workforce

Tomorrows
world
Pharmacy of the future

new report on the future

of the pharmacy workforce
sounds oddly Orwellian
in parts. It discusses the
dystopian world of 2040,
where limited public finances produce the
haves and the have nots. It evokes a future
where there is a finite supply of medication,
leaving patients to choose whether they
use their allocation for therapeutic or
recreation purposes.

Read on, and the Centre for Workforce

Intelligences (CfWI) Scenario Generation
Report delves further into the new dawn,
where physical pharmacies are obsolete and
replaced by virtual pharmacies accessed via
smartphone apps and YouTube clips.
This is just one of a number of possible
scenarios for the profession. Elsewhere in the
report, which feeds into the CfWIs A Strategic
Review of the Future Pharmacist Workforce,
the tone shifts from dystopian to utopian. It
says: The entire pharmacy
team is elevated and its
contribution to national
LOOKING 30 YEARS health understood across
INTO THE FUTURE local, regional and national
IS NOT AN EASY government. This section
TASK, ESPECIALLY of the report also calls
WITH THE pharmacists of the future
CURRENT PACE OF advocates for medicines
across all care settings
TECHNOLOGICAL who are recognised as the
AND SOCIAL leaders for healthcare.
CHANGE
The scenarios are
receiving serious
consideration, as the
future of the profession comes under the
microscope. This is happening as part of a
review of pharmacy education, led by the
Higher Education Funding Council for England
(HEFCE) and Health Education England
(HEE), on the supply of graduates in England.
It comes after a steady rise in the number of
people choosing to study pharmacy.

November | December 2013 -

SHUTTERSTOCK

With far more

pharmacists than
jobs predicted in
the coming years,
a review into
pharmacys longterm future and
a consultation on
graduate numbers
are underway.
Rob Dabrowski
looks at the
issues arising.

21

workforce

Cover

STUDENTS
ENROLLED ON
PHARMACY
COURSES:

1998
2012

1,390
IN 2012 THERE WERE 37,900
PHARMACISTS IN ENGLAND.
CFWI PREDICTS A
SURPLUS OF UP TO

19,000
BY 2040

In 1998, 1,390 students enrolled on

pharmacy courses in England. Fourteen
years on, in 2012, the figure almost tripled and
stood at 3,100.
There are a number of options that are
now on the table and being consulted upon
by the HEFCE and HEE. The proposals
include: allowing the market to naturally
determine the number of pharmacy
graduates, a cap on the number of entrants
to MPharm courses as is the case with
dentistry and medicine and a break in study
allowing some students to graduate with a
Bachelor of Science degree.
Sir Alan Langlands, HEFCE Chief Executive,
believes we are at a pivotal moment for
pharmacy education and training. He says:
This consultation offers everyone with
an interest in this matter an opportunity
to give their views on the future direction
of travel. We do not have a firm view, but

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- November | December 2013

it will be especially important to consider

the impact of any decision on the wider
population, patients in the NHS and current
and prospective students who wish to pursue
professional careers in pharmacy.
The CfWI predicts a surplus of 19,000
pharmacists by 2040, if action isnt taken.
With the number of pharmacists registered
with the General Pharmaceutical Council
in England standing at 37,900 in 2012, the
potential scale of the problem is immense,
particularly for community pharmacists,
wh0 comprise almost three quarters of the
workforce (see graph).
The volume of people joining the
profession over recent years has already had
a tangible impact, with tougher competition
for jobs contributing to downward pressure
on wages, although this has been largely
driven by the current funding and economic
challenges for contractors. The most recent

3,100
salary survey by community pharmacy
recruitment specialist Hunter Human shows
that the average basic hourly rate paid to
pharmacists during 2011 was 21.55, down
from 21.65 in 2010. While its figures for
2013 have not yet been released, wages are
expected to have fallen further.
The marketplace has a lot more
pharmacists and some are struggling to get
positions, says Julie Bolam, NPA Head of
Professional Development. The average
pay for pharmacists has also dropped,
particularly in London, where there is more
supply than demand.
It isnt just having an effect on those
joining the profession, but also those who
have been in the workforce for years. Im
working the equivalent of two days a week,
says one locum from Carmarthenshire in
Wales. There are so many people locuming,
youve really got to fight for your place these

workforce

SCENARIOS. FUTURE OF
WORKFORCE IN 2040

1 2 3 4
SCENARIO

Pharmacists are utilised as a

public health service provider
Opportunities for care in
the community and at home
are increased
A flexible modern pharmacist
workforce, with a growing
need to support and serve
where required

SCENARIO

Not a single bricksand-mortar pharmacy

remains open
Total cost of healthcare
has in fact increased
Move towards locally
provided care begins to
reverse, as more and
more people are admitted
to hospital to manage
their conditions

SCENARIO

SCENARIO

General public regularly

consults pharmacists, seeking
expert advice in times of both
good and poor health
Healthcare provision is
variable between face-to-face
and remote service delivery
Patients health is
tracked from birth, and
telemedicine facilitates
self-diagnostic testing

Majority of physical
pharmacies closed
Only a few highly qualified
pharmacists are necessary in
order to meet patient needs
Emphasis on remote advice,
or in-depth face-to-face
consultations for individuals
willing to pay for the service
at boutique pharmacy
advisory companies

