SPECIALTY PROFORMA PHARMACY WORKFORCE PHARMACISTS AND PHARMACY TECHNICIANS

2. Specialty Description

 
 

Source: NHS Careers and Royal Pharmaceutical Society of Great Britain (RPSGB)

Pharmacists are experts in medicines and their use.  In addition to being responsible for the safe and effective purchase, distribution, supply and dispensing of Medicines, pharmacists undertake medication usage reviews and advise Medical, nursing and allied health professional staff on the selection and appropriate use of medicines.  They provide information to patients on how to manage their medicines to ensure optimal treatment.  Pharmacists are able to undertake additional training in order to allow them to prescribe medicines for specific conditions¹.  Pharmacists also play an important role in health improvement.  This is described in more detail under ‘Choosing Health Through Pharmacy’ below. 
 

The role of the pharmacist is expanding, to support patients in their use of medicines and as a part of clinical decision-making across the range of specialisms. The NHS spends some £8 billion a year on medicines and pharmacists have a key role in managing the planning, choice and use of this important resource. 
 

Pharmacists work in a wide range of occupations and settings and for a range of different public and private sector employers – a significant number are self employed as either community pharmacy contractors, locums or advisors. As well as in the familiar high street community pharmacy, there are pharmacists working in primary care, hospitals, prisons and the pharmaceutical industry. There are also opportunities for pharmacists to work in research and teaching as well as in administrative and management careers.² 
 

From the census taken as part of the work of the Pharmacy Workforce Planning and Policy Advisory Group (PWPPAG) in 2003, there were a total of 31,704 full-time equivalent pharmacists in Great Britain.  The table below gives a breakdown by sector: 
 

 
 
 

Around 10% of pharmacists had more than one job, in some cases up to four, in a number of sectors.  The emergence of portfolio careers is a recent but rapidly evolving phenomenon in pharmacy.  
 

Pharmacy Technicians 
 

In all settings pharmacists work with a team of staff including technicians and assistants and in partnership with other registered professionals.  Within the pharmacy team the Royal Pharmaceutical Society of Great Britain (the professional and regulatory body for pharmacists) holds a voluntary register of technicians and provides guidance on the education and training of other support staff.  It is expected that the forthcoming Section 60 legislation (which lists those professions that are statutorily regulated) will introduce a statutory register for pharmacy technicians. 
 

Pharmacy technicians work from technician through to practitioner level of the career framework, supporting the role of the pharmacist and take a lead in the medicine supply function.  Pharmacy technicians work in the full range of sectors as described for the pharmacist.  Currently, there is no data available about total numbers of pharmacy technicians (see data issues below). 
 

3. Anticipated Future Requirements for Trained Specialists

Views from:

SHAs

 
 

Comments following consultation about recommendations for pharmacy in 2005: 
 

In August 2005, WRT published provisional recommendations for pharmacy on its portal (see below, section 14 - Workforce Review Team Recommendations in 2005) and sought feedback from Strategic Health Authorities (SHAs) about these. The following is a summary of feedback not included elsewhere. 
 

Funding is needed to maintain and increase the number of pre-registration students in the hospital sector.  At SHA level, lack of pre-registration training places will become the recruitment limiting factor.  During the past five years there has been an expansion in undergraduate places.  There will need to be a corresponding increase in the number of pre-registration training places to attract them into the NHS. At present this does not appear to be happening.  Particular problems in London and south east England with training capacity were reported. 
 

The significant salary increases for trainees under Agenda for Change and the concomitant increase in on-costs are proving challenging for Workforce Development Directorates (WDDs) and host trusts.  This increase in costs will prevent some SHAs increasing pre-registration training places.  There is a real risk that in the absence of full funding for the costs of Agenda for Change, some trusts will compensate by reducing the number of pre-registration posts in 2006/07.  At the same time, reduction in hours (to 37.5 per week) from Agenda for Change has created the need for more pharmacist posts to cover service hours. 
 

Alternative funding arrangements need to be explored for pharmacy technicians, if the historical salaried route can not be fully supported in the future.  The move towards local pharmacy commissioning might require an increase in the provision of training eg NVQs for technicians and assistants. 
 

Other concerns/issues raised included: 
 

• the patient safety agenda around medication errors and safe use of medicines and medicines management training (for Medical and nursing as well as pharmacy staff);
• increased pharmacy workforce needed for clinical trials particularly in cancer;
• lack of properly funded cancer network posts;
• developing skills of community pharmacists within the new pharmacy contractual framework;
• development of pharmacy prescribers;
• development of consultant pharmacists;
• development of assistant and advanced practitioners;
• continuing skill mix changes and developing roles for pharmacists, technicians and assistants all requiring training and backfill;
• increasing numbers of pharmacists to achieve Working Time Directive targets for Medical staff;
• developing recruitment and retention strategies for existing hospital staff in the light of Agenda for Change;
• evidenced based cost effective prescribing;
• automation in dispensaries allowing better use of staff time; and
• electronic prescribing taking up significant pharmacist time.

