Hospital Pharmacist Vol 7 No 1 p24-26
January 2000 Original Papers

Study leave and the hospital Pharmacist

By C. Cairns, MRPharmS

Objective - To investigate the scope and nature of pharmacists being refused study leave on the grounds of financial, staffing or other reasons.
Design - Questionnaire survey containing a mixture of open, closed and Likeart scale questions. Response data were collated and entered onto an Epi Info database.
Setting - A total of 271 guild-accredited workplace representatives working in hospital and community trusts throughout the UK during March, 1998.
Outcome measures - Reasons for study leave being refused; existence and amount of study leave budget. Agreement or disagreement with a range of statements on the situation around study leave.
Results - Eighty-two responses, covering at least 1,100 pharmacist posts, were received; 65 per cent of respondents reported study leave being refused due to lack of staff cover; 57 per cent of pharmacy departments had a study leave or training budget (mean £117 per head; range £10-460); in some trusts the training budget covered all training including student technician, preregistration pharm-acist and diploma training; 71 per cent of respondents did not agree that pharma-cists get enough study leave; 80 per cent disagreed that study leave was becoming easier to obtain; 96 per cent agreed that study leave should be part of terms and conditions; and 49 per cent agreed that "pharmacists do not apply for study leave as they feel guilty about leaving their work for overstretched colleagues."
Conclusions - Obtaining study leave is problematic for pharmacists in many trusts. The most common reason for refusing study leave is lack of staff cover. Almost half of pharmacy departments have no budget for study leave, and 77 per cent of trusts have done nothing to help pharmacists meet their continuing education requirements.

The group delegates meeting (GDM) of the then Guild of Hospital Pharmacists (GHP, now Guild of Healthcare Pharmacists) held in December, 1997, mandated the guild council "to investigate the prevalence of pharmacists being refused study leave on the grounds of financial, staffing or other reasons." In the discussion at the GDM, a number of anecdotal reports of curtailment of study leave were given by delegates from a number of areas.
Although there appeared to be a potential widespread problem, the evidence provided was subjective, not recorded in any published form and based purely on anecdotal reports from a small group of individuals. No published work could be found on the extent of the problem in the recent pharmaceutical literature, neither as published work nor as news articles.
To address this, the guild council decided to undertake a survey of the guild's accredited workplace representatives to investigate the scope and nature of the problem.

Method

A survey of guild-accredited representatives working in hospital and community trusts in the United Kingdom was carried out in March, 1998. The survey tool was a questionnaire which included a mixture of open, closed and Likeart scale questions. The questions were developed around a number of themes that had been discussed during the GDM debate. The initial tool was prepared by an experienced research and development pharmacist using standard questionnaire techniques. A total of 271 GHP representatives were identified from the database held by the parent union, MSF, and each was sent a questionnaire. The response data were collated and entered onto an Epi Info database. The data were then analysed and reported using frequency distributions and some non-parametric statistical analysis for comparing subgroups. All the data were anonymised on computer entry and final results are from aggregate data.

Results

Respondents Responses were received from 82 representatives (30 per cent) throughout the UK, representing around 1,100 pharmacist posts. The number of pharmacists covered by the respondents ranged from two to 40, with a mean of eight.
The majority of respondents were from acute or mixed acute and community trusts (71; 81 per cent), but responses were also received from specialist (1), community (2), mental health (4) and other types of trust (3). A fifth of the respondents (15; 19 per cent) were from teaching hospitals. One respondent did not identify the kind of trust.
Respondents were located throughout the UK. Table 1 shows a breakdown of respondents by NHS region and/or country.
The response rate was lower than expected. There were two possible reasons for this. Many NHS trusts have more than one GHP representative but returned only one response per trust.
Scrutiny of the returns confirmed that there had been no duplication of returns from any trust. Also, some of the GHP representatives from busier departments may not have had the time to respond. It is also possible that these departments may be those where obtaining study leave may be a problem.

