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On 1 January, two more countries, Rom-ania and Bulgaria, joined the
EU. The previous round of accessions in May 2004 — when 10 countries,
including Poland and Lithuania, became member states — brought
change to workforces and communities in many parts of the UK, triggering
much debate and media coverage. In November 2006, the Home Office published
an “accession monitoring report”, which recorded the numbers
of nationals from eight of the 10 accession countries registering to
work in the UK
between May 2004 and September 2006. Over 20,000 of these workers were
employed in health or medical occupations. Of these, 310 were pharmacists
or pharmacologists, 335 were dentists and 575 were doctors.
Sixty-three per cent of those who applied to the Government’s Worker
Registration Scheme were Polish and this majority is mirrored by Royal
Pharmaceutical Society figures — between May 2004 and October 2006,
85 per cent of pharmacists from the same eight accession states who joined
the Society’s Register were Polish. Moreover, Polish pharmacists
make up 35 per cent of EU nationals (excluding the Irish) joining the
Register since January 2005, overtaking Spanish pharmacists (32 per cent).
Nationals joining the Register from the other seven countries in the
same period barely reach double figures. For example, there are only
12 Hungarians, 12 Czechs and eight Lithuanians, compared with 279 Poles.
Many believe that the free movement of workers will help alleviate the
shortage of pharmacists in the UK. Lloydspharmacy
began recruiting in Poland even before accession (PJ, 8 May 2004, p560). Far-sighted recruitment
agencies have also been capitalising on this new pool. For example, Ateam
Health Recruitment, an agency that previously specialised in sourcing
pharmacists from Australia and New Zealand, set up offices in Warsaw,
where it has run mass recruitment campaigns, sometimes recruiting upwards
of 20 pharmacists in one go for large multiples.
According to Steve Mills, general manager of Ateam, four main factors
need to be
considered when recruiting pharmacists from the EU: registration, language,
professional practice and cultural issues.
Registration
EU directives require each member state to recognise pharmacy qualifications
from other member states. Pharmacists from the EU
can apply to register with the Society. This
requires the completion of questionnaires and declarations, and various
documents to be gathered, translated where necessary, certified and sent
to the Society. At first, there were teething problems: “Initially
we experienced some difficulties registering Polish pharmacists with
the Society, however, these issues have now been resolved,” says
Andrew Hainge,
resourcing manager at Lloydspharmacy.
Aleksandra Parchowska, a 30-year-old
Polish pharmacist working for Co-op Pharmacy in Oxfordshire, told The
Journal: “It was difficult to organise all the paperwork with
the [Polish] Pharmaceutical Chamber but I think it was because I was
one
of the first Polish pharmacists to apply to register after accession.
I think it is easier now.” However, it is still not unusual for
it to take more than six months to get all the paperwork together and
receive a registration number. According to the Society, once all the
correct documents and forms are received, processing an application currently
takes, on average, three to four weeks.
Language
Language influences where EU nationals choose to find work. “I
cannot imagine working in a country other than the UK. For example, there
are many positions in Sweden but I could not work in pharmacy. It would
have to be a job where I would not need to talk to people,” says
Przemyslaw Kulaga, from Rzeszow, Poland, who works for Boots The Chemists
in Kenilworth.
English has been taught in Polish schools (replacing Russian) since communism
fell in 1989. However, is high-school-level English sufficient for giving
pharmaceutical advice? Even though Mr Kulaga has a good command of English
(he was fluent and articulate in interview) he admits he has experienced
some language difficulties at work. “Pronunciation can make
things hard in practice. Even if a medicine, such as paracetamol or hydrocortisone,
has the same name in Polish as in English, the pronunciation is different
and this can make understanding difficult, especially when someone speaks
fast,” he explains. Different accents, particularly in places like
London, where people of over 270 nationalities live, can also present
difficulties. Another Polish pharmacist, Dobroslawa Burda from Katowice,
has been in England for about a year, working in the King’s Lynn
area. Initially, she sometimes had difficulty communicating as clearly
as she would have liked. “I knew medical language from books, but
English in Norfolk is different from English on television and radio.
I did not
understand slang and some idioms,” she says.
The Statutory Committee has heard at least one case in which a pharmacist
was practising
with poor English (PJ, 19 February 2005, p218) but the
Society is not allowed to test pharmacists from other member states for
competency in English (it goes against the freedom of movement of workers
principle) so the onus to ensure that a pharmacist is able to communicate
falls on employers. Some employers insist that job candidates pass an
examination, such as the University of Bath’s English Language
Test, which is specially
designed for overseas medical professionals who want to work in the UK
but, according to Mr Mills, other companies might employ a pharmacist
based on a subjective interview.
