According to Abraham Lincoln: “What kills a skunk is the publicity it gives itself.” And while community pharmacy is not facing an imminent demise, many would agree that its public image smells slightly off.
Results of a survey carried out by the Community Pharmacy Workforce Development Group (CPWDG) — a cross-sector working group with equal representation from the Company Chemists’ Association, the Association of Independent Multiple Pharmacies (AIMp) and the National Pharmacy Association (NPA) — suggest that pharmacy’s image is part of the reason why the sector is facing such “immense pressure”.
The survey, carried out in July 2020, collected information from 40% of community pharmacies in England and found that nearly one in ten (9%) full-time equivalent (FTE) community pharmacist positions were vacant as of July 2020.
The South West and South East of England recorded even higher vacancy rates, at 15% and 18%, respectively. In 2019, the first Wales Community Pharmacy Workforce Survey found community pharmacist vacancy rates as high as one in five in some health board areas.
In its report, ‘A review of the community pharmacy workforce: 2021 and beyond‘, published on 2 June 2021, the CPWDG made a raft of recommendations to tackle the sector’s workforce problems (see Box 1).
Central to the recommendations was a major facelift for community pharmacy. “The capacity of community pharmacy starts with the number of people interested in joining the profession and efforts should be made to ensure an adequate supply of community pharmacy colleagues,” it said.
“Professional bodies, higher education institutes, policymakers and statutory education bodies should join employers to undertake a programme of collaborative work to ensure community pharmacy is seen as an attractive career choice for future pharmacists.”
At a roundtable debate on the report — held on 2 June 2021 and chaired by Nigel Praities, executive editor of The Pharmaceutical Journal — Marc Donovan, chief pharmacist at Boots and chair of the CPWDG, explained: “I think we need to be better storytellers.
“I tell the newly qualified pharmacists in our organisation, ‘There’s not many careers that you can have an opportunity every five minutes or so to positively impact a person’s life every day of your career’.”
But the attendees agreed that the message was not always getting through.
David Evans, AIMp representative on the CPWDG, said: “From a patient’s point of view, and possibly from some other non-pharmacy healthcare professionals, [pharmacy’s image] is actually probably quite positive because they see us as doers, problem solvers.”
However, he added that “the image from within the profession, I think, is very much second rate”.
Box 1: What did the Community Pharmacy Workforce Development Group report recommend?
The Community Pharmacy Workforce Development Group report sets out ten recommendations, including:
- Stakeholders — including professional bodies, higher education institutes, policymakers and statutory education bodies — should work with employers to identify ways to showcase community pharmacy as an attractive career choice for future pharmacists;
- The addition of pharmacy technicians to Patient Group Directions, so that they can vaccinate patients. Pharmacy teams should be able to take on additional tasks, freeing up pharmacists to deliver further clinical services;
- Primary Care Networks should be given flexibility to use funding to commission local community pharmacies to deliver services;
- NHS and Health Education England should develop a programme of continued professional development and life-long structured learning for pharmacy teams, governed by the General Pharmaceutical Council;
- “Significant” efforts should be made to upskill the existing workforce to become independent prescribers, and the requirement to complete two years of registration prior to undertaking a prescribing programme to be removed.
Nick Kaye, board member for the South West of England at the NPA and vice-chair of the CPWDG, explained that part of the problem is that community pharmacy is “quite an understated profession”.
“I don’t think primary care realises how much we do,” he added. “And part of that is our fault for not shouting about it enough, which is what this report is about. And partly, it’s because we’re incredibly professional people that get on with our work and do it. A pharmacist who’s relatively well known once said to me: “An extrovert pharmacist talks to somebody else’s shoes.”
There have been more people seeking to join the profession of late. Data provided to The Pharmaceutical Journal by the General Pharmaceutical Council in March 2021 showed applications to the MPharm had increased by 10.8% compared with the previous year. And, with the addition of pharmacists to the Home Office’s shortage occupation (SOL) list in March 2021, staff from overseas can apply for a skilled worker visa through the UK’s immigration system more easily — applying for a job on the SOL adds 20 “points” to the 70 points needed for a skilled worker visa.
However, there is more competition than ever before to hire pharmacists in other sectors. NHS Digital data show that half of primary care networks did not hire or did not record hiring a pharmacist as of December 2020 under the additional roles reimbursement scheme, despite being funded to do so. Vacancy rates in hospital trusts are also rising.
A wider problem
Of course, window dressing is not the only important thing to attract new recruits. “Reasons cited for colleagues leaving the profession are complex and multifaceted,” the CPWDG report adds.
“They include concerns about pay, excessive workload and pressure, inflexible working hours and a lack of opportunities for career progression.”
In part, the problem comes from a national pharmacy contract — at least in England — that has yet to fund a cohesive and innovative clinical direction for community pharmacy, and the lack of flexibility for local commissioners taking advantage of the expertise on their doorstep.
At the roundtable, Evans noted: “In the 14 years or so that I’ve been an independent prescriber, I’ve not had the NHS commission one episode of independent prescribing from me. I think that’s the fundamental issue. Every bit of prescribing that I’ve done has been private.”
Box 2: How did GPs boost their image?
