PHARMACY WORKFORCE EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012

Transcription

1 PHARMACY WORKFORCE EDUCATION COMMISSIONING RISKS SUMMARY FROM 2012 AUGUST 2012

2 Welcome to the CfWI workforce risks and opportunities: education commissioning risks summary report (WRO ECRS 2012) for the pharmacy workforce. The WRO ECRS 2012 reports cover all professions across health and social care, except the medical profession, which was covered in a report earlier this year ( Each report describes the key issues facing the different professions over the next three years, and aims to support the emerging Local Education and Training Boards (LETBs) on future education and training commissioning. A key focus of the pharmacy workforce report is reflecting that, in order to produce effective workforce plans for the pharmacy workforce, a wider view must be taken, allowing for planning across sectors both in terms of staff and service delivery. The reports do not make specific recommendations for local commissioning decisions as these decisions are made through consultation between the education and training commissioner and employers. The reports will be submitted to the Department of Health in several tranches between November 2011 and the end of August This is a time of great change in the NHS. Employers are considering how best they can transform their services to maximise the quality of patient care, improve productivity and release the 20 billion savings to be reinvested in front line clinical care. This work could have a major impact on the future shape of the workforce and so needs to be considered alongside education and training commissioning decisions that are being made now. Financial allocations are a pivotal component of the overall education and training annual process across England. Presently the Department of Health secures funding to invest in the workforce through the Multi-Professional Education and Training (MPET) levy which is around 4.9bn for 2011/12. This funding is currently allocated to strategic health authorities (SHA) largely based on historic patterns of training. The Department sets out key priorities and holds SHAs to account through a service level agreement. SHAs develop plans for education commissions based on local workforce plans and then commission and fund training from education and clinical placement providers. Looking towards 2012/13, a flat cash settlement for MPET is likely. This allocation will have to accommodate a range of cost pressures which will include new costs, price increases and volume changes. In setting local investment priorities for the MPET allocation, SHAs are encouraged to consider the evidence presented within the WRO ECRS 2012 and the medical specialty training numbers reports. We hope you find the reports useful, and as always, appreciate your constructive feedback. Professor Moira Livingston Commissioning Director CfWI CfWI August

3 Purpose This information has been collated to inform decisions on education commissioning over the next three to five years. It considers the key factors influencing the estimation of future need for both pharmacists and pharmacy technicians, and gives an assessment of the current workforce supply. While not directly commissioned by SHAs, it is hoped that this report will help community pharmacy to consider their workforce. Context In an outcome-driven health service, where patients are placed at the centre of care, society needs to get the maximum benefits from its medicines. The pharmacy workforce, as medicines experts, have a crucial role to play in the optimisation of medicines. There are many examples of innovative practice that provide value and if embedded across the system would maximise outcomes for patients. Furthermore, after salary costs, medicines are the second biggest expense for the NHS, estimated at 12.5 billion in (Smith and Darracott, 2011). This document analyses the pharmacist and pharmacy technician workforce in detail. A pharmacist is an expert in medicines and their use. The majority of pharmacists work in community pharmacy, hospital or primary care settings, ensuring that patients get the maximum benefits from their medicines. Pharmacy undergraduate places are currently funded as part of the higher education system. However, NHS pre-registration trainee pharmacist placements are funded by the SHAs via MPET, and NHS funding of pharmacy contractors occurs for community pre-registration trainee pharmacist placements via the community pharmacy contractual framework. Pharmacy technicians are part of the pharmacy team and work under the supervision of a pharmacist. Pharmacy technicians typically work in community pharmacy or hospital pharmacy, although opportunities also exist in GP practices and primary care trusts. There is no standard national funding rate for pharmacy technician training, which varies throughout the country. CfWI August

4 KEY FINDINGS Next steps There is a potential supply imbalance between pharmacist undergraduate numbers and pre-registration trainee posts which may result in undergraduate numbers exceeding or not meeting the number of placements available. Between 1999 and 2009 the number of pharmacy undergraduate places in England increased from 4200 to 9800, through university expansion and the opening of new schools, with no planned links to demand for the pharmacists in the workforce. Government policy is likely to drive demand for enhanced and advanced pharmacy services to promote healthy lifestyles and support people with long terms conditions in the community. The deployment of staff is changing in the pharmacy workforce, with pharmacy technicians taking on more traditional pharmacist responsibilities, freeing pharmacists to deliver a greater level of patient service. The number of independent prescribers on the pharmacist register has increased by 39 per cent between 2009 and 2010; however, this has largely been driven by employers decisions to reconfigure service. There is a requirement to maintain and develop the current data sets to improve supply and demand modelling for the pharmacy workforce, particularly for non NHS sectors such as community, academic and industrial. The Department of Health (DH) and CfWI to lead further research to forecast the future supply and demand of pharmacists, developing scenarios to determine optimal matching for pre-registration places with pharmacy graduates, against the supply of pre-registration training places available. The DH to explore with wider stakeholders the need for a more active approach to balance student intake with demand for qualified pharmacists. Pharmacy providers and professional bodies working together with clinical commissioners to promote best practice and new ways of working to deliver pharmacy enhanced services. Pharmacy providers and professional bodies working together with clinical commissioners to develop new models of service and skill mix to promote the development of the role of the pharmacy technician. In order to ensure effective workforce planning, the independent prescriber workforce needs to be planned in a more sustainable way, in order to retain the skill set when an individual moves on. CfWI August