GRAPH. PROPORTION OF UK
PHARMACIST WORKFORCE
BY SECTOR

COMMUNITY
HOSPITAL
PRIMARY CARE
INDUSTRY
ACADEMIA
OTHER

213= 71%
63= 21%
21= 7%
12= 4%
12= 4%
9= 3%

days. It is far harder now than it was when I

joined the industry. Weve got more people
looking for work than we have work, and the
number is still going up I can see no sign of it
levelling out.
So why has this situation come about?
Mike Holden, Chief Executive of the NPA,
believes it is because pharmacy is viewed
as a traditionally safe bet for employment
after education. I think its a profession
that was perceived as providing graduates
with guaranteed jobs and reasonable
remuneration when other people were
coming out of university with qualifications,
but no jobs. And, of course, its a great job to
do, he says.
However, while the number of pharmacies
has increased over recent years, that hasnt
been commensurate with an increase in
roles, because of funding limitations. Also,
some universities have seen the course as an

income generator from foreign students.

But predicting the shape and nature of
the profession in the future in order to
decide on the policy for education today
isnt going to be easy. Graeme Codrington,
Workforce Forecasting Expert and Director
of TomorrowToday, a global future trends
consultancy, says that it will be problematic
due to the number of variables the CfWI has
had to take into account (see box overleaf).
Looking almost 30 years into the future is
no easy task, especially with the current pace
of technological and social change. We tend
to notice the technology changes more just
think back 30 years, and youre in a world where
the fax machine had just arrived in offices, there
wereno desktop computers, no mobile phones
and no internet almost no one could foresee
where we would be today, he says.
Less obvious, but maybe more important,
is social change.Thirty years from now,

November | December 2013 -

23

workforce

Cover

IF YOU WANT TO
CHANGE PEOPLES
HEARTS, YOUVE
GOT TO LOOK
THEM IN THE EYE

BOX. VARIABLES AFFECTING

THE FUTURE WORKFORCE
what will we consider to be right, good
and normal, and what will social values be
like? He continues: Demographics provide a
reasonable basis on which to make quite
detailed and significant predictions and, in
general, we can see demographic trends
many decades out.But, in the specifics of
technology, politics and social issues, looking
so far into the future can just be educated
guess work.
Due to this difficulty, the CfWI has
developed four possible options for the
future (see scenarios). It says: These cover
the broadest range of plausible and possible
futures for which the system needs to plan.
It is important to focus on this range of
possible future supply and demand, as it
provides a valuable and realistic insight into
the difference between supply and demand
which will allow effective planning for the
pharmacist workforce.
The most positive depicts pharmacists
providing more care in the community and
a flexible modern pharmacy workforce.
The most negative is a highly centralised
vision, where not a single bricks-and-mortar
pharmacy remains open and the move
towards locally provided care begins to
reverse, as more people are admitted to
hospital to manage their conditions.
The centralised scenario, in my opinion, is
completely the wrong way to go and wouldnt
be good for anyone, says Mike Holden. But
weve got to acknowledge its possibility in
order to make sure that it doesnt happen.
He continues: There are far too many
complex variants to accurately say what
pharmacy will be like in 2040, but certainly
I would like to see every pharmacist as
a prescriber and as the the manager of
the medicine pathway, with most of this
happening in the community, supported by

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- November | December 2013

technology and the pharmacy team.

One element that Mike sees playing
an increasing role is technology, but he is
adamant that this should not be at the cost
of pharmacists interacting with patients in
person. There is growth in technology and
areas such as medical goods distribution
online and weve got apps and widgets and
touch screens in pharmacies now and it is
more virtual and less face-to-face, he states.
Im not saying that there is no place for
that, but it should complement and not
replace interaction between the patient and
the healthcare professional. If you want to
change peoples hearts, youve got to look
them in the eye.
The NPA was involved in the early thinking
process for the report and is currently
formulating its response to the consultation
on pharmacy education, the results of which
are due to come into force for the 2015-16
academic year. It is seeking the views of NPA
Members to ensure that any plans rolled
out have the best possible outcomes for
members, the profession and the public.
There need to be some controls in place,
but I dont think they should be as tight as a
cap, says Mike. It is vital that there is a well
thought out plan in place, because if you
are going to take action, you need to know
exactly what you are aiming to achieve.
Weve got a choice, we can either sit back
and wait for things to happen to us, or we
can take action and affect what is going to
happen, he concludes.
So, if pharmacists prefer the utopian
vision of the future, where they are leaders
for healthcare and advocates for medicines
across all care settings, to the dystopian
scenario where not a single bricks-andmortar pharmacy remains, it is time to act
and influence tomorrows world today.

Technological: remote
technology, personalised
medicines
Economic: economic
climate affecting the
wider UK health economy;
the continued drive for
efficiency in the public and
private sectors
Environmental: the
wider impact of climate
change, potential
development of health
pandemics caused by new
or re-emerging diseases
Political: shifts towards
person-centred care,
the shift of care to
the community
Social: the ageing
population, public health
initiatives, increasing
service user expectations
Ethical: shared decisionmaking with patients

Have your say

A consultation has been launched

by the HEFCE and HEE about a
potential over-supply of graduates
from GPhC-regulated MPharm degree
courses. NPA Members are invited
to share their thoughts by emailing
independentsvoice@npa.co.uk. The web
consultation can be accessed by visiting
npa.co.uk/independentsvoice