Full-time workers make up less that half the register
Pharmacists working full-time in pharmacy-related jobs account for less than half the Register of Pharmaceutical Chemists, according to figures presented to the Royal Pharmaceutical Society’s Council at the October
Council meeting.
In a presentation on workforce capacity, Karen Hassell, senior research
fellow at the University of Manchester centre for pharmacy workforce
studies, said that 70.4 per cent of those on the register are actively
employed in pharmacy-related occupations and, of those, 32.5 per cent
are working reduced hours. This leaves 47.5 per cent in full-time employment.
In terms of numbers, just over 22,000 of the 46,384 pharmacists on the
register work full time and 10,600 part time; 13,000 are not part of
the British pharmacy labour market because they are abroad or working
in a non-pharmacy occupation or not working at all.
Dr Hassell also gave figures suggesting that only five out of six students
who start pharmacy degree courses go on to join the register (see Panel
below, p626).
Dr Hassell was presenting data derived from the Society’s censuses
of pharmacists carried out in 2002 and 2003.
One in six pharmacy students fails to reach the register
More than one in six students who start pharmacy undergraduate
courses fail to progress to registration as pharmacists, according
to the
data presented to the Council by Karen Hassell.
She said that the 1,396 graduates who passed the Society’s
registration examination in 2003 would have entered their schools
of pharmacy in 1998, when the first-year intake was 1,697. These
figures indicated that nearly 18 per cent of those who started the
degree in that year did not go on to join the register. That was
the national picture, and it would be interesting to look at figures
for the different schools of pharmacy. Was such an attrition rate
acceptable? It might just be a blip and it might be worth looking
at previous years. But it is “something that needs some attention
paying to it”.
Linda Stone said that some students may not have dropped out but
may still be in the system “repeating”. She also asked
how many left early in the first year, because universities do
not consider them drop-outs if they switch courses or leave because
their
funding does not come through. Also, some schools of pharmacy over-recruit
in the first year because they expect to lose some students.
Another issue is that this year some schools of pharmacy have recruited
far more overseas students than they have for a number of years.
Many will only have got their funding on the basis that they return
to their country of origin. Two schools have a high number of students
who go straight back to Ireland on graduating.
Dr Hassell said that Mrs Stone was right to point out those issues.
But the data was difficult to unravel because of issues such as
sandwich courses and graduates returning to Ireland. She was only
trying to
start the ball rolling. She had not been able to look at data on
a school level other than for Manchester. But when people are asked,
they all say that attrition is not high and are surprised when
shown the data.
Asked how the attrition rate compared with other courses and other
countries, Dr Ambler said that it was surprisingly difficult to
get hold of the data, although she understood that for nursing
it was
around 12 per cent.
Michael Schofield said that it would be interesting to compare
pharmacy drop-out figures with those for professions such as medicine
and
nursing. |
Inflow and outflow
On inflow to the register, Dr Hassell said that in the year to August
2003, there were 2,146 new entrants — an entry rate of about
4.7 per cent. Where did they come from? There were 1,396 registration
examination passes in 2003, including Belfast graduates and people
taking the adjudication route, and the rest were probably returners
to the workforce and people joining the register from overseas.
In terms of outflow, just over 1,000 people exited the register completely
in 2004 —an exit rate of about 2.3 per cent. Of those who left,
31 per cent were men over 65 and 25 per cent were women under 39. Although
one could guess why these groups were leaving, what about the other 44
per cent?
From a workforce viewpoint, another aspect of outflow is people who are
on the register but live overseas and are therefore not currently available
to work in Britain. Nearly 11 per cent of the register work abroad. Most
qualified as pharmacists in Britain but they are not necessarily British
nationals. Another aspect of outflow is people working in a non-pharmacy
occupation while remaining on the register. This was about 2.3 per cent
of the register, representing just over 1,000 pharmacists.
The main component of workforce outflow is those who pay the fee but
do not work at all. This represents 16.6 per cent of the Register — nearly
8,000 pharmacists. Of these, 76 per cent are retired and about 12.5 per
cent are on maternity leave. Of the retired, about a third are under
retirement age. So there are issues around why they choose to leave before
reaching retirement.
Of those who identified themselves as being economically inactive, 36
per cent said they will return within the next 12 months — but
this claim is not borne out by a comparison of the 2002 and 2003 censuses. Active pharmacists
Dr Hassell said that the 70.4 per cent of respondents who said they
are actively employed in pharmacy-related occupations are equivalent
to
about 32,500 pharmacists; 56 per cent are women, compared with about
52 per cent of women on the register as a whole, and about 42 per cent
of working women are working part-time.
