Pharmacists across the UK are at risk of burnout as staffing shortages drive up locum rates, according to sources speaking to The Pharmacist.

Pharmacies and locum agencies have reported that a combination of workforce issues - which they say is in part driven by the recruitment of pharmacists into primary care networks (PCNs) – and high locum rates has meant teams have had to put in extra hours to stay on top of their workload.

‘We’ve never been busy like this before,’ said pharmacist and independent prescriber Fiona McElrea, owner of Whithorn Pharmacy in Dumfries and Galloway. ‘We’ve got a real problem here. We don’t take days off because, in my head, I couldn’t justify paying a locum £65 an hour when I could be at work.’

‘We are at risk of burnout. We’re coming in early, we’re going home late, and we’re quite often not getting our scheduled days off. I’m more exhausted than I’ve ever been before.’

Mark Burdon, pharmacist and owner of Whickham Pharmacy in Newcastle-upon-Tyne, agreed: ‘I’m doing many, many more hours in the pharmacy than I would normally do. We’ve had major staff shortages caused by Covid infections ripping through workplaces.’

This comes amid a debate as to whether high locum rates have triggered pharmacy closures. However, contractors have told The Pharmacist that any closures have been due to ‘genuine staffing issues’ rather than unwillingness to pay high locum rates.

Shortages across the board

Pharmacies and locum agencies have told The Pharmacist that they are struggling with shortages of both community and locum pharmacists.

One of the most common reasons cited was the recruitment of pharmacists into PCNs, which the Company Chemists’ Association (CCA) reported just last week to be exacerbating the community pharmacy workforce crisis.

Other reasons reported included Covid outbreaks; summer annual leave; higher salaries meaning people can work fewer days; pharmacists seeking more varied roles; patients displaced from busy general practices; and poor treatment and lack of support with increasing workloads.

Mr Burdon continued: ‘We’re in the perfect storm of more interest in community pharmacy taking on new roles, but there aren’t enough pharmacists to go around. It’s just been bad workforce planning. We need to train more pharmacists. It’s the worst I’ve known it my career.’

‘It’s not a bad thing that NHS England and the Department of Health and Social Care have realised that community pharmacy is the solution, but they’ve failed to back that up with the necessary money to cover it.’

Vacancy rates for community pharmacists have doubled in five years, figures from Health Education England found in January this year.

NHS Digital figures indicated that as many as 4,871 pharmacists were working in PCNs in England as of March this year, up by more than 500 since September 2021, indicating that pharmacists were the most recruited role by PCNs via the Additional Roles Reimbursement Scheme (ARRS).

Increasing rates and wage bills

Pharmacists say the shortage has driven up locum rates, which have been rising steadily in recent years, but have reportedly risen significantly in the past year and even in the last few weeks.

Contractors The Pharmacist spoke to suggested that that locum rates had generally increased to at least £30 per hour.

Mr Burdon said that affordability was ‘a major problem’ and that he had seen his wage bills increase ‘massively’ in the past three to four years.

‘The locum rates have gone up significantly. That’s typical – that’s supply and demand, and you just have to accept that it is what it is,’ he said.

Ms Elrea added that, in her experience, there were reliable locums ‘who will absolutely bend over backwards to help us out’. However, she also criticised tactics that she claimed some locums as employing on Facebook locum pages to increase rates.

‘We know that there are locums that work part time and sit and watch that Facebook page until they see people are absolutely desperate for locums, and then they’ll get in touch and put their prices sky high,’ she said.

‘And if the pharmacy doesn’t employ them on that day and the pharmacy is closed on that day because of a shortage of locums, the locums have been known to contact the Health Board,’ she claimed.

The National Pharmacy Association (NPA) has called on NHS England to provide an uplift in the pharmaceutical services global sum as cost pressures in community pharmacy increase.

NPA director of corporate affairs Gareth Jones explained the current workforce pressures in the sector, previously felt in rural areas, ‘now reverberates across towns and cities too’.

