Written evidence submitted by by Boots UK Limited (RTR0121)
Boots operates the largest chain of community pharmacies in the United Kingdom. It is synonymous with pharmacy in the public mind and is one of the country’s most trusted brands.
We operate around 2,300 pharmacies, almost all of which are in Great Britain and registered by the General Pharmaceutical Council (GPhC). This is about 17% of all registered pharmacies. We are the largest single employer of pharmacists outside the NHS. Boots employs around 6,600 registered pharmacists and around 2,000 registered pharmacy technicians, approximately 12% of the General Pharmaceutical Council’s register. In Northern Ireland we operate around 70 community pharmacies that are registered with the Pharmaceutical Society of Northern Ireland (PSNI) and we employ around 220 pharmacists who are registered in Northern Ireland.
We welcome the opportunity to respond to this important inquiry at a pivotal time for the health and social care sector and also being the one of the largest employers of pharmacists and pharmacy teams outside of the NHS.
Boots UK recognises the current workforce challenge within the community pharmacy sector and believes a robust national workforce plan that considers all sectors and the interdependences between these is required to begin to address both acute and longer-term workforce requirements.
It must also be acknowledged that working patterns have been changing over several years, which has been expedited by the COVID-19 pandemic, with greater numbers of the workforce now opting for part-time work in order to achieve a better work life balance. These changes may not be reflected on professional registers, however will need to be considered as part of any longer-term workforce plan.
The need for healthcare professionals to oversee COVID vaccination centres, coupled with GP surgery and Primary Care Network (PCN) recruitment has caused an acute shortage in community pharmacist and technician resources.
There is no true picture of the current workforce, or the future demand that will be necessary to meet the NHS Long Term Plan and therefore future planning is difficult for all employers (NHS Trusts, Community Care Services, PCNs, GP surgeries and Community Pharmacies).
It is therefore necessary to have a coordinated and joined up approach between all stakeholders, including but not limited to professional bodies, higher education institutes, DHSC and pharmacy employers from all sectors to address the current shortage and create a pipeline of trained pharmacy professionals to meet future need and care.
In the short term we believe there needs to be considered action to closely understand the impact of PCN recruitment of pharmacists and pharmacy technicians from the community pharmacy workforce and look to explore and utilise different employment and funding models. One such model could utilise Additional Roles Reimbursement (ARRS) funding to commission community pharmacy to deliver services locally and in an integrated way which would allow flexibility within the entire workforce.
In the long term as mentioned above, there is a need to understand the true current workforce picture across all pharmacy sectors, build a robust workforce plan considering future patient need, demand and the skills of the whole sector holistically, ensuring meaningful integration is achieved within primary enhanced by a workforce with real career development/ progression opportunities.
Please also see above. We believe there needs to be a rapid review of current plans to gather necessary data to understand the current workforce landscape along with interdependencies between different health care sectors and within sectors.
The community pharmacy sector has successfully recruited and employed a good number of trained pharmacists from overseas countries adding to the valued diversity of the profession. Although the overall number of pharmacists on the GPhC register has markedly increased over the last ten years the profession remains on the Home Office’s Shortage Occupation List which we currently support as means of facilitating recruitment needs. But it is worth noting that areas of the country that historically have greater recruitment needs are increasingly less desirable to the overseas population which adds further difficulty to an already tricky recruitment problem.
Brexit has negatively impacted the recruitment of pharmacists from EU. Traditional markets like New Zealand and Australia have also been impacted due to lower salaries now in UK and market forces.
Considering pharmacy training in the UK, as outlined previously, sector independencies ideally need to be taken in to account. The desire for increased numbers of medical students over the past number of years has had a direct impact on the pharmacy student population. Currently for some HEIs it is necessary to enrol a high number of overseas students on to pharmacy degree courses who do not necessarily stay in UK upon qualification. This means of student recruitment may inflate the student to pharmacist numbers as they remain on the GPhC register although they do not intend to practice in the UK upon qualification.
