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There is a feeling that recruitment difficulties will only be short-term ones
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Community pharmacy is likely to face recruitment problems this spring
because of the dual effect of changes to professional registration and
the new contract. There are already signs of a squeeze on the number
of locums available as those pharmacists who, in the past, might have
worked part time have decided to come off the Royal Pharmaceutical Society’s
Register to avoid mandatory continuing professional development and a
higher registration fee. But there is a feeling that any difficulty in
recruitment will only be short-term and the new contract, which is to
be introduced this April in England and Wales, will be enough to attract
newly qualified pharmacists who before may have been tempted to develop
a career in hospital or industry.
Since January pharmacists have had to register either as “practising” or “non-practising”,
and anybody signing up to the practising register also had to commit
themselves to mandatory CPD. Official figures from the Society released
last week (PJ, 12 February, p186) show that although 85 per cent of the
profession had registered by the end of January, just over 2,000 pharmacists
had so far decided to come off the Register. This is nearly three times
as many as the 784 pharmacists who left the profession during the whole
of the previous year.
Impact on recruitment
Hospital pharmacy
Hospital pharmacy is unlikely to face the same locum recruitment
squeeze created by changes to professional registration, according
to the Guild of Healthcare Pharmacists. But it predicts that recruitment
could be hit by changes to the registration of pharmacists from
Australia and New Zealand, who in future will have to undergo the
equivalent of a preregistration year before being able to practise
in Britain.
Immediate past president of the guild Robert McArtney said: “In
the past the pharmacists who trained in Australia or New Zealand
could automatically work here but that is changing. Because they
only do a three-year degree, as opposed to the four-year degree
in the UK, they are going to have to top that up with another year
here before they are entitled to work. That is quite an issue for
us in Wales and it is a big issue for hospitals in London and the
south east.”
He is confident, however, that the changes to professional registration
will not have the same impact on the availability of locums in
hospital as in the community sector. He said: “As far as
hospital is concerned, a lot of the pharmacists who do locums are
younger than they are in community, and are making a career out
of locum work. They are also used to studying so CPD doesn’t
put them off. We haven’t been made aware of any drop off
in locums or people dropping their hours or deciding not to work.
There is also a lot of part-time working anyway in hospital because
we have family-friendly policies in secondary care.” |
The knock-on effect of this exodus is already starting to filter through
to the front line of community pharmacy, particularly in inner London.
Hemant Patel, the Society’s Vice-President and secretary of the
North East London Local Pharmaceutical Committee — the largest
LPC in the country — said: “Changes to the Register are having
an impact on recruitment. I am already picking up evidence of that. A
lot of the elderly pharmacists are giving up because they don’t
want to stay on the Register.” Lack of clarity from the Society
about the make-up of CPD has scared many of them off, he believes. “There
has been a great deal of confusion about it. Some think they only have
to do 35 hours a year while others think it’s all about going on
the website and registering what they are doing. I think we could have
been clearer about CPD and given some examples.”
The Pharmaceutical Services Negotiating Committee and the National Pharmaceutical
Association both said they had expected to see pharmacists come off the
Register because of mandatory CPD but they are optimistic that any damage
to recruitment will be short-term.
Alastair Buxton, head of NHS services at the PSNC, said: “There
did seem to be a bit of a drop in the figures in the first couple of
weeks in January, when you looked at the retention figures. But this
is not an issue to do with the new contract. Whenever CPD comes in it
will have an impact on registration and you will lose people. It may
have the potential to have an effect on the new pharmacy contract — but
it is not a contract issue.”
Colette McCreedy, director of pharmacy practice at the NPA, agreed that
older pharmacists who have traditionally turned to locum work in the
run up to retirement are likely to disappear from the professional pool
which community pharmacists have always called on. She said: “These
pharmacists won’t think it is worthwhile to pay the full registration
fee for just being able to do one day’s work a week or less. There’s
also the CPD commitment to consider. I can’t argue against CPD
but these older pharmacists, particularly, will not want to take that
on. I think there will still be pharmacists who will work part time but
not those who want to work less.”
She was reluctant to suggest that the profession might be on the verge
of another long-term recruitment crisis — similar to that created
by the changes to pharmacy training that brought about the “fallow
year” of 2000–01. She said: “ I think there might be
a problem in the short term but not in the long term as new schools of
pharmacy are opening up, which will increase the number of pharmacists
available. It won’t be a problem like the fallow year but it will
put pressure on employers when trying to deliver the new contract.”
Large multiple Moss Pharmacy also agreed that changes to registration
might have a short-term effect on recruitment but, like the NPA and the
PSNC, is confident it will not be a long-term problem. A spokesman said: “The
introduction of new initiatives or obligations can stimulate certain
pharmacists to leave the Register. Should this happen in this case, there
could be a potential short-term impact on locum availability across the
profession.” However, the company is sure it can overcome any short-term
problems and, in the medium term, expects newly qualified pharmacists
from the new pharmacy schools will fill the gaps. Impact on representation
The impact of the changes to the categories on the Register — which
were brought in to make CPD requirements straightforward — reach
beyond potential staff shortages. There is also a fear that it will damage
pharmacy
strategic representation.
