The Pharmaceutical Journal
Vol 273 No 7313 p249-250
21 August 2004

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First pharmacy post advertised this week under “Agenda for change”

The first pharmacy job to be recruited under “Agenda for change” is advertised in the classified section of this week’s Journal. Gareth Jones (editor of Hospital Pharmacist) reports

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Agenda for change (more)

A highly specialist critical care pharmacist post at Guy’s and St Thomas’ Hospital NHS Trust is the first pharmacy job to be advertised under “Agenda for change”. The advertisement for the post is published in this week’s Journal (pA20). “Agenda for change” is the new scheme governing pay, terms and conditions which is to be implemented nationwide for all NHS staff except doctors, dentists and senior managers.

The post is graded in band 8a, with a salary in the range £36,442–£45,286 (including £5,328 inner London supplement). The normal starting salary for this post under “Agenda for change” will be £38,626, but candidates currently on lower salaries may initially be offered one of the transitional starting points.

Cath McKenzie, principal critical care pharmacist and the manager leading the recruitment for this job, explains that a band 8a post is for someone who already has expertise and experience in the specialty. According to Duncan McRobbie, principal clinical services pharmacist at the trust, there are high expectations of someone at grade 8a, and he or she will come to the post having the knowledge needed to do the job and will be expected to “hit the ground running”. The post holder will be on the same grade as the lead nurse in the intensive care unit, and will therefore be expected to deliver at the same level.

Ms McKenzie says that the post holder will take around five years to reach the top of the scale, if first employed at the normal starting salary for the post. The person will then be in the position to apply for jobs in band 8b, which could include roles in management (the current post holder is moving to the position of director of clinical pharmacy at another hospital) or a more senior position as a clinical pharmacist (including possibly one of the proposed consultant pharmacist posts).

Band 6 and 7 clinical pharmacist and specialist clinical pharmacist posts at Aintree University Hospital NHS Trust are also to be advertised in the next few weeks. The band 6 post will be for a pharmacist who has recently qualified or is new to hospital pharmacy and will involve a rotational programme and the undertaking of a clinical diploma, according to Dave Thornton, principal pharmacist at the trust. The starting salary will be £24,318, which is similar to the B grade post under Whitley Council of £24,211 (including emergency duty commitment [EDC]). The salary for the band 7 post will start at £28,839.

Assimilation

The process of transferring staff from Whitley Council grades to the new bands under “Agenda for change”, known as assimilation, is nearing completion at many of the 12 early implementer sites. Of the 30 pharmacists who have been assimilated under “Agenda for change” at Aintree Hospital NHS Trust, Mr Thornton believes that around 90 per cent are satisfied with the outcome. A couple of jobs have been given a lower band than expected, and one of these is to go to appeal. Two pharmacists have lower pay under “Agenda for change” than with Whitley Council, although their current salaries are protected. One of the pharmacists will also need to complete a job analysis questionnaire because the job did not match a national job profile.

Mr McRobbie says that most pharmacists in Guy’s and St Thomas’ Hospital NHS Trust have been informed of their new pay band under “Agenda for change”. He comments that out of around 90 pharmacist posts in the trust, only one is not matched to a nationally agreed job profile. Mr McRobbie adds that although the issues of pay are almost resolved, the implications of “Agenda for change” in terms of new working practices are only just becoming apparent.

“The outcome of the assimilation process has been great, but the process was difficult and stressful at times,” comments Ms McKenzie. “Your job is a part of you, and when completing the job analysis questionnaire it is therefore challenging to think not about your personal attributes, but what the job involves,” she adds. Explaining why she is pleased with the introduction of “Agenda for change”, she says: “This change has gone well for our profession, because pharmacists have come out at each level one band above every other professional group. This is because the entry level degree for pharmacists is now a vocational master’s [rather than a bachelor’s degree].”

New career path

“Agenda for change” has raised the ceiling of earnings for pharmacists. Mr McRobbie comments that the experience at Guy’s and St Thomas’ shows that “Agenda for change” could offer new opportunities for hospital pharmacists. “While the extended length of the pay scale for pharmacists is an advantage of ‘Agenda for change’, national clarity is required about what pharmacists do for their money. This will be advantageous in the long term with a structured career path,” he says.