The ‘Think GP’ campaign, launched by the Royal College of General Practitioners (RCGP) in 2016, aimed to showcase the highlights of a career as a GP. It was in response to findings at the time showing that around one in eight GP positions were unfilled.
Social media campaigns using #ThinkGP and #nothinggeneral were used to promote a career in the sector
A promotional video to encourage recruitment was produced, as well as a series of videos showing GPs talking about their roles
Data from the Nuffield Trust showed that by 2020, there was an increase of 438 GPs on the register compared with the previous year (from 34,708 in 2019 to 35,146 in 2020).
That said, there are still 1,876 fewer permanent, qualified GPs compared with 2015. Similarly to community pharmacy, there is also a lot of variation in the ratio of GPs to patients across regions in England.
Ravi Sharma, director for England at the Royal Pharmaceutical Society, said that from a commissioner and policymaker perspective, community pharmacy “can be stuck in the idea of lots of pilots, and not moving it on”.
“The [CPWDG] report makes strong recommendations about how to improve, but how do we make a more lucrative clinical pathway towards the future?”
Community pharmacy is certainly not the first healthcare sector that has needed a serious image boost. The ‘Think GP’ campaign, launched by the Royal College of General Physicians (RGCP) in 2016 to showcase the highlights of a career as a GP, was a response to findings at the time, showing that around as many as one in eight GP positions were unfilled (see Box 2).
Speaking during the roundtable event, Nick Haddington, pharmacy dean for the South of England at Health Education England, said that community pharmacy is the “visible face of pharmacy in people’s communities”.
“In terms of the work that needs to be done to promote pharmacy in general, community pharmacy plays an absolutely critical part in that,” he said.
But what are the selling points of a career in community pharmacy? Leyla Hannbeck, chief executive of AIMp, said at the roundtable event that community pharmacy ought to “shout more about the social care aspect of pharmacy”.
“We talk about dispensing; we talk about service delivery — but one thing that, particularly, the [COVID-19] pandemic highlighted is that social care element,” she explained.
“Where would patients have gone if it hadn’t been for community pharmacy being open? Those patients who are lonely, those patients who are suffering from mental illness: who would they talk to? … The social care elements are something that we need to really push forward as part of our image.”
Michael Lennox, chief executive of the Somerset Local Pharmaceutical Committee, said at the roundtable: “I don’t think we’ve lost our mojo. But I think we’ve lost talking about our mojo, because I think community pharmacy at its finest is a fantastic place to practice pharmacy.
“Throughout my career I’ve always found it varied; I find it team based. I find it people focused; I find it patient and customer facing. I think we’ve stopped talking about that. I think it’s still there. But I think we’ve become rather obsessed with operational efficiencies and quality dispensing this, that and the other. And I think we’ve maybe lost a little bit of the humanity around our own sector for a while.”
Box 3: How pharmacy schools are flying the flag for pharmacy
Several UK universities are working to promote pharmacy at secondary school level, engaging with students of all ages to explain the role of a pharmacist and other pharmacy staff, as well as to highlight the university entry requirements for pharmacy-related courses.
Mark Dallas, associate professor and director of the Outreach School of Chemistry, Food and Pharmacy at the University of Reading, explained: “Prior to the pandemic, teams of pharmacy staff and students would go into schools, colleges or take part in science festivals to explain the role of a pharmacist.
“Our efforts in this area are largely to break down some preconceived ideas about pharmacy, shed light on the differences between pharmacy and pharmacology, and demonstrate how rewarding a career in healthcare can be. If we can open students to the idea that pharmacy can be a challenging but rewarding career then we have been successful in our goal to inspire.”
“It is hard to measure impact in this area, but recruitment numbers in the areas we visit are healthy and we always get asked to come back to those schools. Our sessions receive positive feedback with many students and their teachers routinely responding with ‘I did not know a pharmacist did that’.”
Meanwhile, Swansea University will begin delivering an MPharm degree later this year, and the pharmacy team has delivered a range of outreach activities to local schools and colleges. These have been mostly virtual, so far, given restrictions brought about by the COVID-19 pandemic.
Andrew Morris, head of pharmacy at Swansea University Medical School, said: “Working with the Step Up to Swansea University team, and with external agencies such as the Seren Network [a Welsh Government initiative developed to help academically promising students in Wales achieve their academic potential and support their education pathway into leading universities], we were able to arrange a number of online events.”
Some of these were webinar style activities, designed to promote elements of pharmacy but also reinforce the science A-level curricula. We covered ‘Drugs in sport’, which introduced elements of analytical chemistry, and the ‘Dangers of nitrous oxide’, which focused on the pharmacology of laughing gas. A kitchen table chemistry webinar also looked at some of the chemistry behind effervescent dosage forms and the stability of drugs.
“All of these sessions also highlighted pharmacy as a potential career option, and provided details of the university entrance requirements for pharmacy”.
Morris added that, although their outreach events are “typically aimed at students about to apply for university, we have also visited schools — pre-lockdown — to talk to Year 9 students about pharmacy as a career option, and we have also delivered training sessions for networks of school careers advisers”.
The Royal Pharmaceutical Society has produced a series of videos showing the breadth of work done by pharmacists in different settings, including community pharmacy. The sector is also a major part of the Society’s #WeArePharmacy campaign, which aims to celebrate and recognise the profession.