A shortage of pharmacists and pharmacy technicians working in Scotland’s GP-based pharmacotherapy service needs to be urgently addressed, the Royal Pharmaceutical Society (RPS) director for Scotland has told The Pharmacist.
Laura Wilson also highlighted the need for long-term workforce planning for pharmacy staff, akin to current work being done by the Scottish Government around planning for the medical and nursing workforce.
The pharmacotherapy service was established in 2018 alongside a commitment for every GP practice to be able to access an NHS pharmacy service.
When it was implemented, ‘we saw a large movement of pharmacists that were previously working in the community going to work in a GP practices and deliver the service’, Ms Wilson said.
While she said that the movement of the workforce has now become ‘more stable’, she highlighted issues with the number of pharmacy professionals available to provide all three levels of the service to general practice.
‘The idea behind the service was that there is a pharmacy team, and that different people will provide different services,’ explained Ms Wilson, who noted that this went from level one, which provides basic medicines reconciliation, all the way up to level three, which utilises prescribing skills to provide medicines reviews, clinics and other services.
‘But one of the issues with it is around the skill mix that is available to actually provide the services,’ Ms Wilson added.
Not having enough pharmacy technicians working in the service ‘means that the pharmacists are then stuck doing level one’, noted Ms Wilson. This was instead of being able to progress up to level three, ‘which is what most pharmacists want to be able to do’, with many having moved to the service to develop their clinical skills, Ms Wilson told The Pharmacist.
A shortage of pharmacists also means that some practices only have access to the lower levels of the service, she said.
Since the RPS and the British Medical Association (BMA) in Scotland raised concerns about the service in January, some progress has been made, Ms Wilson said.
‘The majority of practices now do have some access to the pharmacotherapy service, which is great,’ she said.
But she added that work still needed to be done to enable better use of skills mix, and to identify different ways of running the service effectively for different practices, such as utilising hubs.
In particular, she said that reinstating the funding to train pharmacy technicians would help.
The RPS said that it understood that the National Pre-registration Trainee Pharmacy Technician was announced in 2022 and not renewed in 2023, with Health Boards now having to fund any training themselves.
‘The funding being pulled is definitely one of the major drawbacks to actually identifying and training people,’ she said, adding that there was no incentive for pharmacy employers to invest in training pharmacy technicians who would then go to work for the pharmacotherapy service,' said Ms Wilson.
'It would be good to see the fund reinstated to ensure future needs are met, access to appropriate skill mix, and succession planning is in place,' she added.
And she called for the Scottish Government to conduct workforce planning for pharmacy professionals as they are currently doing for doctors and nurses.
‘It’s got to be planned for. You can't just turn [the service] on overnight and expect there to be enough people to provide it,’ she said.
And she urged the Scottish Government to consider workforce planning to ensure that the pharmacotherapy service would be able to provide a greater range of services to patients and support practices in more ways in the future.
‘We need them to be able to look at the workforce that we have now, project what that's going to be in the future and what the need is going to be if we progress the pharmacotherapy service,’ she said.
She added that if the service was expanded, there may be a change in the requirements for each role, which would require a workforce plan ‘that will enable that to be met in the future’.
‘Once we have the implementation, and pharmacists are offering level three of the pharmacotherapy service, I think they will find that they’re on a daily basis able to use the qualifications that they've received, or they've gained after leaving university,’ Ms Wilson said.
She added that pharmacists would be able to use their prescribing qualifications and will become ‘an integral part of the GP team, providing that expert advice on medicines, and being able to interact on a daily basis with patients and helping them with issues around their medicines, which I think will be invaluable’.
And Ms Wilson described the change in pharmacy training that will see all pharmacists qualifying as independent prescribers at the point of registration from 2026 as ‘a game changer for patient care’.
‘It will be a really big benefit to the healthcare system that we have in this cohort of prescribers [that are] ready to go,’ Ms Wilson added.
A Scottish government spokesperson said that since 2018 it had 'significantly increased the pharmacy workforce within GP practices providing the pharmacotherapy service'.
'As at March 2023, there were 658 WTE pharmacists and 429 WTE pharmacy technicians in post supported by a number of pharmacy support staff.'
And they added that the the Chief Pharmaceutical Officer (CPO) has established a pharmacy workforce forum 'to look at the workforce challenges to set a strategic pharmacy workforce plan'.
'We are also building the pipeline of pharmacists with approximately 240 students graduating each year from the two Schools of Pharmacy in Scotland', they added.
National funding for NHS pre-registration pharmacists places was increased from 170 to 200 places in 2018, and then to 224 in 2023/24.
By 2024/25, the Scottish government expects to have funded a total of 120 additional pharmacist trainees in Scotland over the years.
And the national Pharmacy Technician Technical Apprenticeship scheme, launched in March 2022 with NHS Education for Scotland (NES) and Skills Development Scotland, increased the number of pharmacy technicians by 106 working across healthcare settings.
What do the different levels of the pharmacotherapy service involve?
Level one (core) services delivered by pharmacists
- Authorising/actioning all acute prescribing requests
(Pharmacist Independent Prescribers can action (instigate and sign) prescriptions, non-prescriber pharmacists can action prescriptions but they still require to be signed by a prescriber.)
- Authorising/actioning hospital Immediate Discharge Letters
- Medicines reconciliation
- Medicine safety reviews/recalls
- Monitoring high risk medicines
- Non-clinical medication review
Acute and repeat prescribing requests includes/ authorising/actioning:
- hospital outpatient requests non-medicine prescriptions
- instalment requests
- serial prescriptions
- pharmaceutical queries
- medicine shortages
- review of use of ‘specials’ and ‘off-licence’ requests
Level one (core) services delivered by pharmacy technicians
- Monitoring clinics
- Medication compliance reviews (patient’s own home)
- Medication management advice and reviews (care homes)
- Formulary adherence
- Prescribing indicators and audits
Level two (additional - advanced) services delivered by pharmacists
- Medication review (more than 5 medicines)
- Resolving high risk medicine problems
Level two (additional - advanced) services delivered by pharmacy technicians
- Non-clinical medication review
- Medicines shortages
- Pharmaceutical queries
Level three (additional - specialist) services delivered by pharmacists
- Polypharmacy reviews: pharmacy contribution to complex care
- Specialist clinics (e.g. chronic pain, heart failure)
Level three (additional - specialist) services delivered by pharmacy technicians
- Medicines reconciliation
- Telephone triage