5 Health Education England (HEE) to consider the development of a new workforce census to gain a greater level of understanding of the pharmacy workforce. CONSIDERATIONS FOR FUTURE REQUIREMENTS Policy drivers Table 1 summarises the key policy drivers and the relevant references. Table 1: Policy drivers affecting the pharmacy workforce Key drivers 1. Modernising Pharmacy Careers (MPC) proposals for reform of pharmacist undergraduate education and pre-registration training. In response to the changing role of pharmacists, the MPC programme board has reviewed the current education and training system for pharmacists. This review argues that the current separation between undergraduate teaching and work-based learning creates a weakness, as a lack of exposure to clinical practice makes the transition from academia to work more difficult. Proposed reforms include the establishment of a formal partnership between universities and employers, and the delivery of an integrated five-year masters course, which would ideally include two major clinical placements in the fourth and fifth years, lasting six months each. The MPC programme board proposes that universities and employers would be jointly responsible for the delivery of this programme, including joint signoff and delivery of training. These proposals were submitted as independent advice to the Secretary of State for Health in June 2011 and the relevant recommendations are currently being considered by the Department of Health (DH), the Department for Business Innovation and Skills (BIS) and the Higher Education Funding Council for England (HEFCE). It is not yet clear what the exact workforce implications would be if these reforms were implemented. However, moving to a five-year integrated programme may make English universities less attractive for international students, and would result in an additional year of student loans, tuition fees and maintenance costs for national students 1, which may lead to a reduction in the number of students Relevant policy Review of pharmacist undergraduate education and pre-registration training and proposals for reform (Smith and Darracott, 2011) 1 The Higher Education Funding Council for England (HEFCE) currently provides funding for pharmacy as a science/laboratory based subject (band B) CfWI August

6 enrolling into pharmacy courses. The MPC proposals for reform suggest that this risk could be mitigated by including pharmacy students in the NHS Bursary and tuition waiver fee programme. A further impact of these reforms is that a significant expansion of the number of clinical staff involved in teaching and assessments would be required, which would need to be carefully planned. 2. Compulsory registration of pharmacy technicians with the General Pharmaceutical Council (GPhC). From 1 July 2011 it became a legal requirement for pharmacy technicians to register with the GPhC in order to practice in England, Scotland and Wales. Before July 2011 a grandparenting period was established, making registration possible for trained and experienced pharmacy technicians who did not hold new GPhC approved qualifications. The impact of this change ensures a standardised level of skills and competencies within the pharmacy technician workforce across all sectors. This not only benefits the overall pharmacy workforce, but also demonstrates to employers and patients that technicians are appropriately trained and qualified and have the focus on patient safety that is expected of the registered healthcare professionals. 3. Role of pharmacy in public health Public health problems across the UK are cause for concern, both in terms of health outcomes and costs to the economy 2. Through the delivery of enhanced pharmacy services such as the provision of NHS health checks, sexual health services, the new medicines service (NMS) and the establishment of healthy living pharmacies (HLPs), community pharmacies are positioned as valuable public health resources. Furthermore, community pharmacies are highly accessible; approximately 99 per cent of the population can get to a pharmacy within 20 minutes by car and 96 per cent can do so on foot or using public transport (The Bow Group, 2010). Within Healthy Lives, Healthy People: Our strategy for public health in England (DH, 2010) pharmacists are explicitly referenced as providing a critical role in public health, a message which has been reiterated in Healthy lives, healthy people: Update and way forward (DH, 2011) and strengthened via the establishment of the pharmacy and public health forum. The increasing drive for the establishment of enhanced The Pharmacy Order (2010) Pharmacy in England: Building on strengths delivering the future (DH, 2008a) Implementing the Next Stage Review visions: the quality and productivity challenge (DH, 2009a) Equity and Excellence: Liberating the NHS (DH, 2010a) Healthy Lives, Healthy People: Our strategy for public health in England (DH, 2010b) Healthy Lives, Healthy People: Update and way forward (DH, 2011a) DH Press Release Lord Howe launches new Pharmacy and Public Health Forum (DH, 2011b) 2 For example, rising rates of alcohol abuse are projected to cost society up to 25.1 billion a year; smoking related disease claims over 84,000 lives a year with a direct cost to the NHS of over 5 billion, and Britain is deemed to have the highest obesity rate in Europe (The Bow Group, 2010). CfWI August

