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Job cuts and pay freezes — doom and gloom for hospital and PCT pharmacy

By Debbie Andalo

Although the Government has promised that the health service will be protected from cuts, the reality already appears different. Debbie Andalo looks at how hospital and primary care trust pharmacy posts are being affected

See Recruitment review


This autumn the NHS will discover how much money it will need to save in order to help clear Britain’s £156bn deficit when details of the Government public spending review are published. Although the Government has promised that the health service, especially front-line posts, will be protected from cuts and that the NHS will see a year-on-year growth, the reality already appears different.

Hospital and primary care trust pharmacists report a slowing down of recruitment or posts being frozen. Outsourcing of pharmacy services is being talked about as a way of saving on staff costs and there is also evidence of cutbacks starting to appear in pharmacists’ training and development. One hospital chief pharmacist says: “Most people are having to prioritise the services they provide and look at what they can stop doing in order that they can still ensure patient safety.”

Job cuts

The results of the annual recruitment survey, which takes a UK-wide look at pharmacy staffing in primary and secondary care on a single day — 31 May 2010 — is due to be published about the same time as the spending review. For the first time, trusts are being asked to give details of jobs that are at risk and posts lost since the previous survey 12 months ago.

Although the data are still being collected, Susan Saunders, co-ordinator of the National NHS Pharmacy Staffing Establishment and Vacancy Survey and director of London Pharmacy Education and Training, says: “We are hearing that posts are being frozen or are vacant. Some trusts have a blanket cut of 10 per cent savings on every part of the organisation and we have heard from a couple of acute trusts [that are] looking at 6 per cent cuts.

“I have also heard of a couple of chief pharmacists putting forward a strong case that [a cut of this magnitude] is not going to result in a safe pharmacy service. It’s a strong issue and they are fighting to save jobs.”

One trust principal pharmacist, who is in talks with managers to protect posts, was reluctant to be named in case identification damaged negotiations. The principal pharmacist reveals: “In some trusts, there is no recruitment going on at all while in others there is much tighter control over vacancies, much greater vigilance and critical management taking place. There is also discussion going on about outsourcing services, such as the outpatient supply of medicines to reduce staff overheads.”

Ms Saunders believes that some hospital posts, particularly those at the lower grade band 6, may be protected because of pre- and post-election promises to save front-line posts because these roles are patient-facing. But the arguments for saving higher grade posts, which are more strategic, may not be so easy to make, she predicts.

Lost posts and band drift

David Miller, president of the Guild of Healthcare Pharmacists, predicts that, when the annual recruitment and retention survey is published this autumn (200), it will reveal continuing unfilled vacancies that are then at risk of becoming “lost posts”.

He says: “In terms of patient care, an unfilled vacancy or lost post is one and the same thing. They disappear in terms of patient care as the pharmacist isn’t there.”

Mr Miller is pragmatic about the future of NHS spending. He remains to be convinced that the health service will escape the axe that will fall across the public sector services, irrespective of the political promises made before and after the general election.

He is also concerned that “band drift” — where pharmacists are promoted beyond their skills to fill crucial posts — will continue this year in cases where vacancies are being allowed to be filled.

He warns: “If the reason for band drift is recruitment and retention then that isn’t in the interest of pharmacists because they will be put in positions that they should not be put in, but if the drift occurs because it’s about true development then that’s good for the profession as a whole.”

PCTs get involved in training

One way that primary care trusts are trying to catch newly registered pharmacists and prevent them going into the community sector is to become involved in preregistration training. Gillian Laurence, head of medicines management at Leeds NHS and a committee member of the Primary Care Pharmacists’ Association, says: “In the past, it has been difficult for a small PCT, for example, to have the critical mass needed to support a [preregistration trainee] or a newly [registered] pharmacist through the training programme that they are required to meet.

“But I think PCTs are starting to get more involved in training and to look at more career pathways. Training does create the opportunity to retain [preregistration trainees]. It makes long-term sense because it means they can then fill the band 6 and band 7 vacancies.”

She adds. “It’s no good investing in [preregistration trainees] and then losing them to elsewhere.”

Ms Saunders says the issue of not enough pharmacists being trained, which was around 12 months ago, has eased slightly. A special Department of Health task force, which was set up last year (2009) to work with strategic health authorities to commit more preregistration training places, has created about another 100 places.

She says: “We now have about 693 training places but I still do not believe that it is enough. If you look at band 6 posts, [these pharmacists] generally stay in post for two years before moving on, which means the NHS needs to train half that number again every year and that isn’t happening.”

