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Bob Gartside is a pharmacist from Gwynedd
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Tucked away in the smaller print of the new community pharmacy contract
are provisions on hours of service which may make a profound difference
to the practice of pharmacy and to the public’s perception of that
practice. Under the new contract, community pharmacies must be open for
a minimum of 40 hours each week but they are free to set their own opening
hours provided the minimum of 40 is provided. As far as can be ascertained,
there will be no provision for rota cover, although primary care trusts
in England and local health boards in Wales will be able to establish
special out-of-hours schemes if they so wish and, presumably, if they
are prepared to finance such schemes.
This looks a modest little measure but its implications are surprisingly
large. Forty hours a week, of course, is 9am to 5.30pm with a half-hour
lunch break on five days a week. Those contractors who want to will be
free to work a five-day week, with the pharmacy closed on Saturday and
Sunday. For company pharmacies, the manager’s job will be easier
and more standardised, and the need for locum pharmacists will be greatly
diminished. The company management’s life will also become that
much easier because an inordinate amount of its time and effort presently
goes into staffing pharmacies on Saturdays.
A win all round? Not quite, because apart from the effect on locums there
is the little matter of pharmacy manager’s pay if their hours are
reduced to 40 per week. Is their pay to be reduced accordingly, or will
the effective hourly rate be increased to compensate? How will this encourage
them to remain in their present jobs? There is also the effect on other
staff to consider. It might be possible to trim back staff numbers, but
what then is to happen when staff members are absent through illness
or holidays? Is it possible to quantify these possible effects?
At present the average community pharmacy needs about 1.5 whole time
equivalent (WTE) pharmacists. If we take 40 hours as being a typical
working week (and Agenda for Change lays down a 35-hour week for hospital
pharmacists, remember) then a pharmacy which is open for 54 hours per
week needs an additional 0.35 WTE pharmacists. Five weeks’ holiday
a year needs 0.1 WTE, two weeks’ sick leave needs 0.04 WTE and
one week’s corporate governance adds a further 0.02 to give a rounded
total of 0.5 WTE pharmacists in addition to the manager. So a five-days-a-week
pharmacy only needs 1.15 pharmacists against 1.5 needed for a six-days
-a-week pharmacy. The lessened need for pharmacists is obvious.
If we take it that 40 per cent of community pharmacies are company-owned,
and 50 per cent of these can be closed on Saturdays then the national
need for pharmacists to man the 11,000 community pharmacies falls by
770 and we might expect the current pharmacist shortage to be cured.
However, we do not know yet the impact of three other non-contract measures.
First, the Royal Pharmaceutical Society’s personal retention fee
is to rise by 23 per cent on 1 January 2005 and various age and part-time
reliefs are to be abolished. It may be expected that a number of pharmacists
will remove themselves from the register in consequence. Secondly, continuing
professional development will become mandatory and this may also be expected
to result in a number of pharmacists leaving the register. Anecdote suggests
that many of these will be mature, retired pharmacists who presently
provide an extremely valuable reservoir of labour in times of crisis.
Thirdly, it looks as though pharmacists who wish to practise in community
pharmacies will have to register with PCTs, perhaps from 1 April 2005.
Registration with one PCT will suffice for pharmacists working in England
and registration with one LHB will suffice for those wishing to work
in Wales; those who wish to work in both England and Wales will have
to register with both a PCT and an LHB. The conditions for registration
with PCT/LHBs are not yet known but are sure to include the need for
a police check and it will almost certainly be necessary to demonstrate
a commitment to CPD. There may well be other hurdles. It is unclear whether
these conditions can be met by next April.
Taken together, these three additional measures will undoubtedly result
in losses to the register of pharmacists and only a 2 per cent loss will
counterbalance the possible manpower gain from Saturday closures. Since
15 per cent of the register are over retirement age the future looks
uncertain at best.
Of course, this is not the end of the potential problems. At a time when
prescription numbers grow inexorably it has been decided to have a new
contract which will explicitly reward quality rather than quantity, despite
the fact that the ever-growing quantity will not go away. A concentration
on quality can only mean the employment of more pharmacists and it is
to be expected that we will see pharmacies actively adopt measures to
limit the numbers of prescriptions they process, since quantity will
be a less important determinant for remuneration. Relaxation of control
of entry will make it easier for more pharmacies to be opened to cope
with the continuing flood of prescriptions, but who is going to staff
these new pharmacies?
Perhaps the new, shorter hours and easier working in the community will
attract pharmacist recruits from the hospital service where it begins
to look as though Agenda for Change may be going to lead to the service
becoming less attractive. It would be an interesting example of the law
of unintended consequences if this small change in the hours of service
provisions of the community pharmacy contract were to lead to great difficulties
in the hospital
service.
There is one other effect of this change in hours- of-service provision.
Many essential small pharmacies (and they are going to be kept in Wales)
now work the minimum 30-hour week needed under the present contract to
qualify for the support payments. If they have to increase their hours
to 40 per week there will be appreciable extra costs for a fragile part
of the pharmacy network and an appreciable change in quality of life
for the proprietors of these pharmacies. A small change is all that is
needed to help preserve these pharmacies. |
The
Pharmaceutical Journal