A second community pharmacy session focused on manpower. The session, on September 14, was chaired by the President (Mrs Christine Glover) and presentations were heard from Mr Wally Dove (chairman of the Pharmaceutical Services Negotiating Committee) and Mr Ian Caldwell (a past President of the Society and a former chairman of its Manpower Committee). Mr Dove believed there was a "serious manpower problem" in community pharmacy, while Mr Caldwell held the view that, in fact, jobs would be needed for at least 30 per cent more pharmacists in 20 years' time
There is a serious manpower problem in community pharmacy, Mr Wally Dove (chairman, Pharmaceutical Services Negotiating Committee) told the Conference. However, unlike in hospital pharmacy, no consensus existed about the problem in community, which for Mr Dove, both as PSNC chairman and as a pharmacy owner, was "hugely frustrating".
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Wally Dove: design degree courses to match modern needs |
The causes of the problem were not simple or straightforward. First, there were regional variations - some parts of the United Kingdom had a significantly worse shortage than others - but the problem was nationwide.
Second, it was not necessarily the case that there was an overall shortage of pharmacists, just shortages in certain sectors, including community practice.
Part of the reason for this was that an increasing number of graduates were being employed in the industry, by health authorities, by supermarkets and even by non-contract pharmacies. "And once primary care groups evolve into primary care trusts, as they will from next year, I believe we will also see a growing number of pharmacists employed directly at PCT level," Mr Dove said.
Quality problem
But it was not just a case of shortages. There was a quality problem as well.
"We all know that even when it is possible to find [pharmacist] cover for temporary periods, the quality of that cover sometimes leaves something to be desired. But the quality problem is ultimately a function of the shortage we are facing," Mr Dove declared.
Turning to recruitment, Mr Dove pointed out that many good pharmacy graduates who would grow into excellent pharmacists chose not to enter pharmacy careers at all. "The fact is that around 10 to 15 per cent of pharmacy graduates do not join the register," he said.
Some saw their degree as a general qualification rather than a vocational one, and went on to work in non-pharmacy professions. Others decided to work abroad, at least for the early part of their career. Putting all these factors together resulted in a recruitment problem.
"And, unless we do something about it, the outlook for community pharmacy is, I am afraid, more of the same," said Mr Dove.
He said that impending fallow year for preregistration trainees, caused by the introduction of the four-year pharmacy degree course, added to the problem.
He went on to say that averting a manpower crisis in community pharmacy not only relied on adequate recruitment. "We also have to make sure that those recruited stay in pharmacy. Unfortunately, at the moment there are signs that this is not happening."
So why did pharmacists choose to leave the profession?
Mr Dove said that the biggest, single answer lay in a word that preoccuppied the PSNC for much of its time, namely, money.
Pharmacy graduates, quite reasonably, had the same expectations as their friends and peers who graduated in other disciplines. When they found that their income and their career progression was likely to be limited in community pharmacy, some of them decided to move on.
"And when they leave pharmacy," said Mr Dove, "the likelihood is that they will not come back. All that education and training and those early years of experience are lost to the profession for ever."
It was not that their income aspirations were unreasonable. The problem was that community pharmacy had been squeezed hard by the Government in recent years.
On the National Health Service side, the Government had systematically reduced the real terms size of the budget and had devalued the important work pharmacists did. As far as counter business was concerned, increasing pressure from other retailers - especially the major supermarkets - was beginning to take its toll.
But money was not the only source of the problem. Many pharmacists in practice found the state of the profession overall to be frustrating and unattractive.
"They see a profession still seeking to redefine its role, still struggling to get to grips with some of the issues laid bare in the Nuffield report 13 years ago. . . . In short, if we are travelling into a New Age, we have not yet arrived and it is not certain that we have decent directions," said Mr Dove.
Women pharmacists
A further cause of retention problems was the number of women pharmacists on the register. Many of them eventually chose to leave the profession for financial, professional or family reasons.
So what could be done?
Mr Dove believed that if the development of community pharmacy could be steered to ensure that it more closely matched the aspirations of younger pharmacists, that would begin to make a difference. It would be a long-term process, but he was optimistic that it could be achieved.
