare providers need to understand the education supply chain and what HEIs are able to provide and vice versa.

The implications of a more diverse provider market within the NHS

Commercial considerations regarding data collection and workforce planning will be important for private providers such as those found in community settings or future Foundation Trusts. Pharmacy includes many smaller, private providers, eg small independent community pharmacies, who employ very small numbers of staff and there is evidence that workforce planning, including data provision, may be onerous for them.

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

There are already a range of existing arrangements in place across the pharmacy profession. There is an opportunity to ensure that pharmacists in all sectors are able to consistently access quality training and education regardless of their sector or place of work.

Responsibilities for planning and developing the workforce must apply to all providers of NHS funded care. Greater clarity is needed however on how the proposals would be implemented and developed for private providers of NHS services such as community pharmacies (including the roles of self employed professionals such as locum pharmacists), secure environments, private clinics and hospitals etc.

Healthcare providers have an obligation to plan thoughtfully for the whole workforce however it is vital that this obligation is measured and monitored and that mechanisms to address the situation are available if this obligation is not met.

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

The RPS supports a greater focus on education and training outcomes but there is limited evidence available and this is an area that requires further investment and development.

The role of the Centre for Workforce Intelligence (CfWI)

The RPS has been working closely with the CfWI providing valuable input and engagement in areas such as professional advice, scenario planning and benchmarking—these are essential for accurate workforce planning.

The roles of Skills for Health (SfH) and Skills for Care (SfC)

The RPS supports the continuing role of these sector skills councils. SfH and SfC should continue to focus their support for a more skilled and flexible workforce.

The role of NHS Employers

The RPS supports the continuing role of NHS Employers and would recommend that it works more closely with non-NHS employers providing healthcare.

How funding will be protected and distributed in the new system

We would urge that the funding system is ring fenced. Guidance needs to be developed by HEE so that funding is fairly and transparently distributed to provide consistent opportunities for multi-professional training and education. We also believe that the funding models need further consideration.

How future healthcare workforce needs are being forecast

Current workforce models appear to be inadequate with many professions over or under supplied. The government needs to provide greater support for workforce modelling so that future healthcare workforce needs are more accurately predicted.

Data currently collected and used for workforce planning is of either non-existent or of variable quality and accuracy. There are also issues with workforce planning for specialist healthcare professionals as the data collection may not be sophisticated enough to ensure workforce planning at a specialist level.

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

Better succession planning is needed. At present it is not clear how the Government’s proposals support this. The needs of all staff, including part-time and temporary staff as well as staff on maternity leave or a career break, need to be taken into account in the development of these proposals to ensure that no groups or individuals are disadvantaged and that the workforce is as flexible and adaptable as possible.

The place of overseas educated healthcare staff within the workforce

As registered pharmacists practising in the United Kingdom, overseas pharmacists play a role in the provision of healthcare, contribute to the economy. The 2008 pharmacy workforce census indicated that over 10% of the UK’s pharmacist workforce qualified overseas therefore adequate workforce planning and education provision should ensure that the reliance on staff trained overseas is reduced so that the UK is more self-sufficient and does not unintentionally cause skills shortages in other countries.

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

Links to the devolved administrations need to be made stronger and healthcare workforce flows between England and the other countries of the UK more clearly understood.

How the public health workforce will be affected by the proposals

Pharmacists and their staff, in all sectors of the profession, have a vital role to play in public health and it is important that pharmacists are considered as part of the multi-professional workforce strategy for public health. We agree it would be useful for local authorities’ views to be considered, as commissioners of public health services, however this could be achieved via other routes.

December 2011

Prepared 22nd May 2012