Developing a sustainable, high quality pharmacy workforce is essential to delivering services in a complex and evolving healthcare environment, particularly as more opportunities arise for pharmacists to take extended roles.
Hertfordshire and West Essex Sustainability and Transformation Partnership (STP) has a well established medicines optimisation group, comprising important pharmacy leaders in the area and focusing on integrated pharmaceutical care. Our STP has empowered the pharmacy sectors to review how they can collaborate and work together more closely. In May 2018, the group undertook a pharmacy workforce review to understand any issues and to prepare for future opportunities.
The workforce review included a PESTLE (political, economic, social, technological, legal and environmental) analysis of the pharmacy workforce; a Freedom of Information (FOI) request to the General Pharmaceutical Council (GPhC); a review of local submission data to the national community pharmacy workforce report; and a discussion within the STP medicines optimisation group to gain tacit knowledge.
We made a number of important findings.
In response to the FOI request, the GPhC suggested that 1,100 pharmacists and 316 pharmacy technicians were registered at Hertfordshire and West Essex postcodes. Our review found that approximately 628 whole-time equivalent (WTE) pharmacists and 209 WTE pharmacy technicians are working in the Hertfordshire and West Essex STP region:
- Hospital care: 155 pharmacists and 93 pharmacy technicians;
- Community, NHS trust (Hertfordshire only): 4 pharmacists and 1 pharmacy technician;
- Mental health, NHS Trust (Hertfordshire only): 16 pharmacists and 5 pharmacy technicians;
- Clinical commissioning groups (CCGs): 44 pharmacists and 4 pharmacy technicians;
- GP surgeries: 22 pharmacists (17 part of the NHS England pilot and 5 employed outside of the pilot) and 0 pharmacy technicians;
- Community pharmacy: 383 pharmacists and 106 pharmacy technicians.
A larger pharmacist and technician workforce is required, both locally and nationally, owing to the development of new roles. However, there are significant recruitment and retention issues for band 7 pharmacists and band 4 and 5 pharmacy technicians within the STP; and the majority of training for clinical pharmacists and technicians is undertaken in hospital.
New roles should be introduced, including clinical pharmacists in general practices (one WTE pharmacist per primary care network of 30,000–50,000 people will create approximately 40 posts over the STP in 2019–2020, with similar annual increases in posts planned each year for the following four years), pharmacists in care homes and pharmacists in urgent care centres.
These roles are perceived as desirable owing to their flexibility, the lack of on-call work, no weekend working and their clinical focus. These posts have pulled staff from all sectors; however, the acute sector has had the most difficulty in refilling vacancies.
We noted an increasingly female-dominated workforce, particularly in the younger age brackets. Approximately 60% of the pharmacists registered in England are female. The ratio is 64:36 (women:men) in the 25–34 years age bracket; however, this becomes 50:50 in the 55–64 years age bracket. This change must be factored into strategic workforce planning.
The perceptions and expectations of job satisfaction of the millennial generation appear to be different from previous generations. This affects recruitment and retention, and may require job redesign.
Significant time is spent on non-clinical duties by pharmacists in provider services. This is in conflict with the recommendations in the Carter review, which require 80% of pharmacist time to be spent on clinical activities.
National strategy requires the same services from community pharmacy within a reduced financial envelope, leading to poor morale and reduced goodwill.
Future reduction in funding for hospital preregistration pharmacists could reduce the number of trainees at a time when the profession needs to increase the number of pharmacists qualifying. The national proposal to reduce funding for trainees should be reviewed.
In order to increase the number of preregistration places available, CCG teams could be enabled to train preregistration students if they had access to the same funding streams as in hospital, but this will require additional national funding.
New sectors of pharmacy must avoid working in isolation from the wider pharmacy workforce; they can do this through clinical networks, better communication and collaboration. These networks will need to be established in each STP.
We suggest several solutions to the staffing issues highlighted by the review:
- We need greater emphasis on flexible working, especially in sectors that have the most difficulty recruiting (for example, the hospital sector), including flexible, part time, shift working and portfolio working. As the acute sector moves towards seven-day working, there may be opportunities to offer flexible options;
- We must design and highlight benefit packages that appeal to a younger workforce. For example, these may include overseas placements, postgraduate skills development, personal development offerings and key worker housing schemes;
- In order to meet the requirements of the Carter review, we must look at the skill-mix to enable pharmacists to reduce non-clinical tasks;
- We should develop posts that progress individuals through grades once competencies have been achieved. CCGs should be encouraged to become involved in training posts, starting with preregistration students, in order to relieve some of the training pressures on hospital pharmacy;
- Joint posts should be established, for example between CCG or GP practices and provider organisations, although concerns about this proposal will need to be worked through. We should enable networks for clinical pharmacists in GP practices and for those working in urgent care service.
The medicines optimisation group at Hertfordshire and West Essex STP has received funding from NHS England in 2018–2019 as one of the seven pilot lead STP areas to identify good practice and leadership within an STP model, and 0.4 WTE has recently been allocated to a senior pharmacist for one year to take forward the recommendations of our workforce review. We believe that our workforce review could help others and stimulate debate as the issues identified in Hertfordshire and West Essex STP may be similar in other geographical areas.
Sarah Crotty, head of pharmacy and medicines optimisation, NHS Herts Valleys Clinical Commissioning Group;
Chetan Shah, chief pharmacist, Hertfordshire Partnership University NHS Foundation Trust