"Progress is frustratingly slow, but there are some signs - in pharmacy prescribing and medicines management proposals, for example - that pharmacy is going to evolve into a stronger profession. These new disciplines, in addition to the core dispensing function, could help to form the basis of a newly defined community pharmacy service - the kind of service that graduates are equipped for and keen to provide," he said.
However, the development of new roles increased even more the need for additional pharmacists; indeed, most pharmacies would require a second pharmacist and that raised significant funding issues, which the PSNC was already seeking to discuss with the Government.
The irony was that while professional development might cause more to enter and saty in the profession, the need for extra pharmacists would exceed current predictions by a long way.
Mr Dove suggested that a good starting point for resolving the manpower issue would be if those who cared about it could reach a consensus on the problem. Until recently, there had seemed to be differences of opinion between employers, contractors and the bodies representing them on the one hand and the Royal Pharmaceutical Society on the other. However, in recent months there had been encouraging signs that the Society was prepared to adopt a fresh outlook on manpower. It had agreed to expand the remit of its Manpower Committee so that it would become a "centre of excellence", advising interested parties on supply and demand issues and trends in pharmacy.
"If it can focus the Society on tracking the manpower problem and providing definitive evidence, as well as bringing the Council closer to the position that the PSNC and the National Pharmaceutical Association and all pharmacy employers have adopted for some years, then it is to be wholeheartedly welcomed," said Mr Dove.
He went on to say that, all too often in the past, messages had been mixed because of a tendency towards isolationism. "That weakens us in the eyes of others and, most importantly, it has meant that the manpower problem remains largely unaddressed."
He hoped that common messages and common proposals could be agreed. "If we can achieve consensus, then we will be in a far better position to tackle the problem and to persuade others - notably, the Government - to play their part in tackling it, too."
Mr Dove outlined two proposals that he believed would help.
First, he called for a joint working group to be set up drawn from the PSNC, the NPA, major employers, academics and the Society, whose objective would be to identify strategies for reducing the manpower problems in pharmacy. Second, he suggested that one of the keys to unlocking the manpower problem was to ensure that degree courses were designed to match modern needs and could anticipate future developments. To that end he called for a joint review of pharmacy degree course requirements, involving the Royal Pharmaceutical Society, the PSNC, the NPA, the Company Chemists Association, and heads of pharmacy schools.
All bodies needed to work together instead of viewing the various facets of the manpower problem as "turf issues".
Mr Dove concluded: "If we do work together with a common agenda, then I believe the manpower problems can be solved. The result will be a community pharmacy profession better equipped to tackle the challenges and realise the opportunities that lie before us. That is a goal we have to achieve."
The challenge for the pharmacy profession is to make certain that in 20 years' time there are worthwhile careers for at least 30 per cent more pharmacists than there are today. That was the view put to the Conference by Mr Ian Caldwell (a former chairman of the Royal Pharmaceutical Society's Manpower Committee).
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Ian Caldwell: a current levelling out in the jobs market for pharmacists |
Mr Caldwell went on to relate that figure to the number of jobs that were currently available.
There were about 4,000 major multiple pharmacies. If they were open 14 hours a day, seven days a week, that amounted to 98 hours. If a pharmacist's working week was 40 hours than 2.5 FTEs were needed to service each pharmacy. Adding 20 per cent to allow for holidays, sickness and training, resulted in a figure of 3 FTEs per outlet. The total requirement, therefore, was 12,000 FTEs. By the same token, independent community pharmacies accounted for 10,000 FTEs, hospital for 5,000, industry for 1,500 and primary care group advisers 500 FTEs, giving a total of 29,000 FTEs - enough jobs, in other words, for the 29,240 FTEs on the working register.
Levelling out
Mr Caldwell said that these figures suggested a current levelling out of the job market for pharmacists. In the next 20 years, however, there could be many more pharmacists in circulation than could be employed in what were currently considered to be worthwhile pharmaceutical occupations.
His calculations, which he accepted were "crude", indicated that the working register in 2019 would comprise 38,920 FTEs. That figure was based on a projected total register size (increased at 2 per cent per annum) of 62,600, of which 40,600 were female and 22,000 were male. Applying the "availability to work" formula gave 19,120 women and 19,800 men, or 38,920 FTEs. And it was on that basis that Mr Caldwell suggested that 30 per cent more worthwhile jobs would be needed for pharmacists by 2019.
