The Pharmaceutical Journal
Vol 268 No 7191 p439-447
30 March 2002

This article
Reprint
Photocopy

PDF* 75K

Employment issues summary

Employing locum pharmacists

Pharmacies have always needed to employ locums, but during recent years that need has become greater than ever. There are several reasons for this, not least the recruitment crisis in that pharmacy owners, multiples and hospitals are finding it difficult to fill full-time permanent pharmacist posts.

The "fallow" year which resulted in the registration of relatively few pharmacists last summer has added to the difficulties, as has the longer pharmacy opening hours in both hospital and community.

Locums are also needed to cover the time that permanent pharmacists are spending in providing additional services such as medicines management and visiting nursing homes. Add to that the fact that growing numbers of pharmacists are being attracted to posts as prescribing advisors in primary care organisations, it is not surprising that one-fifth of all community pharmacies are staffed by locums.

For the pharmacist owner or manager, competition is becoming stiffer all the time, with patients having increasing choice as to where they have their prescriptions dispensed and buy their non-prescription medicines. Pharmacists, therefore, need to be sure that they leave their pharmacies in the hands of a reliable locum.

Indeed, it is the responsibility of the employer to ensure that they have adequate and competent pharmacy cover. This means that anyone employing a locum should check that the potential locum is a registered pharmacist, ie, registered with the Royal Pharmaceutical Society of Great Britain. Pharmacists qualified in other countries must not be employed as locums unless they are registered with the Society.

Registration often in-volves little formality, particularly if the pharmacist has qualified in a member country of the European Union or a country with which the Society has a reciprocal agreement (eg, Australia, New Zealand), but it is still vital that the pharmacist employed is registered with the Society. It is also advisable to ask for and take up references.

In the near future, it will also be crucial to ensure that any locum is on a local list of pharmacists that will be held by the primary care trust (PCT). The NHS Reform and Health Care Professions Bill, now going through Parliament, will likely require that PCTs set up lists of pharmacists who work for pharmacy contractors, and contractors will not be allowed to engage locums unless they are on such a list. These lists are likely to be developed during 2002.

How to find a locum

There are several ways of finding a locum. The first and most obvious way is through local networks, for example contacting other pharmacists to see if they know of any reliable locums in the area. Personal recommendations are worth a lot. Friends and past colleagues can also be a useful source. Moreover, pharmacist locums often advertise their services either in the pharmacy press or in person by visiting their local pharmacies and leaving a business card. It is worth spending a few minutes with potential locums who visit the pharmacy to help ascertain their credentials and find out about the experience they have had. Their details can then be kept on file for future use.

However, with an increasingly mobile workforce, many pharmacists, particularly company managers, may not work in one place for long enough to develop such local networks. Managers of multiples may also have responsibility for 30 or 40 branches so, no matter how good their networks, it is unlikely they will know a sufficient number of pharmacists to obtain adequate cover for their branches.

Locum agencies

Locums can also be obtained through a locum agency. The growth in the locum market has led to a dramatic increase in the number of locum agencies from four in the early 1980s to more than 30 today. Some have been in the business a long time with well-established premises and a number of staff, while others are much smaller and may be run from pharmacy premises as another arm to the main business. Pharmacists sometimes complain about the services offered by locum agencies, and although these services may indeed be variable, there are a number of things an employer can do to secure a good service.

Mark Koziol (director of Provincial Pharmacy Locum Services) recommends that employers should, above all, seek to develop alliances with a few good agencies. "Although if you're desperate, the idea of contacting 15 agencies at once may seem attractive, it's not good policy to use agencies like doormats. Reputable agencies that get to know you're doing that will be reluctant to book you a locum. What an agency wants is to generate repeat business and it therefore aims for a closer relationship with the client."

Employers should also try to avoid, as much as possible, making last-minute arrangements. Some agencies have set themselves up specifically to arrange locums at short notice, but they may only take a booking within the 24-hour period before the locum is required. With these types of arrangements, the level of security can be considerably lower and the fee paid to both the agency and the locum higher than usual. When working with an agency it is therefore best to give as much notice as possible of requirements.

Ruth Glassman (director, Capital Locums) says that what she most appreciates on the part of employers is honesty. "It's as simple as that," she says. "We appreciate that pharmacists will often call more than one agency to fill a vacancy, but it's nice if they call us if they fill the vacancy from elsewhere. Otherwise, it wastes a lot of time. But the worst thing of all is when pharmacists rebook a locum introduced initially by an agency. In my book, that's stealing," she says, "and not the best way of building up a good relationship."

Most agencies charge a one-off introductory fee for a new locum, then a fee for each day or part day that the locum works. In common with all agencies, Mrs Glassman feels strongly about employers cancelling bookings, and she warns that she will still charge the agency fee if the client cancels for any reason.

How to help your locum

All employers want to attract the best locums and there are several ways to ensure that they enjoy working for you and want to come back. Not surprisingly, the top priority on most locums' lists is a tidy and well-organised pharmacy, particularly the dispensary and medicines counter. There is nothing worse for new locums than not being able to find their way around.

