On 5th February, in the Telegraph newspaper, the CCA Chief Executive Malcolm Harrison stated that the vacancy rates in his members’ pharmacies had doubled between 2017 and 2021. He claimed that because of a shortfall of 3,000 pharmacists almost 20% of his members’ pharmacies will be forced to reduce their hours, limiting patient access to medicines. He argued that unless the government addresses this with a new workforce plan, patients will face long waiting times and pharmacy closures. He said that plans for community pharmacy to do more in primary care were merely a pipe dream unless the government faces the facts.
Following this, the CCA was involved in the organisation of an All-Party Parliamentary Pharmacy Group meeting which was clearly designed to try and persuade parliamentarians that there was a pharmacist shortage and one of Mr Harrison’s requests to them was that the regulations should be changed. We assume that he refers to changes to the rules on supervision, possibly enabling pharmacies to operate without a pharmacist.
Speaking at this meeting, PDA Chairman Mark Koziol said that closures where not being caused by a national shortage of pharmacists, they were being caused by a huge reduction in the desire of pharmacists wanting to work in community pharmacy and particularly for the multiples. This was caused by the deteriorating conditions that they experienced in community pharmacy and the treatment that they had experienced at the hands of the multiples. He qualified what he said by explaining that the problems to a significant extent had been caused by the huge reduction in global sum payments to contractors in England leaving many with no place to go other than on a cost cutting exercise.
Following the event, the CCA released the following statement on 15th March:
The Company Chemists’ Association (CCA) is disappointed that the Pharmacist Defence Association (PDA) continue to claim that the very real workforce challenges the community pharmacy sector faces are an isolated problem affecting CCA companies only or are even totally non-existent.
PDA Chairman Mark Koziol attended the 22nd of February All-Party Pharmacy Group evidence session on the pharmacy workforce where he heard, first-hand, the recruitment and retention challenges that Anil Sharma, an independent pharmacist and Paul Mason, Superintendent Pharmacist at Lo’s Pharmacy, an independent multiple, faced.
These issues are just a microcosm of what is happening nationally and across the entire health and social care system. Indeed, the Department of Health and Social Care has commissioned NHSE/I to produce a long-term workforce plan for this very reason. To dismiss the very workforce challenges that Anil and Paul spoke so eloquently about at the event which the PDA’s Chairman attended, is disingenuous and a disservice to the pharmacists and pharmacy staff that have worked tirelessly over the Covid-19 pandemic.
We strongly urge the PDA to join the CCA and all employers in the sector to stand united on the workforce shortage issues affecting pharmacies up and down the country. We hope that together we can work with commissioners to secure better workforce planning and concerted investment into a sector which so desperately needs it.
The CCA recently talked to Anil Sharma, who owns a small group of pharmacies with his wife in East Anglia, who said the following:
“I am finding it increasingly challenging to recruit pharmacists despite our pharmacies delivering a whole host of services. It’s becoming impossible to recruit across city and rural areas and this is due to a lack of career opportunities in community pharmacy because of the sector’s flat-funding and pharmacists being drawn to Primary Care Networks (PCNs). We’ve not struggled like this in all my sixteen years of trading. Ultimately, we feel unsupported and underinvested by the Government especially when pharmacists have done so much over the pandemic. The workforce crisis is particularly apparent in rural areas and will continue to have a huge impact on the elderly patients in such places. I would invite anyone who believes that the workforce crisis does not exist to come and see what’s happening on the ground.”
The PDA has been challenged by the CCA to a public debate and is happy to respond if this gets the right outcomes for patients, pharmacists and the community pharmacy sector. The PDA has always engaged constructively, but others should listen and not simply seek to divert the debate.
Some facts
Over recent months the PDA has had more than 5,000 responses to surveys and has shared the findings publicly. The situation is complex, but when added to published statistics, some key features of the situation are:
- There are more pharmacists on the register than ever before
- An increase of 17,141 (39%) since 2011
- There has been an increase in the number of registered pharmacy technicians of 13,625 (118%) since 2011
- And yet there has been around a 38% reduction in dispensary and counter staff since 2017
- The number of community pharmacies has broadly stayed static since 2011
- 63% of pharmacists surveyed do not believe that there is a shortage of pharmacists
- 54% of those pharmacists surveyed working for multiples in England are looking to change their role in the next 12/18 months,
- 17% of these aiming to become locums
- 23% looking to move out of community pharmacy and into another sector
- 11% looking to retire
- 27% looking to leave pharmacy altogether to retrain in another career.