Locum pharmacists are generally self-employed. According to barrister
and pharmacist Graham Southall-Edwards, although the Society has no authority
over locum agencies, the superintendent
pharmacist of a
pharmacy chain booking a locum with
poor English could be held to account. “Companies ought to have
in place systems to ensure safe working and the ability of the pharmacist
to speak English with adequate proficiency is a basic requirement of
any safe system of working. It is up to the superintendent pharmacist
to make sure that an agency is ensuring pharmacists’ English
is up to the required standard,” he warns.
Professional practice
Anatolijus Kostiukevicius arrived in the UK from Lithuania in January
2005. “You cannot compare pharmacy in the UK and pharmacy in
Lithuania. The first day, I thought ‘Oh my God. I am a 40-year-old
man, with 18 years’ of pharmacy experience, but I don’t
know anything’,” he says. For example, in Lithuania, community
pharmacists do not keep patient medication records. Instead, patients
keep their own record, called a “prescription
passport”. Mr Kostiukevicius explains that Lithuanian pharmacies
only have pharmacists (two or three in an average-sized pharmacy) and
technicians, who need to have completed a four-year college course. “In
Lithuania, there are no 16-year-olds selling medicines over the counter,
and you will not find
sandwiches on sale in pharmacies,” he says.
Mr Kulaga, who was a community pharmacist for three years before coming
to the UK, also found he had to “learn everything again from the
beginning”. The rules are different. For example, in Poland, a
prescription for
antibiotics is valid for only seven days. Over-the-counter practice also
differs. For example, the UK has a smaller range of OTC medicines than
Poland and pharmacists in Poland tend to recommend more herbal remedies. “What
can be good advice in Poland may not be so good in England,” Mr
Kulaga says.
However, according to Mr Mills, no pharmacist recruited through Ateam
is in charge of a pharmacy from day one; they go through an induction
period. Boots, for example, asks pharmacists it has recruited from the
EU to complete a three-month induction and allocates a mentor to each.
Mr Kostiukevicius did not come to England via a recruitment agency. While
his registration application was being processed, he worked in a London
pharmacy, doing anything from dispensing to sweeping the floor. Once
registered, he looked after dispensing for nursing homes in a two-pharmacist
store to build up experience and confidence. Later he began to do locum
work. “The first 10 months were difficult, in terms of language,
learning a new system and financially,” he says. “Although
everyone is different, pharmacists from the EU need at least one month
to understand how UK pharmacy works,” he advises.
Cultural issues
Employers and employees also need to be aware of cultural differences.
For example, it is estimated that 80 per cent of Poles are Roman Catholic
and this could affect services such as emergency hormonal contraception
(EHC). Abortion is rare in Poland and EHC is not available over the
counter. Mr Kulaga, who was undergoing induction at Boots when he spoke
to The Journal, said: “[Supplying EHC over the counter] is a
hard situation that I am not used to. I have dispensed [EHC] many times
in Poland but I did not have to decide about it — the [ethical]
responsibility was the doctor’s, not mine.” He was not
sure if he would like to sell EHC but commented that the issue is not
just religious, but ethical. Miss Parchowska is also Roman Catholic
but has fewer worries about EHC, which she has supplied under patient
group directions. “I understand that there is a big teenage pregnancy
rate in this country and I treat EHC as a necessity,” she says.
One thing Miss Parchowska does find
difficult is the management side of the job. “I think English pharmacists
are trained differently. There is no need to be a manager in Poland,” she
explains. A pharmacist who did not want to be named commented: “In
Poland, when somebody goes to work, they do their work properly. I find
it difficult to motivate staff here, who seem to have less
respect for work.”
Some people have noticed differences in demeanour. According to Mr Kostiukevicius,
English people smile more than Lithuanians. “In Lithuania, our
pharmacies are more serious. When I first started working [in the UK],
my boss would ask me questions like ‘Anatolijus are you happy?
Anatolijus are you angry? Anatolijus are you sick?’ 20 or 30 times
a day. And it was because my face was so serious,” he says.
Attractions and aspirations
What makes someone want to settle in a country that he or she has only
visited once as a tourist, if at all? Undoubtedly, many Eastern Europeans
coming to the UK are economic migrants but a larger salary was not
the main reason given by any of the pharmacists interviewed. Rather,
they all emphasised professional and lifestyle factors. “The
situation of pharmacists in Poland is not so bad. You can earn a better
salary than others. The average pharmacist in Poland earns about £500
per month. However, [coming to the UK] is a good chance to develop.