7 pharmacy services to improve public health outcomes creates a significant opportunity for the pharmacy workforce, although provision of such services is variable across England. In order to ensure an effective workforce is in place to deliver enhanced services, pharmacists will need to adopt a more personalised approach to patients. Additionally, roles such as health trainers within HLPs can be performed by pharmacist support staff, so the greater use of skill mix and the impact of widening roles needs to be well planned. There is also a potential workforce risk that the provision of additional service will place additional demand on the workforce, which needs to be carefully considered in commissioning decisions. 4. Optimising medicines use The DH estimates that 300 million is currently being lost every year in the NHS due to medicine wastage, at last half of which is avoidable. The cost to the NHS of people not taking their medicines properly and not getting the full benefits to their health is estimated at over 500 million a year (DH, 2011c). The Government has shown a clear interest in maximising the use of medicines in order to improve health outcomes for patients and reduce waste. For example, the NHS White Paper Equity and Excellence Liberating the NHS (DH, 2010) highlights the important role pharmacists can play in optimising the use of medicines and improving people s health. Medicines use and procurement has been established as a QIPP workstream, and a steering group has been established to investigate the improved use of medicines to report later in 2012 (DH, 2011c). A number of medicines optimisation initiatives such as Medicines Use Reviews (MURs), prescription interventions, and the New Medicines Service (NMS) are already in place and can be further built on. A cultural change will be required in the pharmacy workforce to a more personalised approach to patients, by providing them with better information about their medicines and involving them in decisions about their treatment. This is likely to ensure that patients comply with their prescribed treatment course leading to improved patient outcomes. 5. Impact of responsible pharmacist regulations The responsible pharmacist regulations came into force in October 2009, building on the 1968 Medicines Act, creating a legal duty for the responsible pharmacist (RP) to ensure Pharmacy in England: Building on strengths delivering the future (DH, 2008a) Implementing the Next Stage Review visions: the quality and productivity challenge (DH, 2009a) Equity and Excellence: Liberating the NHS (DH, 2010a) DH Press Release - Improving medicine use and cutting wastage to be tackled (DH, 2011c) New Medicines Service Guidance (NHS Employers & Pharmaceutical Services Negotiating Committee, 2011) Medicines Act (1968) The Medicines (Pharmacies) (Responsible Pharmacist) Regulations (2008) The Medicines (Pharmacies) (Responsible CfWI August

8 the safe and effective running of the pharmacy at all times, and replacing the concept of personal control 3. The RP regulations introduced the concern of the responsible pharmacist being able to be absent from the pharmacy for up to 2 hours. This is an enabling provision to allow pharmacists to extend their role and pursue greater involvement in public health and patient advisory services. The implementation of these regulations, allowing pharmacists to leave a pharmacy for part of the day, provides a significant workforce opportunity as it enables pharmacists to offer a broader service to their community. However, this will require a cultural shift for many pharmacists as they will need to depend on a greater plurality of skill mix to deliver a safe and effective service in their absence, while being legally accountable for those individuals actions. The Medicines and Healthcare products Regulatory Agency (MHRA) announced in 2012 that it is reviewing the RP regulations as part of the Government s campaign to reduce unnecessary administration. Its recommendations will be reviewed by a ministerial group. If the regulations are removed, a greater use of skill mix would be viable to deliver service, such as technicians being used to hand out prechecked prescriptions or the sale of selected medicines in the absence of a pharmacist. Regardless of the MHRA s recommendations, the right skill mix, effective team working and strong relationships with senior management are needed to effectively implement RP regulations. 6. Pharmacist independent prescribers From May 2006, pharmacists have been able to act as independent prescribers able to prescribe any licensed medicine for any condition within their competence, with the exception of controlled drugs. The MHRA has since put in place changes to medicines regulations to enable the mixing of medicines prior to administration in clinical practice, effective from 21 December 2009, and changes to the Misuse of Drugs Regulations in April 2012 mean that appropriately qualified pharmacists will now be able to prescribe controlled drugs. In 2010 there were 1545 independent prescribers on the pharmacist register, an increase from 1108 in At the time of the most recent pharmacy workforce census in 2008, of those registered independent prescribers who responded to the census and provided details of their main Pharmacist) Regulations 2008: Guidance (DH, 2009b) Medicines Act (1968) Prescription Only Medicine (Human Use) Order (1997) Improving patients' access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England (DH, 2006) Changes to medicines legislation to enable Mixing of Medicines prior to administration in Clinical Practice (DH, 2010c) The Misuse of Drugs (Amendment No.2) (England, Wales and Scotland) Regulations (2012) 3 The Medicines Act (1968) does not define personal control or how the pharmacist is to comply with the requirement, the commonly used interpretation is that the pharmacist is in control only when physically present on the registered pharmacy premises, thus allowing the sale and supply of medicines to continue (DH, 2008). CfWI August

