The Pharmaceutical Journal
Vol 276 No 7406 p752-753
24 June 2006

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NHS funding deficits take their toll on hospital pharmacist workforce

Hanadi Ghannam, clinical rotational pharmacist, Heart of England NHS Trust, describes the state of the hospital pharmacy workforce

Recent announcements on job losses have thrown uncertainty on the future for many NHS employees. The BBC has reported redundancies running into thousands — 7,000 were reported up to May 2006 — with the Midlands said to be losing at least 3,650 jobs. The Government is resolute that only temporary, clerical or administrative staff places are being cut, thus minimising any impact on patient care, but many trusts have had to freeze recruitment and have already made cuts to management and nurses.

Why have these cuts had to be made and what impact have they had on hospital pharmacy? NHS Employers, the organisation representing employers on workforce issues in the English NHS, recently issued a briefing to explain: “Reductions in workforce numbers are being considered for many reasons, including the reconfiguration of primary care trusts, changes in NHS funding arrangements, the introduction of new providers of services and provision of more care in the community rather than in hospitals.

“Some financial changes in the past year have been quite significant and sudden at a local level, in part because of organisations preparing for the introduction of the new Payment by Results system, as well as some primary care trusts commissioning less work from their local NHS hospital or uncertainty about the level of work they will require them to do. A number of NHS trusts also have substantial historical debts which they now have to pay off.”

It has conducted a survey of human resources directors at trusts where job losses have been announced. The results confirm rumours of redundancies, although at levels much lower than those reported in the media (see Panel below). Most trusts did not provide exact figures but “almost all were confident that they could avoid compulsory redundancies”. Only the University Hospital of North Staffordshire, a trust with a “history of significant financial and managerial problems” reported plans to make a large number of staff redundant.

These figures are in stark contrast with what the media have given, but they account only for redundancies and not the loss of posts. Anthony Oxley, president of the Guild of Healthcare Pharmacists, is also sceptical: “We do not have any exact figures so it is difficult to comment but I think the numbers of job losses will be higher than what has been quoted. I question the position that NHS Employers has taken.” Even if trusts are able to keep redundancies to a minimum, funding deficits can still have a significant impact on services. One NHS trust in the West Midlands, which did not want to be named, ended 2005–06 with an overspend of £7.3m. The pharmacy department has been asked to make drug budget cuts of £250,000 and staff cuts of £142,000. For the next year, pharmacy staff will not be paid for extra hours or be able to accumulate time off in-lieu or overtime. The department has now lost four full-time positions and cannot replace another three recent vacancies, leaving the pharmacy department stretched and staff morale low.

The chief pharmacist at the trust explained the impact it has had on the service: “Our outpatients pharmacy is now closed on Friday afternoons to reduce running costs. To avoid wastage of drugs in the health economy and reduce spending on discharge prescriptions we are now rolling out the use of patients’ own drugs across the hospital without the qualitative benefits and safeguards of ward-based pharmacy teams. Ward visits get cancelled more often than before due to lack of pharmacist cover. Consequently I cannot justify staff going on study leave, even if we had the funding.”

This picture is common: pharmacy redundancies have been kept low by diminishing vacancies, the use of locum staff and cutting back to essential services, but this puts a strain on departments that are already understaffed. Mr Oxley accepts that there is an element of inevitability: “Unfortunately pharmacy is not exempt from cost-cutting exercises but job losses, even if they are vacancies, should be properly planned and not knee-jerk reactions to deficits. Losing professional staff is a serious issue as it deskills our workforce. Hospitals doing this will find that in the long run they have shot themselves in the foot.”

In its annual hospital staffing survey, the NHS Pharmacy Education and Development Committee reported that for 2005, 16 per cent of hospital junior pharmacist posts were vacant and locums filled an additional 14 per cent of posts. This is despite an 8 per cent growth in hospital pharmacist numbers. The impact of this is a significant reduction in modernisation and service development, with up to 70 per cent of hospitals reporting service reduction or refusal.

This deficit is set to increase. Agenda for Change has led to a reduction in hours for pharmacists from 39 hours per week to a normal week of 37.5 hours, which requires 4.8 per cent additional staff to make up for the shortfall. There is also high staff turnover: 21 per cent of pharmacists left their employing hospital in the previous year and 10 per cent left the hospital sector altogether.

The funding shortfalls have inadvertently impacted on hospital preregistration training. As a result of Agenda for Change, the salary of a hospital preregistration trainee has gone up by about £5,000 to £19,163. Many regional workforce development directorates, which fund these posts, have found themselves unable to finance the new higher salary. To resolve this problem, hospitals either keep the same number of preregistration posts at the lower salary, or cover the shortfall themselves. Many have opted for the second choice, but as a result cannot afford to take on so many preregistration trainees: the Hampshire and Isle of Wight Strategic Health Authority, for example, has now lost two posts.

David Scott, who manages preregistration trainee recruitment for the NHS, estimates that nationally there may be as many as 60 hospital posts lost in the coming year. Although the number of posts has been steadily rising from 568 in 2004 to 609 for the 2006 intake, it is outstripped by the growing number of graduates, with 1,625 expected in 2006 and 1,957 in 2008. This ratio is still better than in many other graduate markets, however, and Dr Scott believes that students should not be discouraged: “I still think that hospital pharmacy offers excellent training for students and there are plenty of opportunities, so do not let the competition put you off from applying.”

While competition for preregistration posts may be growing, the mood among junior pharmacists is sombre: “Until this year I would have said job prospects were good, but with recent events across the UK, NHS jobs now are not guaranteed,” commented Puneet Sharma, a pharmacist at Wolverhampton Royal Hospitals. “Lately very few D-grade and above jobs are being advertised and so career progression is slowing down. Even sideways movements are difficult within a region.”

Collectively, NHS trusts ended the 2005–06 financial year with a cumulative deficit of £598m, a sum that represents 1.5 per cent of their total turnover. The Government has asked everyone to keep this figure in perspective, but whatever its long-term impact, the short-term reality may see some pharmacists looking elsewhere for employment.

Hospital pharmacy has the potential to develop some excellent new roles and services, but without adequate funding, few will see them become a reality. It seems that the reputation of the NHS needs some repair if it is to avoid worsening problems within hospital pharmacy.