Dr Hassell said that just over 24,000 pharmacists now on the register
are women. The number is expected to rise because about 60 per cent of
students entering pharmacy are women. She added that women are leaving
pharmacy or reducing their participation surprisingly early. Even within
five years of graduating some 14–15 per cent choose to leave the
register, either because they are not working at all or have chosen to
do something else. The proportion increases with age.
Women also do not necessarily return to work full-time after having children. “I
guess the issue that can be posed is how you retain those women in the
workforce,” Dr Hassell said. “There are issues about flexible
working, choices of sectors you work in, working environments and working
conditions — all the conditions that go with being a parent.”
Of those people who are economically active, 7 per cent (about 2,200)
are over state retirement age. Of the men, 28 per cent (about 4,000)
are in the 50–64 years age group and therefore approaching retirement
age.
In the 2003 census, 72 per cent of active pharmacists worked in community
pharmacy, but roughly 8,500 out of 23,000 were locums. Of the rest, 21
per cent were in hospital pharmacy and 8 per cent in primary care. Part-time workers
On part-time work, Dr Hassell said that the 32.5 per cent who work
reduced hours represent about 10,500 pharmacists altogether. To allow
comparisons
with other fields, the study used the Government’s definition
of part-time as less than 33 hours a week. For women, the proportion
working part-time is about 42 per cent and for men it is about 20 per
cent.
The proportion of part-time workers varies with sector of practice.
In community pharmacy overall it is about 36 per cent, but it ranges
from
10.6 per cent for managers to 59 per cent for locums, who form a workforce
of 8,500. Commenting on a figure of only 25 per cent for hospital pharmacy,
Dr Hassell said: “I find that interesting, because it is dominated
by women in the hospital sector, yet it has a much lower rate of part-time
working.” The proportion in primary care is about 36 per cent.
Turning to those who work very few hours, Dr Hassell said that registration
data showed that in 1992 about 15 per cent of pharmacists worked for
fewer than 10 hours a week and 11 per cent worked between 10 and 34.
The 2003 census showed 6.5 per cent — about 2,100 pharmacists — in
the under-10 hour group and 27 per cent worked longer part-time hours.
So the proportion of part-timers overall is increasing, but the proportion
working very few hours a week is falling.
Dr Hassell added that as well as identifying part-timers the census found
that a significant proportion work more than the 48 hours maximum in
the new European directive. Most are proprietor community pharmacists. Career choices and expectations
Dr Hassell said that, unpalatable as it might be to the Society, many
people said they chose pharmacy because they did not get the grades
for medicine. There are issues around pharmacy being a caring profession
and about its status and reputation. Flexibility of working arrangements
and job security are among the motivations for choosing pharmacy. Family
influences are also important.
Locum pharmacists asked why they chose to become locums talked about
autonomy, and about not wanting to get involved in paperwork, staff rotas,
etc. They just want to be responsible for themselves alone.
Turning to pharmacists’ expectations of their careers, Dr Hassell
presented some early findings from a longitudinal cohort study looking
at the careers of pharmacists over five years. When asked what they expected
from their career, people tended to talk about lifestyle issues rather
than the working environment or skills needed. They often spoke about
having a choice of different sectors and being able to do many things
with a pharmacy degree. It was of some concern that people were not talking
about particular career paths.
People also talked about pharmacy being a rewarding career — not
just financially rewarding, but emotionally, intellectually or socially
rewarding. But the aspect of a rewarding career came out only after a
lot of probing. Major issues
Dr Hassell said that one major issue arising from the census data was
how to attract back the 30 per cent of pharmacists — nearly 14,000 — who
are not currently part of the British labour market. Strategies need
to be considered for attracting back those who are overseas, those
in non-pharmacy occupations and those who are not working at all.
Of the remaining 70 per cent, nearly a third — just over 10,500 — work
reduced hours. The proportion is increasing year on year and is higher
in certain sectors and in certain jobs. Why do many people work part-time
and why do so many leave altogether?
Dr Hassell concluded: “Can services, existing and new, be delivered
when such shortcomings exist? About 23,500 pharmacists work in the community
sector, but only 16,500 or so full-time. Nearly 2,000 community pharmacists
are over retirement age. Nearly 3,000 pharmacists are approaching retirement
age. Nearly 8,500 community pharmacists are locums. Nearly 5,000 of those
are working part-time.” Is there a problem?