9 job, the majority worked in a hospital setting, accounting for approximately 48.1per cent, in primary care (28.4 per cent) and in community pharmacy (21.6 per cent) (Seston and Hassell, 2011). It is not conclusively known how many independent pharmacist prescribers are practising. However a survey 4 conducted by the University of Southampton and Keele University in 2008 found that 80 per cent of pharmacist prescribers had used their independent prescribing qualification, and 71 per cent of the pharmacists were currently prescribing. The greater adoption of independent prescriber status provides a significant opportunity for the healthcare workforce at large, as it allows pharmacists to work in integrated clinical teams and allows for the greater use of skill mix. However, current evidence suggests that nonmedical prescribing has been largely driven by employers decisions to reconfigure service around the contribution of an individual. In order to ensure effective workforce planning, a more strategic approach is needed to ensure non-medical prescribing is sustained within organisations when non-medical prescribers move on. Emerging issues During engagement with key stakeholders, a number of emerging issues were identified which may impact on the pharmacy workforce in the future.. Employers reported that a number of hospital pharmacies have outsourced their outpatient dispensing services. While there are clear benefits to outsourcing, such as economies of scale and enabling staff to focus on the core business of medicines management, there may also be the potential impacts on the provision of training for the pharmacy workforce. There has been a substantial growth in the number of 100 hour community pharmacies in England, rising from 450 in to 689 in (Health and Social Care Information Centre, (HSCIC) 2011a), an increase of approximately 53 per cent. This may affect the way the workforce is proportioned at local levels, as pharmacies with 100 hour licences will require a larger workforce to deliver services. However, it should be noted that in October 2011 the DH published a consultation document proposing that pharmaceutical needs assessments (PNAs) replace the current market entry test for pharmacies which is likely to slow the growth in 100 hour pharmacy contracts. 4 The survey was conducted in the autumn of 2008 when there were 358 pharmacist independent prescribers who had been qualified for longer than 6 months, and all were surveyed. It should be noted that the numbers of pharmacist independent prescribers have grown significantly since this survey. CfWI August

10 During engagement with the CfWI, the RPS expressed concerns over the impact the proposed reforms of the NHS may have for pharmacists working in primary care posts. Based on the 2008 pharmacy workforce census respondents, approximately 7.2 per cent of actively employed pharmacists work in primary care settings. The NHS Pharmacy Education and Development Committee (NHS PEDC) is currently working to map the transition of PCT organisations, which should provide a level of understanding of the impact of PCT closures on the pharmacy workforce. As a newly registered profession, it is not yet clear what effect the regulation of pharmacy technicians will have on skill mix, however, the profession believe that there will be more delegation of technical tasks to technicians, enabling pharmacists to spend more time on clinical activity. The Association of Pharmacy Technicians UK (APTUK) raised concerns regarding the supply of pharmacy technician pre-registration places. According to APTUK, preregistration pharmacy technician places are partially funded by MPET for hospital pharmacies, but are generally funded by employers. Within hospital pharmacy, considerable variation exists across the SHAs regarding how funding is applied; some SHAs fully fund, some partially fund and some provide no funding for places. APTUK reports that due to financial uncertainty the number of training places available is currently in decline. This has the potential to limit the drive for a greater use of skill mix in the pharmacy workforce through the delegation of suitable pharmacist tasks to technicians in order to free up pharmacists time for more clinical roles. The APTUK also raised concerns that there is regional variation in the provision of training infrastructure to support pre-registration trainee pharmacy technicians due to operational pressures (Acres, S., 2012). Demographics Due to the ageing population, combined with the prevalence of long-term conditions and public health problems in England, demand placed on the pharmacy workforce is likely to increase. According to the Office for National Statistics (ONS), the English population is estimated to increase from approximately 52.7 million in 2011 to 60.8 million in 2031, an increase of approximately 15 per cent. Those aged 65 and over are estimated to increase from approximately 8.8 million in 2011 to 13.2 million in 2031, an increase of approximately 51 per cent. Approximately 15 million people in England suffer from a long-term condition (LTC), and while the number of people with LTCs is projected to be broadly stable until 2018 and beyond, the number of those with co-morbid long-term conditions is set to rise from 1.9 million in 2008 to 2.9 million in 2018 (DH, 2010d). CfWI August

11 Additional drivers Pharmacy enhanced services add significant value in the drive to improve the public health of England, and support those with long term conditions. Some of the most recent initiatives include the establishment of healthy living pharmacies (HLPs), with 163 HLPs across 15 HLP primacy care trust (PCT) pathfinder areas established at the time of writing, and the introduction of the New Medicines Service (NMS) in October 2011 to support patients with long-term conditions who have been prescribed new medicines. DH policy will continue to drive the development of enhanced pharmacy services to meet the public health needs of the population and support people with LTCs. However, while there is evidence of local best practice, there is a lack of universal excellence across the country. Technological advancements will provide a range of opportunities for the pharmacy workforce through the use of e-prescription systems, robotics and automated dispensing, which is now a fairly prominent aspect of dispensing and supply in hospital pharmacy. An advanced example of this is NHS Greater Glasgow and Clyde, which has improved efficiency of service and reduced waste through the use of dispensary automation. This has led to efficiency gains on staffing costs, which were reduced by approximately 2 million, and has released staff from supplying medicines to working directly with patients (Taheri, 2012). While it is difficult to quantify the exact impact the advancement of technology will have on the pharmacy workforce, it is likely to produce increased efficiencies and free staff from routine tasks, allowing them to focus on more patient-facing activities. Locum pharmacists account for a significant amount of the pharmacist workforce. According to the 2008 pharmacy workforce census 37 per cent of community pharmacists work as locums, accounting for 26 per cent of all respondents actively employed in pharmacy. There is no clear conclusion whether the long-term use of locums is a sustainable model. According to the Centre for Pharmacy Workforce Studies (CPWS), small-scale qualitative case studies have revealed that in some cases locums are prepared to deliver enhanced pharmacy services, while evidence also exists to the contrary, with the locum workforce being viewed as a largely inflexible resource. (East and South East England Specialist Pharmacy Services, London Pharmacy Education and Training, Skills for Health and NHS Workforce Review Team, 2009). The current economic climate appears to be having an effect on the locum workforce, multiples such as Boots have noticed a trend of locums moving from selfemployed to employed status and joining their organisation as permanent members of staff, a trend which is predicted to continue (Andalo, 2012). Demand for pharmacists in education is likely to rise due to the expansion in the number of schools of pharmacy, which is market driven. There are currently 26 universities in the UK offering the GPhC accredited MPharm degree 5. The increased 5 Based on the General Pharmaceutical Council provider list ( CfWI August

