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Stephen Goundrey-Smith is health care development
manager at SGS PharmaSolutions
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The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
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Over the past few years, the pharmacy profession has become
increasingly preoccupied with the demographics of its workforce, as is
evidenced by
the series of published research reports and conference presentations
by the Pharmacy Workforce Research Unit at Manchester University.
One
of the key issues that has been highlighted in the emerging body of research
is the growing crisis in pharmacist recruitment and retention.
In the community sector, the main problem has been the functional shortage
of pharmacists working in community pharmacy. Because of a lack of pharmacists
able or willing to take up permanent posts
in community pharmacy companies, many pharmacies are run using locum
pharmacists, either during the interregnum between permanent pharmacy
managers or, in some cases, instead of a full-time pharmacist. The results
of the 2002 National Workforce Census indicated that no less than 38
per cent of pharmacists working in community pharmacy were locums.
In my experience, the locums are sometimes former contractors or employee
pharmacists from the local area — who are semi-retired, or who
may have family commitments — who bring with them a wealth of valuable
local knowledge.
More often than not, however, the locum may be booked from an agency
and may have travelled 50 miles or more for a day’s work. In this
situation, it is likely that the locum will have no local knowledge whatsoever.
Furthermore, although a locum agency will ensure that pharmacists are
registered and appropriately accredited, there is no guarantee that a
pharmacy organisation will find a locum pharmacist who has the appropriate
type and level of experience to work effectively in a particular pharmacy.
The widespread use of locum pharmacists, therefore, has implications
for the service provided by community pharmacies. First, there is the
potential for a lack of continuity in the patient care provided by a
pharmacy. Secondly, support staff may have increased, possibly inappropriate,
responsibility for commercial and merchandising issues in a pharmacy
which is staffed primarily by locums. Thirdly, there may be sporadic
provision of enhanced services from a pharmacy, depending on what each
locum is accredited to provide, or willing to provide.
However, this situation is about to change. Comments
from pharmacy employers in a recent feature on community pharmacy
in The Pharmaceutical Journal (30
June 2007, p769) indicated that, in various companies, the trend
is towards more pharmacists being recruited to full-time pharmacist posts
within pharmacy companies, with a corresponding reduction in the engagement
of locums. This may be for a number of reasons.
It is easier to provide employee pharmacists with consistent training — especially
to fulfil enhanced services. It is easier to incentivise, or threaten,
employee pharmacists to encourage them to meet service targets, eg, medicines
use reviews. Also, notwithstanding initiatives by company superintendent
pharmacists to bring standard operating procedures to the attention of
locum pharmacists, employee pharmacists are likely to be more familiar
with company procedures. Locums may still be used for holiday cover but,
even then, some pharmacy chains have a pool of employed relief pharmacists
to cover gaps in the rota, to reduce locum use to a minimum.
Furthermore, there are other prevailing factors that are likely to reduce
the pool of locum pharmacists available. The recently announced increase
in Royal Pharmaceutical Society registration and retention fees may well
lead to older pharmacists who are on the point of retirement, or pharmacists
with other career options, to retire from the Register. The low hourly
rates paid by some pharmacy companies may make being a locum pharmacist
a less attractive proposition, compared with employment as a salaried
pharmacist. The stresses of being a self-employed person, and the lack
of support given to locums by pharmacy professional bodies, may lead
to some locum pharmacists choosing employment
as an easier option.
However, a crucial issue in the continued engagement of locum pharmacists
by pharmacy operators is the ability of locums to deliver enhanced services,
as specified in the new pharmacy contract, and this was
highlighted in the comments of pharmacy employers.
Primarily, this will be concerned with conducting MURs and, in some areas,
this will also include repeat dispensing, minor ailments and provision
of emergency hormonal contraception and other medicines under patient
group directions.
In all probability, these pressures will combine to produce an increasingly
hostile business environment for locum pharmacists. The number of locum
pharmacists available for work is likely to decrease, especially during
the course of next year, when the impact of the registration fee increase
takes effect. Locum pharmacists are likely to become increasingly rare
and will consist of two types.
On the one hand, there will be those who
are particularly dedicated and talented, or who wish to remain self-employed
for personal reasons. On the other, there will be the underperformers
and the unemployable, who would be unable to get work elsewhere.
Both
types of locum will cause difficulties for pharmacy operators, though.
The former will be in demand, and pharmacies will find out the hard way
that it is a seller’s market. The latter will be more readily available,
but will be a liability to the pharmacy’s business.
Yet locums are potentially a useful resource for any pharmacy operator.
Unlike employees, they may be deployed at will and for as long or short
a time as is necessary. A good locum may bring a breadth of pharmacy
experience that an employee cannot match. Furthermore, a good locum who
is adept at networking will have business intelligence that is valuable
to a pharmacy operator.
However, gone are the days of locum pharmacists who, in the memorable
words of a previous PJ correspondent, are no more than “corpses
with certificates”. In the brave new world of pharmacy in the run-up to 2020, only a certain type of locum community pharmacist will survive.
Most significantly, the best-equipped locum pharmacists will be those
who have an in-depth understanding of the pharmacy market and the health
care economy — the surgeries, hospitals, primary care trusts etc — within
a 30–50 mile radius of their homes.
Locum pharmacists will be most effective when they are local to a particular
area. Successful locums will be clinically focused on the pharmaceutical
care needs of specific patients and of the local patient population.
They will be accredited to provide enhanced services. They will be willing
to embrace
the new ways of working that are enabled by the electronic transfer of
prescriptions and the use of other new technologies in the pharmacy.
The new breed of locum pharmacist will be highly valued by pharmacy employers.
But, pharmacy operators, beware! These pharmacists will be an expensive
resource because they will be able to name their fee. Furthermore, these
pharmacists will need their fee to pay their increased registration fee
and still preserve the income — and quality of life — they
deserve. |
The
Pharmaceutical Journal