The Pharmaceutical Journal
Vol 276 No 7396 p438
15 April 2006

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Do refugee and overseas pharmacists get a raw deal from Great Britain?

By Chijioke Agomo

An article entitled “Refugee doctors — a valuable resource” (BMJ Careers, 25 February) again raised a difficult topic that affects not only the medical profession but also the pharmacy profession in Britain. According to the British Medical Association, there are around 2,000 refugee doctors in the UK. Refugee doctors, just like refugee and overseas pharmacists, have been described as ready-made professionals. For refugee doctors to register in the UK the estimated cost for courses and examinations is put at £3,500, which compares favourably with cost of training a medical student (£200,000). In the case of refugee and overseas pharmacists, the cost of registering in Britain has been estimated to be about £20,000 to £25,000 (including fees and cost of living). However, the problem is not just the money involved, but how each profession is responding to reduce the burden faced by these groups.

The General Medical Council now waives the fee for the Professional and Linguistics Assessment Board (PLAB) 1 examination — the first of the two requalification examinations for refugee doctors — and offers a reduction in the cost of limited registration. Refugee pharmacists in Britain may be benefiting from the Refugee Health Professionals Steering Group, established by the Department of Health in 2000. However, there is nothing to show that either refugee or overseas pharmacists are getting any other help to cover the costs of university conversion and registration in Britain.

Problems

On arrival here, these pharmacists face the problem of finding a preregistration placement and employment, and these are not always easy to obtain. The situation is made worse with the lack of networks, employers’ uneasiness about foreign pharmacists’ abilities, gaps in their CVs and the lengthy process of registration. For preregistration training, which is the gateway to practice, placements are usually secured by home-trained pharmacists long before they complete their undergraduate courses. Refugee and overseas pharmacists have no choice but to accept less adventurous placements, if any. In addition, there may be the burden of supporting family members in their home countries. This may add to the pressure and affect performance in the registration examinations.

One needs to bear in mind that many foreign pharmacists seeking registration in Britain are highly qualified professionals in their home countries and the relationship that exists between them and Britain should be seen more as symbiotic than as parasitic. Britain offers better job opportunities and stability and, in return, gets experienced pharmacists for next to nothing. Moreover, these are generally mature, self-motivated individuals who can contribute positively to the UK economy. Great savings can be achieved through the employment and retraining of refugee and overseas pharmacists, particularly at this time when the NHS is struggling financially. This becomes important when we remember that the present introduction of university fees with the resultant indebtedness through student loans will ultimately lead to demands for better wages to pay off these loans.

One is aware of the political debate that goes on with the use of migrant workers. However, market forces cannot be ignored and the truth remains that many foreign countries lack both the political will and infrastructures to keep their graduates, with many of their emigrants ending up contributing more to their various countries than if they had stayed at home.

Now that the UK Government is changing the relevant legislation (through the point system) in favour of attracting highly skilled workers from outside Europe, the pharmacy profession must be seen as supporting this initiative. In the US and Canada, for example, the attraction of overseas trained pharmacists has remained high. Many employers in these countries (particularly the US) are also willing to reimburse all expenses incurred during the registration process. This shows how much these employers appreciate foreign professionals’ contribution to their countries’ economies. So it is not surprising that many overseas pharmacists with the original intention of working in Britain are now going to the US or Canada instead. This probably becomes clear when the number of overseas pharmacists who sat/passed the Society’s registration examination in June 2002 (164/137) and June 2005 (26/16) are compared.

About 83 per cent of the overseas pharmacists who took the examination in June 2002 passed, unlike in June 2005 when the figure went down to 61 per cent. A reduction in the quality of overseas pharmacists taking this examination over this period is not the likely reason. Instead, it seems that the more stringent conditions introduced by the Society over this period gave rise to such a remarkable difference in performance.

In 2002 when registration cost less than £3,000 (fees only), to cushion the effect of the gap year (transition from the three to four-year pharmacy training) some UK multiples sponsored some overseas pharmacists. They also provided accommodation, guidance and intensive training for the registration examination, with these contributing massively to the higher pass rate recorded in June 2002. The situation now is different, with many refugee and overseas pharmacists not able to raise the fees for the university course (about £8,500).

Demand

The present Government is now giving more and more responsibilities to pharmacy in health care delivery, with pharmacists increasingly taking up new roles in primary care, public health and prescribing. As these roles develop, one would expect the demand for pharmacists in Britain to increase. Although new pharmacy schools mean more pharmacy graduates, it is not certain yet that these new schools or even the expected influx of pharmacists from other European countries will meet this demand. The way forward will be to revert the registration process to what it used to be before the recent changes by abandoning the one-year mandatory full-time conversion qualification — the overseas pharmacists assessment programme — as agreed recently for pharmacists from New Zealand and Australia. This is particularly important when there are no published data to show a significant difference in practice between those foreign pharmacists who did not attend the one-year university retraining and those who did. Alternatively, shortening the duration of the university component to, say, three or four months would go a long way towards lessening the burden on applicants.

I implore the pharmacy profession to reconsider how it deals with these pharmacists.