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Crucial medicines management role should keep pharmacists’ jobs safe

By Debbie Andalo

In this special feature on pharmacy recruitment, Debbie Andalo looks at the hospital and primary care sectors, where, it appears, pharmacists are staying put for the time being

See Recruitment review


Public sector spending cuts, changes to out-of-hours cover and impending NHS reorganisation are hanging heavily over hospital and primary care pharmacy this winter. Although there is some optimism that change, even if it is uninvited, can create opportunity, pharmacists in both sectors are staying put for the time being.

The recruitment process is slowing down as vacancies that do occur are being scrutinised by trust chief executives to see if they really are essential posts. But despite the lack of movement in the pharmacy workforce and uncertainty about the future shape of  pharmacy in primary care, there is confidence that medicines management and clinical pharmacy roles will still be needed in the coming months and, in fact, become increasingly more important as organisations look both to save money and to protect patient safety.

Susan Sanders, co-ordinator of the latest national NHS pharmacy staffing establishment and vacancy survey which was published in November 2010, says it is difficult to predict what will happen to pharmacy recruitment in the next 12 months.

But she admits: “We are in for a hard time in the coming year. I am not just talking about the number of posts but also about whether the number of posts are sufficient to deliver services as required. I am not sure that we can guarantee that.”

There is anecdotal evidence that concerns about patient safety are “an issue” for some chief pharmacists and not for others. She says: “I know of a number of trusts that are having to make 10 per cent cuts across the board so in those cases people are equally concerned about their own jobs as well as how they can manage a service.”

Liz Kay, director of medicines management and pharmacy at Leeds Teaching Hospitals NHS Trust, says her department has managed to create a “balanced financial plan” despite having to find a 10 per cent reduction. The trust is fortunate that pharmacy is entitled to recoup some of the savings pharmacists make on the trust’s overall drugs budget so this money along with “savings from consumables such as cleaning products and stationery” has helped to balance the books, she says.

Hospital trusts across England are having to prove to their chief executives or directors of human resources that those vacancies which are occurring in pharmacy need to be filled. Although there may be greater scrutiny, redundancy is not on the agenda, according to David Miller, president of the Guild of Healthcare Pharmacists and chief pharmacist at City Hospitals Sunderland NHS Foundation Trust.

He says: “I haven’t heard anything in terms of acute trusts and people being made redundant but people may not be filling vacancies. In my own trust we have had some vacancies but have been given approval to recruit to them.

“While we have had to justify posts for the past few years there is now more scrutiny and the process is getting longer and the [final] decision is taken by the chief executive, whereas five or six years ago it would have been left to the chief pharmacist.”

Neil Caldwell, consultant pharmacist at Arrowe Park Hospital in the Wirral and former north west regional representative of the guild, says the pressure on vacancies is having an impact on morale. “Morale is variable across the North West and everyone is under pressure,” he says.

“Many staff within the NHS, in the current climate, are evaluating their role and responsibilities and may feel a little uncertain about the future.”

Philip Howard, consultant pharmacist at St James’s University Hospital in Leeds, adds that morale is damaged when staff are having to fill the gaps created by unfilled vacancies. He says: “Morale is always going to be less than optimum when you are already working hard and then have to pick up the work of other people’s vacancies.”

According to the latest national pharmacy workforce survey there has been some improvement on the number of band 7 posts that have been left vacant. In 2009 the vacancy rate in this band was 19 per cent; a year later it had fallen to 17.6 per cent.

Wasim Baquir, guild regional representative for the north east and a senior clinical pharmacist and academic practitioner at North Tyneside General Hospital, says vacancy levels could have an impact on career development.

He says: “I think what will happen is that people will get stuck in band 7 as there is little opportunity to move into band 8 because that means more money. I think what is going to happen is that pharmacists are going to have to work harder to prove themselves as specialists and get approval from their employer to create a specialist role for them.

“They are going to have to prove to their employer that they have something that is needed. I think there will also be a bit of frustration as people get stuck in jobs.”

Professor Kay has already noticed that where her trust has advertised 8a posts the number of applicants has gone up and they have been of a higher quality. She says: “I think that is happening because the number of posts available for staff seeking career development is fewer than in previous years.”

