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Education

Disappointment at decision to ignore call to cap pharmacy student numbers

The government’s decision not to introduce some form of intake control went against most responses to a consultation on the matter.

Greg Clark, minister for science, universities and cities, states government's refusal to ignore cap on pharmacy student numbers

Source: Richard Gardner / Rex Features

Greg Clark, minister for science, universities and cities, says the decision not to cap pharmacy student numbers is in line with wider government policy

A government refusal to introduce controls on the number of pharmacy students in the UK has been met with disappointment by pharmacy organisations. However, plans to make pharmacy a five-year integrated degree will press on, a move that has been welcomed.

An analysis of responses to a 2013 consultation has been released by the Higher Education Funding Council for England (HEFCE)[1], and found that the majority of those surveyed supported the introduction of some form of student intake control.

However, Greg Clark, the government’s minister for science, universities and cities, vetoed this option in a letter to HEFCE on 1 September 2014. “I have decided that it is not necessary to introduce a specific student number control for pharmacy.” The minister says that this is in line with wider government policy to remove student number controls wherever possible.

Removing limits on student numbers across higher education became government policy in autumn 2013, around the same time as the consultation on pharmacy student numbers — a joint exercise between HEFCE and Health Education England (HEE) — was launched. HEFCE is responsible for distributing funding to universities in England and is part of the Department of Business, Innovation and Skills, while HEE acts on behalf of the NHS to oversee the training of healthcare professionals and is part of the Department of Health (DH).

The consultation, initiated by Clark’s predecessor, David Willets, was in response to a comprehensive analysis by the Centre for Workforce Intelligence, which predicted that there will be an oversupply of between 11,000 and 19,000 pharmacists by 2040. The number of pre-registration trainees has grown from 1,534 in 2003 to 2,842 in 2013 and the number of schools of pharmacy in the UK continues to grow, now standing at 27. There are fears of a shortage of pre-registration training places for pharmacy graduates and a high level of unemployment.

Three options were proposed in the consultation: maintaining the status quo and allowing the free market to determine numbers; introducing an intake control on student numbers; or creating a break-point in the degree that would only allow a certain number of students to progress to become pharmacists.

Dave Branford, chairman of the English Pharmacy Board of the Royal Pharmaceutical Society (RPS), says the responses to the consultation show that most stakeholders are unconvinced that patient care or the student interest would be best served by allowing the market to continue to determine outcomes, or by creating a break-point during study. “The RPS will be seeking an early meeting with officials to understand the basis for such a disappointing decision.”

Mark Koziol, chairman of the Pharmacists’ Defence Association, says the decision not to cap numbers is part of a wider problem. “There’s no workforce vision for pharmacy, so any decision would have been arbitrary.” Koziol says the original consultation was “all about supply” and did not address demand.

He adds that the DH has failed to identify, “in anything other than in the most vague and wishy-washy” terms, exactly what it is that pharmacists will be doing in the future. Koziol suggests that the oversupply of pharmacists will be exacerbated by the current rebalancing legislation, which he predicts will transfer responsibilities from pharmacists to technicians. He argues that remote supervision will mean pharmacists are no longer required in community pharmacies.

Rob Darracott, chief executive of Pharmacy Voice, disagrees but says that more work is needed to define how pharmacists and technicians should work together. Darracott is also disappointed with the decision not to cap student numbers. “We’re talking about a health profession — the vast majority of 18-year-olds going to study pharmacy are expecting to come out the other side as practising pharmacists”.

Darracott says that the introduction of a five-year integrated degree has the potential to mitigate some of the problem. Currently, the pharmacy degree is a four-year course, with a subsequent preregistration training year. The proposed plan is to integrate this work-based training into a five-year degree. If this is introduced it will “have to bring in an element of control over student numbers”, says Darracott, because universities will have to work with employers to guarantee training for their students.

HEE now intends to prioritise the reform of planning, funding and delivery of pharmacy education because of the “now well-embedded direction of travel in the NHS to use the knowledge and skills of pharmacists more effectively”.

Proposed changes to the pharmacy degree were not mentioned in the minister’s letter. He instead addresses the current lack of pre-registration training places that are open to pharmacy graduates. “It is necessary for universities to ensure that prospective pharmacy students are aware that in studying pharmacy they are not guaranteed a post-graduation pre-registration year place,” he writes, adding that he will ask HEFCE to work with HEE to ensure prospective students are fully aware of this before applying for courses.

The British Pharmaceutical Students’ Association hopes the minister’s comments will not negatively impact on the continued development of the five-year degree proposal. It also expressed disappointment in the decision not to cap student numbers.

One organisation in favour of the decision is the Pharmacy Schools Council. It says it is working with stakeholders across the pharmacy sector to develop a vision of what the role of the pharmacist will be in the future, building on the plans for a five year degree.

The General Pharmaceutical Council (GPhC) did not comment on the decision about student intake controls, but said it looks forward to playing a part in progressing pharmacist education and training, particularly around the introduction of a five year integrated degree. “In early 2015, the GPhC will be undertaking a pre-consultation exercise on the regulatory standards for the initial education and training of pharmacists.”

HEE indicates that under the reforms emphasis will be placed on more pharmacists becoming independent prescribers. Darracott, who was involved in developing the proposals, explains that the education reforms were looked at with a view to how “pharmacists could be independent prescribers from day one”. 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066927

Readers' comments (3)

  • Graham Phillips

    In case you missed my letter to the journal on this, here it is!

    INCANDESCENT!