12 demand may be further compounded by the proposed redesign of the core curriculum to reflect the increasing needs of clinical practice development and a greater emphasis on practice-based multidisciplinary teaching methods, which would require a greater level of clinical academic teaching. The academic workforce is a small workforce, accounting for 2.8 per cent of actively employed pharmacists according to the 2008 census, and is typically difficult to recruit to. In order to enable the academic workforce to resource the expanding number of schools, schools of pharmacy may consider developing clinical academic pathways. In addition, an increasing number of active senior pharmacists may deliver clinical teaching to students. Commitments to teaching need to be factored into workforce plans to ensure effective service delivery is maintained. In 2007 the white paper Trust, Assurance and Safety: The Regulation of Healthcare Professionals in the 21 st Century introduced the concept of revalidation of both medical and non-medical health professionals, which was reinforced by Principles for revalidation Report of the Working Group for non-medical Revalidation (DH, 2008b) which established 12 key principles for revalidation. A programme of research led by the RPSGB was later transferred to the GPhC, which agreed a draft definition of revalidation as The process by which assurance of continuing fitness to practise of registrants is provided and in a way which is aimed primarily at supporting an enhancing professional practice (GPhC, n.d.) accompanied with a draft set of principles. While revalidation is likely to lead to the consistent high-quality provision of care in the pharmacy workforce and long-term improvements, the impact on the workforce needs to be carefully planned. For instance, the GPhC may take into account the frequency of assessments so as not to encumber the workforce. CfWI August

13 CURRENT AND FORECAST SUPPLY Existing workforce In order to present baseline data on the pharmacist workforce, a number of sources of data have been used: General Pharmaceutical Council (GPhC) register data: Anyone wishing to work in England, Scotland or Wales as a pharmacist must register with the GPhC, which is the regulatory body for both pharmacists and pharmacy technicians. As part of this project, the GPhC provided the CfWI with register data for pharmacists and pharmacy technicians as at January It is important to note that unlike its predecessor, the GPhC does not operate a non-practicing register and all pharmacists/pharmacy technicians on the register must declare that they intend to practice. Data has been reported as recorded and, where appropriate, assumptions have been made regarding how the data has been analysed. These have been clearly stated within the analysis. National NHS Pharmacy Staffing Establishment and Vacancy Survey (2011): This survey is performed by the NHS Pharmacy Education and Development Committee (NHS PEDC) and provides data on staffing levels among NHS pharmacy staff. The survey asked chief pharmacists or a designated person in NHS organisations for point of prevalence data on 31 May 2011 and achieved a 100 per cent response rate. Pharmacy technician pilot census (2010): The pharmacy technician pilot census was undertaken prior to statutory pharmacy technician registration in July 2011 in order to provide preliminary data on this workforce. The census questionnaire was distributed to all pharmacy technicians with a registered status on the voluntary register in January 2010, with an address in England, Scotland or Wales. Of the eligible home pharmacy technicians contacted on the voluntary register, 6178 responded, providing a sample of 75 per cent. Royal Pharmaceutical Society of Great Britain (RPSGB) Workforce Census (2008): The latest pharmacy workforce survey was carried out in 2008 across a sample population of 43,845 pharmacists, of whom 30,517 responded, giving a response rate of 69.6 per cent. Despite the high response rate overall, it should be noted that this sample does not necessarily reflect the entire population precisely. For example, younger pharmacists were less likely to return their questionnaires than older pharmacists, and women had a higher response rate than men. Royal Pharmaceutical Society of Great Britain (RPSGB) Register Analysis (2010): Before the formation of the General Pharmaceutical Council (GPhC) and Royal Pharmaceutical Society (RPS) in 2010, the RPSGB held responsibility for regulation of the pharmacy workforce, and as such the pharmacist register. The CfWI August

