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Opportunities, shortages … and absent leaders


Opportunities, shortages … and absent leaders

We are witnessing the breakdown of the pharmacy workforce and network in real time but nobody is willing to take action, says Mohammed Hussain


It is acceptable to hold multiple views and for those views to be in tension with one another. For example, it is a self-evidently greater good for pharmacy and patient care that we have so many fantastic opportunities in primary care and prescribing roles, but also that the growth of these roles from 50 in 2016 to over 6,000 by 2022 is having a detrimental effect on the workforce sustainability of both hospital and community pharmacy networks.

It is also right that the locum pay for pharmacists should reflect the increased cost of living, increased demands of the role and reflect the professional responsibility for the role.

Until recently, locum wages in many areas were still locked at the £20p/h rate that I first encountered 20 years ago. Very few other sectors would have experienced this wage stagnation over two decades. Curiously, the other example that came to mind was the wages of public sector workers who have also experienced wage stagnation since the financial crisis of 2008.

The other perspective is that the community pharmacy sector has been very heavily squeezed by the NHS. The so-called ‘pharmacy cuts’ from 2016 sought to cut the pharmacy network by a third by making pharmacies financially unviable. This was an intentional policy to force between 1,000 and 3,000 pharmacies to close.

The only respite to this utterly short-sighted policy was Covid-19, when the pharmacy network was called upon to support the national mobilisation in response. Imagine, then, the state of the nation and primary care had the government achieved its aim of forcing closures of thousands of pharmacies.

Community pharmacies and the workforce responded valiantly, helping to maintain the medicines supply and vaccinating the nation. Leyla Hannbeck from the Association of Independent Multiple Pharmacies recently said 650 pharmacies had been forced to close in the last six years. This shows that the government was able to achieve some of its aims in forcing closures, but it masks the response that pharmacies had to make by reducing staffing levels, curtailing investment and reducing service levels to stay afloat.

In recent months, there has been a growing awareness of some pharmacies regularly closing and proclaiming that this is due to “pharmacy shortages.” The argument has been that there are just not enough pharmacists, locum or employed, to provide the requisite cover. Locum representatives have countered that there is no shortage but that pharmacies are refusing to pay the market rates for locum cover.

Closing a pharmacy down for multiple days must be the last resort. The consequences for patient care, but also the stress caused to staff who return to work after a closure, is immense. This will likely lead to more people leaving the sector and the downward spiral continues.

Into this vortex, national bodies have been absent. The General Pharmaceutical Council sought it fit to issue warnings to locums at the beginning of Covid around wage demands but has remained largely silent on the impact and implications of repeated closures that clearly impact continuity of patient care. The argument from the GPhC is that this is a contractual matter and could be a defensible position if this was an ad-hoc issue. But it’s not. It’s now become a structural, highly destabilising issue, with hundreds of pharmacy closures every quarter.  

NHS England should be regulating the closures and taking enforcement action but has also not engaged with the challenge and allowed repeated pharmacy closures to become acceptable. Worse still, the official figures are only of those pharmacies closing and notifying NHSE - we don’t know how many pharmacies close but never notify.

LPCs are tying themselves in knots over this crisis too, as they represent pharmacy contractors and don’t want to be seen as criticising repeated closures. Other national bodies, the PSNC, Company Chemists’ Association and Pharmacists’ Defence Association, are trading blows over whether this is a workforce shortage or artificial pay caps.

There is some anecdotal evidence of the working culture changing, with some contractors reporting that some locums cancel booked shifts at the last minute and seek emergency rates, or that increasingly locums are not willing to book in advance and lock in the rate, rather waiting and seeking emergency bookings with commensurate higher rates.

We are witnessing the breakdown of the pharmacy workforce and network in real time and yet no-one appears willing to take any actions. The current situation did not happen overnight. This is a legacy of government policy, austerity, wage stagnation, dishonourable conduct by some players on all sides and poor national leadership.

The key problem is the absence of a workforce strategy and serious engagement with this challenge by all stakeholders. We need a comprehensive pharmacy workforce strategy combined with regulators and the NHS taking enforcement action where patient care is impacted. Pharmacy workforce impact should be the highest risk on the risk register of all organisations in pharmacy. You will be surprised to hear that it is not and that’s why we are where we are.

Everyone blames someone else. They are not sufficiently willing to work with others to take strategic actions. The current pharmacy strategy appears to be ‘let it burn’ but no-one calls the fire brigade.


Mohammed Hussain is an independent contractor and non-executive director of Bradford Teaching Hospitals Foundation Trust.












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