Covid-19 vaccination session rates in Scotland are indicative of a wider problem for pharmacists

The PDA has continued to support locum pharmacists who have been subjected to changes in the arrangements for their role in providing Covid-19 vaccinations in Scotland.

Fri 16th April 2021 The PDA

Fluctuating arrangements around Health Board fees for providing Covid-19 vaccination sessions in Scotland have caused significant unrest for pharmacists.  As a result, the PDA has been in communication with health boards and government and provided individual advice to many members.

What are the issues?

The Scottish government made arrangements for primary care health professionals to be able to provide sessions of Covid-19 vaccinations as a backup to the standard NHS arrangements as part of the ongoing efforts to help the country end the pandemic. This would have resulted in a mixture of NHS employees working at their usual pay rate working alongside the independent primary care contractors under different arrangements.  In the instance of independent primary care contractors, a rate of £231 was agreed to be paid to the contractor for each 3.5-hour session.

This meant for pharmacists that a community pharmacy contractor may be paid £231 for a session for which they would provide a pharmacist employed by them to undertake the service. Alternatively, a locum pharmacist could be providing that service for that rate directly, and this applied to locums from other health professions too, such as dentists and optometrists.

A significant number of locum pharmacists offered their services as vaccinators under these arrangements. Many of them engaged in the specific training, endured Hepatitis B vaccinations and they purchased specialist Covid-19 vaccination indemnity insurance. Not only have they invested financially and intellectually, but they also face professional regulatory and personal health risks in supporting the Covid-19 vaccination service.

Whilst the PDA has heard from Health Boards that they are very grateful to pharmacists in supporting this program, unexpectedly, a significant media-led public outcry occurred focusing on the difference being paid to lower paid NHS employees, in particular with nurses as compared to locum contractors. Into this debate was simultaneously introduced the argument that community pharmacies needed the locums to be available so as to ensure the continuation of normal community pharmacy services to patients.

Consequently, government guidance was issued on 5 March which was that locum pharmacists should no longer have the option to provide the service at that rate.

However, not only would the community pharmacy contractors be allowed to continue to provide the service for the £231 rate, but the arrangements for other locum health professionals, e.g., optometrists and dentists, to provide that service directly for the £231 rate, were also maintained.

Contractual breaches

Some health boards initially cancelled the arrangement with no notice and the PDA not only advised its members about their contractual rights in the event of a potential breach of contract, it also wrote directly to the Chief Executive of the Greater Glasgow and Clyde Health Board to ask a number of questions (see below).  It received a detailed response.

At least one health board then changed its position and wrote to the PDA to confirm that for those individuals who already had an existing arrangement and agreed Provision of Service Agreement they would continue to honour the contract. Less than two weeks later that same health board changed position again and gave notice to terminate the arrangement.  Unfortunately, yet again that communication gave less notice than required under the contract and hence the PDA has once again advised members about addressing such a breach of contract.

While that advice may end the contractual issue, the overall situation has caused many members to contact the PDA with general concerns about the wider structural problems for pharmacists in Scotland.

The difference between professions

A meeting was held between officials of the PDA and senior civil servants in Scottish government to ask why it was that locum pharmacists have been singled out for exclusion from the agreed arrangements, while locum optometrists and dentists may continue to receive the agreed rate.  This is particularly frustrating as PDA members working in the vaccination service report that typically the pharmacists are the most experienced vaccinators as the other professions may never have undertaken deltoid injections prior to working for the vaccination programme.  Pharmacists have significant experience of administering the influenza vaccine in community pharmacies.

The reason given that only pharmacists have been targeted by this change is that unlike those other professions, it had been agreed that pharmacists would not be on the health board’s NHS performers list.  When the PDA asked who this had been agreed with, no answer was given. This is not only unfair, but it is divisive; putting pharmacists on the same playing field as other independent primary care professionals is something the PDA believes must be achieved and this is now to be pursued.  

What was the involvement of Community Pharmacy Employers?