- The number of new GP practice roles is far outweighed by the overall increase in the number of pharmacists
- There are significant concerns over safety and the wider working environment
- Many pharmacists do not want to practice full time and a significant proportion want to leave the profession
- The above, lead to a supply and demand challenge, but some pharmacies, mainly CCA members, are closing pharmacies in breach of the NHS contract rather than pay the rate necessary to engage locums
- The PDA have written to the Superintendent pharmacists at Tesco, Morrisons and the other CCA member companies regarding safety at CCA member pharmacies
Those pharmacists who had moved to another sector from community pharmacy and especially those who had moved into the new GP Practiced based area told the PDA that their primary motivation for doing so was Professional fulfilment, career development and more sociable working hours. These sentiments agree with those expressed by Mr Sharma in the above CCA statement.
The CCA
The CCA is an organisation that represents the interests of the shareholders of large corporations, who maximise their profits. It is perhaps unsurprising that CCA would try to treat the symptoms by pursuing solutions (such as changing the regulations on supervision) which might increase their profitability, but which will do long term damage to pharmacy, rather than put in place remedies to resolve the longer-term causes.
Why would anyone want to increase the number of pharmacists on the register so as to reduce the vacancy rates for the CCA members, only then to have pharmacists so burned out and disillusioned by their experiences that they either take pay cuts to work with professional fulfilment in other sectors of the profession, feel that to preserve their wellbeing they will work part time only, or worse still, they choose to leave the profession altogether. This means that an enormous human and societal investment is being squandered. There can be very little that is more damaging to the interests of the profession.
It is interesting that when the CCA want to persuade parliamentarians that theirs is a just cause, they often rely upon the experiences of independents to make their case. This happened also during the ‘salt of the earth’ campaign in parliament to resist the initial pharmacy cuts which was led by the NPA.
We know that independents go the extra mile to look after patients and try to keep their services running. It is evident the extent to which Mr Sharma from East Anglia (an area of historic pharmacist shortages) truly cares for his patients as he explained to the APPG how he had missed a family funeral rather than have a pharmacy close due to a lack of a pharmacist.
Would this impassioned commitment to the profession and to patients exhibited by Mr Sharma have been a concern shared by an area manager of a CCA member? Indeed, Freedom of Information requests obtained by the PDA recently showed that certain CCA member pharmacies were responsible for 98% of temporary pharmacy closures in Scotland. Information gathered from pharmacist locums is that often they are available to work, but that the area managers have simply refused to pay them the hourly rates or travelling expenses, preferring to close the pharmacy instead.
CCA member companies are mainly large retailers or wholesalers, and they operate in a very different place and style to small pharmacy businesses. Neither Mr Mason nor Mr Sharma are represented by the CCA and more importantly the CCA does not represent their kind of business. PDA members typically have far more in common with small pharmacist-owned independent pharmacy businesses, than either have in common with the shareholders and venture capital investors of the CCA members. It is unfortunate that through the scale of their pharmacy ownership, CCA members will inevitably have an impact on the wider conditions and reputation of community pharmacy. This is clear when one sees their influence over the pharmacy contract negotiations which has led to commoditisation of community pharmacy activity. Inevitably and sadly, the consequences impact upon smaller businesses like Mr Sharma’s.
PDA Response
Mark Koziol, PDA Chairman responded to the CCA statement: “The PDA is already on record as wanting to support pharmacy businesses to secure more funding, particularly in England, and recognises the genuine pressures on finances, it was heart-breaking to hear Mr Sharma report at the APPG how, unable to engage a locum, he recently missed a close family member’s funeral, and that he is discouraging his own children from joining the sector. Far from dismissing the contributions of Mr Mason and Mr Sharma, the PDA recognise how they reinforce what thousands of PDA members are already telling us.”
