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Has stability returned to the primary care sector? Survey aims to find out

by Debbie Andalo

In the second part of our feature, Debbie Andalo discovers what senior pharmacists think about the state of employment in primary care pharmacy

For the first time a national survey of pharmacy staff vacancy rates in primary care is being carried out in 2008. Questionnaires are being sent to all primary care trusts, or their equivalents, across the UK. This will give an indication of where the jobs are being left unfilled.

The survey is being carried out by the National Pharmacy Education and Development Committee, which promotes the profession’s education and training. The UK-wide initiative follows a similar survey of the 31 London PCTs last October, which revealed vacancy rates of 13.2 per cent and 11.5 per cent among pharmacists and pharmacy technicians, respectively.

The survey is being co-ordinated by Peter Sharott, director of East and South East England specialist pharmacy services. It will based on PCT vacancy rates for May 31 this year. He says: “It will give us a fix on the number of people, the vacancy rates and patterns. It will act as a starter and give us a base line to work form.”

The survey comes as pharmacists working in primary care in England say that some stability has returned to the sector following the upheaval caused by reorganisation over the 18 months.

Morale has improved and pharmacists are getting on with the job, rather than being diverted by fears of redundancies; there is also some excitement about the professional opportunities which the pharmacy White Paper, “Building on strengths, delivering the future”, will bring as well as the review of health care in England being undertaken by Lord Darzi, who is due to report his findings shortly.

Sue Carter is area head of medicines management, prescribing and pharmacy for West Sussex PCT and a former chairman and secretary of the Primary Care Pharmacists’ Association (PCPA). Morale in her local PCT hit rock bottom last year while PCT mergers were still going through, but this summer, she says, people are feeling more optimistic about the future: “Morale is a lot better. Although the organisation is still going through change, there is a feeling of trying to make the organisation work”.

Current PCPA chairman Shailen Rao also reports that morale has improved nationally. He says the sector is “slowly starting to settle” following reorganisation, and for many people in pharmacy “the reality wasn’t as bad as the perceived problem”.

However PCTs are still facing change and new ways of working though the government’s “world class commissioning initiative”, which aims to improve the quality and commissioning skills of PCTs. He says: “This is creating [further upheaval] in the new organisations — the only constant is change.”

However, he believes there are also opportunities for pharmacists through world class commissioning. He says: “I think there is still a need for medicines management teams and PCTs to look at medicines management and what it should look like if you want to make it fit for world class commissioning.”

Plenty of opportunities

Although some pharmacists lost their jobs through reorganisation, Mr Rao says “the work still need to be done” and there are plenty of opportunities for pharmacists who may have been made redundant to work freelance.

Mr Rao, who lost his job and works as a consultant, says: “The past year has been fantastic. I have taken on a variety of jobs working on the prescribing budget for a group of GPs involved in practice-based commissioning. I have also been involved in developing a commissioning toolkit as well as working with other PCTs and the pharmaceutical industry on medicines-related projects. The jobs are there and the work has to be done. There are creative job opportunities.”

His views are borne out by Harriet Lewis, head of community pharmacy services and pharmacy development manager for Trafford PCT. While she believes the results of the Darzi review will bring new clinical opportunities for pharmacists, she thinks the option is already for pharmacists “who sit behind their desks at the PCT” to become independent prescribers. “I know of one or two people who have already done it — some as a result of the fall-out through reorganisation but others who just felt they needed a good kick up the backside.”

She believes there are also other job opportunities around drugs misuse services. “I know of one pharmacist, who felt he needed to do something new as he was so bored, who took himself off and did a post-graduate qualification in substance misuse. He is now providing a specialist practitioner service to a drugs and alcohol team.”

She, like Mr Rao, was also aware of other cases where pharmacists who had lost their posts through reorganisation were now offering their services as self-employed independent consultants. She says: “It’s an interesting development — they are still doing the same job in terms of clinical expertise but doing it directly for the GPs.”

Ms Lewis reports that pharmacy primary care is more settled this year. “It feels much more secure,” she says. Her opinion is shared by Ms Carter who adds: “We are pretty stable at the moment and there is some recruitment going on — if we can find the time to wade through the recruitment process. While there isn’t a network or national exchange of information across the profession and PCTs, it does feel better than it did last year.”

She says that the workload has increased for PCT pharmacists in the past 12 months, especially around risk. “We are trying to make sure that there are appropriate posts, and people in those posts, to manage the risks around medicines.” There are also new job opportunities for pharmacists through practice-based commissioning, says Ms Carter, although the extent to which this is happening across her own PCT is variable.

She says: “There are areas where it’s having a big impact and other areas where it isn’t.” Some PBC groups have used the initiative to employ pharmacists while others “think they can use the money (which could have been spent on employing pharmacists) in other ways.”

In Trafford, Ms Lewis reports that some PCTs are looking to hive off their medicines management services to practice-based commissioning groups. She says: “Some PCTs have identified that it should be within PCB clusters — if they are organised enough — either to employ the service directly or for it to remain provided by the PCT for the time being.”

At the heart of the issue is who should pay for the service, she says. “I think from a job perspective it is better if the work stays within the PCT because (whatever happens in the future) it will always need a corporate medicines management function. I do though think that some of the medicines management practice-based work is being hived off and medicines management staff are being employed by the GPs.”

Pharmacists working in primary care, like other NHS sectors, have their eye on the new pharmacy White Paper and are hopeful that it will bring new clinical responsibilities.

Ms Carter says: “There are still a lot of ‘what ifs’ and ‘buts’ and I think in some ways it is quite difficult to get to grips with the White Paper and I think it is still open to interpretation. But I think it is really a great time to be an NHS-employed pharmacist. There are some really great challenges and being at the nub of things — working with patients to improve concordance and compliance.”

Citation: The Pharmaceutical Journal URI: 10008195

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