    So, despite all the evidence, painstakingly compiled by the pharmacy profession, ably led by the RPS, our justified expectations of a cap on pharmacy student numbers are dismissed in a few brief sentences by Greg Clark, “Minister for Universities”

    Fellow pharmacists please note, The Rt Hon Greg Clark is MP for Tunbridge Wells, Kent and can be found on twitter here: @gregclarkmp Please pay him a call!

    According to “our Greg” a cap is “not necessary for pharmacy students because it is government policy to remove student number controls wherever possible to give students greater choice" and encourage universities to offer better quality courses”
    What utter rubbish. Other health professions (medicine, dentistry) benefit from student number controls why should pharmacy be any different?
    In his astonishingly brief letter, Mr Clark states that pharmacy students "can and should benefit from this reform” but, other than political dogma, adduces no evidence whatsoever in support of his assertion. Neither does he explain how the five-year integrated pharmacy training that all agree is needed to produce “fit for purpose” future pharmacists can possibly be achieved without matching students numbers to places related to the demand for pharmacists.
    The RPS has been working on this issue for years. We had all the relevant authorities onside, and the consultation which ran last year revealed overwhelming support for controls. In fact only the vested-interests of the Schools of Pharmacy demurred and they are fatally conflicted on this issue.
    I have been agitating for a much wider role for pharmacy in the NHS under the campaign theme “How Pharmacy Can Save the NHS”. This weekend the RPS had an incredible success in the media arguing for a Nationally-Commissioned, Pharmacy-based common ailments service.
    http://www.rpharms.com/what-s-happening-/news_show.asp?id=2347
    Significantly, the RPS lined up the medical profession and others behind the campaign.

    The RPS also wants pharmacists to have: closer links with GPs; access to patients’ electronic health records; increased input to care homes and an increased role in patients with long-term conditions. All of these, of course, rely upon pharmacists having the right education and skills. We need to attract the very best students to our profession, reward them decently upon qualification and not treat them as “expendable cannon fodder”. It seems Mr Clark is woefully ignorant of all these issues and its down to us to disabuse him. The RPS needs to add one more strand to its campaign

    Meanwhile I am incandescent


    Graham Phillips, FRPharmS

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  • "...the oversupply of pharmacists will be exacerbated by the current rebalancing legislation, which he predicts will transfer responsibilities from pharmacists to technicians. He argues that remote supervision will mean pharmacists are no longer required in community pharmacies."

    I hope this is a misquote! Now is not the time to capitalise on fears and drag the remote supervision issue back into the limelight.

    Rather than halting progress, we should be aiming to develop new roles for the expanding pharmacy workforce. We should be aiming for 2 pharmacists per pharmacy where the workload is such that its unbearable for one. We should be aiming for closer working with GPs in primary care; long term condition support, pharmacist prescribers supporting acute and minor ailments, physician's assistant roles, etc.

    GP representatives want 10000 more GPs. We will have 10000 excess pharmacists. Let's have some common sense - we have a massive opportunity to save the NHS some money and to improve patient outcomes.

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  • With the government’s decision not to manage entry onto MPharm programmes in England, we seem to have come full circle to the position we found ourselves in a couple of years ago, but probably now in a worse situation. Then, NHS civil servants were advising me (as the then chair of CUHOP) that it was unlikely to fund growth in preregistration places beyond those it felt was necessary to meet the healthcare needs of England, following the precedents set in Northern Ireland and Scotland. After a long discussion on managed entry into schools of pharmacy aimed at addressing this issue, including a consultation where controlled entry was largely supported by the profession, its regulators and educational funders, this avenue for the moment has been closed. So the unresolved issues remain as follows.
    So far there appears to have been a growth in NHS funded preregistration places to accommodate the current increased numbers of preregistration graduates. Will the NHS continue to fund this growth into the future, noting the need for closing £8 billion funding gaps and given that the Centre for Workforce Intelligence report on the pharmacy workforce predicts an oversupply of pharmacists?
    Stephen Messham of the BPSA is right to flag up (Pharmaceutical Journal 25th October) that in future even if NHS funding continues, growth in preregistration numbers is unlikely to match the ever increasing number of graduates (given two new schools having intakes this year, one more next and one more the year afterwards, with probably more in the planning stage).
    Luigi Martini and Sian Howells (Pharmaceutical Journal 25th October) report on concerns in preregistration placement experience of some of their graduating students, and it is notable that the recent expansion in preregistration places appear not to be in the hospital sector, the larger multiples or industry, who in the main have well developed preregistration training programmes.
    In his announcement the minister seemed to want to promote informing applicants of the pitfalls of entering a pharmacy course, i.e. the increasing chance of not being able to complete a preregistration training programme for many graduates. Once this becomes common knowledge to career advisors and in social media discussions it would be expected to result in a significant decline in the quantity and quality of applicants to English schools of pharmacy, as the most talented seek other more secure routes into healthcare professional practice. The severity of the ‘market correction’, and its consequences are unpredictable, but it is a fair bet that it will be damaging to pharmacy education for several years to come, and could even result in the perhaps unexpected consequence of pharmacy courses declining in those universities that generally find it easiest to attract high quality candidates.
    How will the recommendations of Modernising pharmacy careers workstream 1 be implemented, a proposal supported by most of profession, where there will be a need to match undergraduate numbers to major placement numbers? Indeed if significant numbers of pharmacy graduates are no longer going to be able to enter professional practice, there will be pressure to make the courses more generic to prepare graduates for a variety of other career options.
    Sadly, it would appear that David Willetts laudable wish to ‘secure the student interest’, as well as more generally those of the professions and ultimately the patients they serve, is no longer a priority.

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