Pharmaceutical Journal Vol 263 No 7059 p271-273
August 21, 1999 The Society

Position paper

The pharmacy workforce: what we know and what we don’t know

Robert Dewdney

The Council of the Royal Pharmaceutical Society has approved the publication of a paper on the pharmacy workforce position. The paper’s objectives are: to explain the present and possible future role of the Society with respect to pharmacy workforce planning; to share information helpful in describing and understanding the state of the labour market for pharmacists; and to identify types of information that can improve knowledge and understanding of the labour market for pharmacists. The paper has been prepared by the head of the Society’s education division, Dr Robert Dewdney

The modern history of investigation of the pharmacy workforce begins, neatly and perhaps not coincidentally, within a year of pharmacy becoming an all-graduate entry profession. That beginning was a motion adopted at the Society’s 1971 branch representatives’ meeting, which prompted the Society to collect and collate information on the sectors and extent of pharmacists’ employment. This activity has been overseen by the Society’s Manpower Committee, operating with a remit to monitor and provide workforce information to the Society’s Council. As well as this regular data gathering and presentation, the committee has from time to time commissioned or co-operated in ad hoc studies of factors impacting on pharmacy workforce.^1,2,3
It must be clearly stated whenever this subject is being discussed that neither the committee nor the Council controls the supply of new pharmacists. A limited direct influence that once existed disappeared in 1987, when the Department of Education together with the University Grants Committee and the National Advisory Body for Local Authority Higher Education (for the then polytechnic sector) abandoned annual consultation with the Department of Health and Social Security and the Society on quotas of funded student places for schools of pharmacy.
Within a higher education system where funding follows students, what has constrained unfettered expansion of pharmacy student numbers since 1987 has been concern that precipitation of unemployment among pharmacists would lead to negative feedback on the quantity and quality of applicants to schools of pharmacy. More significant over recent years has been a cap on funded student places within universities.

The Society’s role

The Society has among its Charter objects

• To advance chemistry and pharmacy.
• To promote pharmaceutical education and the application of pharmaceutical knowledge.
• To . . . promote the interests of the members in their exercise of the profession of pharmacy.

In pursuit of these objects, the Society often directs, leads or supports reform of pharmacy education and training, eg, the introduction of the registration examination and the four-year degree course, and many lesser developments. The Society also has a specific statutory role of accreditation with respect to pharmacy pre-qualification education and training, the degree course and preregistration training. In fact, this statutory role is the main source of the Society’s power to influence the development of pharmacy education and training.
Thus the Society addresses the need to have the right quality of new pharmacists. However, it is the case that schools of pharmacy and pharmacy employers could educate and train any number of students (high or low) provided the resources of accommodation, equipment and teachers/trainers were adequate to produce the right quality of “output”.
Is there then a role for the Society beyond that of quality assurance of future practitioners, and the monitoring of pharmacists’ numbers and work patterns which it chooses to undertake?
Few would disagree that for a profession to flourish, even for it to survive, it must have practitioners in sufficient quantity, as well as appropriately capable. Thus consideration and influencing of pharmacist numbers is within the scope of the Society’s Charter objects. Fortunately, this does not arise as a major issue very often — “fortunately” because when it does arise it presents a considerable challenge. Now is incontrovertibly such a time.

Emergence of difficulties

From the summer of 1995 onwards, not unreasonably prompted by the announcement of the move to all four-year pharmacy degree courses and the consequent lean year for new pharmacists in England, Wales and Northern Ireland (2001), the Society began to receive reports of workforce shortages. Its early action (in 1996) was to discuss these reports with representatives of the National Health Service Executive,² the National Pharmaceutical Association and the Pharmaceutical Services Negotiating Committee. Some months after these discussions, the Society’s Manpower Committee sought evidence and understanding of the shortages from a series of semi-structured interviews of representatives of these and other main stakeholders.
(During 1997, the Society and the NHSE were in contact with the Department for Education and Employment, which was persuaded to classify pharmacy as a shortage subject. This has and continues to facilitate the gaining of work permits for overseas pharmacists registering in Britain.)
What is the state of knowledge from this and other work? This can be organised under two headings, what we know about the supply side of the situation and what we know about the demand side.

