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Higher community salaries are driving down hospital pharmacist recruitment

by Debbie Andalo

Hospitals are struggling to recruit basic grade and senior pharmacists this year. In the final part of our special feature Debbie Andalo finds out why

Opening of 100-hour pharmacies has upsides and downsides for recruitment

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

Higher community salaries are driving down hospital pharmacist recruitment

Hospital pharmacy is struggling to recruit basic grade pharmacists and those at senior level in 2008. The lure of a higher salary in the community is continuing to attract young pharmacists on band 7, who are turning their backs on a hospital career.

The competition from the community has been acknowledged by the NHS Pay Review Body in April 2008, which is, significantly, recommending a “golden handcuff” for pharmacists after five years of service in the NHS.

Although hospital pharmacist leaders are pleased that the review body has accepted that there is a recruitment and retention problem in the sector, they believe any recruitment and retention payment should be targeted at pharmacists on lower bands where, they say, recruitment is toughest.

David Miller, vice-president of the Guild of Healthcare Pharmacist, says: “I am optimistic about the future because the review body has recognised that there is a vacancy problem and that there is a market force problem — the trick is to create a workable solution.”

During the past 12 months acute trusts say that band 6 and 7 posts are remaining unfilled. Their experience reflects the findings highlighted in the NHS pay review body report, which puts the vacancy rate in England and Wales of band 6 posts at 17.2 per cent, just below that of band 7, which was put at 18 per cent.

Some of these pharmacists are attracted to the community sector, where they can earn more money, while others, say the trust chief pharmacists, are being pulled towards primary care trusts attracted by the offer of a 9am to 5pm working week.

The pharmacy White Paper, “Building on strengths, delivering the future”, while promoting the benefits of hospital pharmacy, is likely to make the inter-sector competition even worse, warns Mr Miller. He says: “A survey of career aspirations of graduates at Aston a couple of years ago ticked all the boxes for a career in hospital because they wanted flexibility within a clinical environment. If a job in the community in future means that you can get the same job enrichment which hospitals offer at the moment, as well as the salary differential, then it’s going to be a problem.”

Preregistration trainees

The number of preregistration trainees attracted to a career in hospital pharmacy varies, hospital pharmacy bosses report in 2008.

Ron Purkiss, clinical director for medicines management and pharmacy at Sheffield Teaching Hospitals NHS Foundation Trust, says that while Sheffield has traditionally had little difficulty with recruitment and retention, this is the first year his trust has been unable to recruit basic grade pharmacists.

The issue is made worse for him because the trust has decided to expand its pool of basic grades to 24.

He says: “I have been trying to recruit 13 more basic grades as so far I have recruited two. I can’t get the people to apply, and at the same time, the quality of those who do apply is really poor. I think the market forces for young basic grades has changed and that universities are promoting clinical pharmacy in the community, whereas, in my opinion, if you want to do clinical pharmacy you should come to secondary care. At the same time chemist chains and supermarkets are offering terms and conditions which we just can’t compete with.”

However, Peter Croot, the pharmacy manager at Basildon and Thurrock University Hospitals NHS Foundation Trust, Essex, says he has had a lot of applications from preregistration trainees and is taking on four at this level this year.

He believes the trust is able to attract new graduates because of its established links with pharmacy schools at the University of East Anglia in Norwich and the new pharmacy school in Medway. He says: “I think we are benefiting because the trust has always put a big impetus on education and training.”

Liz Kay, clinical director for medicines management and pharmacy at Leeds Teaching Hospitals NHS Trust, has had difficulty in 2008 filling posts at band 7 even for “really nice” three-year rotational posts which offer a solid grounding in clinical pharmacy. There have also been problems filling band 8a posts.

The NHS Pay Review Body put the current vacancy rate in England and Wales of band 8 posts at 8 per cent. She says: “I haven’t had problems filling 8a posts before. That is definitely new.”

She is concerned that some trusts may be taking on band 7 pharmacists to fill band 8 posts. She says: “ There just aren’t the people applying for the posts. I think what is happening is that there is a grade differential and people who are band 7 are applying for 8a posts — something which Agenda for Change was meant to stop.”

Her fears were borne out by Mr Croot’s experience in Essex. He reveals that his trust has been unable to find pharmacists to fill band 8a posts such as jobs in medicines information or senior pharmacists in admissions, so has had to offer the jobs to band 7 pharmacists instead. He explains: “That means I have got to train them internally which puts an additional strain on senior pharmacists.”

AfC influence on gradings

He believes one of the factors influencing where the vacancies are remaining unfilled is the grading of jobs under AfC. He says: “I think we suffered from not having many band 7 jobs under AfC — they either fell into band 6 or band 8a.” Mr Miller, however, warns trusts against being tempted to “grade drift” posts in order to fill vacancies. “I have seen examples of people in posts who are not eligible for that grade.”