14 Centre for Pharmacy Workforce Studies (CPWS) produced a detailed analysis of this register from 2004 to Where appropriate, data from the 2010 register analysis has been used within this document. Where necessary, additional specific data has been provided from the GPhC to aid this analysis, such as data on the number of pharmacy students. Pharmacist supply According to the GPhC, there were approximately 37,174 practicing pharmacists in England as at January The latest register analysis performed by the Centre for Pharmacy Workforce Studies (CPWS) identified 39,139 registered (practising and non-practising) pharmacists in England in 2010 (Seston and Hassell, 2010), giving this data a level of validity. It is important to recognise that the pharmacy workforce is employed across a number of sectors. Table 2 provides an overview of how the workforce is proportioned across these sectors according to the Royal Pharmaceutical Society of Great Britain s 2008 workforce census: Table 2: Proportion of pharmacist workforce by sector of practice (2008) Sector of practice Proportion of workforce as at 2008 Community 71.0% Hospital 21.4% Primary care 7.2% Industry 4.1% Academia 2.8% Other 3.8% *A pharmacist may have reported a position in two separate sectors, or two different jobs in one sector, hence the column percentages exceed 100% Source: Pharmacy Workforce Census 2008 (RPSGB) The 2011 National NHS Pharmacy Staffing Establishment and Vacancy Survey (NHS PEDC, 2011a) reports that as at May 2011, there were 7,322 established full-time equivalent (FTE) pharmacist posts in the NHS in England. Of these, 6,741 FTE were occupied, and approximately 5 per cent of pharmacist posts were not occupied after three months. Age profile Figure 1 shows the age profile of the pharmacist workforce based on the GPhC register data (headcount) as at January The age profile shows that the pharmacist workforce is a relatively young workforce, with approximately 52 per cent aged 39 or younger. The high proportion of young pharmacists in the workforce may be a reflection of the increase in the number of pharmacy undergraduates joining the workforce within the last ten years. Figure 1 suggests no risk to workforce supply due to retirements. The long tail on the right hand side of the graph show that pharmacist retirement is spread over a wide age range. CfWI August

15 Total Education commissioning risks summary Figure 1: Headcount (HC) age profile by 5 year age band, 2012 pharmacists Age profile (registered HC) - Pharmacists *Data is reported as recorded. Data for England includes those on the register with a country of residence identified as England, the Isle of Man or Greater London, and excludes those identified as residing in the UK. Approximately 0.3% of pharmacists did not have an age and a further 5 per cent of pharmacists in England were reported as being under 25 and have not been included in the age profile. Source: General Pharmaceutical Council as at January 2012 Gender Age bracket (years) According to data provided by the GPhC as at January 2012, female practicing pharmacists currently account for 58 per cent of the register, outstripping males by over As can be seen from table 3, women have outnumbered men on the register for several years, and of those who joined the pharmacist register in 2011, 61 per cent were female and 39 per cent were male, indicating that this trend is set to continue. Table 3: Gender analysis of registered pharmacists by year Gender Male 44.5% 43.8% 43.1% 42.6% 41.9% Female 55.5% 56.2% 56.9% 57.4% 58.1% Total (n) *Data is reported as recorded Source: Royal Pharmaceutical Society of Great Britain Register Analysis 2010, Seston and Hassell (2010) CfWI August

16 AfC band Education commissioning risks summary Current vacancies and employment Data from the National NHS Pharmacy Staffing establishment and vacancy survey 2011 suggested that as at May 2011, 5 per cent of pharmacist posts were not permanently occupied after 3 months across England. This can be broken down per country to the following 3-month vacancies for NHS pharmacists: England: 5.0 per cent Northern Ireland: 3.8 per cent Wales: 4.3 per cent. The vacancy rate for England has been in decline, a trend which appears set to continue, as the 3-month vacancy rate for 2011 decreased from 8.5 per cent as at May 2010 to 5 per cent in May 2011as shown in figure 2. Figure 2: NHS posts not permanently occupied after three months as at May 2011 pharmacists Band 9 Band 8d Band 8c NHS pharmacist posts in England not permanently occupied after three months (FTE) as at May 2011 Band 8b Band 8a Band 7 Band 6 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% vacancy rate Source: National NHS Pharmacy Staffing Establishment and Vacancy Survey (NHS PEDC, 2011a) However, it is important to note that although vacancy rates for NHS pharmacists at band 6 and 7 are high compared to other bands, vacancy levels at these bands have reduced in recent years. Table 4 provides three-month vacancy rates for qualified pharmacists by Agenda for Change (AfC) bands, as cited in the NHS Pay Review Body (NHSPRB) 26 th report (2012). This data shows that three-month vacancies at both band 6 and 7 have reduced substantially across the UK. CfWI August

17 Table 4: Three month vacancy rates for qualified pharmacists by Agenda for Change (AfC) bands, May Pharmacists Participating countries England, Wales and Northern Ireland All UK Countries All UK Countries All UK Countries* Band 6 (AfC band) 14.8% 20.9% 11.6% 6.7% Band 7 (AfC band) 10.1% 14.1% 11.5% 6.3% Source: Pharmacy establishment and vacancy survey data presented in NHS Pay Review Body - 26th report (2012) *Data for Scotland relates to September 2011 instead of May 2011 At a national level, the UK Government has taken action to improve the recruitment and retention of band 6 and 7 pharmacists, including the formation of the Pharmacist Numbers task and finish group the introduction of the MPC programme, which has considered recruitment and retention of band 6 and 7 NHS pharmacists the flexibility for employers to use local recruitment and retention premia (RRP) where appropriate. The NHSPRB 2012 review of pharmacist RRP concluded that there is no need for national RRP, and that any remaining recruitment and retention issues will exist in specific geographical regions. This is reflected in evidence reported by the NHSPRB (2012) which shows that the band 6 three-month vacancy rate ranges from 29 per cent in the North East SHA to 2.6 per cent in the East Midlands SHA, and that band 7 vacancy rates range from 10.6 per cent in the West Midlands SHA to 3.5 per cent in the London SHA. Portfolio and part-time working There is a trend towards part-time, flexible and portfolio working in the pharmacist workforce. Data from the 2008 census in figure 3 shows that 32 per cent of pharmacists are working part time and 17 per cent of actively employed pharmacists hold more than one job. While the proportion recorded as working part time within the census is substantial, participation rates have remained relatively stable over the last few years (Centre for Workforce Intelligence, 2011). However, a future change in participation rates would have an effect on a number of sectors where part-time and portfolio working are common. For example, the 2008 census recorded high part-time working rates in sectors such as primary care (39.5 per cent), community (33.0 per cent), and hospital pharmacy (28.2 per cent). There is little recent evidence on part-time and portfolio working across the pharmacy workforce. Further research would be required to assess the prevalence of part-time and portfolio working in the current economic climate. CfWI August

