By Outsider

It’s hard to keep track of the increasingly desperate petitions for locum services arriving in my inbox. If I so chose, I could quite happily spend the holiday season in any given northern market town – in luxurious accommodation – and still turn a handsome margin.  

The workforce situation, if not yet the crisis the Company Chemists’ Association was trying to make it out to be to The Times recently, is certainly not abating at the rate that would normally be expected, given how recently more than 1,000 new registrants joined the profession. Where are these newly minted pharmacists?  

This financial year, the average primary care network has nearly £300,000 to spend on staff through the Additional Roles Reimbursement Scheme (ARRS). That will have doubled again by April 2023. To put this into context, in 2023-24, the money the NHS will be spending on these PCN roles will be in excess of a third of the entire community pharmacy contract value. With pharmacists and pharmacy technicians on the PCN shopping list, it is inevitable that, given the right circumstances, this new money will have a disruptive effect on the current pharmacy workforce. 

Whilst all this new money is flowing into PCNs, pharmacies have had to jump through hoops to retain all of their funding in the Pharmacy Quality Scheme, including the need for PCN-wide business continuity plans. So here’s an idea for next year’s business continuity plan: when the community pharmacy can’t open because it’s being held hostage to extortionate locum rates, let’s recycle one of those ARRS employed pharmacists to help keep it open. 

In other news, the three largest pharmacy chains in the United States have just been found culpable for their involvement in the ongoing opioid crisis after a court case in Cleveland, Ohio. The judgement rests on the definition of a “public nuisance” and is likely to fall away on appeal. But the heart of the claim, that pharmacies “have watched as the pills flowing out of their door cause harm and failed to take action as required by law”, cannot but have some resonance on both sides of the Atlantic. 

Whilst all this new money is flowing into PCNs, pharmacies have had to jump through hoops to retain all of their funding

Over the course of the pandemic, opioid prescribing has increased. Considering there have been fewer elective surgical procedures and presumably fewer workplace accidents, this can be indicative only of a general decline in the mental health of the population and a consummate decline in the ability of the health service to manage the associated risks. I’ll admit, I don’t a have a research paper to hand to back that up, but I don’t think I’m barking up the wrong tree. Just as in America, the vast majority of those opioids will be supplied by community pharmacies. 

A gaping hole

Whilst the recent expansion of the New Medicine Service (NMS) to cover additional conditions is welcome, the absence of any structured post-prescribing care or intervention for opioids is a gaping hole in patient care that is asking to be filled. NICE guidelines require regular review of opioid painkillers and transition to non-opioid therapy for most chronic conditions. Aside from the decency of providing good care, patients have been successfully suing prescribers of Controlled Drugs and winning since 2002, which is an increasingly precarious legal and financial position for the health service to find itself in. 

With general practice suffering its own workforce issues, it seems imperative that community pharmacy offers a solution. Pharmacists see patients more frequently and are often close enough to households to recognise a serious risk of diversion. This intervention could previously have been made using a Medicines Use Review (may that service rest in peace). However, maybe, in the spirit of recycling, we could resurrect an MUR-like service targeted at opioid prescribing. 

Finally, when reading numerous emails offering ever increasing rates to locum here, there and everywhere, sometimes the size of the prize is itself a disincentive. How awful a day must it be if the pharmacy needs to offer £40, £50 or even £60 pounds an hour to secure a Responsible Pharmacist? I’ve been lucky (or unlucky) enough to work in pharmacies dispensing 300 items a week and pharmacies dispensing nearly 300 items an hour, but nothing before made me feel the need for rates that high. 

Perhaps if I knew I would spend a day delivering quality patient care – meaningful interventions such as NMS, the Community Pharmacist Consultation Service, the Discharge Medicines Service or even a post-prescribing opioid review – then £50 an hour would be more attractive. But if the day looked like that, they probably wouldn’t need to offer it, and that pharmacy would have no problems staying open. 

Outsider is a community pharmacist