Health, Wellbeing and Local Government Committee
Committee Inquiry into Health and Social care Workforce Planning - Written Evidence from the Royal Pharmaceutical Society of Great Britain
Purpose
In this paper we will provide information to support the Health, Wellbeing and Social Care Committee enquiry on aspects of workforce planning in Wales in relation to the pharmacy profession, in line with their terms of reference. A summary of the work undertaken by the Society to develop a workforce planning model and the key features of the pharmacy workforce that can be drawn from our data is provided, as well as providing an overview of workforce planning, role development and training for the profession in Wales.
The Royal Pharmaceutical Society of Great Britain (RPSGB) is the professional and regulatory body for pharmacists in England, Scotland and Wales. It also regulates pharmacy technicians on a voluntary basis, which is expected to become statutory under anticipated legislation. The primary objectives of the Society are to lead, regulate, develop and represent the profession of pharmacy. A National Pharmacy Board for Wales is responsible for implementation of RPSGB policy and provides strategic leadership and support for pharmacy practice development in Wales.
Background
Pharmacy in Wales is a diverse and dynamic profession working at all levels in the health service to ensure that people get the best from their medicines and that other healthcare professionals have access to advice and support on medicines management. The pharmacy team is composed of pharmacists, pharmacy technicians and support staff (pharmacy assistants and medicines counter assistants) with appropriate skills and knowledge, according to their roles.
There are 2341 pharmacists with a registered address in Wales and of these 56.2% are female and 250 are registered as non practicing. There are 380 registered practicing technicians of which 96% are female but this figure is not reflective of all technicians working in Wales as registration is not yet mandatory.
Key features of the pharmacy workforce (GB) include:
The majority of pharmacists, whilst delivering services on behalf of the NHS or to NHS patients, are employed in the private sector, working for either large publicly quoted companies or for small and medium sized enterprises.
More than a third of pharmacists working in community pharmacy are locums, some work regularly for the same pharmacy combining community practice with teaching and sessional work in general practices.
More than half of pharmacists working in community pharmacy are working part time (which is defined as less than 32 hours per week). The majority of this group are female
Around 10% of pharmacists are multiple job holders undertaking part time work in up to three different sectors.
Approximately 20 % of registered pharmacists in Wales (450) work in secondary care.
1. The division of responsibility amongst organisations charged with workforce planning and the mechanisms they use
The Role of RPSGB
The role of the Society in recent years has been to support workforce planning through development of tools, research and analysis of its registration data. Further details are provided in section B.
The RPSGB has commissioned work led by Professor David Guest, Kings College London, to develop a proactive and responsive workforce and modeling system for analysing future workforce needs in pharmacy and to identify the factors affecting the supply of pharmacists.
The major outcome of the programme was a sophisticated workforce model, developed as a flexible planning tool within which the impact of changes in the assumptions of supply and demand can be tested. The model is based on information derived from the Society’s Pharmacy Workforce Census (2002 and 2003) and shows that the future demand for pharmacist services is likely to outstrip increases in supply across employment sectors.
In addition, The RPSGB has worked with the Centre for Pharmacy Workforce Studies, Manchester in commissioning an annual registry analysis and detailed census of the registry (2002, 2003, 2005) which has provided detailed scoping of the workforce profession in the UK and longitudinal analysis over time.
1.2 Pharmacy Workforce Planning in Wales
The picture of workforce planning for the pharmacy team in Wales is not a comprehensive cross profession approach and there is no central overview. The pharmacy workforce is mobile across all sectors of the profession.
The following information relates to both pharmacists and pharmacy technical staff.
1.2.1 Community Pharmacy
In Community Pharmacy, private sector employers undertake their own workforce planning for their own workforce needs. They are intrinsically linked to the business plans of the organisation and as such are commercially sensitive. There is no co-ordination of planning for future workforce at a local or national level within the sector.
1.2.2 Secondary Care
Workforce data for the professions tend to be provided by Trust Human Resource Departments. Depending on the approach taken in each organisation, this process can be divorced from the practitioners, and may not adequately reflect planned or anticipated service developments.
There is concern that workforce planning, whilst being important, is not urgent, and hence does not carry a sufficient priority when HR functions are under increased work pressure due to factors such as mergers and implementation of Agenda for Change and the Electronic Staff Record.
