Executive summary

There is evidence that the demand for pharmacy services depends on the size and composition of the population therefore the projected increase in the size and change in the composition of Scotland’s population is likely to increase the demand for pharmacy services.
There is evidence that the demand for pharmacy services depends on socioeconomic deprivation therefore the demand for pharmacy services is likely to vary within and between NHS boards according to variation in socioeconomic deprivation.
The demand for pharmacists depends on public sector policy objectives such as the demand for pharmacists to work in GP practices.

The ratio of applications to acceptances for four-year MPharm courses in Scotland seems to have been decreasing since 2012.
The number of first-year students on MPharm programmes in Scotland decreased from 290 in 2011-12 to 250 in 2015-16. This may be partly due to a decrease in overseas student intake by the University of Strathclyde.
The percentage of first-year Scottish-domiciled MPharm students at RGU increased each year between 2013-14 and 2015-16 and the percentage of first-year Scottish-domiciled MPharm students at Strathclyde decreased each year between 2013-14 and 2015-16.
The probability of completing the programme in Scotland was over 0.75 within four years and over 0.85 within six years.
The latest PRPS survey found that most students qualified from a school of pharmacy in Scotland and more than 80% planned to remain in Scotland;
112 pharmacists qualified from an independent prescribing course in 2016 compared to 58 in 2015; and
There were 43 pharmacy technicians in training in the managed sector in 2017.

The 2017 NHSScotland staff and vacancy survey (covering Acute, Central, Mental Health and Primary Care) showed a 3.36% increase in the number of WTE staff compared to 2016.
The number of WTE pharmacists was 1242.57 and the number of WTE pharmacist vacancies was 84.
Since the last Staff and Vacancy survey, WTE numbers increased for Pharmacists, Pharmacy Technicians and Support Staff. The vacancy rates for Pharmacy Technicians and Support Staff also increased slightly.
There was variation in the number of WTE staff per capita between NHS boards but the variation is similar between surveys.
The second Scottish Community Pharmacy Workforce Survey was undertaken in February 2018 and found that there are an estimated 1484.86 pharmacists working in the Community sector and 76.34 WTE pharmacist vacancies.
There were no pharmacy occupations on the latest shortage occupation list.
Between 2011 and 2017 median gross hourly pay for pharmacists in Scotland increased at about the same rate as the UK and since 2014 median gross hourly pay of pharmacy technicians and dispensing assistants in Scotland increased relative to the UK.

1 Introduction

In April 2009 Audit Scotland found that workforce planning for pharmacy staff was not well developed and recommended that the SG should work with NES, NHS NSS and NHS boards to develop national pharmacy workforce planning information to support NHS boards in taking forward workforce plans and workforce development. In response to this recommendation the SG set up a Pharmacy Action Plan Steering Group and created a Pharmacy Workforce Planning Project, which agreed that NES and NHS NSS would work together to analyse pharmacy workforce data to inform the Pharmacy Action Plan Steering Group. Following a review of pharmaceutical care in Scotland the SG published a vision and action plan, which recommended that

NES, working with key stakeholders such as the Schools of Pharmacy and the NHS boards, should be commissioned to undertake data collection and trend analysis to lead to better supply and demand forecasting, and capacity planning for the pharmacy workforce.

2 The demand for pharmacy services

Audit Scotland reported that the demand for pharmacy services was a function of the size and composition of the population and the level of socioeconomic deprivation. The following sections report the latest population projections for Scotland and the spatial distribution of socioeconomic deprivation in Scotland.

2.1 Population projections

Audit Scotland reported that the demand for pharmacy services was a function of the size and, because the number of medicines people are prescribed rises after age 50, the age distribution of the population. Therefore the expected future demand for pharmacy services depends on the population projections for Scotland.

Between 2017 and 2026 Scotland’s population is projected to increase by 2.82% and the number of people aged 50 and over is projected to increase by 8.13%.

2.2 The distribution of community pharmacies by SIMD

Audit Scotland reported that the demand for pharmacy services were a function of the level of socioeconomic deprivation. The following chart and map show this relationship in two ways by linking the the postcodes of community pharmacies published by PSD of NHS NSS to NHS NSS SIMD data. The chart reports the number of pharmacy practices in September 2017 by SIMD decile and the map shows the location of pharmacy practices by SIMD rank.

SIMD is a relative measure of deprivation that ranks each of the 6,976 Data Zones in Scotland from most deprived to least deprived.

There seems to be a positive relationship between the SIMD decile and the number of community pharmacies: there were more community pharmacies in SIMD decile 1, the most deprived decile, compared to SIMD decile 10, the least deprived decile.