Hospital trusts are also bracing themselves for an additional impact on recruitment caused by the new arrangements for hospital out-of-hours services, including pharmacy. There are fears that the changes, brought about through Agenda for Change reforms, could mean pharmacists losing as much as £200 a month in on-call remuneration.

Some pharmacists who have in the past been reluctant to be on call may welcome the chance to work differently even if it means less money. But hospital pharmacists are worried that any drop in income could prove to be the tipping point for an exodus of clinical pharmacists into the community sector where salaries are generally already higher.

Says Mr Baquir: “I think there will be those who are really committed to hospital who will be prepared to take the hit, others will grumble about it and some will go.”

The Royal Pharmaceutical Society is already “working behind the scenes” to help address any recruitment and retention issues which may be triggered by the out-of-hours issue. But it says that because it is not a trade union it is unable to take a lead on pharmacists’ pay and conditions.

Neal Patel head of corporate communications at the RPS says: “The Society does intend to raise concerns with trusts directly if the proposed on-call changes are believed to be a risk to patient care.”

He revealed this is already happening in Wales after some members called on the Society to intervene because they were worried that the changes could put patient services at risk.

Primary care

While on-call working arrangements are being overhauled in the hospital sector, the changes facing primary care pharmacists are much more fundamental following the Government’s announcement this summer that primary care trusts (PCTs) are to be abolished with GPs becoming the new commissioners of primary care services. Pharmacists working in the sector admit the decision was a shock and unexpected.

Shailen Rao, past president of the Primary Care Pharmacists’ Association admits: “Everything is up in the air at the moment. Nothing is for certain.”

Although abolition is not on the cards until 2013 he believes the most significant changes will happen in the next 12 months. “I think that [the changes] will be much quicker than 2012 as the pathfinder sites are already being set up. I think there will be a fairly rapid transition in the next 12 months.”

Like others working in the sector he is confident that primary care commissioners, whether they be trusts or GP consortia, will always need the medicine management expertise of pharmacists. “There will always be a need for primary care pharmacists because the good work has been recognised.”

But he is not entirely convinced that all of those in primary care will be prepared to see through another major NHS reorganisation. He says: “I think some will move on and say that they can’t put up with this and will go to a safe haven or take early retirement.”

Gillian Laurence, head of medicines management (commissioning) at Leeds PCT, describes current times as challenging. She says: “The scale of change set out in the White Paper is unprecedented and large numbers of staff working in PCTs will be affected by the changes.”

In the short term these uncertainties about the future could damage recruitment, according to PCPA chairman Duncan Petty, who is a practice pharmacist in Bradford and Airedale Teaching PCT. But he believes the clinical skills pharmacists have that allow them to save money and to protect patient safety will save them from any job cuts.

“There is and will continue to be an ongoing requirement for the functions for which primary care medicines management and prescribing support staff have responsibility. Professional staff are more likely to be protected from management savings by the virtue of being regarded as clinical staff, being responsible for statutory and ‘must do’ functions or [because] their funding [is] coming from the GP prescribing budget on an ‘invest to save’ basis.”

He predicts that some primary care pharmacists will find themselves employed by new organisations, possibly local authorities — which under government reforms are taking on more public health duties — or a GP or NHS commissioning board. Those who currently provide services direct to GP practices will, he believes, remain “largely unchanged.”

Mr Rao, who runs his own company providing medicines management support to GPs as well as other consultancy services, thinks other options for primary care pharmacists could include forming social enterprises or private organisations that contract their services to GPs.

He says: “The model is already there. We have it in practice based commissioning. I think pharmacists will have to go out and find new avenues for employment and set up links with their GP paymasters. I think most areas will accept that they need medicines support. The real question will be ‘What does that medicine support look like?’.”

Primary care pharmacists are being offered support by the PCPA as they deliberate their future and try to secure long-term job security. Other help is also coming from the RPS, which acknowledges that those working in the sector are worried about their future. Its English Pharmacy Board is currently looking at ways of supporting them to transfer their skills and roles across to the new NHS organisations.

And the RPS is already organising a meeting in December 2010 that will include representatives from across the sector, including the PCPA and the guild, to consider future options. But, like others, the Society is confident that the crucial role pharmacists play in primary care will still be needed — even though their paymasters may change.

Citation: The Pharmaceutical Journal URI: 11050924

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