It may be obvious but, before arriving at the pharmacy, the locum will need the pharmacy's full address and telephone number as well as the hours of opening and closing, or the hours they are expected to work, if those are different. It is also important to give good directions on how to get to the pharmacy, where to park, how far away the bus stops, the time taken to walk from the train station and what the rush hour is like.

Systems and procedures

Good communication is vital — particularly in relation to the systems in the pharmacy. All relevant information for running the pharmacy should be provided and left in an obvious place. A special locum file can be a useful approach for this. This could include some or all of the following information:

• The staff — their names, hours of work (including breaks and lunch hours) and their main capabilities and responsibilities
• What to do in case of emergencies such as attempted break-ins, broken glass, burst pipes, floods (provide all appropriate emergency telephone numbers, such as the local police, glazier, locksmith, plumber, burglar alarm company, etc; include your own telephone number unless you will be away on holiday)
• National Pharmaceutical Association membership number
• Telephone numbers of local general practitioners, the health authority and any nursing homes for whom you provide services
• Stock ordering systems (names and telephone numbers of different suppliers, identifying those used for different types of stock — generics, stoma supplies and so on; provide information on when orders should be sent, with deadlines, how often and the means of transmission, eg, computer, phone or fax, and whether the onus is on the pharmacy to place the order or whether the supplier contacts the pharmacy)
• Deliveries (the times of day different suppliers are expected to deliver)
• Private prescription tariffs (pharmacies vary in the amounts they charge so be clear about the system in use; if private prescriptions represent a significant proportion of the business, money can be lost by not providing locums with the relevant information)
• Details of any regular Controlled Drug prescriptions, including methadone
• How often patients come and what happens at weekends and bank holidays
• Details of additional pharmacy services (such as prescription collection and delivery services, nursing homes, needle and syringe exchange schemes, etc)
• Opening and closing procedures for the pharmacy (including who does it, and any codes required for the burglar alarm, although you probably do not want to write these down on paper)
• Keys, including the CD cabinet key, and key holders (where the keys are kept and who is responsible for them)
• Cashing up and banking procedures (again stating who is responsible and how often you expect cash to be taken to the bank; make sure there are plenty of paying-in slips)

Computer

For most locums the most important thing to know is how to operate the pharmacy computer. Indeed, when speaking with the locum at the time of making the booking, check whether they are familiar with your system. At least one member of your staff may be an expert, but still leave the instruction manual handy, with a summary of the main points if the manufacturer provides one.

Provide information on how to switch the computer on and off. Although this may seem trite nowadays, some pharmacists switch off their monitors at the end of the day, but leave the computer itself on, while others switch everything off. Make sure any passwords needed for entering the system are clearly marked, as well as any closing down procedures, including back-ups if required.

The locum should also know what do if the system fails. And, last but not least, leave a good supply of labels, making sure that someone knows where they are kept.

Information sources

Leave all reference sources in an obvious place. The Royal Pharmaceutical Society's Code of Ethics states that current editions of 'Martindale', the British National Formulary, "Medicines, ethics and practice", the Drug Tariff and, perhaps, the Data Sheet Compendium should be available for consultation in all pharmacies. An 'OTC Directory' is also useful.

Responsibilities of the locum

Be clear about what you expect from your locums. This will include the usual professional responsibilities associated with supply of prescribed and non-prescription medicines. It is important to explain to the locum the capabilities of your staff — for example, whether you have a trained dispensing technician and whether your medicines counter staff are trained to use a protocol or something similar for sales of medicines.

Of course, locums may decide that they want to handle medicine sales and supplies in a slightly different way than you do. If this is the case, it is their responsibility to explain their preferred way of working to the staff. Indeed, well-trained staff will often ask a new locum how they like to deal with these matters.

Owners and managers may have different ideas as to whether they want a locum to be involved in ordering, endorsing prescriptions, cashing up, banking and so on. You may have staff who do these things already, but if you prefer your locum to do them, leave instructions in the information file.

Insurance

Locums will expect you to carry professional indemnity insurance that covers them, too. Assuming that you are a member of the National Pharmaceutical Association, the Chemists' Defence Association automatically covers your locums. Increasingly, locums will have their own personal professional indemnity insurance as well.

Payment

What locums always appreciate is prompt payment without any hassle. It is important to explain how this will be arranged — whether by cheque, cash, bank transfer — and where any payment will be left in the pharmacy.

It is also important to run an internal audit trail, particularly with regard to locum fees and expenses. In other words, make sure that the fee and expenses which have been agreed are those that are paid. This can be a significant issue when a locum has been booked by a third party, ie, by a manager or owner who is not present in the pharmacy on the day the locum works.

What can happen is that the locum turns up at the pharmacy and the member of staff with responsibility for paying the locum may not know what amount has been agreed either for the fee or the expenses. This can work both ways in that the locum may be paid less than they were expecting or sometimes more.

There have been cases of locums claiming expenses and fees not agreed in the first instance and discrepancies can be huge, so it is important to clarify exactly what has been agreed and to communicate that to the member of staff who will be involved in dealing with the locum.

Dr Mason is a pharmacist and freelance writer from Sydenham, South East London