He warned, however, any projection on manpower made the bland assumption that the right pharmacist with the right skills would want to live where the jobs were. That, in turn, was compounded by the decision on who was the main earner in a marriage or partnership.
But where were new jobs going to come from? That would depend on professional, commercial and information technology developments and on what an ageing population needed and expected from pharmacy. He referred to a comment that had been made by Mr Bill Cummins at the New Zealand Pharmaceutical Conference in 1997. Mr Cummins had said that 70 per cent of the jobs which would exist in 2010 had yet to be invented.
Information technology, in particular would become increasingly important. Mr Caldwell said that access to the internet would not be a problem for the public. He hoped that the Royal Pharmaceutical Society was acting now to be the user-friendly, authoritative source of information in the English language. He suggested that the volume of information available on the internet was expanding at such a rate that the profession had to seek to become the guide, gatekeeper and interpreter of that information for the individual. The pharmacist, in other words, could become "an up-graded health counsellor who gets paid".
Mr Caldwell reminded the conference of the roles that had been predicted for pharmacists at a 1995 meeting of the International Pharmaceutical Federation in Munich. These were medicines management, outcome measurement, compliance monitoring, robotics management, and dependent and independent prescribing. These projected roles had been echoed in the recent Crown report.
If pharmacists raised their eyes to the world outside, they would see that bigger was going to be better. Amalgamations of chains and trusts would mean fewer promoted posts but might create more specialisms for pharmacist employees and consultants.
Referring to the Pricewaterhouse Coopers report "Open sky retailing", published in May, 1999, Mr Caldwell said that it had predicted a future that was not yet recognised because it depicted the disappearance of market boundaries.
"Our pharmacy multiples will be very small fry compared with utilities companies, such as Scottish and Southern providing social and heath care services or with media companies like BSkyB using their data to tailor services - whether welfare, leisure or financial - to the needs of the individual. The list goes on and on."
Mr Caldwell warned that these "global, mega-providers" would not need to make a profit initially. Their aim was to buy market share - the market did not matter. The profit came from cross-selling to a huge customer base.
"In the end, however, these global monsters will have to buy all sorts of expertise. How much of it will come from pharmacy? You guess. I can't."
Against this background, independents could enjoy a very different future from that of today. Provided they joined together under some sort of virtual chain or marketing banner, they could compete better with corporate bodies and offer the advantage of continuity of face-to-face personalised service.
Also, the 1998 Competition Act might affect discounts and equalisation deals, and help to level the playing field. If prescription sales became even less profitable than they were now, multiple expansion might slow with a consequent moderation of staff demand, Mr Caldwell said.
Intellectual roles
He went on: "When independents learn to share the services of specialists there will be a further modest increase in jobs of a few hundred. If we get pharmacies run by primary care trusts, they will almost certainly cause the closure of some existing pharmacies. Since 100 drugs account for 42 per ent of all prescriptions and as automation becomes cheaper, there will be a role for mechanised dispensing, perhaps actuated by patient smart cards. At best, this would have a neutral effect on manpower but would allow pharmacists to add value by doing the medicine and outcome management roles - the intellectual roles."
Mr Caldwell said that there were many other challenges that he did not have time to address, including remuneration, career structures, quality of life, quality of pharmacists and professional independence.
"We have faced challenges before and overcome them. In this century we've gone from crushing leaves and pounding roots through Erlich's ‘magic bullet' to sulphonamides and antibiotics to specific antagonists and gene therapy. Things change and we change with them," said Mr Caldwell. "The ultimate challenge is for us to be true to our responsibilities."
Mr Caldwell added that there was a school of thought which suggested that massive over-production of graduates should be aimed for and "the de'il tak' the hindmost".
He had two objections to that. First, it cost the public money without prospect of return on their investment. Second, people did not go into pharmacy just to take any old job. They did it to contribute to the health and welfare of society at large.
Mr Caldwell concluded: "By the terms of our Charter, we are responsible for the promotion and safeguarding if the interests of pharmacists, and to me that demands that members are enabled to follow their profession."