Are there any hospital job vacancies for pharmacists?
The latest NHS pharmacy staffing and vacancy survey paints a relatively calm picture for hospital pharmacy recruitment and staffing but, as those with an eye to NHS reform will tell you, the sector is far from being a sure-fire bet for future pharmacy employment.
The latest (2010) survey covers the May 2009–10 period, which is pre-NHS reform, and pre-Quality Innovation, Productivity and Prevention initiatives, and both of these are set to have significant influence on the job market in hospital pharmacy at all bands. For this reason, David Miller, president of the Guild of Healthcare Pharmacists, is waiting with interest to see the 2011 survey, which will cover the May 2010–11 period, and the effect on the numbers of hospital pharmacist posts of the on-going cost-saving QIPP programme. He says: “At this point, it is just impossible to know where the number of posts will be.”
The 2010 survey shows that the number of UK pharmacist staffing establishments in NHS trusts was up 2.2 per cent (152.7 full-time equivalents), compared with the 2008–09 period, and that overall more posts were established than disestablished during the year, suggesting a net increase in the number of pharmacy jobs to be had, particularly at bands 7 and 8a.
Vacancy rates, often cursed by the understaffed and overpressured pharmacy department, also fell overall — down from almost 14 per cent of the total pharmacy workforce in 2008–09 to 11.4 per cent in 2009–10. Even at the problem band 6 level, which has traditionally been plagued by higher-than-average vacancy rates, rates have fallen to an almost respectable 16.3 per cent. Although still above the average pharmacy vacancy rate, this is much improved on the 24.8 per cent permanent vacancy rates (ie, one in four posts vacant long-term at band 6) seen during 2008–09.
This fall in the number of vacant band 6 posts, even taking into account the greater proportion of posts lost (disestablished) at this band than any other level, suggests a net inflow in the number of junior NHS pharmacists. Almost certainly, Government efforts to oil the wheels of preregistration training in NHS pharmacy (the Task and Finish Group on Pharmacist Numbers) will have contributed to this — by increasing the lure of NHS pharmacy through better access to mental health trusts and primary care organisations during preregistration training, and rethinking the timing of the recruitment interviews for preregistration places. Possibly also playing a part is the growing disenchantment with unsociable hours in 100-hour community pharmacies or disquiet over the emergence of MUR “factory” multiple pharmacy posts. It may be that downward pressure on community pharmacy salaries, not to mention reducing vacancies in community pharmacy, have also played a part.
As to the reasons for the loss in the number of band 6 roles, it is possible that this may be due to ongoing and upwardly mobile “grade drift”, actual increased demand for more specialist roles and a lack of back-fill for the newly vacated lower grade post.
Whatever the reasons for the reduction in the band 6 vacancy rate, the net increase in the flow of newly registered hospital pharmacists is generally being seen as a good thing; it adds much needed fuel to a training level widely considered the “engine room “for hospital pharmacy expertise at the higher levels.
However, as with all national overviews, there are areas and niches that buck the overall trend. Overall long-term pharmacy vacancy rates of 11.4 per cent in England belie regional pockets of vacancies that increased during 2009–10, compared with the previous year. Typically these are found in the harder-to-fill regions such as the south west, and may be due to previous years’ recruitment drives that are yet to bear fruit.
This is certainly the case at South-West Strategic Health Authority, says Liz Redfern, its director of patient care and nursing and workforce development. “Between 2009 and 2010, we increased the number of pharmaceutical posts in the region to ensure that we maintain high quality standards of services. However, it takes time to recruit to new positions because we need to ensure that we attract the best possible person for the job. The NHS in the south west is dedicated to ensuring that patients receive the highest quality health and care services timely and appropriately,” says Ms Redfern.
