Underfunding underpins the locum issue
Locum rates have gone up due to the mismatch between supply and demand. Locum costs should be included in contract negotiations to improve the funding, says Nick Kaye…
“There has never been a better time to be a pharmacist and never been a worse time to own a pharmacy.” This was overheard during an interesting conversation between two pharmacy owners. As my eldest son is set to become the fourth generation of the family to become a pharmacist when he starts university in September, I wondered whether it was really true.
The community pharmacy my grandfather owned and worked in would be unrecognisable to him today, but he would still be familiar with its place in the community. It’s hard to imagine, but when he started practising the NHS did not exist. He could not have envisaged a world where pharmacists work in doctors’ practices, let alone all the other changes in pharmacy practise.
I wonder what he would have made of pharmacists being able to prescribe. Would he have said: ‘Well, I do that all the time when I recommend an over-the-counter medicine. I make up the product according to the needs of the patient.’ This is what personalised medicine was 50 years ago. Or would he have been shocked that those pharmacists who are prescribers can write a prescription for everything a GP can?
I think it would have surprised him, but in a generation this will be the norm. As my eldest son starts his university journey this September, and when he eventually qualifies as an independent prescriber, it will be part of the course. I wonder what the next ‘normal’ will be for the profession in 20 years’ time? Maybe the full circle of personalised medicines spiced up with pharmacogenomics?
Back to the present day, my hope is that all pharmacists become prescribers so that the scope of practice within community pharmacy can increase. Why do I need to practice in a different setting to use the skills that I have obtained? Pharmacists will prefer to prescribe in a community pharmacy over other settings because it the most rewarding place to practice.
I believe this could be easily achieved with minor tweaks like community pharmacies holding prescribing budgets. But until that happens, it feels like some pharmacists are moving across to other new roles. A lot has been made of these roles, and the way they have taken people out of pharmacies has contributed to a shortage of pharmacists in the community.
Much has been written already about the strain this can cause on the provision of health to our patients. Practicing as I do in the far south-west of England, it does generally seem harder to book locums than it has been historically - and I know this is an issue elsewhere too.
For the business in Cornwall where I am a director, we use a number of regular locums. They have put their rates up, and some of the newer locums who come to us are more expensive. I accept that we have to pay locums the going rate and we value their professionalism and skill.
The issue for pharmacy owners is that the contract framework in England has not improved and right now it is fundamentally underfunded. My belief is that we should be looking at locum rates and the NHS-managed sector bandings and build these into contract negotiations to improve the funding quantum. If that increases by retaining dispensing and growing clinical services, then community pharmacy will be the place where people want to practice.
I am fortunate to work in various roles, but my favourite days are on the frontline in the community pharmacy as you never know what will come through the door.
Yes, there are lots of pressures on the pharmacy workforce and many different directions in which pharmacists can choose to practice. Maybe there genuinely has “never been a better time to be a pharmacist” although in England there have been few times when it has been harder to own a pharmacy.
The job is still stimulating, varied and enjoyable in my view. But it needs the funding it deserves.
Nick Kaye is a community pharmacist in Newquay and vice-chair of the National Pharmacy Association. These are his personal views.