She is also concerned that preregistration training places might disappear as the cuts deepen, a move she described as short-sighted. PCTs, she confirms, are becoming more involved in training the profession but it remains patchy across the UK.

However, she says: “There is some innovative work taking place. In Cambridgeshire, for example, training is dovetailed between the PCT, community pharmacy and the acute trusts.”

In London, a successful training scheme has been developed between Guy’s and St Thomas’ NHS Foundation Trust and NHS Southwark. Across the Thames, in Kensington and Chelsea, another training programme has been developed around its community hospitals. But these are the exceptions.

Ms Saunders says: “It is quite difficult generally for PCTs, with their limited training capacity in terms of human resources. [Preregistration trainees] can’t do the whole year in a PCT if they don’t get patient-facing experience. In acute and mental health trusts, it is common to find [preregistration] training because it’s all part of the human resources training and development.”

In London, she says PCTs are also generally reluctant to take on any new training commitments because of the uncertainty about the future PCT configuration in the capital and impending public spending cuts, although she points out that preregistration training costs are met centrally by the department, with money being fed down through SHAs.

Central funding, however, is not available for continuing professional development or for the training of diploma students, where trusts have to dig into their own coffers to pay their fees. This lack of protected DoH funding is having an impact in the current financial climate.

Ms Saunders comments: “If you have frozen posts and staff vacancies, it’s hard to release people to attend training days. And, anecdotally, we are finding that is already happening in London. People are not being released for training on one-off study days for  pharmacists.”

She added that time will tell what trusts decide to do about funding diploma students in the future. “Even if [diploma funding] is approved, there will be no additional money for it and, without funding, the cost will have to come out of staff budgets,” she warns.

Jobs freeze

The jobs freeze is not restricted to acute trusts. Gillian Laurence, head of medicines management at Leeds NHS and a committee member of the Primary Care Pharmacists’ Association, reveals: “If there are any posts coming up as vacancies, the majority of primary care trusts are being asked to put forward a business case [for filling the post]. It’s the case for medicines management posts and other jobs as well.

“Posts are not automatically being filled and, although this has generally been the case in the past, there is a feeling that these cases are being looked at more critically — whether a replacement is necessary or if there is a better way of delivering a service.”

As in previous years, she says it is still difficult to recruit pharmacists to lower
because newly registered pharmacists are tempted by the more lucrative packages on offer in community pharmacy (PJ, 3 July 2010, p25).

Posts retention

The issue for chief pharmacists across primary and secondary care in the coming months is how to persuade senior managers that pharmacy posts should be retained. One strong argument, of course, is that good medicines management in both sectors can help save money, so getting rid of these kinds of experts is a false economy.

But what else can they do to help protect the profession in these times that Prime Minister David Cameron has said will see the most drastic spending cuts for a generation?

Ray Fitzpatrick, clinical director of pharmacy at the Royal Wolverhampton Hospitals NHS Trust and professor of pharmacy at Wolverhampton University, believes he has the answer.

Professor Fitzpatrick has come up with the first benchmark for hospital pharmacy staffing levels (PJ, 22 May 2010, p504), which he says could be useful ammunition when pharmacy posts are under threat. “That was one of the reasons I did the work in the first place because a colleague asked me for help because he felt he was understaffed and his trust asked him to do some benchmarking.”

The benchmark developed by Professor Fitzpatrick, based on the number of pharmacy posts to the number of hospital admissions, found that, in England, the mean percentage full-time equivalent pharmacy staff per acute trust admission was 0.114 per cent. The comparable figure for mental health and social care trusts was 0.467 per cent.

He found wide variation nationally and regionally and believes chief pharmacists should be able to work out their own individual trust benchmark because the statistics for pharmacy workforce numbers and hospital admissions are readily available. Pharmacy leaders would then be able to compare their benchmark against the regional and national statistics, he suggests.

Professor Fitzpatrick explains: “The benchmark could be used if there were some serious pressure to take money out of the system. It might also be used to help change skill mix or pharmacy headcount. You can use benchmarking to say this is where we are in comparison to the national position. There is scope to use it to defend your position externally, to use it in discussion internally with general managers, but also as a change tool within your own department.”

The last option is particularly useful if a chief pharmacist is looking for staff support as he or she struggles to find the pharmacy department’s share of the cuts because, as Professor Fitzpatrick admits: “When you try [to] say to staff ‘I think we can do without certain band 8 posts and [we could] use that money to buy band 5 technicians instead and then put anything left over to offset our savings target’, there will be resistance.”

Citation: The Pharmaceutical Journal URI: 11016438

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