18 Figure 3: Percentage of actively employed pharmacists working part time by sector (2008) Percentage of actively employed pharmacists working part time by sector (2008) Primary care 39.50% Community 33% Other 32.70% Hospital 28.20% Academia 23.80% Industry 18.10% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Percentage employed *Part time working is defined as 32 hours per week. The census achieved a response rate of 69.9 per cent Source: Pharmacy Workforce Census 2008: Main findings (RPSGB, 2009) Students In order to become a pharmacist, students are currently required to complete a four-year accredited Master of Pharmacy (MPharm) degree course, followed by the completion of a year of pre-registration training and successfully passing the GPhC registration exam. NHS pre-registration trainee pharmacist placements are currently funded by the SHAs via MPET, and community pre-registration trainee pharmacist placements are funded via the General Pharmaceutical Services Contract. While the number of NHS placements is agreed on an annual basis, there is no limit set on the number of community placements. According to the GPhC, in 2009/2010 there were 10,599 pharmacy students studying and 2,199 students graduated in England. Additionally, there are currently 2743 pre-registration trainee pharmacist in England (Simpson, 2012). At present there is no link between recruitment to schools for pharmacy and preregistration trainee pharmacist placement commissioning. This creates a potential risk to workforce supply, as undergraduate numbers could potentially exceed or not meet the number of placements available. From 1999 to 2009 the number of schools of pharmacy in England increased from 12 to 21, and student numbers rose from 4,200 to 9,800. However, there is no firm evidence that pre-registration trainee pharmacist placements are not currently being secured (RPS, 2012a). CfWI August

19 Recruitment In order to ensure effective workforce planning, it is important to consider the migration of pharmacists between sectors. Data collected by NHS PEDC in 2011 indicates that approximately 52 per cent of pre-registration trainee pharmacists in England accepted permanent NHS posts following registration in 2011, with approximately 48 per cent choosing other destinations such as working as a locum in any sector (15.6 per cent), community pharmacy (7.3 per cent) and travelling (4.1 per cent). An exit survey was performed in June-July 2011 by NHS PEDC in order to identify potential factors that influence the decision for pre-registration trainee pharmacists to either stay in or leave the NHS (NHS PEDC, 2012). The survey identified no significant statistical significance in terms of the starting salary, job security or flexible working hours, as reasons for leaving the NHS. Pharmacy technician supply Staff in post According to the GPhC there were approximately 16,650 practicing pharmacy technicians in England as at January As with pharmacists, it is important to recognise that pharmacy technicians work across a variety of sectors. Table 5 shows the distribution of pharmacy technicians by sector determined from the 2010 pharmacy technician pilot census. The results show that the largest proportion of pharmacy technicians are employed in community pharmacy, accounting for 67.4 per cent of census respondents, followed by hospital pharmacy accounting for 21.2 per cent, and primary care, accounting for 5.1 per cent of all actively employed census respondents. Only a small proportion of actively employed pharmacy technicians hold more than one job (4.0 per cent) and a similar proportion (3.1 per cent) work in more than one sector 6. It is important to note that the data below is based on respondents to the pharmacy technician pilot census, which derived a sample of pharmacy technicians with a registered status on the voluntary register as at December 2009, with an address in England, Scotland or Wales. 6 Please note that the pharmacy technician pilot census was performed prior to statutory pharmacy technician registration. Therefore, while this provides a useful insight the data should be treated with care. CfWI August

20 Total Education commissioning risks summary Table 5: Proportion of actively employed census respondents pharmacy technicians working in each sector Sector of practice Number Percentage (%) Community 3, % Hospital 1, % Primary care % GP practice % Industry % Academia/education/training % Strategic health authority 6 0.1% Prison service % Ministry of Defence % Other pharmacy % *Data reported as recorded. Note: A pharmacy technician may have a position in more than one sector, hence the percentages when totalled exceed 100 per cent. Source: Pharmacy technicians workforce census 2010 (Seston and Hassell, 2012a) Age profile Figure 4 shows the age profile of the pharmacy technician workforce based on GPhC register data (headcount) as at January The age profile shows that the pharmacy technician workforce is a relatively young workforce with 45 per cent aged 39 or younger, and the largest segment of the workforce (16 per cent) aged Figure 4 suggests no immediate risk to workforce supply due to retirements. Figure 4: Headcount (HC) age profile by 5 year age band, 2012 pharmacy technicians Age profile (registered HC) - Pharmacy technicians Age bracket (years) *Data is reported as recorded. Data for England includes those on the register with a country of residence identified as England, the Isle of Man or Greater London, and excludes those identified as residing in the UK. Approximately 0.1% of recorded entries had an age listed below 20 years and have not been included in this analysis. Source: General Pharmaceutical Council as at January 2012 CfWI August

