Workforce pressure cooking
In recent months, pharmacy contractors have reported increased staff shortages, exacerbated by Brexit, Covid and ongoing NHS reforms, leading to difficulties maintaining services and even temporary closures. Confirmation of a developing workforce crisis arrived last year, when pharmacists were once again added to the Home Office’s Shortage Occupation List for the first time in a decade.
Back in October 2021, representatives from the CCA, the NPA, AIM and PSNC met senior NHS England and NHS Improvement (NHSE&I) officials to discuss the limited availability of professionals for community pharmacy roles, jointly citing what they called “a critical shortage of pharmacists and pharmacy technicians in the community sector”. They called for a collaborative effort across the sector, NHS and Government to address both “the immediate pinch on capacity” and “the longer term challenges”.
In January this year, a survey by Pharmacy Magazine found that 74 per cent of respondents had suffered staff absences due to Covid-19 infection, and the Company Chemists’ Association (CCA) suggests that an ongoing recruitment drive of pharmacists into NHS primary care networks (PCNs) and GP practices is also taking its toll. According to the CCA, 3,000 pharmacists have been recruited into PCNs since 2019, equating to around 10 per cent of the community pharmacist workforce.
And then there’s the Royal Pharmaceutical Society’s latest annual Workforce Wellbeing survey, conducted in partnership with Pharmacist Support, which reported that nine out of 10 respondents (89 per cent) were at high risk of burnout, one in three (33 per cent) had considered leaving their role, and the same number had considered leaving the profession altogether.
While the recent Health Education England (HEE) Community Pharmacy Workforce Survey 2021 provides a useful snapshot of the community pharmacy workforce in Spring 2021, a year is a long time in pharmacy – especially in these rapidly changing times – and this data has limited use when it comes to analysing the root of current pressures.
The responses – from 47 per cent of contractors (5,271 pharmacies) – indicate that trained dispensing assistants and pharmacists were the two most populous employee groups in 2021, as in the previous survey, in 2017.
Except for pharmacists and trained dispensing assistants, where headcount numbers had increased, all employee groups experienced a reduction in headcount numbers, with a 5 per cent overall reduction in the workforce headcount compared to 2017.
PCNs and CCGs should... consider the impact of creating new roles on all healthcare providers in the area
The full time equivalent (FTE) figure for pharmacists increased by 2,798 since the 2017 survey and, while the number of community pharmacies reduced slightly, the headcount of pharmacists increased by just over 4,000. However, the proportion of respondents who said it was “fairly difficult” or “very difficult” to fill pharmacist positions rose from 21 per cent in 2017 to 56 per cent last year.
According to Alastair Buxton, director of NHS services at the Pharmaceutical Services Negotiating Committee (PSNC), the current workforce challenges require “a team approach across pharmacy, the NHS and Government”. However, he emphasises that as “solutions to workforce shortages are generally implemented over the longer term… in the immediate future, we will continue to seek to ensure Government and the NHS understand the issues contractors are facing and apply this when making decisions which affect the sector.”
National Pharmacy Association (NPA) director of corporate affairs Gareth Jones says that while the “relatively low response rate to the 2021 HEE survey means we should be cautious about reading too much into the data, they are consistent with what we hear all the time from pharmacies struggling to recruit and retain pharmacists and pharmacy technicians and maintain services.”
He believes one practical step would be a requirement that local impact assessments are carried out prior to any recruitment into PCNs/Clinical Commissioning Group (CCG) sites under the Additional Roles Reimbursement Scheme. “PCNs and CCGs should, in association with local representative bodies, consider the impact of creating new roles on all healthcare providers in the area and on their ability to deliver their objectives on behalf of the NHS.”
The cross sector Community Pharmacy Workforce Development Group (CPWDG – hosted by CCA, with NPA and AIM) published its Review of the Community Pharmacy Workforce in June 2021. This found a 9 per cent FTE pharmacist vacancy rate across England, but significantly higher in the South East (15 per cent) and South West (18 per cent). Reasons cited for leaving the profession again include concerns about pay, workload and pressure, and a lack of opportunities for career development and progression.
To maximise opportunities, the CPWDG says “efforts will be necessary to increase the capacity and capabilities of pharmacy colleagues. This should include continued professional development, parity in opportunities between the current and future workforce and the development of infrastructure to allow pharmacists and pharmacy technicians to use their clinical skills.”
Although welcoming HEE’s efforts to quantify the extent of the issues around recruitment and headcount in community pharmacy, Malcolm Harrison, CCA chief executive, says it cannot stop at numbers: “The CCA, with the CPWDG… will be undertaking further data collection and analysis to understand the extent of staff shortages and advise NHSE&I on workforce planning.”
In Wales, pharmacies were able to use the NHS Jobs website to recruit during November, in a pilot a spokesperson from Community Pharmacy Wales describes as having been “very successful and is now in the process of being rolled out to any pharmacy in Wales”. In addition, Betsi Cadwaladr University Health Board in North Wales recently started a pharmacist and technician recruitment campaign with an external agency, recruiting not just to manage sector vacancies, but across all sectors as a piece of collaborative working.
Nonetheless, implementation of wider rescue strategies needs to hustle, according to LloydsPharmacy. “There are mounting pressures facing community pharmacy which aren’t unique to LloydsPharmacy,” says a spokesperson. “Workforce challenges are creating significant difficulties. We have an action plan in place and are actively bringing in new recruits, but this situation requires a sector-wide response. It is not something that community pharmacy providers can address on their own.”
It’s not just pharmacy bodies that are leaning on the Government for action. In response to a warning from Conservative MP for North Devon Selaine Saxby, that the wellbeing of patients in her community is being jeopardised by a lack of pharmacies, pharmacy minister Maria Caulfield said “more can be done to better utilise the skills of community pharmacy teams”. But she dodged the main issue by pointing to the five-year community pharmacy contractual framework and the increase in the number of pharmacists and pharmacy technicians working in general practice, urgent care and care homes as evidence of the Government’s investment in pharmacy.
For some, this is still missing the point. Last August, the board of Community Pharmacy Scotland (CPS) called for a temporary stop to the recruitment of pharmacy workforce to GP primary care support roles, saying that the “workforce shift” of the last three to four years “has occurred with no planning to account for the needs of hospital or community pharmacy services, with the vast majority of individuals coming from the latter.”
“Opportunities for the profession in all sectors of practice are better than they have ever been, which is fantastic,” says Adam Osprey, policy and development pharmacist at CPS. “But they are also more numerous than we have ever experienced, with no joined-up workforce planning to accompany the sharp increase. This remains a significant issue as we head into 2022 as the vacancies and trends that we are observing suggest that the three main employers of pharmacy professionals in Scotland (community, hospital and NHS GP support) will not all be able to fill their identified vacancies for some time.”
Ever watchful, the Pharmacists’ Defence Association (PDA) is calling for clarity on the veracity of claims of a drain in the GP/PCN direction. In a statement this month, it said it “has not seen evidence that there is a genuine shortage of pharmacists, and indeed recent analysis of the number of pharmacists entering the GPhC register supports that it is a myth that new roles in GP practice have caused shortages.”
When it comes to the workforce crisis, the PDA says official evaluation of the pharmacist workforce does not address the elephant in the room: “Representatives of community pharmacy employers seem to consider everything else except addressing those root causes that are within their control, such as improving working conditions, enabling protected training time, and agreeing to fair reward as well as providing adequate levels of support staff, and offering flexibility and career development opportunities.”
In a perfect storm of compounding challenges, steering the most direct course is going to need all hands on deck.
PDA Workforce Check Survey The PDA is canvassing feedback from members about their current roles and possible career intentions