The hospital pharmacist career path is more attractive under “Agenda for change”, than under Whitley, because it has brought out a new level of clinical practitioner, suggests Mr Thornton. Under Whitley Council arrangements, many hospitals did not have any purely clinical posts above grade D, with grade E and above being only available for management roles. Under “Agenda for change”, pharmacists can do basic rotational training and a clinical diploma lasting about three years at band 6, move to band 7 and start to do specialist training, and then move to band 8a as a highly specialist clinical pharmacist. This could equally be applied to technical posts. The difference between a band 7 specialist and a band 8a highly specialist post is the requirement for the latter job to have a higher level of knowledge, training and expertise. “More steps are more easily accessible to more people,” he says.

Mr Thornton comments that under Whitley Council arrangements, newly qualified pharmacists completing a clinical diploma could advance to a D grade post within three years. He says: “Progression under ‘Agenda for change’ could be a culture shock because it will not be possible to make such a quick progression in terms of salary.” The key difference across the bands in general is the score for knowledge and skills. The knowledge and skills requirement for bands 6 and 7 is the same, so the difference between these bands is about taking on more clinical responsibility. This could potentially devalue the clinical diploma, suggests Mr Thornton, because it will not get points in the job analysis. Junior pharmacists may question the value of a clinical diploma, although the job profiles for band 7 at Aintree ask for a diploma or equivalent experience.

According to Ms McKenzie, career paths will be better mapped out under “Agenda for change”. It will no longer be possible, for example, to undertake a D grade post in elderly care followed by an E grade post in critical care and then a F grade post in medicines information. The career path will be much clearer, although people will need to make decisions about their direction much earlier. In band 7 pharmacists will need to decide what they want to do (eg, clinical pharmacy, technical services, education and training, etc) and then get the experience they need for an 8a highly specialist role.

Terms and conditions

Contracted hours for pharmacists will reduce from 39 per week to 37.5 per week under “Agenda for change”.

Ms McKenzie comments that this change is having an impact on the provision of the weekend service. At Guy’s and St Thomas’ they are reviewing what services should be provided at the weekend. Ms McKenzie criticises the rules preventing staff in band 8 jobs from doing overtime. She comments that medical consultants are paid overtime for working extra sessions and there should be no reason why this should not also apply to other health care professionals. Mr McRobbie also suggests that it will take people slightly longer to obtain the experience and training needed to progress to a higher position with reduced working hours.

The reduction in hours for the pharmacists across the department at Aintree hospital is equivalent to one whole time equivalent post. A business case has been made to the trust which, as a result, has agreed to fund an extra basic grade pharmacist.

Holiday entitlement under “Agenda for change” is based on years of service. Staff will receive 27 days when starting in the NHS, rising to 29 days and 33 days after five and 10 years of service, respectively (in addition to general public holidays). Staff who are on longer holidays when assimilating to “Agenda for change” will have their entitlements protected for five years. However, according to Mr Thornton, an anomaly exists when, for example, a D or E grade with less than 10 years’ experience in the NHS moves to a new job at an early implementer site. The holiday entitlement may drop from about 32 days a year to 27 or 29 days, depending on length of service.

A further change to the terms and conditions is the introduction of gateways at either end of the bands. Rather than automatically receiving an increment every year, as has been the case under Whitley Council grading, staff will need to demonstrate that they have developed sufficiently to continue moving up the band at two points on the scale.

What happens next?

National roll-out of “Agenda for change” is now scheduled for December, subject to agreement from a ballot by Amicus of members of the Guild of Healthcare Pharmacists in the autumn. The agreement will be backdated to October 2004. The other early implementer sites will also advertise vacancies as they arise under the new system, but jobs advertised under Whitley Council terms will still be seen until the national roll-out has been completed.

The implications for pharmacists of “Agenda for change” are now starting to become clearer with the experience of the early-implemeter sites. There appears to be some optimism among those most closely involved in the process that it should offer hospital pharmacists a fair deal. While salary increases at the lower end of the spectrum may be slower, the ceiling at the top has been lifted allowing all hospital pharmacists to work towards more challenging and better paid jobs.