In January 2019, Health Education England (HEE) informed trust chief pharmacists who host HEE-funded preregistration pharmacist placements that, following an internal review, the salary support funding for these placements will be cut from the historic 100% to 75% from September 2020. There was no prior warning, no discussion with stakeholders and no formal consultation process. HEE confirmed that no external consultation had taken place. I requested a copy of the cut’s impact risk assessment, which I am still awaiting — in its absence, let’s consider our own.
We need to ask, first, is there an evidence-based need to maintain or even increase pharmacist preregistration placements? Second, is there demand and demonstrable value in maintaining the placements?
As for the first, HEE’s letter ironically hit my desk a few days after the launch of the ‘NHS Long-Term Plan’, which saw pharmacy leaders on social media celebrating the essential role pharmacists across settings will play in the plan’s delivery. For example, the number of pharmacists working in general practice and supporting care homes will be boosted, adding to the 810 full-time equivalent pharmacists already working in general practice as of September 2018.
An extra 343 people passed the preregistration exam in 2018 compared with 2011, but this increase comes nowhere near providing enough pharmacists to meet today’s expanded roles, let alone the ‘NHS Long-Term Plan’s’ staffing requirements for the future. HEE will expand its GP practice preregistration training scheme for 2020–2021, but an estimated 6,000 pharmacists will be needed to fill new positions in primary care networks by 2024. And in 2018, NHS providers reported a consistent pharmacy turnover rate of 14% and a vacancy rate of 7.3%–7.8% over the past three years.
Place this in the context of hospitals recruiting extra pharmacy staff to support seven-day services; longer opening hours for dispensing activities; weekend ward pharmacy services; new services in the emergency department; medicines optimisation on the ward; and, particularly, extended pharmacist independent prescribing. Alternative roles for post-foundation pharmacists are rapidly expanding, without a corresponding increase in the number of post-foundation pharmacists in the pool. It is no surprise that we cannot fill all our vacancies now. We need to maintain, or increase, the number of preregistration placements.
Secondly, is there value in maintaining these placements? Health Education England’s own evaluation of preregistration recruitment identified that, of the 2,161 placements offered through the Oriel recruitment system in 2017, 734 (34%) placements were in an NHS hospital — the second highest after placements offered by large community pharmacy organisations (although not all community pharmacies listed their placements on Oriel). More tellingly, all available hospital placements were filled, against 75% filled across all sectors. And 91% of applicants selected hospital training as their first choice; and on average, there were 1,094 applicants for each available hospital programme. Hospital placements are clearly popular and highly valued by applicants, and the proposed changes to salary support could reduce the number of these placements available on Oriel.
Hospital pharmacy has excellent success in supporting preregistration pharmacists’ move onto the professional register: in 2018, 95.7% of people taking placements in hospital had an overall pass rate, against an all-sector overall pass rate of 78.8%. Why would any sensible workforce plan reduce the number of these placements?
The funding change was announced shortly after our trust had been asked to put forward proposed commission requirements for 2020 and, particularly, to consider new and innovative placements. We were keen to propose a new, additional preregistration extended placement in partnership with a general practice, to build on our existing short practice placement.
But now, instead of looking forward to developing versatile pharmacists, I worry about how I can maintain the four existing placements, never mind supporting another. The funding change was announced uncomfortably close to the 1 March 2019 deadline for trusts to confirm their placement numbers for 2020 — we are left to hastily negotiate with our finance teams to make decisions with big implications for our future workforce.
So, what do I do? Do I lose a permanent pharmacist post — when meeting pharmacy demands in the trust is already a struggle — to fund pharmacists of the future? The funding cuts feel like workforce planning based only on short-term financial considerations, rather than demand-led and evidence-based assessments of what the future pharmacist workforce really needs.
Mary Evans, chief pharmacist and clinical director of pharmacy, Luton and Dunstable University Hospital
- This a personal opinion and should not be seen as the view of Luton and Dunstable University Hospital