Risk Assessment for Commissioning (RAC)

In November 2005, results were published from a survey of the SHAs about their commissioning/training intentions for 2006/07.  Twenty SHAs responded in relation to pharmacists and pharmacy technicians.  Ten of these SHAs said that they would be increasing pre-registration training for pharmacists, eight said they would maintain training at current levels and two would reduce training.  At the same time eight would be increasing training for pharmacy technicians, 11 said there would be no growth in training and one said they would be reducing training. 
 

More detailed information is available on the WRT portal at: 
 

http://www.healthcareworkforce.nhs.uk/index.php?option=com_content&task=view&id=400 
 

Comments from SHAs in South East England (Hampshire and Isle of Wight, Kent and Medway and Surrey and Sussex) 
 

Source:  South East Medicines Management Education and Development Team

The proposed funded commissioning levels for the one-year pre-registration year for pharmacy graduates in 2006/07 have had to be reduced in one of the three SHA areas, as a direct result of the impact on the increase in salary costs of a pre-registration pharmacist following Agenda for Change.  All three SHAs/WDDs agreed to continue to fund these posts at 100%, but one has had to reduce the funded level of commissions from 2005/06 to keep within the same funding envelope, as no additional funding to support this increase was thought to be coming centrally.

 
 

The community training grant from the Department of Health (DH) has been increased in 2006/07.  This means that the community pharmacy sector will be more willing and able to offer training placements during the pre-registration year, which should help to address the increasing numbers of graduates from new schools of pharmacy.  Work will need to be undertaken to assure the quality of the clinical placements and training across the multiple businesses involved. 
 

Due to the mandatory requirement that any person involved in the dispensing of medicines process must hold a full NVQ level two or the requisite dispensing modules, there has been a decrease in the number of student technician training posts in the south east as trusts invest in the level two training.  A knock on effect will be a reduction in the numbers of NVQ level three qualified technicians entering the workforce, when mandatory registration for pharmacy technicians is instigated once the Foster review of regulation is completed (expected in 2006).  This could lead to a supply issue. 
 

There is also anecdotal evidence that the NHS is losing qualified NVQ assessors and verifiers from the technician workforce to the community sector as historically the community sector has not invested in the NVQ assessment infrastructure, however now that both NVQ levels two and three requirement apply across all sectors of the profession there is high demand for this skill set. 
 

Many of the technicians able to join the voluntary technician register are currently employed within the NHS.  There is evidence that this workforce may be migrating to the community sector so that community pharmacy will be ready for the imminent regulation changes again having an impact on workforce within the NHS.

 
 

DH – Choosing Health Through Pharmacy³ 
 

‘Choosing health through pharmacy’ is a strategy about pharmacists and their staff in all NHS sectors.  This document states: 
 

“Pharmacists will play a key role in the ‘health-promoting NHS’ described in the Government’s White Paper ‘Choosing Health: Making Healthy Choices Easier’ (Department of Health, 2004).  Their distinctive contributions will echo the White Paper’s main themes, such as reducing tobacco and alcohol consumption, obesity, unwanted pregnancy, and inequalities in health. For community pharmacies, their location provides opportunities for community involvement and leadership (eg through school and workplace initiatives).  Pharmacies are local, accessible and convenient for patients and the public.  In many places, they have extended opening hours. 
 

“The Department of Health states that current shortfalls in numbers of staff means that existing staff need to be deployed flexibly.  The skills escalator should be used to develop new staff and skills.” (The skills escalator encourages staff from diverse occupational backgrounds to access new work-based knowledge and skills, enabling them to perform more effectively in their jobs or to move on to other jobs.) 
 

“It is possible to use a range of different skill mixes to achieve the goals in this strategy, with various combinations of directly employed and shared staff. Most pharmacists and their staff will continue to deliver public health services as one part of their work, albeit of growing importance. Additionally individual pharmacists and their staff, trained to deliver specialist services such as stop smoking or weight management, could be wholly employed within the pharmacy, or shared between pharmacies, or shared with the PCT, or with local primary care and hospital sectors.”   
 

“Suggestions for pharmacy public health workforce development: 
 

• Specialists or consultants in pharmaceutical public health should continue to develop their strategic leadership roles across communities.

 
 

• PCTs should review their public health teams and ensure that pharmacy is included within their workforce development programmes.

 
 

• Each pharmacy team could have a named public health lead accountable for the quality of delivery of public health interventions, training, etc, who could be trained and, in the future, accredited as a public health practitioner.