Sue Ambler, the Society’s head of research and development, said
that the workforce changes are significant but do not necessarily mean
there is a problem. The key questions are: “Is this an ongoing
trend” and “Will it get worse or better?” The only
way to find out is to follow it, and also to find out what students expect,
what they want and what they get.
She said that the pharmacy workforce planning and policy advisory group
[a joint project between the Society and the Government health departments
in England, Scotland and Wales] is working in that area. It has commissioned
a study with Aston University to look at career expectations of Year
1 and Year 4 students. And a longitudinal study with the University of
Manchester will follow the 2006 cohort and also take a snapshot of 2003
graduates. The work is building towards an ability to model what is happening
and predict whether more or fewer pharmacists are needed.
The other side is the demand side. How many pharmacists are needed today,
tomorrow, in five years and in 10 years? How will the balance of pharmacists,
pharmacy technicians and support staff change? What will be the effect
of robotics on the workforce? And the effect of new community pharmacy
contract?
The advisory committee hoped to share the results of the work in December. Discussion
Linda Stone said that, with 8,500 declared locums, there is an issue
of how the Society gives them more support, in terms of ensuring that
they can access information that typically goes to contractors or owners
or managers and does not hit the locums at all.
Commenting on the early drop-out among women, she asked whether there
was an ethnic issue in that certain groups may perhaps not be permitted
to work once they marry and have children?
Dr Ambler said that ethnic minority women actually appear to stay in
the workforce longer — probably because they are more likely to
have extended families that help them provide child care.
Gerald Alexander said that he was concerned about the delivery of quality
services under the new contract with so few pharmacists working full
time. He was concerned about system failure in terms of prescription
volume increases and the ability to deliver other services. It was gratifying
that the schools of pharmacy were expanding.
Douglas Simpson said that the part-time nature of the workforce might
tie in well with enhanced services provided on a local basis under the
new contract, since many services lent themselves to sessional, part-time
work. He added that robotics might take a lot of the drudgery out of
the dispensing process and free pharmacists for new contract activities.
The Treasurer (John Jolley) asked whether any analysis had been done
on the type of work that overseas pharmacists were engaged in, with a
view to predicting the probability of people coming back.
Dr Hassell said that overseas pharmacists tended to be slightly older
than on the register generally, more likely to be male than female and
more likely to work in industry.
Michael Schofield said that the research brought up big skill mix issues.
One could not look at the pharmacist workforce without also looking at
the technician demography.
The Vice-President (Hemant Patel) said that anyone who has tried to recruit
a pharmacist, whether as a locum or an employee, knows how difficult
it is at present. Were there tools to measure under- or over-capacity?
If not, how could they be developed?
Dr Ambler said that work is being done with the Government health departments
to set up a model that would allow the mapping of demand and supply in
a way that would enable one to change various parameters and predict
the effect on the workforce. Preregistration places
Clive Jackson said that undergraduate intake was increasing across
the schools and new schools of pharmacy were being founded. But he had
seen no figures for the current increases and the potential of the
new schools. Information was needed to identify the impact on preregistration
placement requirements.
Graham Phillips said that, despite an increasing supply of graduates,
he was not aware of any proper attempt to manage the preregistration
situation. He was often approached by people desperate for preregistration
places.
Dr Hawksworth said that the availability of preregistration places was
obviously a rate limiting step. Work was being done by the workforce
advisory group to address that issue and would take into account the
modelling that Dr Ambler had spoken about.
Answering a question, Dr Ambler said that pharmacy workforce planning
was complicated by the way in which undergraduate courses were funded,
the position the schools found themselves in and the market they were
playing in. It was different to medicine, which had a formal process
for getting the right numbers in the right places at the right time to
produce the right number of doctors. On top of that, funding for preregistration
training is separate from funding for undergraduates. There is no hook
between the two.
The Secretary and Registrar (Ann Lewis) said that it is not just about
training places. There is no point in creating places if the capacity
to train those people is not there.
Maurice Hickey suggested that the next survey should ask proprietors,
hospital managers and primary care trust managers whether they have difficulty
in recruiting pharmacists or locums. He suggested the figures should
be broken down by region because he suspected that certain areas have
severe shortages. The profession’s great plans for the future will
come to nothing if it does not identify and deal with the existing problems.
Dr Hassell said that, because about 90 per cent of pharmacists are registered
at their home addresses, the 2003 census asked for the postcodes of their
work addresses. The aim was to use the information to answer workforce
development confederations and PCTs that were asking for information
on pharmacists living or working in their areas so that they could start
to map out their local service delivery plans and see if they have enough
people to deliver those services
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The
Pharmaceutical Journal