44 45
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which describes levels of NHS-employed pharmacy staff and does not include community pharmacy staff who are contractors to the NHS, indicate that between May 2010 and May 2011 pharmacist staffing establishments in the NHS overall decreased by 0.1% across England and decreased by 0.4% across Wales (Scotland is undertaking a separate survey to report NHS pharmacy establishment and vacancy rates).
Ensuring that the pharmacy workforce is able to meet this rising demand is likely to be challenging, especially in the context of the current major reorganisation of the NHS in England. Figure 5.4.1 shows the number of established, occupied, and vacant pharmacist posts (Full Time Equivalents, FTEs) in England and Wales from 2008-2011.
Figure 5.4.1. Established, occupied, and vacant NHS pharmacist posts in England and Wales, 2008-2011
Workforce planning and development
The size and complexity of the NHS, the increasing demand for health services, the length of time it takes to train pharmacists and pharmacy staff, and the political environment within which it operates all conspire to make it difficult to deliver effective workforce planning and development of the pharmacy workforce [7].
Workforce planning and development is not just about ensuring the continued supply of high quality pharmacy staff for the future in order to meet health demand, it is also about developing career pathways so that pharmacy staff remain engaged and actively participating in the workforce. There is a strong link between staff engagement and productivity. Increasingly, the creation of new roles has been the impetus for workforce development. Roles such as prescribing have been developed with the required education delivered by universities supporting learning in the workplace. There are also opportunities for new roles (e.g. public health).
Making the pharmacy workforce more productive will require a review of skill mix. Up-skilling of the pharmacy technician workforce in many hospitals to undertake the role of an
acredited checker of final prescriptions has freed up pharmacists time to develop more clinically-orientated duties and new roles. Technology such as automation of dispensaries and electronic prescribing may also improve the productivity of the pharmacy workforce, though further evidence is required.
Balancing the supply and demand of pharmacists
The pharmacy workforce model of 2003 [8] stated that, by 2013, there would be a significant shortage of pharmacists. However, the removal of pharmacists from the Home Office s Shortage Occupation List [9], growth in the number of pharmacy undergraduates, reduced vacancy rates in the NHS, changes in the health system, and the current economic environment provide evidence that there is not an overall undersupply of pharmacists. Increased demand (e.g. higher numbers of prescription items dispensed) is not in itself evidence of shortage as the workforce may be working more productively.
Indeed, the pharmacist workforce may be in danger of moving to oversupply, but there are considerable geographical variations and differences between sectors; up-to-date workforce intelligence is needed to fully understand the current situation. Other workforce risks will need to be identified to plan for the future.
The Centre for Workforce Intelligence (CfWI) provides advice to health and social care planners, clinicians and commissioners in England about workforce planning and development. In 2011, the CfWI identified other risks to the pharmacy workforce, [10] including:
Non-alignment of pre-registration trainee pharmacist placements with the expansion of undergraduate placements (in the long-term this may be mitigated by the proposals for the integrated undergraduate degree and pre-registration year)
Age profile: In 2010, 10.6% of registered pharmacists are aged 60 or over (11.6% in 2009) which means that a large proportion of the workforce could be lost within a few years
Part-time working and high proportion of female pharmacists (in other words, the supply of pharmacists is not being maximised)
Locum workforce: The high proportion of locums in the workforce may not be a sustainable model
The academic workforce: Do we have enough pharmacists teaching at schools of pharmacy?
Wellbeing of pharmacists: Increased workload and other factors could be having an adverse effect on the wellbeing of pharmacists
Retaining pharmacists within meaningful careers
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N um
be r o
f p os
ts (F
TE s)
9000
8000
7000
6000
5000
4000
3000
2000
1000
0 2008 2009 2010 2011
Number of occupied posts (FTE) Number of vacant posts (FTE)
Number of established posts (FTE)
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5.4.3. Strategies
The coalition government has laid down a proposal for planning and developing the health care workforce outlined in Liberating the NHS: Developing the Health care Workforce [11], including the creation of Health Education England (HEE). HEE will provide sector-wide leadership and oversight of workforce planning, education, and training in the NHS in England (see Figure 5.4.2). HEE has undertaken its role in shadow form from April 2012 and taken over the current role of Medical Education England (MEE), albeit an expanded one as HEE will have oversight of nursing and allied health professions in addition to pharmacy, medicine, dentistry, and health care scientists. The Modernising Pharmacy Careers (MPC) Programme Board (part of MEE) was established in 2009 to ensure the pharmacy workforce has the knowledge, skills, and capabilities to deliver pharmacy services of the future. MPC s work focuses on education and training (pre-qualification), developing pharmacy careers (post-qualification), and cross-cutting projects (e.g. workforce models and new ways of working).
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Figure 5.4.2. Education and training system
Secretary of State
Department of Health
Health Education England (HEE)
Local Education and Training Boards
Health Service Providers
Public Health England
NHS Services Commissioner
R&D Innovation
Local Stakeholders
A Focus on locality