The Pharmaceutical Journal
Vol 270 No 7248 p658-659
10 May 2003

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The national workforce census:
(1) Locum pharmacists and the pharmacy workforce in Britain

By Karen Hassell, PhD, and Phillip Shann, MSc

The first full census of pharmacists was commissioned by the Royal Pharmaceutical Society in August 2002. Over the coming months, The Journal will publish a series of articles on the census. The first of these focuses on locum pharmacists

Now that a national census of pharmacists registered in Britain has been undertaken,¹ it has become possible to identify the number and demographic characteristics of pharmacists working as locums. It is also possible to assess the amount of work they undertake, describe the types of pharmacies in which they work and identify the number of jobs they have. This article presents these findings and considers some of the possible implications for professional practice and policy that arise from them.

Locum pharmacists

There is a large locum workforce in Britain. A small proportion (1.4 per cent) of the home register (pharmacists with registered addresses in England, Scotland and Wales) work as hospital locums. However, almost a quarter (23 per cent) report working as community locums; this is the equivalent of 28 per cent of the active register, or 38 per cent of the workforce employed in the community sector.

Compared with the register as a whole there are proportionately fewer female pharmacists (51.7 per cent) among community locums, fewer younger pharmacists and a greater proportion of older pharmacists, particularly in the 50 to 59 years age group.

Greater proportions of community locums work less than full-time hours per week (defined as 33 hours per week) compared with the profession as whole (43.3 per cent work 24 hours a week or fewer, compared with 22.7 per cent of the register). These part-time patterns of work are even more pronounced if only the hours worked within the community sector are considered (57.6 per cent work 24 hours or less in community pharmacy compared with 31.1 per cent of the home register). Age and gender interact with work commitments, with younger pharmacists working more hours in community pharmacy than older locum pharmacists, but not necessarily full-time hours in this sector. The younger locum pharmacists are far more likely to work full-time hours in total (ie, including all jobs). Women locums are more likely to work fewer hours compared with men, but it is still important to recognise that relatively large proportions of male locums work less than full-time hours, whether just in community pharmacy, or in total (36 per cent work 24 hours or less in total).

The difference in total hours worked against hours worked in community pharmacy is indicative of the "portfolio" type working practices of community locums: 28 per cent have more than one job, compared with 14 per cent of the home register. Other jobs may be held within the community pharmacy sector: for example, 2.8 per cent of community locums also report being a retail manager. However, other sectors of practice are more common: 10 per cent also work in the hospital sector, 4.9 per cent also work in primary care and 6.7 per cent also work in some other sector of practice.

Community locums work fairly evenly across the pharmacy types, with roughly a third working in independent pharmacies, a third working in multiples, and a third in small and medium chain pharmacies.

Are all locums the same?

An appreciation of the heterogeneity of the locum workforce in pharmacy is central to our understanding of it. A common assumption is that locum pharmacists are young pharmacists, straight from their preregistration year, looking for a high salary to pay off large student debts. While this may be true of the young pharmacists performing locum work, it is clear from the census that young pharmacists do not dominate the locum workforce. Older pharmacists are in the majority and it is likely that their reasons for becoming a locum are different from those of their younger counterparts. On the one hand, they may well be choosing to work part-time in a way that gives them control over their work, for example, enabling a better work/life balance. On the other, they may be looking to retire, but do not want to end their professional career completely.

Locums also include women with young children working evenings or weekends to suit family commitments, or full-time academics working one day a week to maintain familiarity as a practising pharmacist (indeed 29 per cent of pharmacists who work in academia also work as locums in the community pharmacy sector). Additionally, many locums may fit a "portfolio" pattern of work, with a number of different jobs in different places, or may be "regular" locums often working full-time hours in the same store, chain or locality. It is noteworthy that 44 per cent of those who work as community locums work more than 32 hours a week in total.

Such diversity emphasises the complexity of factors likely to be at play behind the size and composition of the locum workforce. The motivations behind working as a locum may be dependent on a number of factors related to age, gender, domestic circumstances, other pharmacy positions held and the stage people are at in their careers. It would be particularly beneficial to pinpoint the reasons why people choose locum work across different sub-groups of pharmacists, along with other issues such as the perceived disadvantages of their working patterns. Alongside consideration of this heterogeneity in the locum workforce, it may also be useful to consider more general overarching factors that may be involved in the shaping of it. For example, the size of the locum workforce may also be indicative of satisfaction levels in the profession.

Implications for policy and practice?

Clearly, the locum workforce is large, and this finding alone has significant implications for practice, not least around the issues of clinical governance, regulation and continuing professional development. How, for example, can such a potentially transitory workforce be regulated? What does it mean for the delivery of pharmaceutical services in the community when such a large proportion of the practitioners are temporary members of the pharmacy team? It is likely that some locums will work regular hours in the same location, but it is also likely that many more will work irregular hours in a variety of places. This could perhaps make continuity of care for patients problematic, and could present challenges to skill mix for the local team. It may also raise serious questions about the potential of pharmacy to deliver on local pharmaceutical services pilots, since most primary care trusts submitting LPS proposals require a named pharmacist on the LPS service contract.

