With no control on student numbers, tomorrow’s pharmacists will have a bleak future

The outcome of the consultation from Health Education England and the Higher Education Funding Council for England on ‘Ensuring a sustainable supply of pharmacy graduates’ concluded that it was necessary to introduce some form of control on student numbers. It is therefore difficult to rationalise the decision from the Department for Business Innovation and Skills that “it is not necessary to introduce a specific student number control for pharmacy” (
Pharmaceutical Journal 2014;293:412).

This decision is flawed, will negatively affect the pharmacy profession and is not in line with the policies currently in place for other healthcare disciplines such as medicine and dentistry, where there is some form of capping on student numbers.

Pharmacists by numbers

The last pharmacist register analysis performed by the Centre for Pharmacy Workforce Studies (CPWS), based at Manchester Pharmacy School at the University of Manchester, identified 46,310 registered pharmacists in 2011, of which approximately 82% (37,887) were registered in England^[1]
[
2]
. As of March 2013, there were approximately 47,391 registered pharmacists in Great Britain, of which there were 38,867 registered pharmacists in England. It is expected that this number will continue to grow over the coming years due to a number of new schools of pharmacy opening in the past few years.

In its review of the future supply and demand for the pharmacist workforce in England looking ahead to 2040, the Centre for Workforce Intelligence (CfWI) identified some options for change in light of the growing number of pharmacists in the workforce. The first option was not to cap student numbers, which, it concluded, would almost certainly lead to unemployment of pharmacists in the short-to-medium term. The review highlighted the risk of increasing mismatch between graduate numbers and available training places if employers were to make reductions in the number of available training places in the short term. The report also suggested that high levels of unemployment would make pharmacy less popular as a profession – and thus as a career choice – leading to an eventual undersupply in the medium to long term. The other two options were capping the number of students entering the MPharm degree, or capping the number of preregistration placements available.

The decision not to cap pharmacy student numbers signals challenging times ahead for the pharmacy profession. Pharmacy graduates will potentially be unable to register as pharmacists if they fail to find a pre-registration training placement. Young pharmacists, already saddled with debt, will face a future of lower salaries.

In the meantime, the EU freedom of movement directive (Directive 2004/38/EC), which allows pharmacists trained in the EU to practise in the UK (provided they meet language proficiency standards), is likely to compound the problem of the oversupply of pharmacists.

Placements and salaries

For 2015, the NHS in England and Wales commissioned 666 training placements and Scotland commissioned around 170 places. In England, the Department of Health (DH) operates a grant scheme that covers the training and supervision of MPharm graduates through the community pharmacy contractual framework. The fixed grant per trainee is currently set at £18,440. This figure was agreed in recognition of the contribution that pre-registration trainees make to the workforce and is in line with dispensing assistant remuneration. The DH does not currently apply a cap to the number of pre-registration placements, which has risen steadily over the past ten years across the primary and secondary care sectors (
Pharmaceutical Journal 2013;291:554).

In the NHS, trainee salaries are fixed using the NHS pay scale system ‘Agenda for change’ at band 5 (£21,500) and, because this is a nationally agreed pay framework, salaries cannot be reduced easily. As NHS finances continue to tighten, the number of funded places is at risk of being reduced further.

In the community, we have already seen a decrease in the number of pre-registration placements. For example, Boots The Chemists, the largest chain multiple in UK, halved its number of pre-registration placements between 2012 and 2013 from 702 to 324.

More than 95% of pharmacy students will intend to register as a pharmacist following their four-year MPharm study, according to a survey conducted by the British Pharmaceutical Students’ Association in 2012 with 2,217 MPharm students. However, the decision not to cap student numbers puts this aspiration at risk because the number of graduates will eventually exceed the number of pre-registration positions. If the number of placements in the community continues to drop and graduate numbers continue to rise, it will not be long before we see graduates unable to secure a placement to complete their training.

As seen in other professions, the free market could also potentially catalyse a “brain drain” overseas. Similar concerns were noted by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain in their recent survey published in the BMJ
^[3]
, which showed that 79% of newly registered anaesthetists were considering opportunities overseas due to oversupply concerns in the UK.

What’s happening in other countries

In the United States, free market dynamics has led to challenging employment prospects for many pharmacy graduates. In 2000, there were 80 colleges and schools of pharmacy in the United States^[4]
. Since then there has been an addition of 50 new schools of pharmacy, as of July 2014, so the number of accredited colleges and schools has increased by 63% since 2000. Purdue University, one of the United State’s highest ranked colleges of pharmacy, has tracked the employment prospects for its graduates, noting that in 2008 each graduate had up to eight job offers, peaking to 12 offers in 2009 and dipping in 2013 to around three offers per graduate. Like the UK, the United States had a period where there was a shortage of pharmacists, but that shortage no longer exists and the growth of PharmD programmes does not appear to be acutely responsive to the marketplace.

There is no control on the number of pharmacy graduates entering universities in Australia. There were six schools of pharmacy in 2002. By 2012, this has increased to 19. The Pharmacy Guild of Australia, the national body representing community pharmacy in Australia, has since expressed concern about the oversupply of pharmacists caused by the large increase in graduates each year.

In New Zealand, there are concerns about the proliferation of “hole-in-the-wall” dispensaries opening up in the larger cities due to an oversupply of pharmacists coming on to the market, leading to suggestions that schools of pharmacy should reduce the number of intake of students per year, although no plans to do this have yet been made.

Decision should be challenged

No graduate is entitled to employment but a policy that would undoubtedly lead to an oversupply of pharmacy graduates and pharmacists is unacceptable. It is morally reprehensible for the profession to allow this decision to go unchallenged. As the UK election draws near, now is the time for members of the profession to make their feelings known to their local members of parliament. Even though tampering with a free market economy counters government ideology, I believe, in this case, an exception should be made.

As an academic working in a school of pharmacy, I realise I may be at odds with a number of my fellow academics on this issue but a control on numbers with a focus on selecting the best candidates is a logical way forward to maintain high professional standards, ensure patient safety and produce a career pathway that is appealing for the brightest and the best to join.