Outsider: The search for greener grass

When is a pay settlement not a pay settlement? And when is a recruitment crisis not a crisis?

This year is seeing a resurgence in trade union power across all sectors. It’s good to see them doing their bit and pushing for better terms of service for their members. I’m not sure what to make of the fanfare that greeted the Pharmacists’ Defence Association’s recent settlement with LloydsPharmacy though.

While the numbers themselves – two non-recurring lump sum payments equivalent to three weeks’ pay – seem okay on the surface, I suspect the pharmacists working there would rather have certainty about what the name above the door will say by the year end, and assurance about staffing levels across the rest of the pharmacy team. 

It must be a strange reality working for what was once a premium employer and now arriving for work each day unsure whether the business will be under new ownership. 

I certainly remember watching with some envy as colleagues at my large, vertically integrated multi-national would jump ship for what seemed back then to be astonishing pay increases.

Perhaps it was always going to end this way, but it seems unbelievable that in such a short period of time, one of the jewels of community pharmacy, and of many a high street and community, has been so poorly managed and led that by the end of the year, it will be unrecognisable if still here at all.

People in stormy waters seek safe ports and, increasingly, community pharmacists are seeing primary care, specifically in practice-based roles, as an attractive option. The headline pay may not be as great, but the working hours look good – weekends off and not a bank holiday rota in sight.

Community pharmacy can’t do collective bargaining for a better settlement in the way that junior doctors and nurses have been doing with their strike actions; we have to rely on Community Pharmacy England for that. 

But bank holiday coverage gets patchier every year, and that in itself might send a message. Looking at the published rota cover for some areas in May, the combination of pharmacy closures and the Royal College of Nursing’s strike action will leave some Integrated Care Board (ICB) leaders scratching their heads in concern.

Health Education England has yet to publish the results of its (now contractually mandated) community pharmacy workforce survey for 2023, but the impacts of staff shortages can be seen easily enough. It’s often reported as a crisis, but that word is getting a lot of use currently.

What is clear is that some areas are affected more than others. Commissioners from Wales will go to Kerala in India this month to recruit healthcare staff – primarily nursing staff, but also pharmacists. 

This is a prestigious government- backed plan, and there’s even supposed to be a minister going – presumably forgetting it’s not the 19th century any more. Lots of other ICBs are watching with interest, with some sending people along to observe the process and see if they want to copy it. 

One can only guess at the cost of the jolly recruitment trip. What we do know is that it won’t be cheap and can only serve as a temporary sticking plaster for a wound that has been left to fester for so long it sometimes feels like amputation might be the only solution.

Why do we know this? Because we’ve done it before – this century, when the pharmacy degree course changing from a Bachelor’s to a Master’s added a year on to its length.

That whole year’s intake from university to practice was delayed – essentially a fallow year. At the same time, the accession to the European Union of seven former Eastern Bloc states opened the door to mass recruitment of pharmacists from overseas.

Yet once these new recruits were settled in the UK, their employers realised they hadn’t actually solved the problem. Once the fixed term loyalty lock-ins expired, they faced the same staffing issues as before because they hadn’t fixed the real issue – retention.

If you’re tied to a checking bench, or stuck in a basement care home dispensary, working 54 hours a week, it doesn’t matter whether your salary seems gold-plated (whatever your frame of reference).

The staffing issues the sector faced at the turn of the century are pretty much the same as those confronting us now: poor working conditions and lack of a clear career path, combined with the grass looking greener on the other side. The only difference is which side the grass is on.

Back then, the grass was actually green, or the shop front was. Now, it’s a practice-based job with every weekend off and no chance of missing the Coronation quiche at the street party because you need to do a rota cover.

Outsider is a community pharmacist