Pharmacist supply and demand disconnected
“Pharmacist supply and demand has become disconnected, with potentially dramatic consequences for the future of the profession,” warned PDA Chairman Mark Koziol. “If pharmacy is to flourish then it is important to ensure that the forces of supply and demand are linked with an intelligent plan, but currently no such plan for pharmacy exists,” he continued. “There will be trouble ahead if these issues are not addressed, and the PDA wants to work together with other pharmacy bodies to develop solutions.”
There are now 26 schools of pharmacy in the UK, around 63 per cent more than ten years ago, with three more due to open. There is no central control on pharmacy numbers and no limit to the number of additional courses set up. This also raises the question of whether there are sufficient numbers of suitably experienced teaching staff to run these new courses. A lack of workforce planning therefore threatens to affect both the quality and career prospects of newly qualified pharmacists.
According to PDA Director John Murphy: “We have studied similar situations emerging in other parts of the world and it is rare to find a subject that could affect so many pharmacists in such a significant way. It is vital that action is taken to minimise the disruption.”
The academic view
Professor John Smart, Chair of the Council of the University Heads of Pharmacy (CUHOP) and a speaker at the conferences, argued that undergraduate numbers must be capped and that UK schools of pharmacy are nearing capacity as the number of new entrants has more than doubled over the past decade. Increasing numbers of trainee pharmacists could force the government to introduce a cap to limit the cost of preregistration training. Insufficient preregistration places would then detract from the popularity of the course, with knock on effects in term of status and ultimately upon government funding, said Prof Smart.
The Government’s ‘Modernising Pharmacy Careers’ programme has proposed that the pre-registration year be split into two six month placements, with universities and employers jointly responsible for the delivery of a five year integrated training programme. This would mean that in future, the number of new entrants should never exceed the number of work-based placements. However, these plans are unlikely to be enacted for at least four years and CUHOP wants student numbers managed now. It also wants to be, “closely involved in this discussion, with the aim of managing the transition to ensure the best outcome for students, schools of pharmacy, the profession, government and ultimately patients”.
The view from the GPhC
According to its Chief Executive, Duncan Rudkin, The General Pharmaceutical Council has no direct role in controlling student numbers – these are matters considered by a number of other bodies to include:
- The Scottish and Welsh governments
- Health Education England (which will be responsible for the strategic planning of NHS education and training in England with a budget of £5bn)
- Local Education and Training Boards (regional bodies responsible for commissioning and overseeing NHS education and training)
- The Centre for Workforce Intelligence.
As far as pharmacy education is concerned, the GPhC is responsible for approving qualifications for pharmacists and pharmacy technicians and accrediting education and training providers.
Mr Rudkin added that it was important to understand that the growth in numbers is not only driven by new schools, but also by existing schools. In the eight years between 1998/99 and 2006/07 there was an 80 per cent increase in the number of students within the existing schools, from 5,534 to just over 10,000. Furthermore, he was at pains to point out that there was no correlation with the premise that established schools of pharmacy provided superior courses to the new ones.
Developments from the Society
Martin Astbury, President of the Royal Pharmaceutical Society, discussed factors affecting supply and demand of pharmacists, such as pharmacy openings, increasing script numbers, and changing models of practice. Mr Astbury announced that the English Pharmacy Board is launching a review of pharmacy that will seek to set out ‘New Models of Care Through Pharmacy’ that pharmacists can provide in the reformed NHS. The RPS will be inviting all pharmacy organisations to submit their ideas for this important piece of strategic work.
Recently, a number of pharmacy organisations have been putting forward their ideas, but these have not been connected in any meaningful way and as such they lack traction. The PDA too has been awaiting the proper pre-text to submit its Road Map proposal for England and thus far such a pre-text has been missing.
“We will be inviting views from all pharmacists and pharmacy organisations,” said Mr Astbury. “We know that various organisations like some of the contractor bodies and the PDA have been busy developing some good ideas and we will be keen to consider them in detail during this important project.”
“I am delighted that the Society is going to have a strategic review of pharmacy as such a review is already underway in Scotland, Wales and Northern Ireland at the behest of the various governments” said Mr Koziol. “We all now have an ideal opportunity to submit our views on the future of the pharmacy practice and we will be submitting ours into this useful exercise on behalf of PDA members.”
Can threat be turned into opportunity?
It is necessary to ensure that the oversupply of pharmacists did not just become a subject of an interesting conference and that a plan of activity could be agreed. During the conference and the plenary and focus group presentations the following principles were developed and will now form the basis of PDA policy:
Policy principles
1. A workforce plan must be developed.
It is important to be able to control the supply of pharmacists otherwise it will be very difficult to be able to plan the development of the profession going forward.