What we know: a reasonable amount about the supply of pharmacists

A great deal is known about the Register of Pharmaceutical Chemists in terms of its size and composition by gender and age.⁴ The Society also has a good base of information about sectors and extent of employment from responses to its questions on pharmacists’ annual retention fee forms. Data collation and analysis were facilitated when the Society computerised the register in the mid-1980s, and reports of workforce surveys have been published periodically, such as for 1993 and 1994.⁵ (The latest information, for 1995 and 1996, is now also available. A copy can be obtained by sending a self-addressed C4-size envelope to the Society, marking the letter “1995+96 workforce”.)
A considerable amount is known also about future pharmacists, at least from the point at which they apply to study pharmacy. The Society gathers data on:

• numbers of applicants to United Kingdom schools of pharmacy (data from the University Central Admissions Service and the schools of pharmacy)
• numbers of entrants to, students in each year of, and graduates from, the pharmacy degree course (data from the schools of pharmacy)
• numbers of graduates or sandwich degree course students undertaking preregistration training and new registrants from Britain or abroad (the Society’s own records)

These data for the past 10 years, incorporating information of the gender mix, are given in the Table.
Armed with the totality of this information, and applying actuarial methods, it is possible to predict the size and composition of the register for some years ahead for varying input assumptions. The Society has been pleased to co-operate to enable computer-modelling for this purpose within the NHSE. It is to be hoped that at some point this work will be published or otherwise disseminated.

In recent years, several researchers within and outside the Society have recognised and sought to compensate for limitations of, or to expand on, the Society’s data set. In the main, these efforts have been to estimate the pattern and extent of working of subgroups of pharmacists, and to identify measures that might increase the richness and/or extent of their working lives in pharmacy.
The Manpower Committee itself has for a sizeable sample of the register in 1995 investigated more fully the nature of employment and its inter-relationship with other factors in pharmacists’ lives, including secondary employment, anticipated retirement date, ethnic origin, number of dependents. Dr Karen Hassell and colleagues at the University of Manchester school of pharmacy and pharmaceutical sciences have done more searching work on the impact of ethnicity, particularly, and gender on career motives, again with a national snapshot taken at 1995.⁶ In respect of ethnicity and gender, the Manpower Committee has also studied social trends data from the National Office for Information.⁷ More recently, in mid-1997, the Manpower Committee surveyed a large sample of younger pharmacists (10 years or less on the register) as to the nature and extent of their work, and motives for any changes of their sector of practice or for moving out of pharmacy altogether.⁸

What we don’t know much about: the demand for pharmacists

In any consideration of a market, be it for widgets or pharmacists, it is important to know about the supply and the demand components of the situation. While not perfect, the data about the supply of pharmacists provide much basic information whereas data about the demand side are, at best, patchy. The number of registered pharmacies⁹ and the number with NHS contracts¹⁰ are known. The number of NHS hospital trusts with pharmacy departments can be quantified with some accuracy¹¹ and the number of vacancies in that sector has been assessed periodically.^12,13 That, however, has been near the sum total of hard facts in the public domain.
Over almost a decade, certainly preceding the present shortage situation, the Manpower Committee has sought to address that deficiency. After abortive attempts at a questionnaire survey of employers, in the early 1990s the chairman and the secretary of the Manpower Committee interviewed representatives of employers and other pharmacy bodies. The results of that exercise were never published but were influential in the thinking of the Manpower Committee and the Council. As was mentioned above, a similar exercise was undertaken over the final month of 1997 and the first quarter of 1998, as the major part of the Society’s efforts to gather evidence of and to understand the workforce shortages reported over the previous two years. The hope was for quantification of the extent of employers’ problems and to learn of their future plans (three to five years ahead) for the size of their pharmacy staffs.
In the event, with one or two exceptions, little was forthcoming in the way of data, mainly because the data were not available and partly because companies were reluctant to divulge commercially sensitive information. Nonetheless, much useful information was obtained. Something was learned of the nature and geographical pattern of workforce problems, and a lot was learned about the (supply side) drivers of those problems as judged by employers and similarly interested observers.
The Council received the full report of this exercise in spring, 1998. Lengthy consideration was given to publishing the report but eventually the decision was against this because some of the assertions recorded in it were not quickly verifiable and because the state of the pharmacy labour market was judged fluid, even volatile. The report represented a snapshot of a situation which had evolved further, with the potential significant impact of the White Paper “The new NHS: Modern, dependable”¹⁴ being fully contemplated in late 1998 and beginning to be realised in the first quarter of 1999.
However, from this work it can be stated that the major drivers of increased demand for pharmacists over at least the period 1995 to 1998 have been the acquisition of independent and small group pharmacies by large companies, and the extended hours of opening of these and many other community pharmacies.