Study leave Lack of staff cover was cited by 53 respondents (65 per cent) as the reason for study leave having been refused, and lack of funds was cited by 11 respondents (14 per cent).
Fourteen respondents (18 per cent) cited a mixture of other reasons, the most common (7) being an inappropriate or not relevant request. Despite the wide range of courses available, the number of people sent on nationally recognised courses was relatively small (Table 2). A number of Scottish and Welsh respondents reported that their departments widely used the SCPPE (Scottish Centre for Post Qualification Pharmaceutical Education) and WCPPE (Welsh Centre for Postgraduate Pharmaceutical Education) courses as they were available at no cost to them and were of a high quality.
Although more than half the departments (46; 57 per cent) had a study leave budget, the amount varied widely. Only 34 respondents were able to report the sum available. This ranged from £10 to £460 per head, with a mean±sd of £117±115 per head. The modal sum was £50 and the median was £72.50.
There was a strong trend (P=0.16, Mantel-Haenszel [corrected chi square]) for teaching hospitals to have a study leave budget, and a teaching hospital pharmacy department was significantly (P=0.06, ANOVA) more likely to have a greater budget (mean ± sd £215±144 per head) than a non-teaching hospital (mean ± sd £104 ± 107 per head). However, a number of other factors need to be borne in mind. For example, a large number of departments (43 per cent) still had no identifiable study leave budget.
A number of respondents commented on this, reporting that they had no money for study leave and were dependent on trust funds, the pharmaceutical industry and other "soft monies." Even where departments had study leave/training budgets, respondents reported that the budget covered all training, including student technician, preregistration pharmacist and diploma places.Respondents were shown a range of statements regarding study leave.
They were asked to indicate their agreement or disagreement with the statements to reflect the situation in their trust. The findings are:

• A high proportion (71 per cent) of representatives "disagreed" or "strongly disagreed" that pharmacists in their trust got enough study leave.
• Eighty per cent "disagreed" or "strongly disagreed" that study leave was becoming easier to obtain, while 92 per cent "disagreed" or "strongly disagreed" that pharmacists did better for study leave than doctors and nurses in their trust.
• Only three respondents "disagreed" that study leave should be part of terms and conditions, whereas 43 per cent "agreed" and 53 per cent "strongly agreed."
• There was "disagreement" or "strong disagreement" from 36 per cent of respondents to the statement: "Obtaining study leave is no problem in my trust."
• The statement, "Pharmacists do not apply for study leave as they know that it will be turned down due to cover problems," was "agreed" or "strongly agreed" by 36 per cent of respondents.
• More significantly, 49 per cent of respondents "agreed" or "strongly agreed" that: "Pharmacists do not apply for study leave as they feel guilty about leaving their work for overstretched colleagues." Although this is of concern, it is also a strong indicator of the professional loyalty and commitment of pharmacists.

A number of respondents provided a total of 49 examples where study leave had been turned down for various reasons. Some of the reasons for refusing study leave are quite legitimate:

"Junior pharmacist refused study leave for a diploma cardiology study course as she was not covering general medical wards at that time."

"Study leave was requested for a course which was clinically based; however, [it] had no relevance to that pharmacist's current job."

However, the majority of examples underline the significant role of staff shortages and financial restrictions in curtailing study leave:

"…very severe service commitments at grade D and above. I (principal pharmacist) find it very difficult to find time for further study…"

"Study leave allocated on a first come, first served basis, until money runs out."

"Refused/cancelled due to staff cover problems."

"Several hospitals in trust. I have been refused study leave because of shortage of staff at another. No problem in department I was working in — globally short."

"People just do not apply or are not told of courses by managers…there is no point in telling them because we cannot release them anyway."

"Study leave refused on seven occasions because of lack of staff and inability to maintain service levels."

"No actual cases of study leave being turned down by the trust as I only agree requests which are within department study leave budget. Nine out of ten requests turned down for specialist training because of cost."

