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Terry Maguire reflects on the scant reasons to be cheerful arising from the statistics in the recently-published pharmacy workforce review 2019

Never aspiring to be a riveting read, the Pharmacy Workforce Review 2019 nonetheless identifies some startling and disconcerting facts about those of us who work in the community pharmacy sector in N Ireland. We are not, it has been found, a very happy bunch and we seem to loath our jobs with a spiteful intensity. Boy, we really do need to cheer up!

The Review, commissioned by the Department of Health and published on 9 November 2020, looked at the workforce needs of the profession over the next 10 years. In spite of a 30 per cent increase in pharmacists since 2009, there is a predicted short-fall of some 500-to-800 by 2024, unless steps are taken to attract more into the profession and to retain those currently in post.

I was surprised to find that nearly 70 per cent of pharmacists on the N Ireland register are female and that at age 50, where 90 per cent of male pharmacists are in full-time employment, only 40 per cent of female pharmacists are. I know this puts me at risk of being identified as a sexist swine, but this is a pattern seen in medicine and in that profession, steps have been taken to properly and politically address it.

When asked if they were to start their careers over again, would they choose pharmacy, only 23 per cent said they would

The Review avoids this issue. Clearly, the expanding role of the pharmacist is in itself a good thing: Our skills are in demand, we have seen an expansion in the number of pharmacist posts in hospitals and in general practice working alongside GPs, and this expansion has been largely at the cost of the community pharmacy workforce. This has been further agitated by immigration to exotic locations such as Co Cavan and even further South, with nearly 70 moving their skills to the Republic since 2016.

Pharmacists working in community practice have a long list of gripes, which presents clear evidence of a highly-stressed workforce. Three-quarters feel they have no control of their workload and 78 per cent feel overwhelmed by patients’ expectations. Many feel they cannot get involved in new roles, as the capacity to do so just doesn’t exist and as a result, they feel that their skills are under-utilised.

Eighty per cent feel that their work is not appreciated by the DoH and the Health Board and an equal number are under constant stress to the point that they might make a mistake and as a consequence, be sanctioned. Many identify the lack of opportunity for advancement in their careers as damaging to morale and they feel a strong sense of professional isolation.

When asked if they were to start their careers over again, would they choose pharmacy, only 23 per cent said they would. I’m not sure how this would compare to other professions and whether it is age-dependent, but it seems to be a feature of younger pharmacists, which is not good. I have a friend in TV production who has recently employed a pharmacist in his company and I know three others who have left to do accountancy or medicine.

A year ago, the Head of the School of Pharmacy at Queen’s pleaded with me to tell my colleague to stop moaning and complaining about community pharmacy, as this despair was affecting the numbers of local applications to study pharmacy. When her staff visited school careers events to promote pharmacy, they were getting feedback from parents and pupils that pharmacy seemed a poor career choice.

In 2011 at Queen’s, there were 191 first-year intakes compared to 129 in 2019 and the School was having to attract foreign students to make up the places; students who would return home when their studies were complete, so of no benefit to our workforce. In 2011, significant cutbacks to community pharmacy funding was the main trigger to shattering morale, and I accept that I was complaining as much as the next. I had not appreciated that my grumpy comments would translate through to fewer joining the profession and more choosing to leave. It was a perfect storm that is now causing some pharmacies to reduce their opening hours because of a lack of pharmacists.

This workforce review is important, as it helps identify what needs to be done with the current workforce to make it fit for purpose and fit for the future. Better deployment of pharmacy technicians and more use of automation will allow pharmacists to focus on a clinical future. Or will it? There are plans to integrate the pre-registration year with the four-year pharmacy degree, producing a more clinical and multi-professional training experience across all domains of practice. This is already happening in Wales and Scotland and in parts of England, and is likely to be a reality in N Ireland in July 2021.

This is part of a bigger transformation of the profession and it of course cannot happen in isolation. It is very likely that pharmacy supervision will be considered and likely that there will be a significant relaxation in supervision regulations. There are real risks here. When a pharmacy does not need a pharmacist, there will be a reduction in the cost of delivering the service and less funding for the sector.

We are perhaps getting a glimpse of what the government has in store for UK community pharmacy in the future. Professional pharmacy services, such as medicine optimisation, will be delivered in multi-professional teams within the current GP practice structure. The role of community pharmacies will move to larger supply units, where medicines will be churned-out in personalised patient packs by largely automated systems overseen by pharmacy technicians.

Crikey! In this Review, I have glimpsed a possible future for my profession which has only served to increase my stress, rather than relive it, so I’m not so sure how I can cheer up.

Terry Maguire
Terry Maguire

Terry Maguire owns two pharmacies in Belfast. He is an honorary senior lecturer at the School of Pharmacy, Queen’s University of Belfast. His research interests include the contribution of community pharmacy to improving public health