Mr Patel explained: “It isn’t just about shortages. The impact
is going to be of strategic importance. Before, if people were invited
to make a contribution to a professional conference or attend a meeting
they would rely on part-time people doing locums to cover for them. But
if the number of pharmacists who are happy to do four or five hours dries
up, it’s going to have a strategic impact at a critical time for
the profession in primary care. Just when the profession can make a contribution
a section of the pharmacy community is going to be disenfranchised.”
There are signs that this is starting to happen. He said: “Already
my committee members are saying they can’t come to a meeting because
they can’t find a locum.”
Despite the reluctance of some parts of the profession to take on mandatory
CPD, it is crucial to the success of the new contract, which creates
opportunities for pharmacists to offer more clinical services to patients.
It is also a fundamental plank of the Government’s NHS reforms
that CPD is made a condition of professional registration. Regulations
which open the door to compulsory CPD are likely to be in place later
this year — not long after the new contract is introduced. Most
in community pharmacy expect the new contract to boost recruitment because
it offers an attractive career with the opportunity to develop clinical
skills. But any improvement to pharmacist numbers will have to be set
against the number that may be lost due to what is seen by some as the
financial “penalty” the new contract places on smaller pharmacies. Impact on independents
From April any pharmacy which dispenses fewer than 2,000 prescriptions
a month will lose its £19,000 practice allowance. This, according
to Hemant Patel, will be the death knell for the small independent
pharmacist. The estimated number of pharmacies predicted to fall into
this financial trap has varied from anything between 100 and 700. Mr
Patel is worried because it could lead to swathes of small pharmacies,
particularly in deprived areas, going out of business. He said: “This
is going to create a differential impact. There are places like Tower
Hamlets in London’s East End where 30 per cent of pharmacies
will fall into this trap while across North East London as a whole
it could be 25 per cent.” He predicted these figures could become
even worse in subsequent years because the prescription threshold on
the new contract is not fixed. It will be index-linked to national
dispensing rates. This could work against small pharmacies, which have
a limited ability to increase the number of prescriptions they dispense.
He warned: “This 2,000 threshold is going to wipe out the independent
sector.”
However, his fears are not shared by other leaders of the profession.
The NPA accepts some of the smallest pharmacists who fall into the 2,000
threshold trap could be financially worse off if they decide to sell
up because they might lose their “goodwill” value, which
would have given them a better price. But, like the PSNC, the NPA is
confident that the contract will boost recruitment more than it will
damage it.
Despite some differences of opinion, the profession’s leaders are
united in their uncertainty about which way the recruitment pendulum
will swing in the following months. The picture may start to become clearer
in April, which marks the start of the new
contract but is also the deadline for pharmacists deciding whether or
not to continue practising.
Pharmacy business sales
Pharmacy sales quadrupled in December — compared with the
same period in 2003 — as pharmacists nearing retirement decided
to sell up before the new contract comes in this April, one national
agency reported this week.
Sales of medium and larger pharmacies in the first two months of
the year have also been “significantly” higher than
in previous years, according to Tony Townsend, national business
manager for Orridge Pharmacy Sales. He said: “The market
generally is extremely buoyant. We are having a great time and
had a fabulous end of year.”
Pharmacists selling up are those in their early 50s and older who
are reluctant to go through a period of change and are owners of
medium- to large-size pharmacies. He said: “I think they
are going because of change rather than specifically because of
the new contract. They are reluctant to see change and I think
many of them feel they are being asked to record everything they
do as a matter of routine. They don’t want it.”
There has been no significant increase in the number of smaller
pharmacies coming on to the market but he said there was some confusion
in this group about their exit entitlements under the new contract. “They
are confused about whether they qualify for the £18,000 exit
payment because they do fewer than 2,000 prescriptions a month
or if they are entitled to it because they are an essential small
pharmacy.” [New information from the PSNC may help to allay
that confusion, see p197.]
Meanwhile, a financial analysis of the retail pharmacy industry
released this week predicted acquisitions will increase during
2005. Research by Plimsoll Publishing, industry financial analysts,
concluded there are 59 retail chemists that are likely to sell
up during the year because of “financial stress, with debts
measuring, on average, 13 per cent of their turnover. At the same
time the study revealed there are around 367 “cash rich” companies
in a position to purchase those that are struggling. The analysis,
which appeared in its report, “The Plimsoll portfolio analysis — retail
chemists”, looked at the top 1,000 companies in the industry.
Senior analyst David Pattison said: “These under-pressure
companies are running out of options. As the average industry profit
margin is only 3.1 per cent and over half of the companies are
failing to increase sales, trading their way out of their current
position will be almost impossible. With so many cash-rich companies
operating in the market, selling up might be the only sensible
option left.” |
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The
Pharmaceutical Journal