The upcoming NHS workforce plan must think about how to best use and coordinate the existing pharmacist workforce across different systems, the chief executive of the Company Chemists’ Association (CCA) has said.

Speaking at the Westminster Health Forum on the future of general practice and primary care earlier today, Malcolm Harrison warned that changes in the primary care workforce, particularly the Additional Roles Reimbursement Scheme (ARRS), had caused ‘real problems in community pharmacy’.

After welcoming the recent plans for community pharmacists to deliver more services, including an increased number of blood pressure checks, oral contraception and a common conditions service in England, Mr Harrison warned attendees that ‘things aren't all rosy’ in pharmacy.

‘Whilst it's been great that primary care has been able to recruit pharmacists into PCNs [Primary Care Networks] to deliver certain services, there was never a surplus of pharmacists in the country,’ said Mr Harrison.

‘And so, those pharmacists have come from hospitals and they've come from community, which has caused significant shortages. And we know it has led to hundreds of closures of pharmacies across England.’

He said that the CCA was ‘very, very keenly’ looking forward to the promised and highly anticipated NHS workforce plan ‘to see what the plan is in terms of how do we coordinate the best use of the professionals we have across the systems’.

And he suggested that ‘rather than moving the professionals from place to place to deliver the care’, the plan could ‘think about where best the care can be delivered, and how to ensure that patients get the care in the most accessible way, in a way that suits the professionals as well’.

In a workforce report released last week, the CCA called for community pharmacists to be commissioned to provide ‘packages of care’ on behalf of GPs, ‘rather than taking pharmacists away from accessible high street settings’, as well as other measures such as an immediate and urgent funding review and holistic workforce planning.

The report suggested that the community pharmacist workforce had been ‘funnelled’ into primary care, compounding workload and cost pressures within the sector, but that the scale of this had been hidden within year-on-year increases within the pharmacist workforce overall.

More pharmacists – but not in community

The General Pharmaceutical Council register shows a growing number of registered pharmacists, with 11% more in March 2023 than March 2019 – equivalent to 1,593 pharmacists a year, and 1,306 of whom are based in England, according to CCA estimates.

But in roughly the same time period, between March 2019 and December 2022, the number of full time equivalent (FTE) direct patient care pharmacists (including advanced practice pharmacists) working in primary care in England increased by 6,387, (from around 900 to 7,287).

And over two-thirds of those were funded by ARRS, which allocates central NHS money to GP practices to recruit additional roles such as clinical pharmacists and practice nurses.

When part time and full-time roles are taken into account, the CCA estimates that the actual number of direct patient care pharmacists working in primary care in England has increased by 7,983 between March 2019 and December 2022 – equivalent to 2,129 pharmacists a year.

That’s more than the number of new pharmacists joining the register each year in England, and means that primary care recruitment also includes many pharmacists that previously worked in other sectors, such as community pharmacy.

In fact, the CCA estimates that the growth of the primary care workforce within the first five years of the ARRS scheme – between 2019 and 2024 – will be equivalent to eight years of workforce growth that pharmacy could otherwise have expected. The CCA suggested that primary care recruitment was expected to ‘steal’ eight years growth from the pharmacy sector as a whole by 2024.

The report also said that primary care recruitment of pharmacists had had a worse impact on the rest of the sector than the infamous ‘fallow year’ in 2000 when no new pharmacists joined the register following a change in the degree from three years to four.

It said that the pharmacy sector, outside of primary care, had experienced the equivalent of two fallow years between March 2019 and December 2022, which would reach three fallow years by 2024 if it continued at the current rate.

Workforce shortages but rising workload

In a statement accompanying the report, Mr Harrison said that although recruitment of pharmacists into general practice was ‘not the only factor contributing to the workforce crisis’, it was ‘undoubtedly fanning the flames’.

‘This downward spiral is creating untenable pressure on pharmacists and their teams,’ he added.

The CCA report said that in the context of ‘significant funding cuts’ and rising costs such as locum rates, ‘other costs, such as investment in infrastructure, in automation and in the wider pharmacy team (both numbers and training), have been cut significantly’.

‘Due to the reduction in numbers of support staff, pharmacists must now often undertake work which would previously have been safely completed by another member of the team (which adds to workforce pressures and is exacerbating the ongoing workforce crisis),’ added the report.

‘This limits their capacity to deliver other more clinical tasks, that both patients and the NHS desperately need.’

Coupled with this, demand for pharmacist services has increased ‘significantly’ since the current community pharmacy contractual framework (CPCF) was agreed, with 30 million more NHS prescriptions dispensed in 2021/22 than in 2018/19, and ‘evidence to suggest the pace of growth is accelerating’ by 3.25% year on year, the CCA said.

And six new national clinical services have been introduced by 2020, compared to five between 2005 and 2019 – also reflecting an ‘accelerated’ pace of change, the CCA added.

Meanwhile, a recent estimate by the Pharmaceutical Services Negotiating Committee (PSNC) suggested that in 2021/22, community pharmacies provided 19 informal consultations a day taking around 107 minutes – 43% more than in the summer of 2020.

In total, in 2021/22, there were around eight million ‘patient touchpoints’ – interactions between a patient and a pharmacy – compared to 5.7 million in 2017/18.

‘We are extremely concerned that the increased workload demand will exacerbate ongoing pressures on colleagues,’ the CCA said.

‘To protect the current service provision and release capacity to enable further provision of clinical services, significant investment in community pharmacy is crucial.’

Workforce pressures were exacerbated by rising locum rates, which both led to pharmacist shortages that increased pressure on remaining staff, as well as drawing more pharmacists into working as locums, often working fewer hours on higher salaries, the CCA noted.

Call for ‘urgent measures’

The CCA said that local systems should commission healthcare through community pharmacies, rather than recruiting the community pharmacist workforce to ARRS roles.

‘This would better utilise the extensive community pharmacy network across ICSs, build patient access to care and minimise disruption to the wider system,’ the CCA suggested.

This comes after former National Pharmacy Association (NPA) chair Andrew Lane called for ARRS funding to be redirected to clinical services in community pharmacy.

The CCA also asked for:

  • An ‘immediate’ and ‘urgent’ review of community pharmacy funding
  • Clinical services to be commissioned ‘at scale’ to give community pharmacy ‘the opportunity to earn against new services’
  • ‘Holistic workforce planning’ for all of primary care, and the implementation of a fully funded workforce plan ‘as a matter of urgency’
  • Opportunities for career development within the wider pharmacy team, such as allowing pharmacy technicians to work under a Patient Group Direction (PGD) and independent prescribing
  • Ensuring that community pharmacy staff have the opportunity to use clinical skills, or risk them leaving the sector
  • Changes to supervision that release clinical capacity ‘by reducing the current level of tasks in dispensing that specifically require a pharmacist’.

The association also called for the ‘immediate introduction’ of a funded Pharmacy First scheme, which has now been promised ‘by the end of 2023’ within NHS England’s primary care plans released this week.

NHS England has been approached for comment on its upcoming workforce plan.