Mapping the landscape: an insight into women’s health pharmacy staffing across the UK

Women’s health pharmacists make an invaluable contribution to patient care throughout a woman’s reproductive life and beyond. Women’s health covers several specialist areas, from pregnancy and breastfeeding to gynaecology, menopause services and fertility treatment. 

From managing medication for complex pregnancies that involve pre-existing and new medical issues, to a greater focus on supporting women throughout their lifetime, including the menopause, pharmacists are a vital part of the multidisciplinary team delivering women’s healthcare. 

Some important areas where a pharmacist is essential: 

• Knowledge of drugs in pregnancy and breastfeeding; 
• Interactions between drugs;
• Familiarity with a range of drugs that are seldom seen by other healthcare professionals in obstetrics;
• Supporting patients to get the medication they need in hospital and community; 
• Supporting with guidelines and patient group directions (PGDs).
• Ensuring a smooth supply chain for essential medications.

Women’s health pharmacy is a growing specialty, but there are too few pharmacists in each trust that focus specifically on this area. Over recent years, a group of women’s health pharmacists has been created through the UK Clinical Pharmacy Association (UKCPA), with an active community and network used to share questions and best practice.

Through this network, a common theme has emerged — a desire to know how many pharmacists were working on women’s health in various trusts and how to build business cases for new staff. Owing to the interest in this subject, we sought to determine if there was published information about current women’s health pharmacy staffing levels and, if not, whether we could gather this information and make it available to our members.

Reviewing the evidence

The first step was to search the literature for existing evidence. The local library services greatly facilitated this task by putting search terms together for us. Following a comprehensive search through several online literature databases — see Box — the librarians supplied a list of manuscripts for consideration. 

It soon became clear that there were no standards on pharmacy staffing levels in the women’s health specialty. In fact, the only pharmacy specialty with standards for staffing levels is for the intensive care unit, including paediatric and neonatal critical care^​1​.

Notably, the literature search highlighted manuscripts around safe nurse and midwife staffing levels and the associated impact on patient outcomes^​2,3​. In one analysis, published in 2020, involving data from 35 countries over 15 years, a higher proportion of nurse staffing was associated with lower newborn mortality rates^​2​. A systematic review published in 2021, including 21 studies from 10 countries, showed that increased midwifery staffing was associated with a reduced incidence of perineal damage at birth, postpartum haemorrhage, maternal readmission, and neonatal resuscitation among others^​3​.

It was clear from this that benchmarking is necessary in other professions to form the baseline for future work on recommendations of staffing levels and potential impact on patient outcomes. While there is little evidence on the impact of pharmacist staffing on women’s health outcomes, it is assumed that appropriate staffing levels across the women’s health pharmacy workforce could lead to safer and increased guideline-recommended use of medications, enhanced personalised care and shared decision making.

As a result, we designed a benchmarking project with two phases:

• Phase one: a nationwide survey, disseminated through several networks, about current levels of pharmacist staffing in women’s health services; and 
• Phase two: follow-up interviews and focus groups with respondents from the first phase who volunteer for further involvement.

Assembling the team

Initially suggested by and facilitated by the authors, the UKCPA women’s health committee members were invested in this work and keen to involve other women’s health specialists.

In October 2024, a message was circulated through the UKCPA women’s health forum for people interested in sitting on a stakeholder group. This group consisted of 15 women’s health pharmacists and was responsible for optimising a draft survey that had been initially developed by committee members.

The aim was to make the survey easy to navigate, accessible and as representative of all the UK regions as possible. The survey focused on specialist services and excluded questions about medicines distribution services that would be part of routine pharmacy provision services. 

In December 2024, before the survey was shared more widely, initial responses were gathered through a pilot phase so amendments could be made based on any feedback received. During the ten days of the pilot, seven responses were received from a variety of UK regions (London, Midlands, South East and South West of England and Wales). Positive feedback about the appropriateness and clarity of information and length of the survey and some suggestions for improvement were shared.

Following the pilot, the final version of the survey comprised four parts: 

• Trust information (region and trust, number of hospitals in trust, women’s health services provided);
• Individual services (details of level of clinical service to women’s health wards/areas, details about acuity, clinics etc); 
• Specialist staff-related questions (e.g. number of women’s health specialists, how they were defined as specialists, training needs, funding questions, number of independent prescribers, number of pharmacist-led clinics, non-patient facing tasks, etc); and 
• Staff cover (full-time equivalent) for each grade of staff from 8D to trainees and whether they are considered a specialist, etc).

The survey was disseminated through appropriate networks to as many UK trusts as it was possible to reach. The survey responses were also combined with publicly available data from other sources, such as hospital websites and delivery numbers published by NHS England^​4​.

Findings and implications for pharmacy practice

Between December 2024 and July 2025, the project reached around 60% (n=87) of all UK trusts with maternity services after three dissemination phases across a variety of networks in the UK (i.e. women’s health email group and forum, neonatal networks, chief pharmacist networks, professional society newsletters and word of mouth, among others). In some areas, such as London, 100% of trusts were represented in the responses, while the response rate was much lower in other areas, such as Northern Ireland, where 20% of trusts responded.

The survey showed great variation in representation of different pharmacy staff grades among different UK regions. Two-thirds of trusts (n=55) did not have high-grade women’s health leadership posts (band 8b or 8c/d), which may have had an impact on survey response rate, although the extent of this is unknown. 

Out of all participating trusts, one-quarter (26%, n=23) reported that they did not have a women’s health specialist pharmacist (or they were incorporated into another specialty). Views on what made a role ‘specialist’ differed: three-quarters of respondents (74%; n=49 out of 66) defined specialisation as having “experience in a women’s health specialist role for over five years”.

In 75% of trusts (n=51/68), a band 8a pharmacist was considered a specialist, while 35% (n=17/48) considered a band 7 as specialist. And only 12% (n=8/66) of women’s health specialists run pharmacy-led clinics and/or attend specialist multidisciplinary team (MDT) meetings. The disparities in specialist staffing across different trusts could potentially affect clinical decision making, local protocol design and implementation and ultimately patient outcomes.

Regarding trust acuity in England only, an increased number of staff was reported in almost all band levels, with increasing numbers of babies delivered at the trust. Pharmacy technicians did not follow this trend, demonstrating a potential gap in this staffing group compared with pharmacists. Band 8c/d pharmacists were only represented among trusts with the highest and the lowest numbers of deliveries. 

University and teaching hospitals had greater representation of all pharmacist bands, pharmacy technicians and other support staff compared with district general hospitals. While this is expected to some extent, it also implies the potential for significant differences in the level of clinical women’s health pharmacy services provided. The difference was minor for 8a band staff, who formed the most well-represented staff grade among all respondents. 

Next steps and future direction

Owing to the richness of the dataset, analysis is still ongoing from phase one, and we are currently in the process of initiating phase two of this project. This involves qualitative data collection through semi-structured interviews and focus groups.

Through this phase, we aim to explore the experiences of pharmacists responsible for service provision in women’s health specialities and create a survey for other healthcare professionals in women’s health on how they perceive the role of the pharmacist. It is hoped that this novel piece of work will inform the future of women’s health pharmacy by informing future business cases for additional staffing in this specialty. Additionally, it will set the priority of establishing national professional staffing standards within women’s health and other pharmacy specialties in the years to come.

If you would like to contribute to this piece of work, either as a participant or to help out with the data analyses, please contact the authors directly.