The Welsh Chief Pharmacists’ Committee has recognised the importance of workforce planning for the pharmacy profession and has, through its Workforce subgroup, ensured that there are processes in place to inform the workforce planning process for the pharmacy service across Wales. Staff who are responsible for education and training are directly involved, in order to allow translation of workforce plans into training programme planning, to identify and address capacity issues.
There is no apparent linkage between the workforce planning processes in Trusts and the planning for creation of establishment posts. This results in mismatch of numbers of trainees and availability of permanent posts on completion of their course.
It is essential that when Trusts plan new services they consider in a timely way the staffing requirements for pharmacy workforce to deliver these services.
The workforce planning processes only determine the number of novice recruits that are required in the service. Many novice recruits are motivated to work in clinical, patient-facing roles. There is a need to undertake succession planning and develop attractive career pathways for senior and specialist staff in pharmacy.
1.2.3 Primary Care
In Primary care organisations the pharmacy workforce links into the general workforce planning process for each LHB and is not profession specific. There is no formal co-ordination across Wales or input into the workforce planning for secondary care. This impacts on the secondary care process as a high proportion of pharmacists (and more recently technicians) working for LHBs are former hospital pharmacists. The LHBs do not have their own training structure and rely entirely on recruiting pharmacists from other sectors.
2. The availability of intelligence to inform workforce planning
RPSGB and the GB perspective
As stated in section A, the Society has been able to construct a comprehensive picture of who is working, where and for how many hours in each sector of practice - this information has provided the basis for a mature workforce planning modelii. This model has been developed on a GB basis with analysis of Welsh data incorporated.
In addition to three workforce census reports, the last undertaken in 2005 and published in 2006, the Society (in partnership with the Department of Health and the Welsh Assembly Government) commissioned Kings College to undertake a very large piece of research, also completed in 2005ii. This research looked at the development of demand and supply models for pharmacists across all sectors of practice (public and private).
The model included factual data on numbers of students, pharmacy vacancies and current working profile of registered pharmacists. It also introduced theoretical assumptions based on policy initiatives (impact of the new contract for community pharmacy and Agenda for Change) and future career choices of groups of pharmacists (females and ethnic minority groups).
The model showed that there is and will continue to be a shortage of pharmacists, particularly in community and academia. A summary of the key features of the workforce and consideration of workforce planning for the profession in the GB context is attached as appendix A. The workforce model is currently being updated with more recent registry census data and factoring in known elements of the impact of policy initiatives including workforce demographic trends and the impact (demand) in light off the new contract. This is due early 2008.
To understand in greater depth some of the workforce trends observed in the census and workforce models the Society and Pharmacy Practice Research Trust have commissioned and supported research to look at key influences in practice from undergraduate to registered pharmacist. This includes researching drivers for choosing pharmacy as a career and subsequent career choices. Work on locum pharmacists has also been undertaken in addition to career choices and expectations for pharmacy graduates. There is also currently work ongoing relating to gender and ethnic minorities.
2.2 The European Factor
There is increasing professional mobility within the EEA. For pharmacy this stems from the Directives 85/432/EEC and 85/433/EEC which have now been replaced by the Recognition of Professional Qualifications Directive - Directive 2005/36/EC . This Directive coupled with European enlargement means that many more pharmacists who are EEA nationals and who have EEA qualifications or work experience (which comply with the Directive requirements) are entitled to mutual automatic recognition and registration with the RPSGB. The exact effect on the pharmacy workforce in Wales from this mobility is unknown.
2.3 The Welsh Secondary Care Sector
In secondary care, the Trust Chief Pharmacists have an established workforce sub group and a funded education and training lead pharmacist for Wales. Through this group the specialist has developed a robust profile of the hospital pharmacy workforce based on collation of data from the Trusts across Wales. This has facilitated the commissioning of appropriate training numbers for pre- registration pharmacist places and student technicians across Wales. In addition the development of the postgraduate diploma in clinical pharmacy which has proven to be a significant tool for recruitment and retention. The most recent data on vacancy rates in hospitals in England and Wales shows that Wales has a significantly lower vacancy rate for both Band 6 pharmacists (7.29 % compared with 17.22 % average) and band 7 - 8b pharmacists (5.93 % compared with 11.31% average). These vacancy rates are lower than any English SHA.The clinical pharmacy diploma has also raised the clinical skill levels across the service in Wales.
