What effect could future community pharmacy budget cuts in England have on decisions about pharmacy team staffing levels?

Last December’s proposal of a 6 per cent funding cut to the community pharmacy budget has wide-reaching implications, not just for the number of pharmacies that may be forced to close and the customers they serve, but also for the community pharmacy staff whose jobs could be on the line.

If budgets are cut, then the number of services that pharmacies offer will almost certainly be reduced, which could mean that fewer pharmacy staff are needed. And if pharmacy business owners are looking to reduce their costs, the wages bill may seem like a necessary place to start. All of this comes at a time when pharmacists and their teams feel they are already working flat out to ensure patients and customers receive the best possible care.

“My pharmacy colleagues and I have had to deliver even more services and dispense more prescriptions, [but] the pharmacy budget has not kept pace with inflation or real increases in cost over the years, so shrinking it even further is a blow,” says Sanjay Doegar, owner of Ruislip Manor Pharmacy, Middlesex. “Our only option may be to reduce our costs, which is bound to impact on jobs or services.”

Guljit Singh, owner of Otley Pharmacy in West Yorkshire, says he also fears the cuts will ultimately mean “a big hit to our profits, which might mean reduced hours and possible pay cuts for staff. In turn, if I’m losing staff it could easily mean a reduction in service for customers.” Many organisations that offer business support and advice to community pharmacy are already dealing with queries from pharmacy owners and managers about how best to predict what staffing levels they may need, and also how to talk to staff about what the future may hold for them.

Jobs on the line?

Deborah Evans, managing director of pharmacy consultancy Pharmacy Complete and English Pharmacy Board member at the Royal Pharmaceutical Society, says it’s “completely natural” for small businesses that feel vulnerable and exposed by these funding cuts to look at their staffing levels. “We are already getting some independent owners saying they are not going to be investing in people and premises or filling vacancies, and it’s not just the independents,” she says. “Many companies consider staffing levels as one of the greatest expenses and the most flexible way to manage their costs.”

Small businesses are also having to contend with the new National Living Wage rise to £7.20 per hour from 1 April 2016 (read Living with the living wage), as well as changes to pensions provision, which are both already putting pressure on wage bills. Ms Evans says in light of all this it’s an “understandable reaction to batten down the hatches and look for savings and how to cut costs.”

However, she warns that if staff are engaged in a “save my pharmacy” campaign, then this could have a downside in the form of “a negative impact on their motivation at work, and a tendency to be more prone to sickness”. She says pharmacy owners need to “think about how they are engaging and involving their team, and helping them go through any changes”.

Talking to staff

NPA chairman Ian Strachan, owner of Strachan’s Chemist, a small group of four pharmacies in north-west England, says this is something he’s been doing since early January. “You don’t want to scare [staff], but equally, I feel we all have a duty to be straight and open with them,” he says. “After all, many of them live in the communities they serve from the pharmacy.”

Mr Strachan advises that all staff – be they employed pharmacists, locums, technicians, counter assistants, managers, delivery drivers and contractors – should be involved in planning for challenging times ahead. He says his approach has been to brief staff “on a pharmacyby- pharmacy basis rather than as a group”, because each pharmacy is different.

“We must all look to be more efficient and have an eye to the financial bottom line as well as continuing to deliver excellent service to patients and customers,” he says. “The pharmacy business, as well as pharmacy practice, is something that everyone in the team needs to be conscious of.”

Different directions

There are, of course, ways staff can be deployed more efficiently instead of cutting their hours or making them redundant.

Ms Evans says this funding challenge can be an “important opportunity for pharmacy owners to take stock and look at their business in a strategic way, because just simply cutting staff means you won’t be able to grow your business”.

She suggests that now is the time to be really clear about what your business model is and what you are aiming to achieve in the next three to five years. “Ask where your strengths are and what the opportunities are in your locality,” she says.