21 Gender According to data provided by the GPhC as at January 2012, the pharmacy technician workforce appears to be a female dominated workforce accounting for approximately 90 per cent of the registered workforce. According to the pharmacy technician pilot census, 94 per cent of respondents were female, giving this finding a level of validity. Table 6: Gender analysis of pharmacy technicians on the GPhC register as at January 2012 Gender Headcount Percentage Female 15,005 90% Male % Total 16, % *Data is reported as recorded. Data for England includes those on the register with a country of residence identified as England, the Isle of Man or Greater London, and excludes those identified as residing in the UK. Source: General Pharmaceutical Council as at January 2012 Patterns of work The 2010 pharmacy technician workforce census identified some interesting preliminary findings in the workforce 7 : For actively employed pharmacy technicians, the mean number of hours worked across all sectors was 32.5 hours a week, and those working in community pharmacy worked significantly fewer mean hours than those working in hospital, primary care or other sectors. 45 per cent of actively employed pharmacy technicians worked less than or equal to 32 hours per week. Female pharmacy technicians were significantly more likely to work part time (42.4 per cent) than their male peers (7.2 per cent). Current vacancies and employment Data from the National NHS Pharmacy staffing establishment and vacancy survey 2011 suggested that 4.4 per cent of pharmacy technician posts in England were not permanently occupied after 3 months, as at May This can be broken down per country to the following 3-month vacancies for NHS pharmacy technicians: England: 4.4 per cent Northern Ireland: 4.9 per cent Wales: 0.9 per cent. Figure 5 shows the 3-month vacancy rates for NHS pharmacy technician posts by band as at May As can be seen from figure 5, the 3-month vacancy for band 4 technicians is particularly high at 7.0 per cent, which may indicate a potential supply risk. 7 Please not e that the pharmacy technician s pilot census was performed prior to statutory pharmacy technician registration. Therefore, while this provides a useful insight the data should be treated with care. CfWI August

22 AfC band Education commissioning risks summary Figure 5: NHS posts not permanently occupied after three months as at May 2011 pharmacy technicians Band 8c Band 8b Band 8a NHS pharmacy technician posts in England not permanently occupied after three months (FTE) as at May 2011 Band 7 Band 6 Band 5 Band 4 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0% vacancy rate Source: National NHS Pharmacy Staffing Establishment and Vacancy Survey (PEDC, 2011) The pharmacy technician workforce census (2010) 8 found that 9 per cent of actively employed respondents thought it highly likely that within the next two years they would quit the sector in which they currently work; and 7.4 per cent thought it highly likely they would quit the profession within two years. The most common reasons given by the 9 per cent who indicated they would quit within the next two years included: Planning to retire: 30.2 per cent Low pay: 19.6 per cent Personal reasons: 11.9 per cent Poor opportunities: 11.6 per cent Poor working conditions: 8.5 per cent Lack of flexible working conditions: 4.9 per cent. 8 Please not e that the pharmacy technician s pilot census was performed prior to statutory pharmacy technician registration. Therefore, while this provides a useful insight the data should be treated with care. CfWI August

23 Students To register as a pharmacy technician, students are required to achieve underpinning knowledge qualifications and competency-based qualifications which have been approved by the GPhC, such as: Level 3 NVQ Diploma in Pharmacy Service Skills (QCF) National Certificate in Pharmacy Services Buttercups training level 3 National Pharmacy Association Level 3 Qualifications. A qualifying period of at least two years of work experience is also required, under the supervision of a pharmacist to whom trainee pharmacy technicians need to be directly accountable for no less than14 hours a week. During these two years, trainee pharmacy technicians are required to complete at least 1260 hours of work experience, and at least 315 hours within each year. It became a legal requirement for all pharmacy technicians to register with the GPhC in order to practise in England, Scotland and Wales from the 1 July Geographical distribution Table 7 shows the number of occupied pharmacist and pharmacy technician posts in NHS trusts and PCTs in England as at May From this analysis we can see that the the largest segments of the NHS workforce is employed in London, the North West and Yorkshire and Humber SHAs for both pharmacists and pharmacy technicians. Table 7 also provides an insight into skill mix in the NHS pharmacy workforce by analysing the ratios between pharmacists and pharmacy technicians, which range from 0.9 for the West Midlands SHA to 1.5 for the London SHA. Table 7: occupied pharmacist and pharmacy technician posts in NHS trusts and PCTs in England as at May 2011 Strategic health authority (SHA) Pharmacist posts occupied (FTE) Pharmacy technician posts occupied (FTE) Pharmacists (FTE) divided by pharmacy technicians (FTE) North East North West Yorkshire and Humber East Midlands West Midlands East of England London South East Coast South Central South West Total Source: National NHS Pharmacy Staffing Establishment and Vacancy Survey (NHS PEDC, 2011a) CfWI August