Mr Koziol continued
“We must work together to deal with the causes of these problems. Primarily, we must engage the government to address the damage that has been done by the reduction in the global sum. Importantly, we also need to undertake a no holds barred radical review of the way that healthcare is delivered; Pharmacists have so much to offer in the area of pharmaceutical care– this will deliver professional fulfilment for pharmacists enabling them to develop clinical relationships with patients. It is time that the contractual negotiations with the government received direct input from the representatives of pharmacists at the coal face.
Community pharmacy must stop focusing on selling cosmetics and appearing like it is a shop if it is to be taken seriously by patients and politicians alike. It must be seen as a health centre in the high street, playing an important role as one of the elements of a re-engineered and fully integrated system involving both primary and secondary care.
If we can achieve this then we will no longer need to see pharmacists crushed under the weight of a broken system that focusses upon the wrong things; a new system with far reaching benefits to the NHS, the taxpayer and most importantly in the patient’s journey. If we can move to a place where patients become more important than a corporation’s shareholder profits, then perhaps Mr Sharma will once again feel able to recommend our profession to his children”
Pharmacists’ Comments
The PDA listens and values feedback from practicing pharmacists and below are a selection of relevant comments received from pharmacists that responded to PDA surveys:
“The large multiples have ruined pharmacy, with no idea what it means to be a community pharmacist and the pressures faced. With increases to workload and continuous reduction to staffing hours, has put pressure on the pharmacy team forcing people to leave. This is why pharmacists do not want to work in stores which are now unsafe places to work.”
“A good number of pharmacists qualify every year. So many are deflated by the reality of the job conditions that they leave. I’ve been wanting to leave pharmacy altogether for a number of years. It’s a profession that is overworked, with little credit or respect from your other healthcare professionals, company and management, and customers. The daily abuse can get too much to cope with.”
“There are plenty of pharmacists, the issue is big companies not willing to pay the rates. There are many Locums who don’t get booked on a regular basis whilst pharmacies close because they won’t pay travel”
“Loads of pharmacists qualify every year but the retention of pharmacists is poor. I believe this is due to overworking and unrealistic targets. It’s no longer a nice environment to be in. More money can be earned as a locum so of course pharmacists are going to leave and go elsewhere.”
“I think pharmacists are no longer accepting some of the working conditions when you are employed by a company.”
“Plenty of pharmacists, but who get fed up and leave the profession or leave community pharmacy.”
“Community pharmacy is struggling to retain pharmacists. There are more attractive alternative roles with better pay, hours and working conditions.”
“Due to low pay, poor working conditions, unrealistic expectations and an increased workload pharmacists are choosing to leave their current positions and consider alternative roles or locum.”
“I do not believe there is a shortage of pharmacists especially in the community sector as most large multiples claim. The last two years due to covid, have made a lot of pharmacists have a rethink about the profession in general, talking with respect to community pharmacy. The increase in workload pressure, staff shortages and companies cutting budget while pressuring pharmacies to make more profit without providing the right resources for this. I have moved jobs twice within the last two years moving from managerial roles to being just a pharmacist between various large multiples, seeking for greener pastures in the community sector to no avail. Which is why am even considering moving out of pharmacy and maybe studying a different course altogether.”
“There is a huge number of pharmacists out there. There is no shortage. Obviously, there is pharmacists refusing to work for peanuts in horrendous working environments with unrealistic expectations and hence many have chosen either to leave completely or move area.”
“I don’t think there is a shortage of pharmacists, there is too much pressure on pharmacists to achieve targets. Many pharmacies have minimum staff and since the pharmacist is responsible, they tend to put pressure on themselves to make things work.”
“I believe there are many pharmacists that have become disenchanted with the job and have moved into other jobs or become part time workers. There is not enough incentive to do such a stressful, mentally and physically demanding job.”
Related links
- Safer Pharmacies Survey 2021
- Systemic closure of pharmacies
- Some business not reporting closures to the NHS
- Closures: Pharmacist concerns about patient harm and impact on the NHS
- PDA launches online reporting tool to gather data on pharmacy closures
- Pharmacists highlight more unscheduled pharmacy closures
- Member Voice: The myth of pharmacist shortages
- Pharmacists are being asked to switch pharmacies during the day
- Community Pharmacy NHS Contractual Breach Concerns
- Employers’ report into pharmacy workforce challenges does not address their basic responsibilities
- Inclusion on shortage occupation list demonstrates how there is something broken in regards to pharmacist pay rates
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