Back in 2009, pharmacy was put on the occupational shortage list. Steps were taken to expand the market. Additional schools of pharmacy were established, including my own University’s pharmacy school back in 2013. These steps proved successful when in 2011 the profession was removed from the occupational shortage list.
However, the large increase in MPharm students caused by market expansion coupled with the drastic rate of community pharmacy closures has led to an imbalance between student numbers and preregistration places.
According to pharmacy school annual returns data published by the GPhC in February every year, the total number of MPharm graduates from the academic year 2016/17 was 3,277. For 2018, the annual returns data is not yet available but from January 2018 to present, there is an estimated total of 3,218 graduates who are eligible to enter preregistration training.
Not all, but the majority of these students will apply for their preregistration placements through the ORIEL portal provided by NHS recruitment. As of October this year, there are 2,138 placements commissioned, with the majority of places in retail pharmacy.
The 2018/19 graduate figure is based on the number of those who are eligible to enter preregistration training, and therefore the figure is subject to change as it may not match that of the annual returns data. However, the imbalance between MPharm places and preregistration vacancies has already been labelled as ‘unsustainable’ in a 2012 report published by the British Pharmaceutical Students Association . Due to this imbalance the Higher Education Funding Council for England (HEFCE) has been looking into ways of addressing this problem.
Of the methods that the HEFCE assessed as ‘likely’ to reduce MPharm places whilst not having a large detrimental effect are limiting preregistration positions and linking MPharm places to preregistration opportunities in a quota-like system.
The case for limiting preregistration places include an increase in competition once MPharm students graduate, thereby enhancing the quality of those who are able to progress onto becoming pharmacists.
The proposal relies on a flexible quota in accordance to changes in the number of MPharm students who graduate. NHS Scotland have already put this plan into effect in order to end pharmacy market saturation.
Detractors of this plan argue that students who don’t end up with a preregistration place will be deemed as a ‘loss of investment’ considering the four years of study which they have undertaken. Supporters of the proposal counter by pointing to the fact that not all of those who get on an MPharm programme graduate — a phenomenon known as “MPharm attrition”.
The linking of MPharm places to preregistration positions would likewise enhance quality through increased competition. Invariably for this procedure to bear any fruit, MPharm places would be reduced to end the imbalance between the sheer number of MPharm students and the dwindling number of preregistration training vacancies.
In the long term, MPharm students would more or less be guaranteed a preregistration placement upon completion of the course, which was the status quo before the market was expanded.
Several issues stand in the way of this proposal, universities will have to contend with a reduction in revenue due to less students making it onto MPharm programmes. More importantly, this recommendation would take longer to correct the imbalance as opposed to more radical proposals such as requiring students to have a BSc before advancing on to the MPharm programme.
When considering such a major shakeup of the current system, the balancing of the interests of the patients, students and universities becomes paramount. The method used should continue producing academically and clinically competent pharmacists at a rate which the market can handle.
The current situation is clearly untenable. The ‘free market’, hands-off approach will only exacerbate the problems which we face today. For me, the linking of the number of MPharm students to preregistration training placements in a flexible quota system would be the most suitable to fix the imbalance. Incoming students will be assured of a pre-registration place, students will be more motivated to continue their studies as opposed to worrying if they will get a place after investing around £36,000 in tuition fees.
Source: Mahamoud Ali
About the author:
Mahamoud Ali is a final year pharmacy student at the University of Birmingham.