Special report: the community pharmacy workforce crisis

Confirmation that the workforce crisis in community pharmacy in England has deepened came in August 2023 with the long-awaited publication of the results from NHS England’s ‘Community Pharmacy Workforce Survey 2022’.

The results cement what pharmacy professionals have been saying for a long time — that the shortage of pharmacists and support staff in the community is getting worse. The data reveal that the number of full-time equivalent (FTE) pharmacists had decreased by 13% — 2,646 — compared with 2021, taking it back to the number of FTE pharmacists in post five years ago.

The survey data also show a 15% decline in the number of FTE-employed pharmacists, from 12,892 in 2021 to 10,944 in 2022, and a 26% increase in the number of FTE locum pharmacists, from 4,363 in 2021 to 5,477 in 2022.

The number of FTE foundation pharmacists has also fallen by more than 150, going from 1,573 in 2021 to 1,419 in 2022.

There has been an even greater reduction in the number of FTE pharmacy technicians, with a 17% decline compared with 2021 and 20% decline compared with 2017 — 1,320 fewer (see Figure 1). All other roles also saw a reduction compared with 2021, with the exception of trainee dispensing assistants and trainee medicines counter assistants.

There has been an ongoing tug-of-war between community pharmacy and primary care networks (PCNs) for pharmacy staff since the introduction in 2019 of the ‘Additional roles reimbursement scheme’, which enables PCNs to claim funding for the recruitment of certain patient care roles, including clinical pharmacists and pharmacy technicians. There were 3,294 FTE pharmacists recorded as working in PCNs in June 2022 — an increase from 2,552 in June 2021. This figure has again increased, as of March 2023, to 4,440 pharmacists.

NHS England has said that it is developing guidance for shared pharmacy workforce models to mitigate supply issues and aid retention.

Locums on the increase

There has been a decline in FTE pharmacists in post despite the headcount for pharmacists remaining roughly the same at around 27,000, suggesting that more pharmacists are working part-time, have portfolio careers or are working as locums.

In fact, the headcount for locum pharmacists has increased by two-thirds, from 7,516 in 2021 to 12,124 in 2022, while the headcount for employed pharmacists has fallen from 15,045 in 2021 to 13,184 in 2022 and the headcount for relief pharmacists has fallen from 4,279 in 2021 to 2,403 in 2022 (see Figure 2).

Vacancy rates have risen

Unsurprisingly, vacancy rates for all pharmacists have doubled, from 8% for FTE posts in 2021 to 16% in 2022. However, a note published with the survey data says the 2022 figures are not directly comparable to those from the 2021 survey because the methodology used in 2021 was adjusted for the lower response rate (see Box).

Some 17% of employed pharmacy posts were vacant at the time of the 2022 survey, compared with 20% of relief pharmacist posts and 13% of locum pharmacist posts. The survey defines relief and locum pharmacists as those who work regularly in the pharmacy, such as once per week. Locums are pharmacists who are either part of the workforce model or fill a session owing to the employed pharmacist being unavailable.

The picture for pharmacy technicians is even worse: not only has the number of FTE technicians fallen, but the headcount has also dropped from 7,768 in 2021 to 6,544 in 2022. This has resulted in a vacancy rate of 20%, up from 7% in 2021. However, the number of FTE technicians with an accuracy checking role is holding steady, at 2,014 in 2022 compared with 1,993 in 2021 (see Figure 3).

The vacancy rates for pharmacists are highest in the south-west of England, with Somerset having a rate of 32% and Bath and North East Somerset, Swindon and Wiltshire having a rate of 25%. Vacancies are lowest in Leicester, Leicestershire and Rutland, and West Yorkshire and Harrogate Health and Care Partnership, both at 11%.

For technicians, Our Healthier South East London and South West London Health and Care Partnership the highest vacancy rate at 43%. Lincolnshire has the lowest vacancy rate for technicians at 3% (see Figure 4)

Pharmacist vacancies are perceived to be “very difficult” to fill by almost two-thirds (65%) of respondents, on average, across the 42 integrated care system (ICS) areas in England, with an average of only 1% of pharmacies saying vacancies are “very easy” to fill.

Cornwall and Isles of Scilly Health and Social Care Partnership reported the most difficulty, with 89% of pharmacies saying vacancies are very difficult to fill. North West London Health and Care Partnership and Greater Manchester Health and Social Care Partnership appeared to have the least difficulty, although 46% of pharmacies still said they found recruitment very difficult (see Figure 5). 

On average, nearly half of pharmacies overall (44%) thought that technician vacancies were “very difficult” to fill, with 0% finding them “very easy” to fill. Similar to pharmacists, Cornwall and Isles of Scilly Health and Social Care Partnership struggled the most (75%), while South Yorkshire and Bassetlaw struggled the least (17%).

Independent prescribing makes poor progress

The survey identified an increase of 154 FTE-qualified independent prescribers (IPs) between 2021 and 2022, bringing the total to 1,087 (with a corresponding headcount of 1,576). This equates to 6% of the weighted FTE community pharmacist workforce, which is only a small increase on 2021, when 5% of the weighted FTE community pharmacist workforce were qualified IPs.

Using the headcount figure, on average across the 42 ICS areas, this equates to about one prescriber per seven pharmacies — better than the one in ten reported in 2021 but a number that will need to increase if a national independent prescribing service is to be rolled out in community pharmacy.

All 42 ICS areas have at least some independent prescribers, but the number varies dramatically, ranging from 5 in Gloucestershire to 110 in West Yorkshire and Harrogate Health and Care Partnership. Since the survey was carried out, NHS England has made 6,000 funded IP training places available to pharmacists from all sectors, with 3,000 starting between September 2022 and March 2023, and a further 3,000 starting from April 2023. 

The survey also showed that, on top of only a small increase in numbers of IPs, on average, only 15% of these were prescribing in community pharmacy, including private services. This ranged from as low as 0% of 5 FTE prescribers in Somerset to as high as 44% of 84 FTE prescribers in North West London Health and Care Partnership (see Figure 6).

Future outlook

The shortage of pharmacists was recognised in NHS England’s long-term workforce plan, which was published on 30 June 2023 and promised to increase pharmacy training places by nearly 50% over the next eight years “to meet the demand for pharmacy services”.  

And there are signs that the number of applications for pharmacy courses are increasing, with the latest Universities and Colleges Admissions Service data showing a 28% increase in pharmacy applications for courses starting in September 2023 compared with the previous year (see Figure 7).

In addition to this, NHS England is looking at education and training pathways into the Overseas Pharmacists’ Assessment Programme to further increase international recruitment of pharmacists.

However, both of these avenues will take time to produce the workforce that is needed if community pharmacy is to alleviate pressure on GP surgeries and provide the clinical services that the government is hoping it will. Until then, as The Pharmaceutical Journal has called for, “the NHS needs to offer pharmacy staff a short-term solution that alleviates their time pressures and burnout, opening up capacity to offer the training that is needed, but also making pharmacy an attractive profession in the first place”.