Lack of home-grown talent may put pressure on primary care’s ability on delivering objectives
Primary care trust guidance, published by the Department of Health in January, makes it clear that PCTs should already be well on track with their plans to transform community services.
By April, all PCT services commissioners were expected to have set up proper contractual relationships with their provider organisations and, by October 2009, they are expected to have drawn up detailed plans outlining exactly how community services are to be transformed. But, for pharmacy workforce planners, the deadline has raised the added question of whether there are sufficient pharmacists to support the Government’s strategic objectives.
According to Gillian Laurence, committee member of the Primary Care Pharmacists’ Association, PCT staffing levels have only just about recovered from the wholescale reconfiguration of the sector that saw PCT numbers reduce by around a third.
In terms of pharmacist staffing levels, some 16 per cent of the total NHS pharmacist workforce now works in primary care organisations in England, Wales and Northern Ireland and, according to the first national survey of PCO pharmacy staffing levels, the greatest demand for pharmacists is at band 8a level, which accounts for 41 per cent of all 1,200 or so available posts. Vacancy rates at this level run at 12.3 per cent, which is below the overall 13 per cent vacancy rate seen in the PCO sector as a whole.
Compared with the higher pharmacist vacancy rates in the hospital sector, this may suggest a slightly more stable picture of pharmacy workforce supply and demand in primary care but, as Ms Laurence warns, this may be the calm before the storm.
“The implications for service delivery of the commissioner-provider split are not yet clear,” she says. In terms of prescribing support, for example, the problem is that many PCOs have not decided whether this will become a commissioning or a provider function. It is yet to be seen how practice-based commissioning will develop in light of the PCT role split, and what that sector’s subsequent demand for pharmacists will be.
Roles may trabser to the community
Furthermore, as the ambitions of the White Paper roll out, it is possible that some roles currently carried out by NHS pharmacists could transfer into the community or, at least, will dictate a demand for pharmacists with multidisciplinary experience. The White Paper also signals the need for increased support from technicians
Already, some 7 per cent of the total NHS technician workforce now works in primary care but, with vacancy rates for this profession currently running at 11.4 per cent, which is higher than the comparable rate in secondary care, it is clear that PCOs already have workforce shortages to manage.
Whatever the future skill set requirements will be, it is clear that primary care is on the brink of immense change, Ms Laurence believes. “At the moment, things are far from clear, which is why some pharmacists are staying put, waiting to see how things develop.”
Future demand set to rise
Like hospitals, PCOs are bound to Agenda for Change pay rates and, also like hospitals, they find it hard to compete with community pharmacy when it comes to attracting debt-ridden newly registered pharmacists. But, unlike in hospitals, where band 6 posts are an established junior level (and hence account for 22 per cent of all available posts), in primary care, there are far fewer posts at this level.
In fact, just 1 per cent of all pharmacist posts are at this level. It is not clear whether it is the lack of posts, the lack of structured preregistration training in the sector, or the lack of pharmacist candidates at this level that is fuelling the massive 32.2 per cent vacancy rates at band 6 level in primary care. Either way, it is clear that PCOs are not good at “growing their own” when it comes to the supply of pharmacists.
More pharmacists needed
Looking to the future, it is entirely possible that primary care, like hospitals, is set to need more pharmacists. Ms Laurence says: “By splitting up the two elements of PCO activity, it is possible that there will be some duplication of pharmacy roles, which, in theory, will lead to an increase in the number of pharmacists needed.” Susan Sanders, director of London Pharmacy Education and Training, says that advertisements for head of provider services-type roles are already appearing. “There is a real role for experienced pharmacists who have experience of multidisciplinary working.”
Practice-based commissioners may also come to realise that pharmacists have a role to play in the new look primary care sector and, according to research conducted by GP magazine, it is also possible that new roles for pharmacists in the commercial and consultancy sector will emerge.
According to research released under the Freedom of Information Act, as of April, 39 per cent of PCTs were putting their divested functionality out to tender. Working outside the NHS, such companies are not bound to Agenda for Change, Ms Laurence admits, which could suggest lucrative new roles for experienced higher grade pharmacists willing to leave the comfort zone of guaranteed NHS pay.
Without a major rethink in the way PCOs train, recruit and retain their own junior pharmacists, it is not yet clear how any new demand for NHS pharmacists will be sated. It is also not yet clear how PCOs will pay for the necessary infrastructural changes.
As NHS budgets come under increasing scrutiny, primary care workforce planners may find that calls for more training money fall on deaf ears. PCOs, like hospitals, will have to compete against each other and against the commercial sector for the available workforce. As Ms Laurence says: “There is a pull for pharmacists from all sectors. The question is ‘are there enough pharmacists to go round?’.”
Citation: The Pharmaceutical Journal URI: 10968115
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