While there may be many things that hospital pharmacists need — such as fair pay and a bolstered workforce — a champion for working conditions must be near the top of the list.
In 2022, not only have hospital pharmacists experienced skyrocketing workloads from ongoing pandemic-related demands, increasing numbers of medicine shortages and the growing elective care backlog, but, in July 2022, the sectors in England and Wales were again offered a below inflation pay award for 2022/2023, worth around £1,400. NHS staff in Scotland, meanwhile, were offered a 5% pay rise in June 2022.
As the newly elected president of the Guild of Healthcare Pharmacists (GHP) Nathan Burley, a sexual health pharmacist based in NHS Greater Glasgow and Clyde health board, believes he is the right person for the job.
Burley was appointed in July 2022 and is a self-proclaimed “vociferous advocate of workers’ rights”. He ran for the position to back a profession that he says operates “quietly in the background”, offering to be “a loud … but articulate voice” for the GHP’s more than 4,200 members. However, he will have his work cut out for him.
Unite, the national trade union of which GHP is a member, described the pay award as “a kick in the teeth” and subsequently opened ballots for NHS staff in England and Wales — including for hospital pharmacists — to vote on whether to take industrial action. The ballots for each nation will close on 11 and 15 September 2022, respectively, but if staff agree to take industrial action, Unite has warned that this could mean strikes over the critical winter period.
The Pharmaceutical Journal sat down with Burley to discuss what industrial action could mean for hospital pharmacists and for his objectives as president.
What are your expectations for your term as president of the Guild of Hospital Pharmacists?
I’ve come into this role at a really interesting time for terms and conditions and the professional landscape of pharmacists, especially in the current climate of pay. We have the ongoing pay awards action in England and we’ve got the rejection of pay offer in Scotland, so I feel being the figureheads and the voice of working pharmacists is really important to try to get what is fair and what is right for our membership.
Also, it is important to have clear and open lines of communication — from us to our members and, more importantly, from our members to us — so having high membership engagement and running things like surgeries.
We’ve got our 100th year of existence coming up and we are planning a centenary event, so watch this space.
What have the repeated year-on-year below inflation pay awards meant for staff morale and staff retention?
It’s a real-terms pay cut — that’s not my opinion, that’s not the opinion of the GHP, it’s a fact. And I think that people don’t quite know what’s going to hit them. People will begin to realise that higher energy bills, higher costs of foods, higher costs of things that they do in their spare time, such as outdoor activities, going to the shops, going out for food, drinks, etc. These are all going to become possibly prohibitively expensive. The morale of work is really buoyed up by what people do outside of work as well, so the pay awards being a real-terms pay cut is only going to worsen already quite low morale.
The other point I’d like to make on that subject is retention is crucial. We know that training highly qualified, highly skilled pharmacists takes a lot of time and energy from the existing workforce, but also investment. So we need to retain those, especially those potentially about to retire. If we don’t do that with appropriate terms and conditions, we’re going to face an even bigger issue with workforce.
What are some of the terms and conditions that you’re looking to call for?
Well, inflation-busting pay awards.
Is there anything else?
Having protected learning and development time is crucial. Not only have we got pharmacists doing their advanced practice and consultant practice portfolios and accreditation processes for the Royal Pharmaceutical Society, but we’ve also got significant changes in initial education and training for new pharmacists. For that group of pharmacists, who are at the beginning of their careers, to bring them up to that really high standard we are also going to need existing pharmacists to get the protected time to dedicate to it. Otherwise, we’re just going to have a workforce with more and more tasks, less and less pay. People will vote with their feet.
What do you expect to be the fall-out of the pay awards?
I can’t predict the future. But I do think that there will be less willingness of people to work extra. I think that the NHS, depending on which profession, runs on goodwill for a lot of services. People will be less willing to do that when they have been awarded — and I use that term loosely — a real terms pay cut. I think we’ll begin to see issues with weekend services, additional services, and we’ll see goodwill running out.
What would industrial action look like for pharmacy?
Industrial action doesn’t just mean a strike; it can be a variety of things. ‘Work to rule’ — working to the exact letter of your contract — can be following standard operating procedures to the letter. I know that within the pharmacy profession, we have a lot of standard operating procedures and sometimes people take shortcuts in order to meet service demands. So, people could follow that.