Developments over the past 18 months

It is beyond dispute that many employers in pharmacy, including most if not all of the major employers in the community and hospital sectors of the profession, have continued to experience moderate to severe difficulties in recruiting and retaining pharmacists.
Difficulties in the community sector were impressed upon the Society by the PSNC and the NPA at a meeting of representatives on December 11, 1998. At that meeting the Society suggested and subsequently assisted in the drafting of a letter from the PSNC to the chief executive of the Higher Education Funding Council for England. This letter was in support of bids from some schools of pharmacy for more funded places for pharmacy within universities.
Also in the community sector, the Institute of Pharmacy Management International has recently reported valuable survey data.¹⁵
Hospital pharmacy vacancies were surveyed very thoroughly in 1998 and showed 13.7 per cent of posts unfilled.¹⁶ The difficulties in this directly managed sector of the NHS were impressed upon the House of Commons Health Committee by the Guild of Health-Care Pharmacists and by the Society. (Within the Society’s evidence was an expression of support for bids for extra funded student places for pharmacy.) In its report “Future NHS staffing requirements”,¹⁷ the Health Committee specifically referred to the difficulties of hospital pharmacy.
Within the past 18 months there has also been a clutch of studies of the state of the pharmacy labour market at a regional or area level. Probably the largest of these has been a study for and of Scotland commissioned by the Scottish Office Department of Health (SODoH) and involving a consultative conference on 10 March 1999. The report of that work is at present with senior officials and ministers in the Scottish
Office. It is to be hoped that it will be published, being potentially a valuable source of information.
In spring, 1999, at least three schools of pharmacy were awarded extra funded student places either for 1999 onwards or for 2000 onwards. The head of the Society’s education division fully expects the size of the intake to UK schools of pharmacy to reach a new record high in autumn, 1999.

And what next?

Although a few members have counselled restraint,^18,19 it has been a source of frustration for many in the profession that there has not been vigorous action by the Society to increase the supply of pharmacists, particularly new pharmacists.
The Society has been somewhat cautious for a variety of reasons. Within the past decade the Society has been the recipient of downbeat assessments of the prospects for pharmacists’ employment, in some cases from the same sources as describe current shortages and opportunities for pharmacists’ greater and wider employment. Also, the Society, being a public body, has to be mindful of the fact that any “solution” to the workforce problem wholly or partly based on the expansion of pharmacy student numbers would consume considerable amounts of public money and years of young people’s lives. Again within the past 10 years, the Society has experienced the situation of some graduates having difficulty securing preregistration training places because of sluggishness in the pharmacy labour market.¹⁹ However, there is a more fundamental and perennial reason for a conservative approach.
The extant policy of the Society with respect to the pharmacy labour market (from 1988) is that supply should be related to demand.²¹ Here we return to the fact — though not to rehearse the problem in quite the same way as before — that there is no good evidence base from which to quantify the demand for pharmacists. Furthermore, given that it takes five years to produce a new pharmacist, in workforce planning terms it is more important to estimate the demand for pharmacists in the medium-term rather than for the present. Anyone making such an assessment would need to plan or project

• future models of practice, including the roles of pharmacy support staff
• the consequences of resale price maintenance on medicines being removed, should that happen
• the future of the system for entry into contract to provide community pharmacy services
• the future of the system of remuneration for those services

As is well recognised, requiring no recourse to expertise, supply and demand for any commodity (goods, services or employment) are in dynamic equilibrium. Through price, demand is significantly influenced by supply. There is also the uncomfortable fact that in the modern world markets do not exist in isolation. Many bright young, and not so young, pharmacists (and people considering joining their band) have and will exercise other options than pharmacy if its labour market becomes unattractive. Similarly, health services purchasers/commissioners could seek substitutes for pharmacists in the supply of medicines. Thus, at the risk of mixing metaphors, pharmacy workforce planning is rather like trying to hit an uncertain and moving target from a shaky platform.
Much as it may seem, the above does not lead to the conclusion or advice, “give up”. Just because something is hard to grapple with is not a reason to abandon the struggle. For the moment, for want of the profession having a clear set of goals and strategies to achieve them, the Society is adopting a reactive but cautious approach, including enabling continued steady expansion of student numbers. Both the Manpower Committee and (accepting the committee’s advice) the Council wish to enable positive decision-making by all with responsibility, involvement or influence in pharmacy workforce planning or application (what might be termed pharmacy human resources management).
The Society’s Council has decided that the role of the organisation in this area should comprise:

• enhanced monitoring — monitoring of statistics and indicators of the supply of and demand for pharmacists, and of factors influencing that supply and demand
• profiling sub-populations of pharmacists and future pharmacists — defining or describing the nature and extent of the working lives of pharmacists and pharmacy students
• scenario planning — developing a model or models of the pharmacy labour market and applying different assumptions about the socio-economic climate and the development of the profession, to come up with projections of the supply and demand situations for different sets of circumstances unfolding

The Council has recognised that to achieve the above role, the Society will need on to revamp its Manpower Committee and to employ the services of a person or persons with expertise in human resources management, including the statistical aspects of that specialism. It is budgeting for such.