The pharmacy workforce, in lieu of a plan

Pharmacy is in the policy and political news, which may — or may not — be a good thing.

The House of Commons Health Select Committee has launched a wide-ranging inquiry into the sector in England. These sometimes help, but more often simply restate the obvious, which is already known to those who follow any sector at all closely.

As if to illustrate the point, if you look at the terms of reference for this inquiry, the second point the committee is looking into is “the challenges in pharmacy workforce recruitment, training and retention”. As anyone on the pharmacy front line will tell you, this is probably the biggest issue that the sector as a whole is facing.

Will the inquiry shed any new light on any of this? Time will tell, but I will attempt to in this column.

Oversupply and demand

Towards the middle of the last decade, there were perceptions that the pharmacy training supply pipeline was going to be in considerable surplus. One driver for this was that a few new university pharmacy courses were coming on stream. New schools of pharmacy opened at Lincoln in 2014, Sussex in 2016 (which has since closed) and Swansea University in 2021.

In 2013, the Centre for Workforce Intelligence, looking at the pharmacy student intakes, forecast an oversupply of between 11,000 and 19,000 pharmacists by 2040.

Then, in 2014, Health Education England and the Higher Education Funding Council for England’s joint consultation on ‘Ensuring a sustainable supply of pharmacy graduates’ concluded that there was a need for some form of control on pharmacy student numbers.

However, the Department for Business Innovation and Skills disagreed, concluding that “it is not necessary to introduce a specific student number control for pharmacy” and this was never implemented.

Thank goodness, because those oversupply fears turned out to be spectacularly unjustified. And there now seems to be a big problem in numbers of unfilled vacancies. In early 2021, the problem became official: the UK government reinstated pharmacists on the Shortage Occupation List, making it easier for overseas pharmacists to apply for a skilled worker visa. This has coincided with an increase in the numbers of overseas pharmacists applying to register in the UK, but they are still listed.

Where have the staff gone?

Official data show that the numbers registering with the General Pharmaceutical Council continue to increase, but there are still massive holes, especially for hospital and community pharmacists — although interestingly, not so much in general practice.

The most recent official data from Health Education England indicate that vacancy rates for community pharmacists in England have doubled over the past four years, reaching 7% in 2022. There are even higher vacancy rates for other pharmacy professionals, such as a 8% vacancy rate for community pharmacy technicians.

Data elsewhere are harder to come by, but figures show that the vacancy rate across hospital pharmacy was also increasing year on year, with an average vacancy rate of in 2018–2019 of 8%.  

Why is this the case? It appears to be a classic case of supply not rising at the same pace as demand and retention slipping — something common to other sectors.

Community pharmacy chains across the UK believe that ‘their’ pharmacists are being sucked into general practice through the ‘Additional roles reimbursement scheme’. It is also a widespread belief that the rise of primary care networks in the NHS in England is taking pharmacists out of the community sector.

However, neither of these situations is being addressed by student numbers in the pharmacist pipeline, suggesting that shortages may worsen with a ‘robbing Peter to pay Paul’ effect. NHS England has gone so far as to say that it would develop guidance for shared pharmacy workforce models to mitigate supply issues and aid retention.

But there may be other factors at play here. For instance, it may also be that a higher proportion of women training to come into the workforce means that — perfectly predictably — more pharmacists are working part-time and taking career breaks. As well as this, wide variation in the supply/demand balance are reported by region, and in urban versus rural locations.

Perhaps the pharmacy, GP and nurse shortages (all of which matter) will be fixed in the fabled NHS workforce plan, which currently remains unreleased. There is speculation that it will be published as a 75th anniversary ‘birthday present’ (because of course health systems have birthdays).

At the NHS ConfedExpo bash in Manchester on 14–15 June 2023, neither Amanda Pritchard, chief executive of NHS England, (whose organisation is producing the plan) nor health and social care secretary Steve Barclay could say anything other than that they hope it will be published soon. This lends credence to a report by Sunday Times journalist Shaun Lintern that the 15-year plan is not going to be fully funded, with funding agreed only for certain parts of the plan instead. 

Could we start to see new plans from NHS England about going abroad for pharmacists? That will be when pharmacy knows it has really arrived.

Andy Cowper is the editor of Health Policy Insight and has written about health policy for 22 years