I’d love the title of this blog to be a statement rather than a question, but at this moment in time I’m not sure.
There is no getting away from the ‘brain drain’ from community pharmacy now. I’ve seen several close colleagues make the transition into primary care, supported by ARRS funding in some cases, others without that carrot. Feedback to-date is that, for them, it is the right move.
There is a huge amount of back and forth between contractors and individual pharmacists (e.g., locums) about the availability of pharmacists and current and future numbers. To be honest I’m not even going to quote the arguments because as we know there are ‘lies, damned lies and statistics’. I’ve seen two arguments using the same base data and coming to opposite conclusions.
“Lies, damned lies, and statistics”
Mark Twain
Thinking about this shift in workforce, is it a pull or push effect. Or is it both?
Push or Pull Effect
There is a lot to attract pharmacists and technicians into the primary care roles at currently: -
| Pull Factors | Push Factors |
| Clinically more rewarding/challenging | Few services commissioned by NHSE/PCNS/CCGs to utilise IP |
| Belonging to a wider primary care clinical team. | Often isolated as a practitioner and little clinical discussion with others |
| Better work-life balance (Normally 37.5hrs = 1 WTE) | Often contracted to 40+hrs a week, plus weekend working for some |
| Managing your own workload | Little autonomy and often a top-down approach |
| Fewer management driven targets | Services become focussed on numbers rather than outcomes for patients |
| Lunch breaks | RP regulations and “always on” culture means little time during the day to “switch-off” |
| Protected learning time for some | Often done out of hours - seen as a duty of pharmacy team to ‘maintain competency’ |
| Appropriate skill mix and numbers | Reduced staffing & skill mix with an increasing workload |
Now the items above are not ubiquitous across the individual settings they relate to, and there are good and bad experiences in both primary care and the community setting (a recent Kings Fund Report had some depressing responses from pharmacists), but it does show some of the contrast between the two sectors that is making ‘longstanding community pharmacists’ reconsider their roles.
What’s the Answer?
Well, if my lottery tickets come up tonight, and I end up with the £20 million jackpot - I pledge to sit down and solve this problem for us all.
But in the meantime, I can suggest a few broad topics that might help to stem the tide.
Funding
Money doesn’t solve all the problems, but it certainly enables some innovation in the workplace. Community pharmacy has been in a zero-growth contract with NHSE for a while now - factor in minimum wage increases, inflation, Brexit, and the Pandemic and the funding has shrunk in real terms.
Working Conditions
The Pharmacists Defence Association produced the Safer Pharmacy Charter which personally I felt has some good principles that organisations could engage with and deliver on. I’m not going to reproduce all the principles here, but certainly - rest breaks, physically safe conditions, staffing levels (see above) and respect for professional judgement are key to the engagement of the pharmacy team.
Leadership
This is a difficult one, as this will mean different things to different people. We have bodies who have the interests of the contractors at their core (PSNC, NPA, CCA, AIM) and we have those bodies that represent the profession directly (RPS, PDA, GPhC).
Between these organisations we need a collaboration to develop a vision/future for community pharmacy that individual pharmacists will buy in to, the government will pay for, and those contractors can see a reasonable return on investment for.
Over to You
I am interested to hear what Pharmacists and Technicians think the future of community pharmacy is, and if they believe there is a place for us in the ‘heart of the communities we currently serve’.
Having been in community the whole of my professional life - I hope so.