With regards to pharmacy technicians we acknowledge that this population are eligible to apply for a skilled worker visa, however it may be difficult for individuals to achieve the required points related to salary.
Pharmacy support staff, such as trained healthcare counter and dispensing assistants are not currently eligible to apply for a work visa under the current skilled worker route and therefore the sector is unable to recruit from the overseas population.
We are not aware there is an adequate system currently in place to determine the number of professionals required now or in five years’ time. We believe there needs to be a rapid review of current plans to gather necessary data to understand the current workforce landscape along with interdependencies between different health care sectors and within sectors. The review should look to include understanding the number of pharmacists and technicians, the number of hours worked, geographical location where they are practicing and in which sector(s).
With regards to community pharmacy we support a course with a greater focus on experiential learning, clinical practical experience and a move away from a pure science degree.
Education and training of the pharmacy workforce is fundamental to the future of the profession and the community pharmacy sector in order to support increasing patient demand for health care services and advice along with being able to harness the skills gained to relive pressure on other parts of the health care system.
It is recognised that future pharmacists will be trained to be prescribers as part of the initial education and training of pharmacists and this is welcomed, although consideration is also needed for pharmacists currently on the register too. There is a need to:
Please refer to our comments above regarding the interdependencies and numbers of professional training places for medical and pharmacy students.
Like all front-line healthcare professionals that have been available, face to face, with the public during the pandemic, the pharmacy workforce at the moment is exhausted.
This must be recognised, alongside the challenge of change and the need to address all of the fallout from the pandemic, the unprecedented demand and increased levels of hostility towards staff.
Reasons for leaving the profession ae complex and include, burnout, career options and workforce pressure.
Reasons for moving away from community pharmacy in to general practice (within the profession) – perceived greater job satisfaction, less pressure, better work life balance, the opportunity to advance one’s career and provide services by utilising knowledge and skills which are currently not an option or commissioned in the community sector. Community pharmacy also opens 7 days a week and requires a professional workforce to do so and so roles in general practice for example, which are Monday to Friday in the main are seen as more attractive.
Reasons for reducing hours – Better work life balance, seeking opportunities outside of the profession or greater variety of role and experience within the profession with a portfolio of roles outside of the current employer.
There needs to be an agreed and clear vision for the future of pharmacy professional practice in each sector that will encompass:
Recruitment and retention challenges are starting to feel country wide. Currently our largest number of vacancies are now in London which has never been the case previously.
Historic recruitment needs also remain which are consistently apparent away from main cities (i.e. The South West, Lake District, Lancashire, Humberside & East Anglia areas of England and the Islands and Highlands of Scotland etc). More innovative working conditions could be trialled here, for example, structured multi-disciplinary working and deconstructing some of the contractual and tax barriers to allow portfolio working as mentioned above.
Greater engagement at school age to showcase roles in health and social care to excite local populations to become the next local workforce.
We believe there needs to be a rapid review of current plans and gather necessary data to understand the current workforce landscape along with interdependencies between different health care sectors and within sectors. This will support the development of a workforce plan that delivers a robust pharmacy workforce, which is adequately funded and has a dependable future pipeline of pharmacists, pharmacy technicians and support staff.
This is an increasing challenge for community pharmacy as the sector is seen as ‘private’ and therefore does not attract financial support as other health care sectors with respect to funded CPD for example, where the responsibility sits with the employer and/or induvial.
Please also consider the flexible model described above with utilisation of the ARRS funding along with a recommendation to deconstruct some of the contractual and tax barriers to allow portfolio working as mentioned above.
The role of integrated care systems will be critical in ensuring that local health and care organisations attract and retain staff with the right mix of skills. It will be fundamental for each ICS to consider the impact of any workforce initiative holistically on multiple sectors rather than in silo. This will ensure no detriment to any individual sector is observed and the continuity of patient care remains consistently available to patients across whole systems.