The halcyon days of locuming are long gone, and times are tough for the locum workforce. Where is this heading?

Locum pharmacists are enduring perhaps the toughest market conditions in living memory, with work hard to find, rates falling, and employers calling all the shots. There are simply more locums than jobs, a situation created by a huge increase in the number of graduates, combined with more pharmacists from elsewhere in Europe looking for work. A government cap on student numbers, announced in December, should help stem the flood of pharmacists onto the market, but the effects will not be seen for several years.

Shaun Hockey, managing director of Healthcare Personnel locum agency, describes the work situation as ‘tight’, with jobs particularly hard to find in cities. Positions are slightly easier to come by in north-east England, the far south-west, Norfolk and Suffolk, but the market is not as buoyant as previous years. Advance bookings are difficult to get, with more cover arranged at the last minute. Newly qualified pharmacists are finding it particularly difficult to find locum work, and Mr Hockey tells of ‘horror stories’, like a locum who registered last August, but had only found one day’s work by shortly after Christmas. ‘That’s ringing alarm bells,’ he says.

Employers can afford to take their pick, although there is evidence that they are prepared to pay slightly more for experienced locums. The ability to do MURs and NMS is a prerequisite, and anyone without these accreditations will find it particularly difficult to get work, says Mr Hockey. Some employers are even paying different rates depending on the number of MURs carried out.

Rates vary from around £25 per hour, down to £18 or less in London. Pharmacists’ rates are ‘miles away’ from GPs’, who can get £70-£100/hour as a locum, says Mr Hockey. There is plenty of work around for locum GPs too, with vacancy rates quadrupling over the past two years.

Too many graduates, combined with more locums arriving from elsewhere in the EU has created a ‘double whammy’, he says. Most EU pharmacists prefer to work in cities where there is likely to be an ex-pat community, making work shortages particularly acute in urban areas and partly explaining why London rates are the lowest in the country. The planned increase in retirement age may also contribute to a worsening situation, where no female pharmacists will be able to retire on a state pension for up to seven years out of the next 15.

Advice for locums

Mr Hockey gives locums the following advice: ‘If you’re wanting to stay where you are, get all the qualifications you can. Use an agency or club together to form a co-op – it’s very difficult for individual pharmacists to secure good rates.’ Employers often encourage locums to deal with them direct, but Mr Hockey warns that, in five years, he has not come across a single locum who’s achieved a better rate that way.

Independent pharmacy may be a safer haven for locums, says Lindsey Gilpin, locum and founder of online discussion forum LocumVoice. ‘But with some of the larger firms you might have a good long-term relationship with a local branch, but the decisions are not made there. A lot of locums are dispirited – it’s not an easy time.’ Some are looking to employment, while others are considering alternative careers.

With locums forced to travel further afield to find work, they are more likely to arrive tired, further adding to workplace stress. And those who travel widely will not be accredited for local service delivery in every area. The increasing influence of the multiples is making locuming even harder still, says Ms Gilpin. Many area managers are not pharmacists, bringing additional problems as they can have unrealistic expectations.

Locum pharmacist Dorothy Drury practises mainly in Yorkshire, where there is perhaps more work than elsewhere, but still the local market is depressed. She believes the multiples are at least partly to blame, with their policies of employing fewer second pharmacists and recruiting from abroad. But there may be more opportunities in the hospital sector and locums should consider working across two sectors, suggests Ms Drury.

A lot of locums are dispirited – it’s not an easy time - Lindsey Gilpin

The listening multiple

While multiples generally come in for criticism, Asda appears to take a refreshing approach to its locum workforce. The supermarket chain has run a series of locum listening events around the country for the past couple of years, at which locums are invited to share their views and experiences. Issues commonly raised include Asda’s support for its locums, staff training, rest breaks and dealing with difficult customers.

Asda gives all locums an introduction pack, containing important information such as SOPs and contact telephone numbers. Every new locum is taken through a mini induction at their new workplace to show them the ropes. The company views its locums as an asset. ‘I think locums will always bring something new to our pharmacies because they work with other people,’ says superintendent pharmacist John Evans. ‘There is always something that other people do better and we always encourage new pharmacists to share things with us.’

Even so, more locums are now looking for full- time employment, says Mr Evans. Its rates have fallen, to between £21 and £24 an hour, in line with the market, but not by as much as some other multiples, he says. He is happy to discuss issues with locums and keeps up-to-date with their views via online discussion forums.

Opportunities and challenges

Many locums are concerned about the uncertainty around NHS reforms, and are unsure about what to do or who to talk to, says Ms Gilpin. ‘It’s hard to see the way forward,’ she says. With PCTs dissolved, it remains unclear how locums will gain accreditation for service delivery, for example. Locums are expecting local pharmaceutical committees (LPCs) to make the necessary links with commissioners and understand the new NHS structures for them.

NHS reforms may well create new roles for locums, but they will not be easy to find, warns Catherine Armstrong, locum pharmacist and lead pharmacist at Amicus, a medicines management service in Gateshead. ‘There are opportunities out there, but locums will need to go looking for them,’ she says. Locums will need to understand what the commissioners want and ‘sell’ their services accordingly.

CCGs have all published their commissioning plans and this would be a good starting point for locums looking for new opportunities, says Ms Armstrong. Prescribing advice and medicines management services will be called ‘medicines optimisation’ from now on, and any pharmacists interested in delivering this type of service will have to be quick. The medicines optimisation contracts for the three CCGs in the Gateshead area, for example, were out to tender in March, with decisions expected shortly. INR services in the area were procured last year under the any qualified provider (AQP) model. Some pharmacies submitted applications, but Ms Armstrong is not aware of any individuals doing so.

The situation in Scotland seems to be broadly similar to that in England. George Romanes now employs eight pharmacists to run his five pharmacies in Scotland and the north of England, and has not used a locum for over three years.

‘Five years ago it was almost impossible to get anyone to cover who was competent, but the situation is very different now,’ he says. ‘I wouldn’t like to have to go back to using locums because the contract is so much more complicated now. It requires different skill sets and I think if you’ve got second pharmacist time it makes the job and the services much better.’

Changes to the Scottish contract mean that locums need to be able to deal with a much wider range of issues, ranging from eMAS (the minor ailments service), to Community Pharmacy Unscheduled Care (CPUS – emergency supply arrangements), and direct referrals to out-of-hours services.

Not so long ago, Saturdays would have been a relatively quiet day with local surgeries closed, but now a locum working on a Saturday in Scotland has to be on top of their game. Regular pharmacists know the systems, are familiar with SOPs and know support staff. ‘They hit the ground running. If you are a single-handed business you certainly need locums, but if you’ve got any sort of small group you’re mad not to take someone on an employed basis. That’s the way forward.’

Proprietors are benefiting from the excess supply of locums, although the profession as a whole may not. Five years ago, Mr Romanes received five applications for a pharmacist post, but last summer 41 pharmacists applied for one position advertised in a single journal.

‘It’s probably not good for the profession to be like this but if you’re serious about the service agenda, now’s the time to get two pharmacists in your shop. If you’ve got two pharmacists you can make their job much more interesting and varied.’