| Pharmacists working in primary care have been at the centre
of the financial cuts, organisational mergers and reorganisation of commissioning
services that have dominated the sector for the past 12 months. Many
have lost out in the scramble for jobs brought about by the mergers of
primary care trusts into larger organisations. For some it has meant
settling for a job on the same salary but with less status — this
has contributed to a feeling of low morale in some new PCTs.
The pressure
on these new PCTs to balance the books and clear inherited deficits,
which in some cases have run into millions of pounds, has damaged morale
further. This has been especially acute in those PCTs where pharmacists
have been told to spend their time on finding ways of slashing prescribing
costs rather than concentrating on other elements of the job such as
medicines management or patient concordance.
All these factors have had a direct impact on recruitment — few
new jobs are being advertised and those pharmacists who have managed
to hold on to their posts in the maelstrom are staying put for the time
being.
Uncertainty over how new models of commissioning services will work,
as PCTs relinquish their provider role, is also having a damaging effect
on recruitment. Pharmacists working for PCTs are worried that they will
no longer be needed as practice-based commissioning becomes established
with GPs looking for alternatives for obtaining their pharmaceutical
advice. There are fears that the traditional pharmaceutical adviser role,
historically provided by PCTs, will no longer be required as GPs look
to other groups of pharmacists for that support. This lack of security
about the future means that those pharmacists who have survived the latest
round of job cuts are also not moving, bringing further stagnation to
the jobs market.
Helen Chadwick is deputy chief pharmacist at Milton Keynes Primary Care
Trust, a PCT which escaped the round of mergers in October last year
that created 152 new PCTs out of the existing 303. Ms Chadwick, who is
secretary of the Pharmaceutical Advisers Group in England and Wales says: “The
general feeling that we have is that morale is through the floor. Pharmacists
have been displaced. They have been told that their jobs are at risk
because of the PCT mergers, but even now after the reorganisations which
happened last October, people have been left hanging on still not knowing
what is happening to their job.”
Some PCT pharmaceutical advisers have lost their jobs through compulsory
redundancy while others have volunteered for redundancy instead. Nigel
Barnes, chairman of the group and head of medicines management at the
strategic health authority NHS West Midlands, reckons that only a handful
of advisers fell victim to compulsory redundancy.
He says: “There
were only a few and then there were others who wanted to take redundancy.
In the West Midlands where PCTs came together there was a competitive
process for the senior posts.” Those who failed to secure their
old job within the new organisation often ended up in a new post, a band
below their old job but on the same salary. For pharmaceutical advisers,
for example, this meant becoming a deputy pharmaceutical adviser or taking
on a more general medicines management role within the team.
Pharmacists working in GP practices appear to have escaped most of the
upheaval which has beset those pharmacists in more senior positions in
the PCT team. They are being taken on and employed by groups of GP practices
working together to deliver practice-based commissioning. But the introduction
of practice-based commissioning is bringing a level of job insecurity
to other members of the PCT pharmacy team who are uncertain if they will
still be needed as PCTs move away from providing services.
Ms Chadwick says: “Most PCTs are keeping the pharmacy team together;
the thinking being that there will be a service-level agreement from
the commissioning PCT with the provider organisation created through
practice-based commissioning. We think that pharmaceutical advisers will
still continue to provide a service even if the PCT divests itself of
its provider role. The consequences of all this, if you look at recruitment,
is that people are holding onto their jobs at the moment and not looking
to move. Just one look at the job adverts tells you that the jobs just
aren’t there in primary care because so many people have been displaced.”
Nigel Barnes, on the other hand, is more optimistic about the security
of pharmacy jobs within PCTs as practice-based commissioning takes hold.
He thinks that PCTs will expand the number of pharmacists that they have — even
if the way they are organised may change. He says: “As PCTs divest
themselves of their provider arm I think the employment potential for
primary care pharmacists is improving.”
Another factor which is influencing recruitment in primary care is the
impact of changes brought about through Agenda for Change; the redefining
of NHS (including pharmacy) job descriptions, responsibilities and pay
scales to try and create a more uniform national picture. In practice,
however, the rebanding has not been as uniform as it was meant to be.
Some PCTs that have merged have had similar jobs attracting different
banding. These differences are still being sorted out, which has helped
to bring more stagnation to the jobs market. “There are still people
going through appeals against rebanding at the moment, which is disappointing.
There have been different bands for the same job in different PCTs, which
is exactly what Agenda for Change was meant to sort out,” said
Ms Chadwick.
It is unclear how long pharmacy recruitment will remain in the doldrums.
Nigel Barnes thinks that all the uncertainty created by mergers, commissioning
and cuts is now firmly behind PCTs. He says: “I think we went though
a difficult patch about 12 to 18 months ago as we worked up PCT reorganisation,
which came into effect in October. Most PCT reorganisation and most redundancies
are behind us now.”
He is optimistic that new career opportunities
will start to appear through practice-based commissioning with pharmacists
working within PCTs to provide “clusters” of practice-based
commissioning groups with the medicines management support they need,
possibly on a sessional basis. This could create the need for more pharmacy
posts within PCTs.
Alternatively he predicts some pharmacists could get
together and provide the same support as “stand-alone” teams
contracted to the practice-based commissioning clusters. He says: “It’s
shifting sands — I think we shall see various models which will
exist for a number of years. Pharmacists must make contact with their
practice-based commissioning clusters so that they can lead the agenda
in those clusters and adapt to changing conditions. They need to be able
to provide what the clusters are commissioning. If PCT medicine management
teams provide what the local GPs want they will continue to survive.”
Shailen Rao shares this optimistic vision for the future for primary
care pharmacy and the new career paths and job opportunities on the horizon.
Until January this year, Mr Rao was joint head of medicines management
at Hillingdon Primary Care Trust in west London. Budget cuts that were
brought in to balance the NHS books meant that one of the posts had to
disappear.
Mr Rao decided to take voluntary redundancy. “I felt
it was time to move on and my colleague wanted to stay, so we reached
an amicable solution.” Mr Rao is also chairman of the Primary Care
Pharmacists’ Association and has a national view of the changes
taking place across the sector. “Lots of people have lost their
jobs and are being slotted into new jobs, but many are at different stages
in that process,” he observes.
He admits that the current recruitment market is “very stagnant” as
pharmacists decide to stay put, thankful that they have survived the
changes. “But people are also feeling demotivated by what has been
happening and are therefore less likely to be effective in the workplace.”
Mr Rao, however, believes the “contraction” which the market
is experiencing will be short lived and there will be new career opportunities
and a buoyant recruitment market fuelled by the changes to pharmacy brought
about by practice-based commissioning. But, like Mr Barnes, he thinks
that pharmacists who are resistant to change will get left behind.
During his early days of redundancy he set himself up as a company with
the intention of offering medicines management support to a practice-based
commissioning group. The idea is that he, and not a PCT, would be contracted
and paid by the group to provide medicines management support. It is
a model he believes has the seeds of success.
He says: “PCTs are
principally in the market of making savings — I think it is time
for pharmacy and medicines management to break away from that and move
with the times. I now need to persuade a group of GPs to see this vision
and the benefits it would bring to them. In my case I have seen the fear
and felt it. I have lost my job and got beyond the fear. It is my belief
that change can create opportunity. I think those new opportunities will
start to appear around a year from now.” |
The
Pharmaceutical Journal