 
 

• Counter assistants in the pharmacy are often recruited from the local population, know the area well and may speak the language of a significant local ethnic minority. They have front-line customer contact and their public health role could be developed significantly.

 
 

• PCT health promotion staff and nurses could use pharmacy as a setting for delivering health education sessions and could also be involved in training pharmacy staff.

 
 

• Phlebotomists and nurses could be deployed by PCTs to work within pharmacies, subject to further evaluation of the cost effectiveness of this way of working.”

Professional Body: The Royal Pharmaceutical Society of Great Britain (RPSGB)

 
 

The Pharmacy Workforce Planning and Policy Advisory Group (PWPPAG) has developed and tested a workforce model for pharmacy which can be used to test the impact of changes in policy on the risk of over or under supply of pharmacists.  In its report⁴ PWPPAG has concluded that there is currently a shortage of pharmacists in employment. 
 

The demand side drivers (for pharmacy services and therefore pharmacists’ time) can be summarised into three main themes as follows: 
 

• The ‘Professional Quality Assurance’ Theme – consisting of government laws and regulations; several key test cases and inquiry reports; and command instructions which have reformulated and expanded the pharmacist and technician roles over time.

 
 

• The ‘Organisation of Pharmacy Provision’ Theme – consisting of the working and technological environment, especially concerning the range of services and opening hours in the retail sector; the constantly changing NHS environment, especially concerning patients’ access to more timely service provision; the industrial environment, especially concerning the growth in expectations for safer and novel treatments that are brought to the market relatively quickly compared to the past; and the education environment, especially concerning the need to provide the relatively rapid student expansion of the past 10 years with suitably qualified teaching staff.

 
 

• The ‘Healthcare Expansion’ Theme – consisting of the underlying demand for more services that are related to an ageing population; the government’s funding policies for the NHS and universities; and the development of gene technology and novel treatments and delivery systems to treat previously untreatable or low prognostic conditions.

 
 

The analysis of the likely impact of these themes indicates that demand for pharmacists’ services will continue to outstrip increases in the supply of pharmacists for the foreseeable future unless action is taken to change the supply, the demand and/or the utilisation of pharmacists. On this basis, PWPPAG has identified a number of broad options which in the short, medium and long-term will lead to a better balance between demand for and supply of pharmacists.  These are listed under ‘Options for Balancing Supply and Demand’ below. 
 

4. Workforce Profile

Source: ‘Future Pharmacy Workforce Requirements:  Workforce Modelling and Policy Recommendations’⁴

 
 

NHS Hospital Pharmacy 
 

This sector employs 18% of registered pharmacists. 
 

There are pressures on hospital pharmacy to expand due to among other things: 
 

• introduction of new treatments and methods of care;
• organisation of the manufacture and supply of complex medicines including radiopharmaceuticals;
• level of integration and efficiency of the whole medicines supply chain;
• proposed expansion of hospital pharmacists’ role;
• expansion of hospital specialists’ services to support national directions on cancer and cardiology; and
• need for more specialist management time in a number of areas.

 
 

However, potential growth is likely to be offset by employers redeploying pharmacists in the light of skill mix profile changes and new technologies. 
 

Currently, more than 70% of departments are unable to meet demands made upon them due to staff shortages.  Delivering the National Service Framework (NSF) for Older People is particularly affected.  There is evidence of a high turnover, with 21% of pharmacists leaving hospitals each year.  This could also be assisted with skill mix issues and changes to the education for pharmacy technicians with a nationally recognised qualification that sits between the NVQ level three and the MPharm such as a foundation degree. 
 

NHS Primary Care Pharmacy 
 

This sector employs 8% of registered pharmacists. 
 

This is a complex and rapidly changing service where the organisational model consists of a mix of services and NHS employees, complemented by many self-employed, agency and community pharmacists, many of whom are employees of local community pharmacy businesses.  The key policy drivers that may continue to fuel expansion include: 
 

• new General Medical Services (GMS) contract to improve quality of prescribing;
• pressure on primary care organisations (PCOs) to control drugs budgets;
• pressure on GPs and PCOs to introduce medicines management service, as defined by the NHS Pharmacy Plan and new GMS and community pharmacy contracts;
• pressure on GPs and PCOs to introduce new prescribers working under the aegis of the national standards and protocols and the safety framework defined by the National Patient Safety Agency;
• pressure on GPs and PCOs to reduce error rate in prescribing; and
• practice based commissioning.

 
 

There is evidence that PCOs are finding it increasingly difficult to recruit and retain suitably qualified pharmacists, to meet both current and emerging service requirements.  There is great potential to examine the deployment of staff and review skill mix.  The potential of technicians is underdeveloped in this area.  More detailed research is required about how primary care pharmacy is developing. 
 

Academic Pharmacy 
 

This sector represents 2.2% of pharmacists on the RPSGB’s register in 2002. 
 