"All study leave from December was refused after directorate's study leave budget was exhausted. This budget includes consultant haematologists, etc, whose study leave requirements are costly — one of them is also the clinical director so he gets first choice. There is no budget for pharmacists in this department."

There is also evidence that individual pharmacists are either being asked or expected to contribute financially to training.

"All pharmacists pay 25 per cent course fee towards symposia, day courses, etc, but all travel is paid. Diplomas and Open University courses are fully funded. No travel."

"Individuals have to pay one-third of course fees themselves."

"Three attended UKCPA autumn meeting, but this was totally supported by the individuals concerned (ie, no study leave and no assistance with fees)."

"Staff have been asked to fund themselves to attend courses."

There were also examples of rather shortsighted attitudes towards the training of staff:

"I believe that some of the problems that exist in other trusts are problems of attitude— study leave is the first thing that gets the chop. This causes a downward spiral of expectation."

"Since January, 1998, - block on all one-day study leave due to staffing pressures and maintaining services. This applies to pharmacy technicians and pharmacists."

"The director of pharmacy insists that attendance at group meetings, eg, QA group, aseptic services group, is study leave and not part of the routine business of the department. Consequently the study leave budget is used up unnecessarily (albeit not by much), but more importantly there is the possibility that leave will be refused. I once had to attend the QA meeting in…and pay my own train fare."

Diplomas, certificates

A high proportion of trusts (64; 79 per cent) sent "newly qualified" pharmacists on some form of postgraduate training course. Of these, almost half (44 per cent), sent all "newly qualified" pharmacists, 34 per cent sent only those who were interested, 5 per cent sent three-quarters, 13 per cent sent a half and 5 per cent sent a quarter. The most common reason (nine of 17 cases) for not sending "newly qualified" pharmacists on a postgraduate training course was that this type of training was not applicable or appropriate, owing to department size, type of trust, or prevailing skill mix, for example.

CPD requirements

In the past few years, both the Royal Pharmaceutical Society of Great Britain and the Pharmaceutical Society of Northern Ireland had an expectation on continuing education from their members as part of their continuing professional development (CPD) requirement. At present, this is a minimum of 30 hours per year for both societies. Respondents reported that only 19 trusts (23 per cent) had put into place any actions to help pharmacists achieve this. A number of negative comments were openly reported by representatives in response to this question. An attitude that gave cause for concern was expressed in the following comments, articulated by some respondents:

"The trust expects pharmacists to meet this requirement as part of being a professional."

"This is the responsibility of the individual pharmacist."

The findings of this survey are worrying, and raise issues that are important not only to the guild and its members but also to all pharmacists and their supporting staff who work in the hospital sector of the NHS.
They have significant implications for pharmacy managers and also for clinical directors and general managers with responsibility for pharmacy. This is particularly relevant at the present time, with quality in health care provision within the NHS being a Government priority. The delivery of safe and effective pharmaceutical care depends heavily on the existence of a competent, properly trained workforce whose knowledge and skills are relevant and up-to-date.
There is also considerable "food for thought" for other pharmaceutical organisations, particularly those that represent or support pharmacists in hospitals, including the Royal Pharmaceutical Society of Great Britain and Pharmaceutical Society of Northern Ireland, and/or providers of continuing education events.

Conclusion

Obtaining study leave is problematic for pharmacists in many trusts, and the indications are that it is not becoming easier to obtain. It would appear that study leave is frequently refused because of lack of staff cover. Almost half of pharmacy departments have no budget for study leave. "Newly qualified" pharmacists are likely to have access to a certificate, diploma or masters course in the majority of trusts. Despite the momentum of continuing professional development and the clinical governance agenda, 77 per cent of trusts have done nothing at all to help pharmacists meet their continuing professional development requirements, as laid down by their professional body.

Acknowledgments: The author would like to thank all the accredited representatives and others who took time to complete the survey document and return it.

Mr Cairns is director of the Pharmacy Academic Practice Unit at St George's hospital, London