Recruitment has also been improved through the funding of the student vacational placements at each Trust to build relationships with the undergraduates and has encouraged applications for pre-registration training places at sites throughout Wales.
Supply- Undergraduate training and pre-registration placements
Undergraduate training
The pharmacy undergraduate programme is a four-year Master of Pharmacy programme. Graduates undertake a further year’s pre-registration training and assessment before becoming eligible for registration as a pharmacist by membership of the Royal Pharmaceutical Society of Great Britain (MRPharmS qualification). Pharmacy degrees are funded by the Higher Education Funding Council for Wales (HEFCW) and are not commissioned by the NHS in the same way as medicine and nursing. There has been an expansion in number of schools of pharmacy in Britain in recent years.
The role of the Society in relation to these courses is one of quality assurance. Any university seeking to run an MPharm programme is required to have course accredited by the Society. This process is open to all universities. Thus there is no overarching control of pharmacy undergraduate places either at a Welsh or GB level. This is significantly different for that of most other healthcare professions. There has been an expansion in the number of schools of pharmacy across Britain. There are currently 17 accredited Schools of Pharmacy in the UK with approximately ten new schools currently in the process of accreditation (estimated date of accreditation between 2008 - 2012).
There is one School of Pharmacy in Wales within Cardiff University. It provides undergraduate, postgraduate taught and postgraduate research education to well over 600 students. The School is successful in recruiting international students, bringing income to the School, the University and the local economy and real diversity to the student body. The Welsh School recruits well over half its students from within Wales and again well over half find employment for post-graduate pre-registration training in Wales.
The school of pharmacy produces around 100 graduates each year. Of these, between 20 - 30 undertake pre-registration posts in hospitals in Wales (from a total intake of 38 - 40 posts).
3.2 Pre-registration training
To register as a pharmacist, all pharmacy graduates have to progress through pre-registration training in employment with an NHS hospital pharmacy department or an approved community pharmacy premises.
There is concern in some areas of the profession that at some point in the future capacity for pre-registration training will be exceeded by the number of graduates. A proportion of pharmacy graduates would therefore be denied a route to registration, with a negative feedback effect that this could potentially cause on the number and quality of initial student recruits, even for the Welsh School of Pharmacy.
Recent analysis shows that this is not yet the case, however the full impact of increased graduate numbers from the new pharmacy schools has yet to be felt. Longitudinal research among 2006 GB graduates shows that although not all pre registration pharmacists succeed in getting their placement of choice, the number of pre registration places overall is adequatevi . Research at a later date that incorporates the increased numbers of new graduates over time may well show a different picture.
It is understood that the Welsh School wishes to move as far and as quickly as possible to integration of HEFCW-funded undergraduate education and NHS-funded pre-registration training of future pharmacists. This will require planned integration of the HEFCW and NHS funding streams to establish intercalated clinical placements throughout a fully integrated five-year programme. The main benefits will be that new pharmacist registrants will be more clinically capable, for example in prescribing. There are a number of barriers to this being progressed but these could be more easily resolved on an 'all Wales’ basis through pairing arrangements with private sector employers for example.
3.3 Higher Qualification for Pharmacy Technicians
Development of a degree route for the advanced education and training of pharmacy technicians working in the NHS is being considered by the Welsh School of Pharmacy. If developed it would facilitate career progression that would enhance retention. This may also lead to a new access route to Pharmacy Master degrees and enhance the pharmacist output still further.
3.4 Recruitment and retention
Recruitment and retention of the pharmacy workforce is essential on the delivery of services and research has shown that a fluid turnover and changing workforce can be a barrier to building trust based relationships with other health care professionals. Knowledge of the drivers to both study pharmacy and undertake certain career routes will help to understand why pharmacists move or leave pharmacy altogether. The feminisation of the workforce for pharmacists and technicians and the link with this population to work part time is a key consideration in workforce planning i,iii. In addition, the impact that new policy initiatives have on skill mix, workforce morale and job satisfaction is importantvii.