Overall national increases in hospital pharmacy post numbers also hide regional variations and, by drilling down into the survey’s regional reports, it is clear there are particular issues with pharmacy post disestablishments in Scotland. During 2009–10, Scottish hospitals saw their overall number of pharmacy posts culled 9.2 per cent compared with 2008–09. The figures also paint a stark contrast to the 3.9 per cent increase in pharmacy post numbers seen in England and 3.4 per cent increase seen in Wales. Northern Ireland also saw its numbers of pharmacy posts hit, but down a much more modest 1.7 per cent compared with Scotland, and compared with numbers of posts seen in 2008–09.
Looking at band level disestablishments in Scotland, the 2010 NHS pharmacy staffing survey reveals post losses at all levels, except for band 8b, which actually increased the number of posts by just over 13 per cent. Colin Rodden, the GHP’s national secretary for Scotland, attributes the figures to a complex range of factors, including ongoing Agenda for Change reviews in two of Scotland’s biggest health boards (Greater Glasgow and Lothian), and long-term vacancies which, in the climate of Scotland’s cost improvement plan, may be leading to a “natural wastage” of vacant posts. Whatever the causes, he says the picture is not encouraging for the future of Scottish hospital pharmacy. He says: “If we can’t recruit, we are going to have major problems.”
Pre-QIPP and pre-NHS reform, the period that the 2009–10 survey documents, NHS pharmacy was different then. Increasing demand for hospital pharmacy services from an ageing population, suffering more complex disease areas and demanding treatment with an increasingly available pipeline of specialist secondary care drugs, coupled with achingly high NHS pharmacy vacancy rates, all encouraged a net demand for hospital pharmacists and, with it, pressure to increase salaries and accelerate clinical training as far as Agenda for Change and the savviness of the chief pharmacist would allow.
It was also an era where hospital pharmacies could look forward to new staffing establishments in mental health trusts, as they looked to appoint chief pharmacists rather than deliver pharmacy services through the traditional service level agreement model with another trust.
As QIPP makes its presence felt, it is possible that pharmacists’ medicines management expertise will become more of a valuable commodity, positioning the profession well as an “enabler of the QIPP agenda, helping to meet cost pressures in relation to prescribing practices, avoidance of waste and use of medicines in every setting while maintaining patient safety and high quality care”, according to Susan Sanders, director of London Pharmacy Education and Training, and one of the authors of the annual NHS staff survey.
This is certainly in line with the thinking at the GHP, which suggests that the medicines management role is considered “valuable” in terms of cutting down on drug costs. However, this is absolutely not the experience at Ealing, Hillingdon and Hounslow Primary Care Trust subcluster, which describes its pharmacy team as “decimated” by the need to make financial savings.
Also in pharmacists’ favour is the move towards delivery of care closer to home in integrated care settings, which will, according to Ms Sanders, “continue the demand for qualified pharmacists, pharmacy technicians and pharmacy assistants”. Whether this demand will be catered for by hospital or community pharmacists remains a moot point. Fiscal pressure in the NHS and QIPP are already encouraging the development of public-private partnerships (PJ, 2 July 2011, p26) and community pharmacies, with an eye to the margins available from service development, have already begun to muscle in on pharmacy services typically delivered by NHS pharmacists (outpatient and discharge dispensing, to name two emerging community pharmacist-led activities). When they win a tender, the experience to date is that the community pharmacy provider brings in its own staff, often at the cost of several pharmacy department roles.
The answer to whether these types of service remain in the NHS or increasingly go out to tender in the future stands to have a significant influence on the number of posts available to NHS pharmacists. Fewer posts, particularly at the junior level will mean fewer opportunities for the newly registered pharmacist prepared to forsake a still premium community pharmacy starting salary in favour of the NHS’s more clinical training.Already one-third of NHS preregistration trainees end up heading away from the sector, according to a 2009 study of outcomes and destinations for NHS preregistration trainees.
This has prompted the leads at the Pharmacy Education and Training team to argue that more — not less — needs to be done to ensure that pharmacy graduates end up training and then working in the NHS. Ms Sanders says: “The barriers to training for NHS trusts need to be urgently explored if we are to continue the pharmacy record of wise use of skill mix, and avoid unnecessary wastage of resources.”
Citation: The Pharmaceutical Journal URI: 11080598
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