Pressure will need to be brought to bear upon the universities so that they become part of the solution rather than (as currently) part of the problem.
2. Use new roles to increase the demand for pharmacists – especially in the community/ primary care setting.
This can be most effectively achieved through aligning the interests of the patient, the NHS, the healthcare team, the community pharmacy contractor and the pharmacist.
An absolute necessity however, is that the profession reaches agreement on the models of pharmacy practice and then that it could unite behind that single vision.
3. Drive new roles in the community – but not at the expense of the supply function.
A worrying narrative was emerging where pharmacist involvement in the medicines supply function was being talked down, the idea being that this was a role that could simply be undertaken by registered technicians. Whilst the role of technicians and technology was important, nothing was going to replace the vital safety role played by the pharmacist in undertaking the clinical checks upon prescriptions and in delivering the reactive and proactive patient facing role within the community pharmacy. Whatever new roles were to be designed, these must be built upon the premise that pharmacist involvement in the safety of the supply function was not to be diminished.
4. Major upon the improved safety for patients.
New roles for pharmacists need to have as their main objective the delivery of enhanced safety and an improved healthcare journey for patients. Consequently, it would be highly beneficial to create a quality multi-layered service level provided by pharmacy, which would be built upon a structured career framework in the community setting that would consist of four levels, thus
- Practitioner
- Advanced practitioner
- Specialist
- Consultant
In this way, any new roles for pharmacists could become an attractive proposition for those pharmacists delivering them, enabling those so inclined to specialise and those who prefer to remain as generalists to do so.
5. Develop a supervision policy that sees the community pharmacist being more accessible to the public in the pharmacy and not less so.
The thrust behind the Government’s proposed policy on supervision is to enable remote supervision – the plan to operate a pharmacy in the absence of a pharmacist. As PDA members will know, the PDA has actively campaigned against this idea since it was first proposed by the Department of Health. It is recognised that the policy on pharmacy supervision needs to be updated, but currently the Government appears to think that it would be beneficial for the pharmacy to be able to operate with no pharmacist on the premises.
The PDA’s position on this matter is that any change to the supervision regime, especially in the community setting, must result in the pharmacist being more accessible to the public and not less so. The Government appears determined to launch its consultation on supervision in the near future and the PDA’s position will be steadfast.
6. Pursue and develop new roles that major upon the unique skills of pharmacists.
There is little point in developing roles for pharmacists that could be easily delivered by nurses or others for less cost. It is important therefore to develop new roles that focus upon the delivery of pharmaceutical care, which is defined as:
“A patient centred practice in which the practitioner assumes responsibility for a patient’s medicines related needs and is held accountable for this commitment.”
This is not a role that can be undertaken lightly, or as a service delivered incidentally over the counter. During the conferences, the PDA was able to present elements of its Pharmacy Road Map proposal. Significant new areas of pharmacist involvement which delivered benefits to patients were described, which led to the creation of new roles and responsibilities for pharmacists based upon the delivery of pharmaceutical care, both in the community pharmacy and the residential home setting.
7. Halt the commoditisation of pharmacy services and enable professional autonomy.
In recent years there has been a trend towards the commoditisation of pharmacy services, which is perceived as damaging to the patient and the professional agenda. The delivery of MURs and the financial targeting thereof is a classic example of a service that is now largely commoditised and as a result is not popular with many pharmacists, patients and GPs. Such commoditisation was brought about by coercive and target setting policies of some employers, and it is also attracting considerable scorn and ridicule from the wider healthcare community.
Any new pharmacist roles have to enable pharmacists to work as autonomous healthcare practitioners as per the definition of pharmaceutical care, and not be subject to coercion and aggressive target setting in the corporate retailing setting. The PDA is calling for pharmacists providing pharmaceutical care to be recognised by the NHS as independent autonomous contractors in their own right.
Conclusion
The thrust of what was explored and agreed at these events is simple: if it is possible to balance the increasing supply of pharmacists with the development of significant new roles, then it is still entirely feasible to turn the threat of increasing numbers into a valuable opportunity.
These conferences represent the first time that the PDA has travelled around the country and considered one particular issue in a concerted way. The result is that these events enabled the production of a significant policy platform which the PDA will now actively pursue. Furthermore, the involvement of the other pharmacy organisations in these events, especially the RPS and CUHOP, means that certain aspects of this policy platform will enjoy the agreement and the active support of others, making it much easier to generate momentum for change.
Article published in Insight Autumn 2012