Registry analysis has indicated that pharmacist in Wales are less likely to want to work overseas but further work is required to ascertain migration of pharmacy graduates to other parts of the UK after graduation and pre registration training.
The introduction of Agenda for Change is likely to have a considerable impact on career progression of pharmacists. The requirement for demonstration of relatively fixed levels of previous experience or training will mean that some pharmacists would have to accept a lower grade post if wanting to transfer to a new area.
4. Changing patterns of demand
The role of the pharmacy workforce in the medicines management process is central to the future of the provision of pharmaceutical care for the people of Wales.
The clinical, financial and political risks associated with the use of medicines are becoming ever more evident. Pharmacists are central to managing these risks and playing a pivotal role in patient safety, waste management, self care and delivering care closer to home.
Over the last two decades the main focus for development has been that of the clinical role of pharmacists. The processes of medicines management are evolving and modernising at a quickening rate. New roles related to medicines are developing for pharmacists (e.g. prescribing rights).
4.1 Skillmix
The shift to a more patient focused clinical role has been facilitated in secondary care by a parallel development of the role of the pharmacy technical staff. The Welsh Hospital Pharmacy Service has a strong track record for continuously adapting and developing its' skill mix. This has included the creation of robust training and accreditation programmes that have developed the skills of pharmacy technicians to enable them to take on roles previously undertaken by pharmacists (e.g. Medication History taking). This has enabled the pharmacists to develop advanced roles (e.g. medicines policies, risk management and prescribing) that make better use of their skills and training.
In Community Pharmacy the extension of patient centered services in the new Pharmacy contract is the beginning of the development of clinical specialisation in Primary care. These changes will mean that the development of technical staff in community will have to mirror those that have already taken place in secondary care.
4.2 Technology
The recent investment in Wales in the automation of the dispensing process in secondary care has enabled service re-design and delegation of technical roles enabling the service to absorb workload and offset some of the predicted increase in staffing required to deliver the service in 2007.
The potential and impact of this technology in community pharmacy is yet to be realised in Wales.
4.3 Drivers of Demand
'Designed for Life’ is a stimulating wholesale review of how and where clinical services should be delivered. Medicines management arrangements will need to respond and develop to enable required changes to be effected safely, effectively and economically. The modernisation agenda for pharmacy and medicines management is driving a demand for increased services. All these factors are combining to generate an increasing demand for pharmacists and technicians.
Moves to increase hours of access to services will also impact on manpower. Delivery of services on a 24/7 basis would have a significant impact on numbers needed to train.
This also applies in primary care with increases in opening hours leading to increase in the number of pharmacists and technicians required to deliver services.
4.4 Capacity
A major issue for the service is now the education and training capacity to produce the staff to meet future demand. Training in all care settings has become more rigorous and time consuming. New roles and technologies require different skill sets which need development and support. To maintain the quality of training there needs to be appropriate capacity expansion or quality suffers.
Pharmacy undergraduate, student technician, pre-registration pharmacist and diploma pharmacist training are all work-based. All require the infrastructure of trainers and tutors, supervision, coaching and assessment.
In secondary care, training posts are funded without any infrastructure monies. As the number of trainees has risen, smarter ways of delivering training have been developed and implemented. Never the less the education and training capacity of the service is approaching saturation. Some departments are already unable to accommodate additional training posts, despite the employment costs of the posts being fully funded.
A major piece of research is currently being undertaken to explore the education and training capacity issue.
It is clear that there is a pressing need for investment in the education and training capacity. Failure to do so will impact on not only the pharmacy service but the wider medicines management one too.
In community pharmacy training responsibility is that of the employer. Investment in professional development such as prescribing status and provision of advanced and enhanced services has to be matched by a potential to deliver services. Furthermore with the likely introduction of mandatory CPD and revalidation of registered pharmacists and technicians, the need to increase the educational and training capacity among providers is essential. With the introduction of standards for CPD and revalidation the quality of training and flexible access must be considered.
4.5.1 Clinical and work placements
One of the new degree accreditation criteria is that all undergraduates must have clinical placement experience in a hospital during their undergraduate programme. There are considerably more undergraduates in each cohort than are ultimately recruited by the NHS but all are accommodated as clinical placement students. In Wales, each student from the Welsh School of Pharmacy has a minimum of 2.5 days in a hospital in the entire 4 year course. In many cases this is the totality of their experience due to limited capacity.