People could take the time to log error reports, which they should do. So, they could decide to submit all their Datixs that are overdue over a course of a day. They could also remove their support for voluntary rotas, such as on weekends.
I am not advocating any of this. What I’m advocating for is a sufficient pay award in England and a sufficient pay offer in Scotland. I don’t want — and the GHP doesn’t want — industrial action. What we want is fair pay. But if that is the course that this runs, then that’s what it could look like.
Medicine shortages have been a big issue recently. How is this impacting patient care in hospitals?
The big one at the moment is alteplase, but there’s also been issues with hormone replacement therapies. Various drugs for long- and short-term conditions go out of stock and it is incredibly frustrating. It’s incredibly frustrating from a professional perspective and it’s incredibly frustrating to see your patients have to navigate a very complex maze to try to figure out why something is out of stock.
It impacts on patient care frequently, either directly or indirectly through clinicians and other clinical staff members being occupied by something that increasingly takes a lot of their time. And I think, really, we just need better communication. We need real-time knowledge where stock is sitting in the distribution process or manufacturing process and we need better communication from pharmaceutical companies.
Also, when a shortage is identified, that’s going to have a significant impact on patient care, so we also need the people who write the alerts to liaise with clinicians and the people who use the medicine to ensure that other alternatives are considered.
Is it mainly up to pharmaceutical companies to give the information where stock is sitting or is that something that you would like to see the government take control over?
There is a lot of opacity at the pharmaceutical industry level and it would be useful if they liaised with either the government, or the government liaised with the NHS, or the NHS and the pharmaceutical companies liaised with each other. There just needs to be greater communication and transparency about where stock is, when it is likely to get released and how much is coming to allow clinicians to plan patient care.
NHS Benchmarking data from 2020 show that 32% of hospital pharmacists are qualified as independent prescribers in England, which is below the 50% target set out in the 2016 Carter review. What more can the NHS be doing to support independent prescribing in hospital pharmacy?
At the moment, pharmacist independent prescribing is still in that domain of an additional qualification. We have ambitious targets, as we always do, for people to upskill and to become advanced practitioners or advance pharmacists or pharmacists with independent prescribing qualifications from registration. But what we need to support those ambitious targets are real, tangible things like protected learning time and development time for people not only to develop themselves, but also to develop others.
As a sexual health pharmacist, what are your thoughts on the government’s handling of the monkeypox virus outbreak so far?
Speaking personally, the fact that we have run out of vaccine in some southern NHS trusts is a testament to how quickly our healthcare services have got vaccines into people. I don’t think it’s a brilliant situation, but it shows that we’ve kicked into gear and responded as best as we could, within vaccine supply constraints.
Unfortunately, it’s a niche product and the manufacturer didn’t anticipate a worldwide outbreak. Therefore, supply needs to catch up with demand, which it should do from September 2022 onwards.
The fact that we managed that within sexual health services, which typically doesn’t see big budget increases — it’s a bit of a Cinderella service — is a testament to how sexual healthcare services have been able to rapidly kick into gear and to deliver it.
On 16 August 2022, NHS Scotland published its climate emergency and sustainability strategy, which talks about reducing pharmaceutical residues from hospital wastewater. Is that something that you have seen progress in and is it a realistic target?
This is one of the hidden dangers to society. The effluent, which is the wastewater that’s produced from drug manufacturing plants, everyone’s toilets if you take drugs — especially oestrogen and antibiotics — and hospital effluent, as well, what happens to this water is that it goes out into treatment plants and, after it’s treated, it goes into the waterways and back into the water cycle. But not all of these pharmaceutical components are removed from the water, so if there’s any bacteria around in rivers, on the edges of fields, for example, then they can be exposed to really low levels of antibiotics that don’t kill them, but are enough for them to be developing resistance to that antibiotic. Then, if that water is used to irrigate a field and a child grazes themselves, for example, then that’s a way for antimicrobial resistance to enter into the human population.
These are the unseen consequences of using medicines and not thinking about the impact of them. So I really welcome the targets because it needs to be highlighted. If the target is ambitious, then it’s a good target.