Why is such a large proportion of the pharmacy workforce working as locums? The census cannot answer this question, but research on other professional groups gives some indication as to what is driving this phenomenon elsewhere.

The closest parallel in general practice is the "GP non-principal", which encompasses "locums" "retainers", "assistants" and "deputies". Research on this group shows that they actively choose this work, and do so because of the flexible working it affords, because of the sense of control and independence it provides and because of a general reluctance to take on managerial responsibilities. The downside of working as a non-principal is that they receive less continuing education, are excluded from National Health Service superannuation and are often unable to obtain British Medical Association recommended pay rates. Another study found that for those who used to work as GP principals, "general workload", followed closely by "family commitments" and too much "out of hours" work, was the most commonly cited reason for giving up on principal work.² It would be useful to explore whether similar issues resonate with locums in the pharmacy workforce.

The growth in flexible working patterns within the nursing profession offers further pointers in respect of understanding the pharmacy locum workforce. In terms of contract flexibility, the number of "bank" nurses has increased over the past decade or so, along with an increase in the number of nurses employed on temporary, fixed-term contracts (although the number of nurses employed via agencies has fluctuated).³

Buchan identifies two main drivers behind such changes.³ The first is cost containment. Achieving greater efficiency in the use of staff as part of NHS reforms, by using a peripheral section of the nursing workforce to meet service demand more directly, is cheaper. The second is the drive to improve equal opportunities within the NHS. This is of particular relevance to nursing, given the high proportion of women who comprise the nursing workforce (90 per cent). In this context the 1990s saw increased pressure to provide career opportunities for nurses wishing to work "family friendly" shift patterns, as well as more opportunities for career breaks and job sharing. However, with the possibility of further increases in "peripheral" nursing staff with more nurses employed through "banks" or on fixed-term contracts, there are now concerns as to whether the situation can be characterised more as an increased "casualisation" of the nursing workforce with compromised career prospects and lack of job security for many. Although Buchan notes that both wholly negative and positive views of the situation are over simplified, he concedes that the extension of such flexibility in the nursing profession seems to be more an outcome of short-term uncertainties in service provision than to any long-term strategy.

This brief snapshot of the situation in nursing shows how increases in flexible working patterns are related to structural macro factors, in parallel with the micro aspects of employee choice and preference. Although the labour market in respect of pharmacy locums (particularly in the community sector) is vastly different from that of nurses, it is worth considering whether similar underlying reasons might be at play with regards the reasons why multiple pharmacy organisations are happy to employ so many locums (whether employed directly by companies or self-employed). Could uncertainty in short-term service demand be another factor in the size of the pharmacy locum workforce?

The relationship between increased flexible working patterns and macro structural factors is also evident at a wider societal level. Although the high proportions of non-principal doctors working flexible patterns is attributed in part to changing attitudes towards career and lifestyle,² this is echoed in broader theories concerning the changing role of work in contemporary society in general. Social theorist Ulrich Beck contends that paid work and notions of career are no longer the prime source of activity and identity in society, with a de-standardised, fragmented system of "underemployment" emerging, characterised by highly flexible forms of paid labour.⁴ It could be argued that the high levels of locum work seen in health professions such as pharmacy, nursing and medicine is, on a broader level, simply a reflection of these macro developments.

Aside from the motivations pharmacists may have for working as locums, the range of duties undertaken by locums when working also warrants attention. What exactly is the nature of the work undertaken by locum pharmacists? Is it safe to assume that they do not engage in clinical or more professionally oriented roles? Is it the case, as will be commonly assumed, that they mostly perform tasks related to the dispensing process? There is no evidence base to support these statements and, while no value judgement is attached to either, it may be seen as detrimental to the profession overall that such large proportions are engaging in "non-professional" roles. On the other hand, the locum workforce may actually be helping the profession move forward, since without their contribution to traditional NHS dispensing other pharmacists would not be able to engage in developmental roles. The opening hours of many pharmacies are long, and it may well be the locum workforce that is staffing the extra hours now being demanded through the growth in supermarkets and multiples. Without the contribution of locums many pharmacies might close.

Conclusion

In summary, the locum workforce is large and diverse, with different subgroups likely to have a variety of different motivations for choosing non-standard work patterns. It is generally considered difficult for GP principals to work part-time in general practice, but the community pharmacy sector provides many opportunities for part-time work. Pharmacists can implement phased retirement instead of full retirement, women can work reduced hours to suit child-care commitments, and it appears that many are doing this in a locum capacity, rather than as a permanent employee. Nevertheless, a large proportion is also working full-time hours per week. The two extremes suggest that it will not be possible to attract large numbers of the locum workforce into full-time employment during times of workforce shortages, since a substantial proportion are already working full-time, and those working part-time are likely to want to continue to do so.

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