The limited exposure to acute clinical care is at odds with the current policy for increased clinical responsibility for pharmacists however, Pharmacy degrees are HEFCW funded, not commissioned by the NHS, and so there is no funding stream to provide for the placement cost.
A further consideration is the imbalance in the number of pre- registration pharmacist training places between the hospital and community sectors making rotations between sectors difficult.
Cross Border Issues
There are a range of factors relating to Cross Border arrangements with NHS England along the length of the Anglo Welsh boarder. Services interact and staff move freely between organisations. There must therefore be a consistency and mutual recognition of roles if services are to be sustainable. Short term recruitment advantages will be quickly off set and are thus best avoided.
There are a number of workforce issues associated with the provision of enhanced services within the community pharmacy framework. Most enhanced services require some form of extra accreditation before a pharmacist can provide it. Often, the accreditation issues will differ between Primary Care Organisations and are not transferable. This is a particular issue in Wales, as it has a large number of primary care organisations (22 Local health Boards) in a relatively small geographical area, meaning it is highly likely a pharmacist will work in two or more LHBs. These pharmacists will have to obtain multiple accreditations, often of a very similar nature. There are also cross-border issues, as many pharmacists in Wales will work in England, and vice-versa, where again the accreditation requirements are different.
The Welsh Committee for the Professional Development of Pharmacy is working with LHBs and pharmacy bodies in Wales to develop a standardised approach to Wales, however this will not address the cross boarder issue and having to acquire multiple accreditations has a negative impact on manpower availability.
6. Changing professional roles and training programmes
The development of the Clinical Consultant Pharmacist and Pharmacist with a Special Interest (PhwSI) roles are essential to provide clinical leadership across the profession and to promote the integration of services between primary and secondary care, ensuring the deliver of seamless pharmaceutical care for patients across and between care settings.
The PhWSI role will improve access to specialist services and release capacity from traditional clinical specialists as part of demand management.
7. Reflecting Welsh Diversity
There is no formal requirement for pharmacists or technical staff to speak Welsh and data is not available on the number or location of pharmacies where staff are able to deliver services in Welsh. It is recognised that that bilingual patients find it easier to communicate in their first language in times of stress, for example when ill
RPSGB has commissioned research in this area through the Pharmacy Practice Research Trust and the findings of this research will be published in the near future. This will be forwarded to the committee.
Native Welsh speaking healthcare professionals require support to confidently practice their profession in Welsh. RPSGB is keen to work with other organisations across Wales to help deliver this support.
Appendix A
Summary
S1. Key features of the pharmacy workforce:
The majority of pharmacists, whilst delivering services on behalf of the NHS or to NHS patients, are employed in the private sector, working for either large publicly quoted companies or for small and medium sized enterprises.
More than a third of pharmacists working in community pharmacy are locums, some work regularly for the same pharmacy combining community practice with teaching and sessional work in general practices.
More than half of pharmacists working in community pharmacy are working part time (which is defined as less than 32 hours per week).
Around 10% of pharmacists are multiple job holders undertaking part time work in up to three different sectors.
S2. The RPSGB working with the Department of Health and Welsh Assembly Government has developed and tested the first workforce planning model for the profession that covers the NHS and major private sector pharmacy providers. This has demonstrated an emerging gap between demand and supply; highlighted areas of risk of over and under supply of pharmacists in a number of policy, demographic and technological scenarios over a ten year period and allowed recommendations to be made to manage the emerging risks.
S3. The RPSGB has opened a voluntary register for pharmacy technicians and is awaiting legislation to make this statutory. This, together with proposals in the Health Bill which will define the extent to which pharmacists may delegate certain activities to technicians under supervision and where pharmacy technicians might supervise certain activities in place of the pharmacist, will allow proposals around skill mix to be developed where appropriate.
S4. An area of particular concern, arising from the expansion in pharmacy student numbers (44% since 1998) and the demographic profile of the current workforce, is the lack of planning and capacity development amongst the academic workforce - this is being investigated further but a capacity development programme will be needed. The RPSGB has recently re-launched its PhD Studentship programme in response to the growing problems.