“Have you got the right capabilities and capacity in your business to realise those opportunities? Look at the performance of your team – are they engaged and motivated to deliver the best. Are you investing in developing individuals so they can support the business in different ways? Are you managing poor performance or carrying staff who are not working optimally? Have you got staff working on the right days, or are you resourced based on when they want to work rather than when your busiest times are?”

Identifying areas for growth that are not reliant on prescriptions business is also key. “For example,” says Ms Evans, “you may have services commissioned but, because you don’t have the right staff mix or capacity, you can’t realise the benefits of those services or deliver them to the optimum level. You’ve got to have the right people with the right skills doing the right things at the right time.” And while using locums is always an option to fill gaps in staffing, just because some businesses may be reducing their permanent staff numbers this doesn’t necessarily translate into more placements for locums.

“It’s a buyers’ market in many cases,” says Ms Evans, “so locums have to ask themselves the same questions as employed staff: are you accredited to deliver all the different services? How can you be of most use to the pharmacy you go into to help it optimise its income and demonstrate delivering value to the health system?”

Other opportunities

Looking further ahead, it’s not only pharmacy staff who might have to step outside the roles they are used to in order to survive this budgetary blow.

Will Cavendish, director general, innovation, growth and technology at the Department of Health, and chief pharmaceutical officer for England Keith Ridge have mentioned other changes that the government would like to see for pharmacy, including better integration into the wider primary care and community health system through a Pharmacy Integration Fund, which will encourage closer working with GP surgeries, care homes and urgent and emergency care departments, so that more patients can benefit from pharmacists’ clinical skills.

The Royal Pharmaceutical Society says it “welcomes” this initiative, and has itself launched a new campaign around closer co-operation between care homes and community pharmacies with the publication of its report The Right Medicine: Improving Care in Care Homes. This collaboration is also supported by Pharmacy Voice, whose chief executive Rob Darracott believes there are “many examples of best practice to be found of community pharmacists providing vital and much needed help to the care homes in their community. Community pharmacists and their teams have already demonstrated the value they can add by training care home staff and overseeing compliance with various regulatory requirements in various successful trials across the country.”

However, he warns that “inconsistent local commissioning and a constant shift in priorities from successive governments has made it hard to build momentum” for this so far, which is why PSNC’s call for NHS England to commission more services from community pharmacies comes at a vital time to open up even more scope for community pharmacy staff to expand their roles and continue to contribute to the public health agenda. The negotiating body is recommending that community pharmacies should also:

  • Offer a care package for patients focused on their medicines, and making routine use of electronic repeat dispensing
  • Carry out inhaler technique checks and give coaching sessions to patients who are prescribed inhalers
  • Record prescription interventions using a standard classification system with data collated centrally
  • Routinely offer people medicines reviews when they are discharged from hospital
  • Offer a Pharmacy First service, including giving people advice on minor ailments and making emergency supplies of prescription medicines
  • Take part in up to six nationally agreed public heath campaigns each year.

If these plans come off, they could go a long way to safeguarding jobs for hundreds of community pharmacy staff, but there are still tight times ahead. Nonetheless, Ms Evans believes there are opportunities for pharmacy teams who pull together. “At the end of the day, this kind of thing happens all the time to all kinds of businesses, and it’s how you respond to these changes that is critical,” she says. “Engage and involve your team in this challenge. If you can get everyone to think about how to make your business sustainable for the future you have a good chance of continuing to grow.”

We must all look to be more efficient and have an eye to the financial bottom line, as well as continuing to deliver excellent service to patients and customers

Campaign still under way

The National Pharmacy Association, Pharmacy Voice and the Royal Pharmaceutical Society have been asking pharmacy teams to help gather evidence to show politicians and officials that local pharmacies are much more than just a distribution point for medicines. You can still get involved by doing the following:

  1. Petition – download a petition from the NPA website and encourage members of the public to sign it
  2. Give out campaign cards – for staff and patients to send to MPs
  3. Download a window poster – and raise public awareness
  4. Write to your local MP – there is a template on the NPA website.

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