These issues have been brought on by a ‘range of factors’ including ‘chronic underfunding in England and ‘the migration of many community pharmacists into general practice roles’, he commented.

He continued: ‘Locum rates have risen dramatically and that is one of many cost-inflating elements that contractors are facing UK-wide. These challenges need to be addressed urgently to ensure consistently high-quality pharmacy services now and future improvements.’

The locum agency view

Shakeela Akhtar, chief executive of Manchester-based locum agency LocumBell, described a ‘bit of a battle’ going on between pharmacies and locums. She warned that this is likely to continue ‘until there’s more of a pipeline and more people come through’.

She said that pharmacies were able to pay higher rates during the pandemic while they were receiving extra funding from the NHS, for example towards Covid vaccinations - but as those funds have diminished, operators have decided it is not sustainable to keep paying those rates.

On the other hand, locums have felt the increased rates are fairer remuneration for the work they do, she added.

Mark Hertzberg, manager at Essex-based agency Capital Locums, felt the situation was slightly shorter term. Although he forecasted a ‘bit of a rocky road’ over the coming five weeks, he suggested it could settle come September once people return from their holidays.

‘As an agency we try to find a middle ground – we try to find a rate where the locum’s happy and feeling they’re getting paid what they’re due, but we’re also trying to find a rate where the pharmacy is happy to pay it and feel comfortable paying it,’ he added.

Closures ‘not widespread’

The Pharmacists’ Defence Association (PDA) claimed to have evidence that some operators – such as Tesco - had cancelled locum pharmacist shifts if they did not accept attempts to reduce pre-agreed rates but were blaming staff shortages when communicating this to the public.

It also wrote to pharmacy and healthcare leaders demanding action be taken over what it described as ‘unnecessary’ pharmacy closures by large multiples.

However, contractors told The Pharmacist they had observed pharmacy closures, but that this had been due to a genuine lack of pharmacists - for example, due to Covid infections - rather than an unwillingness to pay higher locum rates.

‘When they are having to close, it purely is because nobody has been available – it’s not an easy decision for pharmacies to take,’ said Ms Akhtar.

Mr Hertzberg agreed that he had also observed instances of pharmacies closing, but that he would not say it was ‘widespread’. He added: ‘I think most pharmacies would rather pay an extra few pounds an hour than shut’.

Ms McElrea said she viewed the requirement for a responsible pharmacist to be physically onsite for it to operate as ‘completely out of date’.

Instead, she suggested that trained technicians should be supported and allowed to do more, and their skills better utilised to address the workforce problems the sector is facing.

‘Most teams in pharmacies are so experienced and well-trained, they can allow that pharmacy to open; they can still deliver medicines safely without a pharmacist there,’ she argued.

‘This problem’s not going to go away, it’s just going to get worse, and if you look at the number of closures that are happening, there needs to be something put in place.’

Workforce plan for pharmacy

This comes after the health and social care select committee last week backed a joint statement from the CCA, National Pharmacy Association and Pharmaceutical Services Negotiating Committee (PSNC) National, which called for a workforce plan for pharmacy.

They said ‘pharmacies of all sizes are struggling and worried about the availability of pharmacists, and about rapidly inflating locum rates’.

Paul Day, director of the PDA, argued the joint statement ‘singles out locum rates’ as a ‘barrier to helping patients and supporting the wider NHS’, rather than any other costs such as wholesalers’ margins and community pharmacies’ desire for profits.

He said the PDA supported a fully funded workforce plan, but called it ‘disappointing’ that employers were claiming that there were insufficient pharmacists ‘while now simultaneously claiming that there are pharmacists available, but that they are too expensive’.

He called on employers to make ‘improvements to the environment in which pharmacists are expected to practice’ and show they will ‘provide fair award’.

Mr Day added: ‘Even if a fully funded workforce plan were secured, if they are to fill vacancies with employed pharmacists and any remaining gaps with locums, these employers will need to show they are a place that health professionals would choose to work.

‘The PDA do not think blaming locum rates is going to make it more likely that existing or newly qualified pharmacists will want to work for them, on either basis.’