Background
The Royal Pharmaceutical Society of Great Britain (RPSGB) is the professional and regulatory body for pharmacists in England, Scotland and Wales. It also regulates pharmacy technicians on a voluntary basis, which is expected to become statutory under anticipated legislation. The primary objectives of the Society are to lead, regulate, develop and represent the profession of pharmacy.
1. The RPSGB is concerned to ensure that the profession has the capacity (in terms of numbers and skills, knowledge and attitudes/values) to deliver high quality services that, above all else, are safe for patients and in which the public can have confidence. It is from this perspective that the RPSGB takes forward its portfolio of work relating to workforce and education policy.
2. The primary
practice responsibility of the pharmacy team is to ensure that patients, their carers and the public achieve their desired health outcomes, primarily through the safe and effective use of medicines. These responsibilities are delivered through the provision of up to date, safe and cost effective pharmaceutical services, information and products. The teams work in partnership with patients (and their carers) and other members of the wider healthcare team in order to discharge their professional responsibilities. An increasing number also undertake teaching and training responsibilities for students and trainees in pharmacy and more widely within the healthcare team.
3. However, it must be recognised that for a number of pharmacists and technicians, who work primarily in industry and academia, whose practice responsibility relates more widely to the discovery and development of medicines themselves and covers research, development, regulatory affairs and production amongst other functions - whilst their practice is not focussed on direct patient care their activities contribute to the wider purpose of the profession of pharmacy.
4. Based on results from the 2003 Workforce Census, carried out by the RPSGB, the pharmacist workforce is distributed as follows:
5. Key features to note are as follows:
The majority of pharmacists, whilst delivering services on behalf of the NHS or to NHS patients, are employed in the private sector, working for either large publicly quoted companies or for small and medium sized enterprises.
More than a third of pharmacists working in community pharmacy are locums, some work regularly for the same pharmacy combining community practice with teaching and sessional work in general practices.
More than half of pharmacists working in community pharmacy are working part time (which is defined as less than 32 hours per week).
Around 10% of pharmacists are multiple job holders undertaking part time work in up to three different sectors.
6. The pharmacy team also includes pharmacy technicians and other support staff; technicians are currently able to join a voluntary register at the RPSGB which it is anticipated will become a statutory register in due course. There are currently 2770 technicians voluntarily registered with the RPSGB. Detailed workforce data is not yet available for technicians, once a statutory register has been established it will be possible to undertake a census and to establish a similarly detailed picture of the technician workforce.
7. The RPSGB, working with the health departments in England, Scotland and Wales, has recently completed the development of a computer based workforce planning model for pharmacists which is designed to assess the impact of different policy options on the risk of either over or under supply of pharmacists. The information provided below is based on the background work underpinning development of the model and outputs from it.
8. How effective has workforce planning been and how should it be done in the future?
Until the work described above was commissioned in 2002/03 no attempt had been made to undertake a profession wide workforce planning exercise for pharmacy. The size of the workforce in pharmacy has been essentially market driven with no centralised planning as seen in for example medicine and dentistry. Overall supply has kept pace with the demand with existing schools of pharmacy increasing student numbers and new schools of pharmacy opening - there has been an overall increase in student numbers of 44% since 1998. The recent modelling work indicates that there is now a gap between supply and demand, especially in some sectors of the workforce and, most worryingly for the long term, in the academic workforce.
9. Many of the large private sector employers in pharmacy have traditionally undertaken quite detailed planning for their own workforce needs. The NHS has monitored its workforce with regular surveys for many years identifying shortage areas and vacancy rates as indicators of undersupply - no central view of workforce demand has been available.
10. In relation, specifically, to the longstanding involvement of major private pharmacy providers it should be noted that for private sector employer’s workforce planning data are intrinsically linked to the business plans of the organisations and, as a result, are commercially sensitive. In conducting its work the RPSGB utilised an independent research team to collect information and to maintain confidentiality. The need to protect commercially sensitive information and to respect commercial confidences was quite unique in pharmacy at the time the RPSGB project was undertaken. However similar concerns will increasingly impact on how and indeed whether workforce planning can be undertaken for other professional groups if the use of private sector providers in the NHS increases.
