Community pharmacies are most likely to fund split-sector roles in Covid vaccination clinics, general practice and primary care networks (PCNs), a recently published workforce survey has suggested.
For the first time, the NHS England (NHSE) Community Pharmacy Workforce Survey 2022 asked pharmacy owners whether they had any staff who were employed by the pharmacy but were commissioned to provide services elsewhere. The data does not include pharmacists or other staff who also have a separate job in another setting.
Pharmacy owners in most areas of England who responded to this question said that they funded some staff to work in PCNs or general practice.
In some areas of England, respondents said that they funded as many as two-thirds of their staff to work in general practice or PCNs, while in other areas of England this was a much lower proportion.
By far the largest split-sector role was pharmacy staff being funded to work in Covid-19 vaccination clinics. In some areas, 100% of the staff employed by survey respondents were funded to do so.
Some staff employed by survey respondents were funded to work in care homes or hospital pharmacy outpatient settings.
In some areas of England, a few pharmacy team members were funded to work within health and justice settings, although this was much more uncommon, with contractors in just seven integrated care systems (ICSs) in England reporting that they did so.
And pharmacy owners in just five ICSs said that they funded a few staff to work in hospices.
While the survey as a whole was completed by over 95% of community pharmacy, with 87% of the data being usable, there was variation in how many answered this question about multi-sector working, so these results may not be indicative of the country as a whole.
Ashley Cohen, owner of Pharm-Assist (Healthcare) Ltd, an independent group of pharmacies in Yorkshire, told The Pharmacist that he has been funding staff to work in multiple settings for over a decade.
‘I saw it as the direction of travel,’ he said. ‘If we didn’t do something to retain, excite and develop our staff, I was noticing [that] there was a natural lifecycle, [staff would] get to four or five years, get bored, and want to do something different,’ he explained.
Now, around a quarter of Mr Cohen’s staff are funded to work for up to three days a week in multiple settings, with three pharmacists, two trainee pharmacists, one accuracy checking pharmacy technician and five pharmacy technicians or trainee pharmacy technicians currently in split-sector roles.
They are employed by the Pharm-Assist (Healthcare) Ltd community pharmacy business, which holds contracts to provide pharmacy services to other settings, such as a prison pharmacy, hospices, hospital discharge units and general practice.
While these roles often do not require additional clinical training beyond what is needed in a community pharmacy setting, Mr Cohen said that they suit confident workers who are good at communicating and working in multi-disciplinary teams.
Pharm-Assist (Healthcare) Ltd team members provide services such as medicines supply and checking, patient medication reviews, discharge planning, stock control, auditing and putting processes in place ahead of Care Quality Commission (CQC) inspections.
‘Traditionally, pharmacists have been very good at just supplying medicines to care homes. Well, any distance selling pharmacy can supply medicines to care homes, but what we can do is we can train the staff, we can audit, we can write their medicines management policies [and] procedures, we can do mock inspections. And historically, community pharmacy has done those for nothing, for free,’ he said.
‘Well, we can charge for these services now and they are very well received.’
Mr Cohen said that the contracts he holds with other organisations help generate income for his pharmacy business, so that it is not solely reliant on the NHS community pharmacy contract, which also allows him to develop and retain his staff.
‘I'm mindful that if I want to pay my staff better, if I want to give them the pay increases that they deserve, and I'd like to pay, then I can't rely on the NHS national [community pharmacy] contract,’ he said.
‘It stops them from looking elsewhere,’ he said, adding that the additional income ‘narrows the gap’ between what he is able to pay compared to NHS and PCN roles.
‘Technicians or pharmacists will be less likely to want to leave because they've been well paid, well remunerated and well challenged,’ Mr Cohen said.
He told The Pharmacist that he is able to bill other organisations at a competitive market rate – sometimes providing pharmacy services more cheaply than they were able to do internally – while still making a margin that allows him to pay his staff more, bring revenue to his pharmacy business and build in extra capacity in his team to provide cover for holidays, sickness and additional needs.
And he said that the other settings can be flexible about releasing contracted staff back to the community pharmacy at busy times.
Mr Cohen said that he wanted to refute the idea that community pharmacy is ‘a broken system’.
‘It's broken if you're just relying on the government to pay you. You've got to diversify, and some pharmacies [are] doing it with travel clinics, others do it with other PGDs,’ he said.
Pharm-Assist (Healthcare) Ltd also runs four Covid-19 vaccination sites and services 50 care homes.
Mr Cohen said that he wanted trainee pharmacists to see that within community pharmacy ‘they can spend time at a GP practice, hospice, hospital wards, a prison and understand that actually, community pharmacy, if you want it to, can provide the right opportunities.’
And he suggested that split-sector roles between community pharmacy and general practice could be particularly beneficial.
‘Certainly now, with independent prescribing, medicines shortages, out of stocks, it would be great if you had somebody linked in to community pharmacy – [that] would be fantastic,’ he said.
He added that some practice-based pharmacists moving from community pharmacy had felt isolated in their new roles and found that they were not able to do as much clinical work as they had hoped.
‘Maybe that might be a lesson learned, that maybe future cohorts could have that link and hybrid working within community [and general practice]. And then you could use your [independent prescribing] IP training, more clinical skills diagnostic skills in a GP setting for long-term conditions, but you could actually be a fabulous pharmacist at both sectors.
‘So maybe that might be the future. But it needs a bit more strategic thinking from my point of view.’
Graham Stretch, president of the Primary Care Pharmacy Association (PCPA), told The Pharmacist that ‘all integrated working is to be welcomed’, as ‘it helps break down silo working and strengthens organisational links improving patient care’.
‘Joint posts are a potentially valuable way of retaining our staff and increasing the professional satisfaction they are able to enjoy in their careers,’ he added.
NHSE said that the data collected in the 2022 community pharmacy workforce survey was informing its ongoing review of the Additional Roles Reimbursement Scheme (ARRS), as well as proposals for supporting the development of multidisciplinary teams (MDTs) in primary care from 2024/25 onwards.
Alan Ryan, national director of education at NHS England, said that the findings of the survey were ‘more important than ever’ following the publication of the NHS Long Term Workforce Plan.
‘Healthcare systems require high quality and transparent workforce data to plan and deliver safe care, improve patient outcomes, and inform staff training and development,’ he said.
And he added that making the annual survey compulsory for pharmacy owners to complete ‘recognises the priority the NHS places on the community pharmacy workforce, and the importance of collecting consistent, accurate data to support effective workforce planning across primary care’.
He said: ‘A wide range of work is being carried out by NHS England to develop the pharmacy professionals and the wider team members across all sectors of pharmacy.
‘These emerging annual data sets will not only inform that work but will also help employers and workforce leads in integrated care boards to build a picture of the whole pharmacy workforce in their locality.’
The survey was conducted in autumn 2022 but the results were not published until last week, with NHSE saying that it took longer than anticipated to work through due to the volume of data collected.
Malcolm Harrison, chief executive of the Company Chemists' Association (CCA) warned that the data could already be out of date.
'Since the autumn of 2022 the situation in community pharmacy has continued to develop. Future surveys will need to be processed and published more quickly if they are to be used to inform accurate decision making,' he said.