He says a typical grade 8 post would be for a pharmacist who has a postgraduate diploma and some experience at a senior level. He says: “I think people are getting quite flexible about the interpretation of what is required for these posts. They may have to train people up but there is a danger that people are not able to work at that level and there is an issue around competencies and the risk that somebody could make an equal pay claim against the hospital.”

The option of a golden handcuff in order to retain pharmacists in the hospital sector is a significant recommendation from this year’s NHS Pay Review Body. Its report acknowledged that there is a problem in the sector retaining pharmacists when they reach their third year in the NHS. Although not recommending a sum of money, the review body suggests that a national retention payment should be offered to pharmacists who have achieved five years of service.

The report says: “The aim … would be to increase the supply of pharmacists to the NHS beyond the point at which they often leave, and to enable experienced pharmacists to pass on their expertise to the newly qualified pharmacists who join them.”

The Guild of Healthcare Pharmacists has suggested that any payment would have to be significant — in the region of £10,000 — if the sector is successfully to hold on to experienced staff. But it would prefer that any retention payment was targeted at band 6 and 7 pharmacists in order to encourage them to join the NHS rather than be tempted by the higher salaries offered in the community.

Mr Miller says: “A ‘golden handcuff’ after five years is not going to get people through the door. I think if you are going to wait five years for a payment you are going to want more than just a sum of money. There is also another issue around who is going to pay it. If a pharmacist spends his first four years with one trust then moves in his fifth year to my trust, does that mean I have to pay it?”

Mr Miller believes any retention payment would have greater benefits if it were offered to people in their second or third year in the NHS because it would help boost the number of recruits into the sector. He says: “I would rather that we had six people for three years than keep two people for five years.” While negotiations on the possibility of a national recruitment and retention payment for hospital pharmacy continues, attempts to introduce local deals along the same lines have been unpopular.

Professor Kay had drawn up plans for introducing a recruitment and retention payment for applications for band 7 posts at her trust, but the proposal was rejected by other chief pharmacists in Yorkshire, so was shelved. She says: “I couldn’t get agreement from other people within pharmacy because there was a feeling that it would have a knock-on effect on recruitment in the other trusts.”

Mr Croot is concerned who would foot the bill if recruitment and retention payments were introduced. He says: “I remember, pre-2000, some trusts introduced recruitment and retention payments and ended up shedding posts to pay for it. If it’s centrally funded it could possibly be attractive. At the moment we don’t have a problem retaining or recruiting people — but that could change tomorrow.”

Movement to primary care trusts

While hospitals have historically lost pharmacists to the community sector there has also, in the past year, been a movement of experienced pharmacists to primary care trusts. There is a feeling that there are new job opportunities for pharmacists in primary care — posts devoted to prescribing and medicines management — created by the development of practice-based commissioning.

In Leeds, for example, the acute trust is looking at creating joint appointment with PCTs in order to stop pharmacists moving into the primary care sector — it is a move other acute trusts are also considering.

Professor Kay says: “I think what is happening is that some people are being trained in the hospital sector and then moving to PCTs as clinical pharmacists. I think we should have more cross sector training opportunities and I think it would be useful if we could have posts where people spend a year in a PCT and then a year with the acute trust.”

No evidence that newly qualified pharmacists trained in Scotland go to the community sector

Newly qualified pharmacists in Scotland who trained in hospital are taking a break before looking for their first job, it emerged in June 2008.

Norman Lannigan

The junior level recruitment problem has been compounded by a new trend of pharmacy students from the Republic of Ireland, who have traditionally stayed on to work in Scotland after their preregistration training, deciding this year to return home instead, according to Norman Lannigan, who is chairman of the national acute leaders group for pharmacy in Scotland.

The lack of available pharmacists to fill junior grade 6 posts can also be attributed partly to low staff morale in hospital pharmacies brought about by delays in implementing new bands and pay rates under Agenda for Change, he said.

In his own board — NHS Greater Glasgow and Clyde, which employs 25 per cent of the hospital pharmacists in Scotland — only 70 per cent of staff have finished their assimilation under AfC, he said.

Mr Lannigan who is the board’s lead pharmacist for acute care, mental health and innovation said: “That is causing a bit of a problem because people aren’t sure what their band is. There is also a feeling among some senior staff that they didn’t come out of AfC as well as they had hoped. People aren’t leaving in droves yet but there is a general air of poor morale, which isn’t encouraging preregistration trainees to come into the service.”

Unlike in England and Wales, those young pharmacists who trained in hospital are not being attracted to community and supermarket pharmacy which can offer higher salaries and greater flexible working.

He said: “There is no particular evidence that newly qualified pharmacists have gone to the community sector, by and large what is happening is that people are deciding to go off travelling and take a break between finishing their preregistration training and beginning their first job. We don’t know yet whether this is a one off or not.”

Citation: The Pharmaceutical Journal URI: 10008196

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