11. The workforce planning model now available for pharmacy will support all the stakeholders interested in analysing the pharmacy workforce. However, for the data to be useful in terms of ensuring that supply and demand are broadly aligned, joint working will be needed at a strategic level - the StLaR initiative between DH & DfES offers a useful model which has progressed discussions about academic workforce and career development.
12. How should the effects of technology, policy, changing demographics and private provision be taken into account?
Impact of these factors on both demand and supply should be considered separately and then combined to assess overall impact on workforce - this requires identification and verification of measures that reflect current workload and determination of attitudes to work amongst the workforce in order to predict impact on supply.
The workload measures used for pharmacy are as follows:
Community Pharmacy: prescription items per pharmacist hour.
NHS Hospital Pharmacy: Whole time equivalent pharmacists per 1000 FCEs (Finished Consultant Episodes).
NHS Primary Care Pharmacy: Whole time equivalent pharmacists per GP Partnership.
Industrial Pharmacy: weighted demand based on a function of the average number of new medicines introduced per year plus a proportion of the number of new medicines in Phase 3 clinical trials + a proportion of the number of GP Partnerships.
Academic Pharmacy: Undergraduates in Schools of Pharmacy per pharmacist.
Three sets of career anchors have been identified and used to predict the likely impact of policy, technology etc. on the supply of the pharmacy workforce. The following three attitudinal profiles (career anchors) predict the propensity of the workforce to leave jobs, sectors or indeed the profession or to reduce working hours:
Improving people’s well-being and making a contribution to society
Ensuring long term employment and financial security
Balancing and/or integrating work and life outside work
As the nature of the workforce changes in terms of socio demographic, gender and ethnicity these profiles are likely to vary across different cohorts within the workforce and need to be monitored and updated regularly to maintain the model.
13. To what extent can and should demand be met?
A range of approaches can be used to bring supply and demand back into balance - a combination has been proposed to address the emerging gap between demand and supply in pharmacy. Care has to be taken in deploying demand side solutions as many will have impacts (often negative) on supply factors - a balance has to be struck and trade offs made regarding timescales to implementation in order to manage expectations and avoid negative impacts on supply side features. This suggests that a significant amount of work is needed to develop a long term view of workforce needs, especially where the training pipeline is relatively long (for pharmacists this is 5 years to initial registration and up to 10 years for some specialist and advanced areas of practice). Initiatives in retention with recruitment should be carefully balanced to avoid alternating and damaging periods of over and under supply.
14. There is a gap between demand and supply in the pharmacy workforce and anecdotal evidence suggests that this is covered in a number of ways:
Working longer hours (the attitude survey indicates that pharmacists work an average of four hours a week longer then their contracted hours).
Dealing more swiftly with scripts at a rate above the official safety levels.
Cutting back on non-core activities and back-up activities.
Some reduction in service provision (e.g. out of hours work; vacancies left unfilled).
Extending the role of pharmacy technicians and assistants, and others, to substitute for pharmacists.
15. Thus whilst there are no outward signs that the service is failing to meet demand and expectations of patients going forward, there must be concerns over the safety and sustainability of the emerging picture. Recognising this as series of policy recommendations have been made by the Pharmacy Workforce Planning and Policy Advisory Group - a number of which have already been set in train.
16. How should workforce planning be undertaken?
For small professional groups, especially those with long training pipelines and whose practice depends on a high level of technical/clinical skill and/or specialist knowledge, a case can be made for an element of centralised planning. As acknowledged previously supply and demand have stayed largely in balance in pharmacy with expansion in student numbers keeping pace with increased demand - this has occurred through the responsive market in higher education and without any centralised planning. However, the emerging problems with academic workforce are a consequence which can realistically only be addressed at a national level. A planned expansion, similar in process to the recent expansion in medical education, would have allowed a more strategic approach to funding and capacity development.
17. Of itself workforce planning for any professional or managerial group will not prevent under or indeed over supply of clinical and professional groups, realistically workforce planning enables those with power to increase recruitment and retention or to manage demand to assess risks and make choices. Unless there are clear lines of accountability to allow appropriate and timely action to be taken the risks identified cannot be managed or minimised effectively.
