The numbers game
Reforms to pharmacy education and training will now proceed without a cap on student numbers, but there may well be unintended consequences.
The UK Government has announced that it will not introduce controls on the number of students entering pharmacy courses. The decision will have come as a blow to those who have waited more than a year for a solution to the growing spectre of pharmacy graduates exceeding the number of available jobs.
A September 2013 review from the Centre for Workforce Intelligence — which offers advice to the government on workforce requirements for health and social care in England — predicted an oversupply of between 11,000 and 19,000 pharmacists by 2040 across the plausible futures it modelled.
So Health Education England (HEE) and the Higher Education Funding Council for England (HEFCE) sought views on how the surplus of pharmacists might be addressed. Three options were put forward in a public consultation that closed in November 2013.
The first course of action was to do nothing — to have the market continue to dictate the demand for student places and number of Master of Pharmacy (MPharm) programmes offered. The second option was to implement pharmacy student intake controls, similar to those used in medicine and dentistry. And the third alternative was to introduce some form of break-point during MPharm degree programmes, whereby a proportion of students leave with a degree qualification that does not result in registration as a pharmacist.
According to the HEE/HEFCE consultation analysis, published in October 2014, there was an overall preference among respondents for student intake controls to be introduced. But the recommendation has been rejected by Greg Clark, the minister for universities, science and cities.
The British Pharmaceutical Students’ Association is not best pleased. Among the association’s concerns, set out in a letter to The Pharmaceutical Journal, is the current deficiency in pre-registration training places available for the growing number of students. Clark has asked HEFCE to take steps to ensure prospective MPharm students are made fully aware of this fact before they apply to study. This will offer little comfort to those students midway through their degrees.
The government currently provides funding for NHS and community pharmacy employers to take on pre-registration trainees. Because this subsidy is finite, there is only a limited number of places on offer.
HEE is taking forward its plans for a five-year MPharm programme that integrates undergraduate education with pre-registration training placements — pharmacy students would graduate and register as pharmacists at the same time. How these training places would be secured and funded has yet to be hashed out. Another major unknown is how the education reforms in England will dovetail with MPharm programmes in Scotland and Wales, which presently ‘export’ pharmacy graduates to England for the pre-registration year.
What HEE has made explicit, though, is that the pharmacy education and training reforms need to be “cost neutral” to the government.
Presumably pharmacy schools will need to have confirmed training places before accepting students on to their new five-year courses. This could ultimately have the effect of constraining entry to pharmacy courses if limited training places are available.
But the reverse could also play out: students would likely be footing the bill for five years of study rather than four, meaning there may be more money in the system. Universities could therefore incentivise employers to take on trainees, which could have the effect of building capacity and result in more students graduating as registered pharmacists.
This outcome would further exacerbate the surplus of pharmacists looking for work. Employers may benefit from having a larger pool of trained professionals to choose from and then only recruiting the best. Many pharmacists would need to rethink their attitudes to professional development and also think beyond traditional pharmacy roles in order to make use of their education and skills. This is the market in action.
But the market in action would also push down salaries, something that is already occurring. Some community pharmacy businesses may even seek to recruit the cheapest pharmacists, as opposed to the best.
Unemployed pharmacists and poor pay could make pharmacy a less attractive career option, and potentially lower the quality of candidates applying to MPharm courses. This would be damaging indeed to the profession of pharmacy.
We paint a grim picture. However, much of it is guesswork. There are many things that still need to be figured out in the reform of pharmacy education and training. And there is a great deal of scope for unintended consequences.
Producing high-calibre pharmacists must be the primary focus, and there needs to be a solution that is effective across the UK. Yet some means of controlling MPharm programme intakes must also be negotiated — whatever the government’s position on the matter.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066963
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