With community pharmacy moving into integrated care boards (ICBs) from April, the need for multidisciplinary clinical leadership is even greater, the director of medicines and pharmacy for North East and North Cumbria ICB and RPS England board member Ewan Maule has said.

He told our sister title Healthcare Leader that the move from community pharmacy into ICBs from April supports the need for ‘clinical leadership to be more multidisciplinary than it has been in the past’.

‘Clinical leadership across all professions is important, and it’s key that its multidisciplinary nature is recognised in ICBs,’ he added.

In particular, he said that clinical leadership has been an issue for pharmacists working in PCNs. ‘The expectation has been that GPs will provide clinical leadership for pharmacy teams, but most GPs have not worked in that way before, and don’t understand the career pathway of pharmacists and their aspirations,’ said Mr Maule.

Those pharmacists who do move into PCNs to fully use their prescribing skills and become clinical specialists may find their new role does not meet their expectations. ‘The growth in PCN pharmacy roles was so quick that they were not particularly well planned or well led,’ says Mr Maule. ‘There isn’t career progression built into the model, and so the turnover of pharmacists and technicians in PCNs has been quite high. Some people work for a couple of years, then move into other sectors, in particular hospital pharmacy where they can work at a more senior level in a clinical role.‘

And over the past twenty years, community pharmacy has become ‘a less attractive role’ for people to work in, because the contracts are still based largely around dispensing, where the bulk of contract funding comes from, he said. ‘The contract hasn’t really kept pace with developments in the profession, such as pharmacists prescribing and taking on clinical caseloads,’ he suggested.

Increasingly, community pharmacy is relying on locums who are charging high rates, which is affecting the quality of care and relationship building within wider PCNs, Mr Maule told Healthcare Leader.

Workforce shortages

While the role of pharmacy, particularly over the last ten years, has ‘grown in all settings’, the workforce hasn’t grown sufficiently to support an increase in demand, Mr Maule added.

‘Primary care networks (PCNs) have created a huge additional demand for pharmacists and pharmacy technicians to be working in new roles [ARRS roles], but this wasn’t accompanied by a workforce plan. So these roles are being filled by people from community and hospital pharmacy,’ he said.

‘What we’ve seen, as those PCN roles have been created, is exacerbated pressure elsewhere in the system. In our ICB for example, there are particular pressures in some of those more rural areas. So it doesn’t take a huge shift in people to move from community pharmacy to PCNs to create a big problem,’ he said.

Paul Day, director of the Pharmacists’ Defence Association (PDA), says the pharmacy union is ‘concerned by research and general feedback that shows many pharmacists are looking to leave the profession. And an elephant in the room at the moment is the level of pay,’ he said.

‘NHS pay levels, need to be increased to help recruit and retain staff and break the cycle that leads to too much workplace pressure and burnout, which in turn reduces recruitment and retention, it’s a vicious cycles,’ he said.

Workforce shortages have been recognised by some parts of the government, and in 2021 pharmacists were added to the Home Office Shortage Occupation List (SoL). Despite these efforts, the Pharmaceutical Services Negotiating Committee (PSNC) Pharmacy Pressures Survey from 2022, found that 91% of pharmacies are experiencing staff shortages.

The Health and Social Care Select Committee recently called for a robust workforce plan for community pharmacy to be laid before parliament within 12 months. ‘They recognise, as we do, that NHS workforce planning has tended to neglect community pharmacy, which is a massive failure of imagination and a wasted opportunity to optimise capacity,’ said Helga Mangion, policy manager at the National Pharmacy Association (NPA).

‘We look forward to a constructive dialogue with NHS officials about building capacity for the long term, which must include a funded plan for community pharmacy,’ she said.

To help tackle the workforce crisis in pharmacy, the Community Pharmacy Workforce Development Group (CPWDG) recommends an ‘urgent review’ of funding, with additional resource to support businesses to meet spiralling costs, support investment in the existing workforce and support the employment of more staff.

An enhanced understanding of the current pharmacy workforce and future need is ‘critical’ says Marc Donovan, chair of the CPWDG, ‘and we look forward to the publication of the government workforce plan in the coming months’. And pharmacy should also be included within the upcoming workforce plan – ‘especially as it is the third largest healthcare profession’, he said.

To encourage retention within the pharmacy profession, the CPWDG would like to see a holistic programme of education and training, with career development through, for example, independent prescribing, or the option for progression as a consultant pharmacist within community settings. This would ‘enhance the capacity and capability of the workforce and increase professional satisfaction, making the sector a more attractive place to work’, said Mr Donovan.

The NPA recommends a robust local impact assessment prior to any further recruitment into GP or PCN sites under the additional roles reimbursement scheme (ARRS). ‘It should calculate the impact on other parts of the local NHS, including pharmacy contractors, and their ability to deliver patient care objectives, prior to any further recruitment under ARRS,’ said Ms Mangion.

‘Forward thinking ICBs might even think about an ARRS scheme for local pharmacies – to provide the staffing levels that would enable services such as structured medicines reviews in convenient community locations,’ she said.

Mr Maule said that having a strong pharmacy workforce in all sectors can have a ‘hugely positive impact on pressures elsewhere in the system, and also on what ICBs want to achieve strategically in terms of things like [addressing] health inequalities. Pharmacy is a sector that can offer so much if it’s commissioned and supported properly.’

Training and pay

Figures from November 2022 show the number of people starting pharmacy training for the first time in the 2022 training cohort year, in England is 2,520.

The education and training required to become a pharmacist is a four-year MPharm degree plus one year of foundation (previously pre-registration) training ending with the General Pharmaceutical Council’s (GPhC) Registration Assessment.

All pharmacists practising in Great Britain must be registered with the GPhC. To register they must pass the Registration Assessment. There are currently 24 schools of pharmacy in England.

Mr Maule said: ‘In community pharmacy, we haven’t seen rises in salaries for a very long time, which is why we are seeing a number of people turning towards locum roles, as locum rates vary and can be very high in comparison to being an employee. This is where we would want to take a joined up strategic approach – not just as an ICB, but as an NHS employer – to ensure we are able to pay our staff better, and have less reliance on locums.’

A version of this article first appeared in our sister title Healthcare Leader's primary care workforce report.