Discussions with government representatives indicated that they had also considered the business needs of pharmacy contractors. It was evident that someone had argued that if many locum pharmacists gravitated towards a more lucrative vaccination service, then this could denude the supply of locums making it more difficult to provide pharmaceutical services. But where was the evidence that this was the case? If anything, PDA members surveyed in Scotland indicate that many locums have had little work in these last months, despite the pandemic.

This issue highlights the much wider concern about Scotland’s pharmacy arrangements.  The PDA asked its members who they thought was responsible for this exclusion situation. Almost 70% of respondents said that they believed that Community Pharmacy Contractors or their representative body, Community Pharmacy Scotland, was responsible.

One phrase used in the response to PDA’s questions from the Greater Glasgow and Clyde Health board said;

“the deployment of locum pharmacists is essential to maintaining the full range of current pharmaceutical care services, such as the dispensing of medicines or the provision of healthcare advice or treatment. To ensure this is the case, the guidance advises that sessional rates can only be offered to the pharmacy contractor.”

Another phrase that appeared in a separate email stated that;

The Pharmacy Contractors are uniquely placed to balance participation in the vaccination programme with ensuring patients have continued access to the essential pharmaceutical care services and their own business needs.” 

The PDA believes that the “the business needs” of community pharmacy contractors must surely be balanced with the legitimate role of locum pharmacists as independent contractors as well as practicing pharmacist employees. The influence of the pharmacist contractors on government has not only been evidenced in this episode, but if unchecked, will influence the future of pharmacy practice in Scotland to the potential detriment of all individual pharmacists.

Furthermore, if Scottish government policy is seen to be too close to the interests of business owners some of whom are large multinational companies and is distanced in its discussions from the interests of the individual pharmacists who are delivering the services on the ground, then this will inevitably give the Scottish government a problem going forward.

It’s time to act.

Unsurprisingly, members in Scotland have called upon the PDA to do more about their general concerns about the imbalance in community pharmacy. Consequently, in the near future, we are deploying a significant increase in our operations to address these strategic and policy issues for pharmacists in Scotland.

Announcements will follow in the coming weeks and in the meantime, we ask all existing members to encourage any of their employed or locum colleagues who have not yet joined the PDA to join now.  The strength of a union is in the number of its members and in unity. The PDA already has 2,500 members in Scotland, but the more members it has, the greater will be the influence of individual pharmacists.

 

 

Questions posed to the Chief Executive of Greater Glasgow and Clyde Healthboard;

  1. Can you confirm which recent Scottish Government guidance you are referring to and who was involved in any discussions that took place?
  2. What evidence has been relied upon to arrive at a view that pharmacy business owners could not access the services of pharmacists and locums to maintain their existing services?
  3. You have recognised that this change in payment mechanism will no longer be suitable to meet the needs of individual pharmacists, because it is quite a different arrangement than that which is currently in operation and will require further discussion with various stakeholders. This indicates some discussion has already been had, what was this discussion and with which stakeholders? Why has the GGCHB not already contacted the PDA Union to discuss these issues prior to issuing its communications?
  4. You have stated that you would still like to see pharmacists recommence their working within the Covid-19 vaccination programme as quickly as possible.   Does this mean that once some funding arrangements have been transferred to business owners, you will seek to lift the suspension on pharmacists’ input into the wider GGCHB Covid-19 vaccination programme?
  5. What arrangements going forward will enable pharmacists to re-engage in the wider Covid-19 vaccination programme. Can you confirm that pharmacists will retain the right to work directly for the wider GGCHB Covid-19 vaccination programme for the previous sessional rates and not be required to work solely through pharmacy business owners.
  6. What consideration have you given to the implications of different healthcare professional groups involved in the vaccination service potentially being paid different sessional rates?
  7. Will any of these proposed changes affect other healthcare professional groups?
  8. Your communication states that the sessional rate (£231 for 3.5 hours) that was previously paid by the GGCHB to sessional locums providing their professional services as vaccinators is now to be paid to pharmacy business owners instead. Under these new arrangements, what are the requirements for these businesses to pay this rate to those pharmacists and locums who it is hoped will continue to operate the vaccination services?

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