Reducing NHS spending bad timing as hospital sector still struggling to fill pharmacist vacancies
News that the Department of Health is heading for a spending efficiency drive will place even more pressure on hospital pharmacy managers still struggling to fill vacant pharmacist posts.
According to the 2008 NHS pharmacy staffing establishment and vacancy survey, it is possible that pharmacy recruitment in the hospital sector could be about to reach crisis point. Between 2006 and 2008, total pharmacy vacancy rates in hospitals had risen from an average 11.7 per cent to 13.2 per cent (although differences in annual data collection methods need to be taken into account).
At band 6, the picture is even more critical since what was considered an unacceptable 17.2 per cent band 6 vacancy rate in 2007 rose to 22.1 per cent in 2008. The difficulties for hospital pharmacy managers trying to manage workload is exacerbated by the lack of qualified technicians, for which vacancy rates remain at 9 per cent (although this has fallen slightly) and, in parts of England, Wales and Northern Ireland, there are also now recruitment freezes to contend with.
Liz Kay, clinical director for medicines management and pharmacy services at Leeds Teaching Hospitals NHS Trust, reports considerable difficulties recruiting newly registered diploma students to unfilled higher grades. The problem, she says, is that, because of the vacancy freeze, she is missing the recruitment window for newly registered diploma students, who can easily go elsewhere to fill one of the 162 currently permanently unoccupied posts at band 8a (or 9.6 per cent of the total posts available at this band) in England, Wales and Northern Ireland.
Her problems are being added to by anecdotal evidence of “grade drift” at this level, which Dave Thornton, chairman of the Guild of Healthcare Pharmacists terms and conditions team, says is demonstrated by the number of advertisements for 8a or 8b level posts not stipulating specialist expertise. “This is indicative of the desperation to fill posts out there,” he says, “as it’s a practice that could leave trusts open to a pay claim.”
Between 2007 and 2008, NHS trusts funded over 19 per cent more (whole time equivalent) pharmacist posts, as well as around 17 per cent more technician posts in a bid to deliver on the new roles for pharmacists demanded by organisations, such as the National Institute for Health and Clinical Excellence.
According to Ron Purkiss, outgoing chief pharmacist at Sheffield Hospitals, the need for pharmacists to prepare high-risk medicines and implement medicines reconciliation has seen an instant demand of 9 per cent for hospital pharmacists.
Add into this the new roles still to come in light of the pharmacy White Paper and it is clear why hospitals have had to up the ante in terms of the number of pharmacy posts they are prepared to fund. But the problem, say those faced with trying to fill the new roles, is that supply is not line with the demand. Despite the increased output from the schools of pharmacy, hospitals are just not attracting enough pharmacists.
Part of the problem is salary. With the average newly registered pharmacist entering the workforce with an £11,000 student debt, starting salaries have become a major concern among undergraduate students (even those in their first year) as has the length of time needed to reach band 8a salary levels, reports Professor Purkiss. It is thought that, at the start of the preregistration year, as many as one in five pharmacy graduates may already be considering a career in community pharmac, compounding hospital pharmacy’s problems.
Another stress point for hospital pharmacy workforce planners is the lack of technical pharmacists, particularly in areas such as quality assurance, quality control and aseptic services. In Yorkshire and Humberside, recent advertisements for aseptic services managers, manufacturing pharmacists and quality-control pharmacists have failed to attract enough quality applicants. As Professor Kay explains: “Clinical pharmacy has received all the publicity. It has been seen as the sexy specialty.”
Finally, primary care organisations are adding to the pressure. Thanks to the emergence of new clinical roles following the splitting of the primary care trusts’ commissioning and provider function, PCOs have a need for more pharmacists but lack the infrastructure or clinical opportunities to train clinical pharmacists.
The hospital sector, already overburdened by new roles and unfilled posts, is prime hunting ground, admits Professor Kay, who says: “PCTs offer less patient-facing work. For the average band 8a pharmacist, who may be more settled in their personal life, a nine-to-five day and a lunch hour starts to look attractive.”
Being aware also of pressure from cash-strapped trusts to reduce the secondary care locum bill, hospital workforce planners accept that solutions to the shortages lies in two areas: recruiting more permanent pharmacists and retaining more of the existing workforce.
To encourage more pharmacists to enter the profession, the Guild of Healthcare Pharmacists has tackled the salary differential by a claim for a national recruitment and retention premium and was waiting to hear whether this would be accepted by the pay review body. Mr Thornton said: “The aim of the national [recruitment and retention premiums] is to incentivise band 6s, who can then be trained to 8a level, producing a stable, properly trained hospital workforce.”
Supporting this theory, Yorkshire and Humber Strategic Health Authority is currently considering a radical overhaul of its training and development programme, which would see undergraduate students exposed to hospital pharmacy via one-month student placements and, post-registration, pharmacists would be fast-tracked to band 8a via an improved multidisciplinary and rotational training model, co-ordinated by a new SHA-wide pharmacy training facilitator.
But, to fulfil this plan, more preregistration training places are required, admits Professor Purkiss, both generally within secondary care, and specifically in his SHA. He estimates an additional 30 places will be needed in the region over the next three years if any of the increasing output from the schools of pharmacy are to be attracted into the hospital sector.
Making the financial case for the new programme, Professor Purkiss says: “Pharmacy makes a significant contribution to the safe, effective and economic use of medicines from contracting and purchase through to effective clinical outcomes. An investment of 0.005 per cent of [the region’s medicines spend] would provide for an effective workforce and training strategy [and] ensure that patient care is improved and is cost effective, in line with the SHA strategic objectives.”
For its part, the NHS has worked to redress the shortages through the development of apprentice schemes for pharmacy technicians. Susan Sanders, director of London Pharmacy Education and Training, is clear that more pharmacists and more technicians are needed if the NHS is to deliver on the aims of the recent strategy documents for pharmacy, such as the White Paper, but admits that, in the current economic climate, it is “hard to bid for increased training funding even though people are aware that there are shortages”.
In the meantime, she says, there simply needs to be better workforce planning at all levels: by the trusts, the SHAs and the DoH. “If you have services to deliver, you need to have the pharmacists to deliver them.”
Innovative programme yields results
Guy’s and St Thomas’ NHS Foundation Trust has devised an innovative preregistration training programme that includes split placements between different branches of pharmacy (primary care, industry and community) and between pharmacy specialties, such as paediatric and mental health. “The diversity of our offering allows the hospital to offer more preregistration training within limited capacity constraints, which, we hope, helps to fill band 6 vacancies, but also produces more clinically orientated pharmacists,” says Aamer Safdar, principal pharmacist lead for education and development at Guy’s and St Thomas’.
But, he also admits that it is a win-win situation for the trust. He says: “If students have a good experience with us, they are more likely to stay with the hospital or recommend us to colleagues. If preregistration trainees ultimately decide to work as primary care pharmacists, the hope is that their experience with us may also prove valuable to the hospital at a later date.”Lack of home-grown talent may put pressure on primary care’s ability on delivering objectives
Citation: The Pharmaceutical Journal URI: 10968112
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