The NHS’s much-anticipated ‘Long Term Workforce Plan’, and its promise to open thousands of new training places to help fill a shortfall of pharmacists and pharmacy technicians by 2036/2037, received an understandably cautious welcome. Pharmacy bodies, including Community Pharmacy England and the Royal Pharmaceutical Society, noted that its “success or failure” would depend on how it was put into practice.
The plan is a complete about-face from the government’s position a decade ago, when it commissioned a report from the Centre for Workforce Intelligence, which predicted a surplus of up to 19,000 pharmacists by 2040. As a result, Health Education England recommended a cap on the number of undergraduate pharmacy students.
Although a cap was never implemented, the report no doubt created a false sense of security in workforce planning for pharmacy professionals.
It was five years later that one of the first signs of a problem emerged, in an analysis by The Pharmaceutical Journal in November 2018, which uncovered a 14% drop in the number of students applying to study for an MPharm degree over the past seven years. NHS Benchmarking Network data later revealed a 0.8 percentage point increase in the number of pharmacy staff vacancies in hospitals between 2018 and 2019. The community pharmacy workforce then followed suit, showing signs of strain as vacancy rates doubled between 2017 and 2022.
The workforce problem is now most clearly illustrated by the ongoing tug-of-war between community pharmacy and primary care networks (PCNs) for pharmacy staff.
In the past year, all four of the major pharmacy trade bodies have called for PCNs to “immediately halt” the recruitment of staff from community pharmacy under the Additional Roles Reimbursement Scheme, with Community Pharmacy England even describing it as “very damaging”. Meanwhile, those working in PCNs, including Graham Stretch, a partner and chief pharmacist at Argyle Health Group, have regarded pharmacy staff recruitment as the “success story of general practice” and are calling for their hiring to continue apace.
It is in failing to address competition between various sectors of pharmacy practice where the NHS’s workforce plan falls short. Without enough of a pharmacy workforce to go around, it is unclear how the government intends to train thousands of newcomers to meet its promises — and guarantee that, when they join the profession, they will fill in the workforce gaps where needed.
The gaps that exist are there for a reason. A survey of 1,496 pharmacists carried out by the Royal Pharmaceutical Society in 2022 painted a grim picture of the profession — particularly community pharmacy.
Nearly all community pharmacists surveyed (96%) said they were at high risk of burnout. Community pharmacy staff were also less likely to be offered protected learning time than their peers in other sectors and were significantly more likely to experience verbal or physical abuse from patients.
It is unsurprising that the same survey found that three-quarters of pharmacy staff had considered leaving the profession as a result. This is compared with 18% of doctors who considered leaving the profession in 2021, according to a survey of 3,386 doctors carried out by the General Medical Council.
The workforce plan makes a notably vague mention of its intentions to retain staff by “improving culture, leadership and wellbeing” within the NHS, delegating responsibility to regional integrated care boards to include primary care organisations in their occupational health and wellbeing offers. The section makes no pharmacy-specific commitments.
In addition to adequate staff to train the new recruits, what will also be needed, without question, are more foundation training places. But, in some parts of England, the number of community pharmacy places available are already moving in the opposite direction. Written evidence from Community Pharmacy Lincolnshire to the House of Commons Health and Social Care Select Committee, submitted as part of its inquiry into pharmacy, warns that local contractors are withdrawing from offering foundation training because of the “significant burdens to support placements”.
This is even before planned changes to the foundation training year, including multi-sector placements and independent prescriber training in 2026, come into effect. With these elements in place, many pharmacies will likely be unable to manage the “significant administrative and training burden” of the new-style placements, the evidence says.
Not least of these additional training burdens will be securing designated prescribing practitioners (DPPs) for thousands more trainees. With each trainee requiring 90 hours of supervised practice over four to six months, the role is a significant time commitment for an already overwhelmed workforce. Add to this the plan for nearly a thousand more pharmacy staff training places by 2028 and the requirements for 3,000 existing pharmacists looking to become prescribers, and concerns around a shortage of DPPs remain valid, even after the chief pharmaceutical officer’s commitment to train 500 more DPPs in 2023.
Political commitments to grow trainee numbers — while desperately needed and very welcome — will only start adding value when the first expanded cohort of pharmacy undergraduates qualifies in 2031. Until then, the NHS needs to offer pharmacy staff a short-term solution that alleviates their time pressures and burnout, opening up capacity to offer the training that is needed, but also making pharmacy an attractive profession in the first place.
Without this, the ‘NHS Long Term Workforce Plan’ is, at best, a promise for the future rather than a commitment for today. PJ