Is there hope for those who want to work in the primary care sector?
Pharmacists with an eye to employment in primary care may be encouraged by the Government’s latest pledge to “ensure high quality management is valued across the NHS, with a commitment to retaining the best talent across the primary care trusts and strategic health authorities”. However, for some, this response to the NHS Future Forum report will come as too little, too late.
A year down the line towards PCT abolition in England, PCTs have already made substantial changes to their management structures and, with this, their headcounts. By the end of June 2011, PCTs in England were expected to have completed the first stage in the abolition process — a milestone marked by the deadline for the formation of clusters and the establishment of clusters’ single executive teams. However, the year-long process, which was first mooted in the NHS reform White Paper of 2010, and which has continued despite the “pause” elsewhere in the reform process, has proved a painful time for pharmacists and medicines management teams in England’s PCTs.
One of the first tasks for Beryl Bevan, chief pharmacist at the new Ealing, Hillingdon and Hounslow PCT subcluster, has been to make over a third of her medicines management team redundant — nine pharmacist posts out of an at-risk pool of 28. She, herself, had to apply for the chief’s post at the new subcluster or face redundancy.
Somewhat ironically, she has been forced to do this just at the time PCT clusters have been asked to stocktake their current capacity and capability in order to provide local commissioners with a snapshot of the commissioning support likely to be available to them in the future.
Mrs Bevan describes her remnant head count as “decimated”, and says that her medicines management team, which was always undermanned compared with the number of GP practices in the former PCT patch, will struggle to do the work now expected of them.
She says that, despite the lip-service given to the Quality, Innovation, Productivity and Prevention potential of medicines management, this has not enabled her pharmacy teams to escape the cull. She said: “The medicines management teams and the GPs went to the powers that be to say we need more people not less, that we need to invest to save, but we were just not listened to. We have just been told that we need to make cuts across the board.”
NHS staff cuts
The Ealing, Hillingdon and Hounslow PCT subcluster is, of course, not alone. From the outset, the NHS has made no bones about the effect of NHS reform on staffing. In briefing documents sent out in July 2010 to accompany the launch of the reform, NHS chief executive Sir David Nicholson warned staff that the NHS would “employ fewer staff” by 2014, and that the transfer of the PCT commissioning role to GP consortia “will have a major impact on staff employed in commissioning roles in PCTs”. Noting that 151 PCTs will slim down to around 50 clusters in the reform, the BBC has suggested that abolition of PCTs by 2013 could affect up to 68,000 NHS managers.
Currently, around 20 per cent of all NHS pharmacist posts are located in PCTs or local health boards, so there is considerable concern at national and local levels over the impact of PCT reform on pharmacy workforce patterns. Destination sectors for primary care pharmacists on the move — typically NHS trusts — are also being charged to make savings on staff costs, which raises doubts on this sector’s ability to absorb staff looking for pastures new. Possibly, some primary care organisation staff may find themselves redeployed in medicines management as former PCTs set up provider arms, requiring significant pharmacy input.
Currently, however, redundancies are happening at all levels, depending on the management structure preferred by the emergent PCT clusters and, clearly, with 151 PCTs reducing to 50 PCT clusters, there is set to be excess demand for the remaining PCT posts. In some areas of higher staff mobility, for example, London, staff can be lost and gained to and from other PCT clusters, which has been the experience of the Ealing, Hillingdon and Hounslow PCT subcluster. But, without a doubt, this intra-PCT cluster mobility will go only a little way to reducing what Sir David admits is “significant uncertainty about how many jobs [to be lost], of what type and in what organisations”.
Despite the uncertainty caused by the job losses, interim employee recruitment agencies have begun to talk up the opportunities ahead for PCT managers with specialist expertise.
Steve Melber is the senior consultant in health at Interim Partners. He believes there are opportunities for interim managers to find work as reform progresses.
As time goes on and as PCTs approach the end of their lifespan, it is possible that short-term vacancies will appear in PCTs, as surviving PCT employees decide not to wait for a redundancy payout but cut their losses and run.
He believes that former PCT staff will be first in line for the jobs that become vacant. He says: “Ever more price-sensitive clients might prefer to appoint an ex-PCT manager turned interim, who is already in their network, rather than seasoned NHS interim managers with a track record, who come at a higher headline rate.”
Furthermore, trusts trying to achieve foundation trust status may also need interim support to help them improve standards of healthcare and meet core targets. He says: “If all trusts now have an obligation to go through that process it should increase general demand for change and performance improvement specialists.”
GPs charged with delivering NHS services in the future have already voiced fears over their competence to lead the clinical consortia and if these fears turn out to be well founded, then consortia commissioners may well choose to buy in that expertise. It is already stated by NHS chiefs that consortia decisions about what can be done in-house and what needs to be done externally will be complicated.
Sir David has said: “It is unlikely, even in the largest GP consortia, that everything will be done in-house. For smaller GP consortia it is more likely that commissioning support will be bought in or shared with other consortia.”
Mr Melber believes this, again, presents opportunities for displaced PCT staff pharmacists. He says: “Perhaps we will see a marketplace where providers such as ourselves can directly provide that commissioning support to consortia in the form of interims.”
Polly Ellison, from consortia consultancy Health First Consultancy, has been working with GP pathfinder consortia from an early stage. She believes that prescribing and pharmacy are very much on GPs’ agenda. She says: “One of the biggest concerns is to ensure that overspend situation is tackled.”
She says that, as consortia form, they are looking to pharmacists to try to influence prescribing. At the moment, they are looking to PCT pharmacists to help them do this. But she adds: “That is not to say that is the way it will be in the future.”
As well as achieving much needed QIPP efficiencies, the aim of the PCT clustering is to make commissioning expertise available to the emerging GP consortia to support their development. In theory, PCT clusters are supposed to be able to offer staff “directly to consortia”, while others will undertake commissioning support functions within the cluster. However, with just three pharmacists to cover 82 practices, Mrs Bevan is clear that, in her PCT cluster, “this just isn’t going to happen”.
For this reason, it is possible that GPs may start to look wider afield for non-PCT-based medicines management expertise, and community pharmacies may find themselves well placed to pick up work that primary care medicines management teams just cannot deliver. Ms Ellison says that there are already examples of GPs working with groups of independent community pharmacies and “cosier, local level discussions to be had”. She believes that community pharmacies bring a whole host of other considerations to GP consortia, for example, their ability to influence public health and deal with the worried well.
For community pharmacists interested in working with GP consortia, she believes there is considerable potential for consortia working. However, Ms Ellison says this will only happen if primary care providers are prepared to embrace multidisciplinary working and only if people are prepared to take a deep breath and forget their prejudices of the past.
Citation: The Pharmaceutical Journal URI: 11080600
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