The inclusion of pharmacists on the Home Office’s shortage occupation list (SOL) in March 2021 has prompted renewed questions about the future of the workforce.
Adding a sector to this list indicates that there are not enough skilled resident workers to fill all of the roles needed in the UK, and makes it easier for staff from abroad to apply for a skilled worker visa through the UK’s immigration system.
Pharmacists were added to the list in 2021, following a recommendation from the Migration Advisory Committee (MAC). Pharmacists had previously been placed on the SOL in 2008, and were removed in 2011. Following an MAC call for evidence, two unnamed contributors said that they “struggled to source workers for these roles due to the specific skillset and qualifications required”, particularly in the southeast of England.
The contributors said that the shortage had arisen from a “decline in the number of pharmacy graduates and increasing demand for their services”, and that difficulties in recruiting were down to “competition from other employers and a general low volume of applicants”.
But while this view of shortages is supported by a number of senior pharmacy figures, data obtained by The Pharmaceutical Journal suggest that work has already started on improving the pipeline of pharmacists of the future.
In its 2021 report, the MAC said that “the [pharmacist] vacancy to employee ratio has generally been lower than the median across all occupations but has exhibited a noticeable upward trend in recent years”.
This is certainly true in hospitals in England. The NHS Benchmarking Network’s Pharmacy and Medicines Optimisation project reported in 2019 that the vacancy rate across hospital pharmacy “has increased year on year”. The average vacancy rate in 2018–2019 was 8%; a small increase from 6.9% in 2015–2016.
The report noted that plans to recruit pharmacists by primary care networks (PCNs) could compound this problem: “With the focus on clinical pharmacists working in primary care and care homes in the NHS Long-Term Plan, this could emerge as a significant challenge for pharmacy departments in the coming years,” the report noted.
However, there is evidence that PCNs in England are also struggling to find pharmacists with relevant experience. PCN workforce data published in December 2020 showed that, at the end of 2020, there were 1,375 full-time equivalent pharmacists in PCNs. But 595 PCNs had either not hired a pharmacist or not recorded hiring a pharmacist.
In February 2020, Nikki Kanani, primary care medical director for NHS England and NHS Improvement, told The Pharmaceutical Journal that some PCNs had had to recruit pharmacists with less experience than they wanted because of workforce shortages — specifically, a lack of pharmacists already working at the required level.
Community pharmacy shortages
In community pharmacy, increased competition for pharmacists is also having a significant impact.
Alastair Buxton, director for NHS services at the Pharmaceutical Services Negotiating Committee, told The Pharmaceutical Journal on 23 March 2021 that contractors “have highlighted that new roles for pharmacists and pharmacy technicians in PCNs are resulting in some community pharmacy staff leaving to take up positions in PCNs”.
There are no official data on vacancies in community pharmacy in England, and vacancy rates may vary across the country. Buxton noted regional aspects to the shortage issue, saying that “contractors report that the situation varies across England”, and adding that “getting quantitative data on that is essential to support workforce planning activities”.
Malcolm Harrison, chief executive of the Company Chemists’ Association, agreed, saying: “These concerns are particularly acute in certain areas of the country. We welcome any decisions that will enable more patients to access pharmaceutical care, but see the addition of pharmacists to the shortage occupation list as only a short-term fix.”
Responding to a MAC call for evidence on migration rules for overseas staff coming to work in the UK, in November 2019, the Royal Pharmaceutical Society (RPS) said that one community pharmacy multiple had “reported a chronic shortage of community pharmacists in every area outside of London now at peak times (winter pressures) of the year and throughout the year in South West, South West corridor, North East, Lakes and East Anglia”. Another organisation, the RPS said in its response, “reported geographical challenges with recruiting pharmacists in all areas outside of Birmingham, Manchester and London”.
There are also signs of similar problems with recruitment in community pharmacy in Scotland and Wales.
In February 2019, Community Pharmacy Scotland said that plans for every GP practice in Scotland to have the support of a pharmacist or pharmacy technician may have to be adjusted, owing to workforce shortages.
Turas data for the Scottish pharmacy workforce showed that, as of 30 September 2020, there were 1,735.2 (whole-time equivalent) pharmacists in post, and 143.3 total vacancies. Of these, 92.1 had been vacant for more than three months.
In Wales, data published in August 2020 showed that community pharmacist vacancy rates were as high as one in five in some parts of the country.
A spokesperson from Community Pharmacy Wales said on 24 March 2021 that the SOL recording a shortage of pharmacists “is a recognition of their importance in delivering accessible healthcare”.
“In terms of community pharmacist numbers in Wales, however, a bigger issue has always been a correlation between a lack of pharmacists and an absence of schools of pharmacy within regional higher education provision.
“Historically, West Wales has always faced pharmacist shortages which can be attributed to this reason, though we are hopeful that when Swansea University starts to release graduates that will have a significant impact on pharmacist numbers in South West Wales.”
What can be done?
In 2019, around 21% of the UK’s registered pharmacists were born outside of the UK, but it is unclear if, in the current climate, adding pharmacists to the SOL will make a difference.
There is evidence that since the UK left the EU, it has become a less attractive place to practise. A General Pharmaceutical Council (GPhC) report from June 2017 identified a significant fall in the number of pharmacist registrations from the European Economic Area (EEA), which “potentially reflects the impact of Brexit”. Papers published for the council’s February 2018 meeting noted that “the number of new EEA registrations continues to be impacted by the introduction of English language requirements and Brexit”.
But it is just a supply problem? The Pharmacists’ Defence Association (PDA) said that the addition of pharmacists to the SOL indicates “a problem in attracting people to the profession, or with recruitment and retention in certain parts of the sector”.
“There is no single cause or solution, however this multifaceted issue requires a detailed workforce strategy for pharmacists, backed by appropriate pay structures and workplace conditions at all employers,” the PDA added.
Sandra Gidley, president of the RPS, identified another lever to improve vacancy rates: “This [shortage occupation] list emphasises the growing demand for pharmacists and their skills in many areas within our health service, such as in new roles across primary care.
“It’s vital that the government invests in the workforce to support staff retention, including enabling protected time for professional development.”
And figures provided to The Pharmaceutical Journal indicate any shortage of pharmacists may be short-lived.
Although the number of pharmacy students has fallen in recent years, that trend has reversed rapidly in the past couple of years.
Figures collated by the GPhC show that intake onto the MPharm degree plateaued between 2016–2017 and 2019–2020, but increased sharply in both 2019–2020 and 2020–2021.
Indeed, the number of students starting an MPharm course rose by 11% in the autumn 2019 intake to 3,743 students, from 3,372 students the previous year. And in 2020–2021, the number rose by a further 10.8% to 4,148 students.
It is possible that one contributing factor to the increase in 2020 may have been the regrading of A-level results two working days after the results were released, owing to the disruption of the COVID-19 pandemic, with many students seeing their grades raised as a result.
Andrew Thompson, chair of the Pharmacy Schools Council, said: “Several institutions had recruited well in clearing on the Thursday and Friday — filling courses — only to find the A-level regrading raised the grades of many previously declined near-miss applicants, forcing an overshoot.”
There are also rising numbers of pharmacists entering the profession each year. As of December 2019, the GPhC reported 58,240 registered pharmacists, an increase of 1,015 compared with the previous year.
With so many conflicting signs, it is hard to see whether the addition of pharmacists to the shortage list will make a significant difference, and perhaps it is no bad thing that (for the next few years at least) the unique skills of pharmacists are in high demand.