Reviewing our clinical services and implementing job planning to get the best out of our pharmacy team

As financial constraints continue to have an impact on NHS pharmacy services across the country, pharmacy leaders face increasing pressure to justify staffing levels and demonstrate value — and London North West University Healthcare NHS Trust is no exception.

To support the trust’s financial management plans, including a headcount reduction, the pharmacy team conducted a comprehensive review of its clinical pharmacy service, alongside a department-wide job planning exercise, to ensure the team is aligned with service needs, financially sustainable and transparently managed. 

Review process

To reassure our trust executive group on our financial control measures, we first conducted a formal review of our entire clinical service. Our clinical team is structured around team leads who oversee their clinical specialties — they are responsible for the wards in their clinical specialty, along with their specialist senior pharmacists and rotational pharmacists. The purpose of this service review was to give an overarching purpose to each clinical team and align their team structure to that purpose (bringing in workforce and clinical data to inform the discussion).

We discussed the trust’s financial position openly; reviewed workforce data against both tangible output measures (e.g. discharges, takeaway prescriptions) and intangible output measures (e.g. staff wellbeing, clinical team feedback). We clarified team purpose aligned to service needs, considered how structures could adapt and evaluated whether redistribution or reduction of staff could be done safely.

Naturally, these discussions were challenging and, at times, anxiety-inducing; however, we emphasised that the initial stage was discussion only and that we would have a follow-up meeting before any decisions were made. We also committed to openly sharing the proposals with all teams to maximise transparency.

Following these initial meetings, we formulated a plan for staffing changes and shared this with our clinical leadership team. We then held a second meeting with each pharmacy clinical team, where we finalised the changes to team structures (e.g. moving rotational posts from one team or site to another), before holding a follow-up meeting after two to three months where we reviewed team job plans.

Implementing job plans

Job plans are structured breakdowns of how healthcare professionals allocate their time across clinical, non-clinical and developmental duties. Extensive guidance for job planning is available from NHS England; however, our department did not have job plans for most staff. We decided to implement the plans to provide a solid foundation for optimising our clinical efficiency. Our challenge: most pharmacists had never seen one.

Fortunately, our trust had two exemplar teams: the St Mark’s Hospital pharmacy team and our local specialist pharmacy service (SPS) team housed at Northwick Park Hospital. Their team leaders: Uchu Meade, consultant pharmacist, and Iram Hussain, associate professional lead at the SPS, led a workshop on job planning for our pharmacy team leaders to share their experience and discuss practicalities, challenges and success stories.

We also shared the NHS England guidance and templates with the wider clinical team, who then began drafting individual job plans.

While many of the practical challenges we encountered — for example, categorising activities or standardising templates — were manageable, the real challenge lay in managing team anxiety. Understandably, the combination of job planning and potential staffing changes created a sense of vulnerability. What could have been a developmental exercise felt, at times, defensive or intrusive.

We responded by ensuring transparency throughout, holding multiple team discussions, and avoiding excessive scrutiny of early job plans. Where significant overworking was documented — some up to 30% over contracted hours — we opened supportive discussions to understand the reasons and consider realistic adjustments.

Outcomes and next steps

Despite the pressures underpinning this work, the process has laid important groundwork for a more sustainable and transparent clinical pharmacy workforce. 

Our senior pharmacists (band 8a and above) have job plans in place and we are continuously reviewing these, considering acute changes in capacity particularly in the current challenging climate. We plan to build on this by developing model job plans for different staff grades, supporting onboarding and succession planning. 

Crucially, this work has helped us reaffirm our department’s collective purpose, align our workforce with organisational need, and advocate more effectively for the value pharmacy brings to patient care.

Poureya Aghakhani, deputy chief pharmacist transformation and medicines optimisation, London North West University Healthcare NHS Trust