There are 13 schools of pharmacy in England.  UK intake in 2002 was 2,187. 
 

Academic pharmacy will continue to expand up to its current capacity constraint level.  This growth will be augmented in time with incremental introduction of new schools.  The organisation of the schools will shift incrementally to a more networked set of organisations, where some specialists are shared across institutions.  Demand for teaching pharmacists will rise due to this expansion, although the schools’ well developed skill-mix agenda will offset some of this demand. 
 

Other points to note are: 
 

• increased demand will also result from redesign of the core curriculum to reflect increasing needs of the clinical practice development;
• the impact of new technology teaching aids will be of limited help;
• potentially, greater emphasis on practice based mutli-disciplinary teaching methods and consequent requirements for many more practice-based clinical placements and supervisors, will stimulate the partnership debate and give it a greater sense of urgency; and
• pace of change is great in academic sector with no indication that this will slow due to any NHS developments.

 
 

[WRT note: there will be a need to look at the capacity within academia and also to look at supply and succession planning of academic tutors with the increased numbers of students and enhancements planned for the undergraduate curriculum] 
 
 

Community Pharmacy 
 

This sector employs about 66% of registered pharmacists.  This is a very complex industry where the business model consists of community pharmacy outlets owned by large chains (46%), smaller groups and chains (10%) and small groups and independent proprietors (44%).  Business pressures on the sector are great. 
 

Detailed research into the community pharmacy business has led to the following conclusions about demand for pharmacists in this sector: 
 

• The community pharmacy business will expand mainly on the basis of the prescription dispensing business.  The structure of the business (the proportion represented across the different types of outlet) will stay broadly the same for the foreseeable future.
• Demand for community pharmacists is expected to rise in the short-term (next five years) to meet current unsatisfied demand, marginal requirements arising from extra continuing professional development (CPD) time and new quality assurance (QA) requirements of forthcoming regulations changes, and potential new business arising from government polices to expand the NHS, including prescription numbers.
• New technology will increase efficiency of prescription dispensing businesses (but as yet this is unquantified).
• The greatest change is likely to come from shift in government policy particularly concerning deregulation and market entry and development of an ‘e-pharmacy’ business.
• The pace of development of innovative new community pharmacy practices will be measured according to local NHS service commissioners and their local investment plans.

 
 

This suggests there are productivity/process advances to be made.  Pilot work or modelling with the commercial bodies would be required, to assess the potential for and effects of this. 
 

Industrial Pharmacy 
 

This sector employs nearly 6% of pharmacists (around 2,200 from census for PWPPAG in 2002), mainly in the manufacturing sector.  A small proportion work in wholesale organisations.  This employment sector is very fragmented, with up to 350 UK-based manufacturing companies. 
 

From the research conducted by the PWPPAG, there is evidence that the demand for industrial pharmacy services is increasing.  However, this has not translated into a commensurate demand for industrial pharmacists, because they have been substituted with other specialists (eg industrial chemists, pharmaceutical formulation scientists, research pharmacologists and geneticists, bioMedical engineers and pure and applied chemists and physiologists). 
 

The industry has taken a very comprehensive approach to its skill-mix and it has as a result, a very elastic stance to the deployment of its workforce.  Demand for traditional industrial pharmacists will not rise to meet expanding service demands, because of the comprehensive changes in skill mix labour substitution policies that have taken place in the last 20 years.  However, there may be some small demand for clinical pharmacists, who have worked in PCOs or in the NHS, to service the big companies’ marketing and sales efforts. 
 

5. Geographical Balance

 
 

There is limited, but incomplete data.  Because there is no central control over the programme of new schools of pharmacy, there will be imbalances in the workforce (see below).

6. Pattern of Training

Pharmacists

 
 

Undergraduate training 
 

The RPSGB reports that pharmacists currently undertake a four year masters level degree, which is funded predominantly by the higher education councils.  There is currently no formal recognition of the need for clinical teaching through the provision of either NHS or higher education funding for work based placements. 
 

The RPSGB reports that there has been a significant expansion in the number of pharmacy undergraduate places (44% since 1998) which is attributable to an increase in the intakes of the established schools of pharmacy and the opening of five new schools since 2003/04.  The continuing programme of new schools is not planned centrally, but it is market driven based on the business cases in individual HEIs.  Provision of pre-registration placements has kept pace with the expansion so far, but there are concerns that this may not be sustainable in the longer term. 
 

In their feedback about the recommendations in 2005 for 2006/07, SHAs agreed that there needs to be engagement between DH and Department for Education and Skills regarding undergraduate training.  Universities are developing undergraduate programmes in areas where SHAs do not need extra capacity.  SHAs need to be part of the process from the beginning, in order to ensure there are sufficient clinical placements and to develop the pre-registration year.