By Malcolm Harrison
I’ve been registered as a pharmacist for over 25 years now, and in my time, so much has changed in community pharmacy. But equally, very little is actually that different. Gone are the dot matrix printers, the telephone calls to wholesalers and the extemporaneous mixing of liquor picis carbonis on a glass ointment slab. But pharmacies and pharmacists are still providing the safe and effective supply of NHS prescribed medicines to the public, and the expertise of pharmacists and their teams help millions of people every year.
Workforce challenges are nothing new either. I recall the fallow year of 2000 and the resultant influx of pharmacists from around the globe as demand outstripped supply in the UK. Interestingly, back in 2000, 510 million NHS prescription items were dispensed by 9,765 pharmacies in England; today, the sector supplies nearly double that, from ‘just’ 11,200 sites. That is a 76 per cent workload increase, yet most pharmacies still operate under the supervision of a single responsible pharmacist. The health system is expecting more and more from us.
In early 2019, the Company Chemists’ Association (CCA) first voiced concerns about workforce pressures and the need for a long-term funding plan. More recently, to quantify the true picture of workforce issues, we have conducted a comprehensive Review on the Community Pharmacist Workforce, which can be found on our website. We’ve uncovered a worrying shortfall of more than 3,000 community pharmacists across England.
But the numbers on their own don’t paint the whole picture. We also know that increasing numbers of pharmacists are working part-time. This, coupled with broader portfolio working, has added to the demand for more pharmacists. To be clear, we know the number of pharmacists is rising, but not nearly fast enough to match increases in demand.
Establishing the facts and understanding the reality is just the beginning – the easy part of solving the puzzle. The harder part is finding solutions that work for everyone. For me, the answer lies in collaboration, evidence led policy making, and a long-term strategy for pharmacists across primary care. Any conversation about the future cannot ignore the fact that there is also a need for the sector to be adequately funded.
Establishing the facts and understanding the reality is just the beginning
In addition to establishing how best to utilise our workforce, we also have an opportunity to review how pharmacy professionals can set about delivering care. The CCA fully supports efforts to review the role of ‘supervision’. There will always be a need for a responsible pharmacist for each pharmacy, but in a modern healthcare environment, we need to think about how to enable our highly skilled professionals to be the best they can be.
We urgently need pharmacists and pharmacy teams to be empowered to work to the limit of their competence. We need regulatory and legislative frameworks to make this possible. It is my hope that any changes made release capacity in pharmacy teams, allowing them to provide more clinical care.
We know that one of the contributors to the current workforce crisis has been the recruitment of 2,400 community pharmacists into NHS Primary Care Networks. We also know they plan to recruit at least the same number again.
We need the NHS to work with us to develop a plan to enable the whole of primary care to meet all of its pharmaceutical care needs, including perhaps the delivery of PCN care services in community pharmacies.
Needs and incentives
We also need programmes of learning for all pharmacy colleagues that support teams to deliver more clinically focused care. This should include independent prescribing qualifications, and we welcome NHS commitments as part of the Pharmacy Integration Programme. It is clear, however, that this commitment must be scaled up if we are to ensure all pharmacists can access training. Training must also be aligned with opportunities for pharmacists to apply their skills, through commissioned services which will help to ensure community pharmacy remains an attractive place to practise.
Finally, we need to take a holistic view of the future pharmacy workforce. If we only look at the number of GPhC registrants and do the best we can with what we have, it will be too late. We need to look further upstream and consider how to attract A-Level students into the MPharm degree.
All in all, we need to incentivise people to choose a career in pharmacy and enhance career satisfaction among those who already have. We can do this by reducing pressures on teams, granting more professional autonomy, and creating more opportunities to make a difference to patients’ lives.
Malcolm Harrison is chief executive of the Company Chemists’ Association
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