I wanted to meet new people and see how pharmacy works in another country,” Mr
Kulaga says. Miss Parchowska says she has always wanted to live in
England — having work and earning money as the only motivation
is not enough.
Ms Burda had a good salary as a medical representative in Poland and
had never been to the UK before her arrival in February 2006. Her reasons
for leaving Poland are in the
following order: adventure, curiosity, money, new knowledge. She adds
that work as a pharmacist in the UK is more interesting than in Poland — UK
pharmacy is more technically sophisticated, and there is less emphasis
on mixing medicines and more on patient counselling. “In England
I have patient records and the pharmacy co-operates with the surgery.
These are positive aspects for patients and pharmacists. In my country,
people rarely ask pharmacists about their prescribed medicines. They
ask about cheaper generics or prices,” she says. These pharmacists
also claim that the UK public listen to pharmacists more.
Having spent his first 25 years under communism, then 15 in “free
Lithuania”, Mr Kostiukevicius has no plans to return to Lithuania. “Life
in the UK is freer. You can go where you want and do what you like,” he
says.
It has been claimed that the migration of health care professionals from
Eastern Europe spells trouble there. But Mr Kulaga says that there are
enough pharmacists in Poland. “Older people tend not to go abroad
because they have families and language difficulties. The main problem
is connected with the migration of young people. However, many will go
back [to Poland] with more experience and make things better,” he
says. Mr Kulaga plans to stay in the UK for at least two years.
In addition, not everyone will take to life in England, Miss Parchowska
told The Journal. “I do not have a strong Polish accent, but I
am lucky. One friend with a strong accent who came after me said she
felt like a foreigner — everywhere she went it influenced her life.
It was partly why she went back home,” she says.
Mr Hainge says that, in general, Lloydspharmacy’s experience of
recruiting from Eastern Europe has been positive. “Our pharmacists
from Poland have a great work ethic and their clinical and professional
standards are comparable to those of their UK colleagues. Apart from
a few cases of homesickness, retention levels among overseas workers
have been encouraging. They are coming here to stay rather than for a
working holiday,” he says.
The future
Calls have been made for restrictions on
migrant workers but it is argued that they fill unpopular posts, such
as in agriculture or food processing. In terms of pharmacy, Sultan Dajani,
a member of the Society’s Council, maintains that these pharmacists
are needed: “We negotiated the [community pharmacy] contract for
four years and had some idea of what was coming. With hindsight, we could
have planned things better. The Polish workforce, provided that communication
is not a barrier, should be looked on as a gift for achieving professional
aspects.” However, Eastern Europeans are not just here to allow
UK pharmacists to take on extended roles. They are keen to join in and
some, like Miss Parchowska, are already accredited to offer services
such as medicines use reviews.
As a contractor, Mr Dajani also appreciates a greater choice of pharmacists.
His pharmacy is in Southampton, which has one of the largest Polish communities
in the UK
(estimated to be 20,000). Mr Dajani says that some of his Polish customers
do not speak English so are more difficult to counsel. He manages, but “if
I could direct them to a Polish pharmacist who could communicate, believe
me, I would. The problem is there isn’t one,” he said.
Ateam expects many more Eastern European pharmacists will want to come
to the UK and has set up a language school in Cracow, teaching medical
English, which is supported by a UK qualified pharmacist. “[The
market] is still immature and we will see numbers increasing year on
year. There are candidates who would like to come but do not have the
language skills and it takes time to put people through language courses,” Mr
Mills says.
In October 2006, the Home Secretary
announced restrictions on the number of Romanians and Bulgarians allowed
to work in the UK. A Home Office spokeswoman says Romanian and Bulgarian
pharmacists who want to work in the UK can either apply for work permits
(employers have to show that the pharmacist will be doing a job where
no suitable UK applicants can be found) or they can apply under the Highly
Skilled Migrants Programme.
Mr Hainge says that, subject to an evaluation of skills, experience and
motivation, and being able to manage the registration issues originally
experienced with Polish pharmacists, Lloydspharmacy may look at recruiting
from our newest EU neighbours.
“It is difficult to tell at the moment if Romania and Bulgaria will prove
fruitful for recruiting pharmacists and significant investment may be
needed in people. But our clients are eager for more,” Mr Mills
says.
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The
Pharmaceutical Journal