The map shows the location of each practice in Scotland and the SIMD 2016 rank of each Data Zone.

2.3 Demand for pharmacists from NHS boards

The demand for pharmacists is also a function of policy objectives. The vision in Prescription for Excellence is that

All patients, regardless of their age and setting of care, receive high quality pharmaceutical care from clinical pharmacist independent prescribers. This will be delivered through collaborative partnerships with the patient, carer, GP and the other relevant health, social care, third and independent sector professionals so that every patient gets the best possible outcomes from their medicines, and avoiding waste and harm.

As part of the support for this vision, the SG allocated funding to NHS boards to employ pharmacists in GP practices:

£16.2m over three years, will be allocated to recruit up to 140 whole time equivalent additional pharmacists with advanced clinical skills training, or those undertaking the training. They will work directly with GP practices to support the care of patients with long term conditions and so free up GP time to spend with other patients. By year 3 all of these pharmacists should be independent prescribers with advanced clinical skills.

The additional 140 WTE pharmacists represents about half of the annual output from the two Schools of Pharmacy in Scotland.

As part of the committment to establish a sustainable pharmacotherapy service in every practice, the 2018 General Medical Services Contract in Scotland announced additional funding to increase the number of pre-registration training posts:

In order to increase the pool of qualified pharmacists to provide the pharmacotherapy service, additional funding has been secured to increase the number of pharmacist training posts from 170 to 200 per year from 2018/19.

Scottish Government’s Achieving Excellence in Pharmaceutical Care stated:

We will deliver the commitment to ensure every GP practice in Scotland has access to a pharmacist with advanced clinical skills.

2.4 Summary

There is evidence that the demand for pharmacy services depends on the size and composition of the population therefore the projected increase in the size and change in the composition of Scotland’s population is likely to increase the demand for pharmacy services.
There is evidence that the demand for pharmacy services depends on socioeconomic deprivation therefore the demand for pharmacy services is likely to vary within and between NHS boards according to variation in socioeconomic deprivation.
The demand for pharmacists depends on public sector policy objectives such as the demand for pharmacists to work in GP practices.

3 Training market information

3.1 Introduction

Registration as a Pharmacist with the GPhC involves completing a GPhC accredited MPharm course, completing a year of pre-registration training, completing the GPhC’s registration assessment, and meeting the fitness to practise requirements for registration.

3.2 MPharm courses in Scotland

Two universities in Scotland offer GPhC accredited MPharm programmes. There are 24 accredited providers in the rest of the UK and three others have provisional approval by the GPhC.

England has three approved providers of five-year programmes, which integrates the MPharm with the pre-registration training year.

Scottish and Non-UK EU students are funded by the public sector through the SFC. The total amount of funding allocated by the SFC to support teaching in Scotland depends on the number of full-time equivalent students and the subject price. The 2017-18 SFC outcome agreement reports that the gross subject price for pharmacy for academic year 2017-18 was £9,336.

Students from the rest of the UK pay tuition fees set by each university. In academic year 2017-18, MPharm tuition fees for students from the rest of the UK were £8,820 at RGU and £9,250 at Strathclyde.

Non-EU students are not funded by the public sector. Fees for overseas students in academic year 2017-18 were £14,360 at RGU and £18,000 at Strathclyde.

There are several demand side subsidies to support students studying at universities in Scotland but, unlike students on dentistry, nursing and midwifery or Allied Health Professional programmes, there is no additional financial support for pharmacy students.

3.2.1 Applications to MPharm programmes

UCAS collects data on applications for and acceptances into all university courses. These data comprise the number of applications through the main application scheme and number of accepted places via all application routes.

The ratio of applications to accepted places is an indicator of the demand for MPharm places relative to the supply of these places. Demand for places seems to have been decreasing at both Scottish providers since 2012.

3.2.2 MPharm students

HESA collects an annual record for each student in training from UK universities in September each academic year.

3.2.2.1 Four-year MPharm programme

Most students entered into year one of the programme but from 2014-15 all new students at Strathclyde entered year two of a five-year integrated Masters programme.

Intakes decreased from 290 in 2011-12 to 250 in 2015-16. One reason for this reduction may be reduced numbers of overseas students being accepted onto courses. Other things being equal this reduction in intakes will result in fewer graduates from Scotland from 2015 onwards.

3.2.2.2 Demographics

The mean age of students on entry to the four-year MPharm programme between 2005-06 and 2015-16 was 19.6 at RGU and 18.64 at Strathclyde.

Since 2009 fewer older students started an MPharm at RGU.

The sex distribution has been similar at both providers during the sample period with females accounting for about 67.78% of first-year students on the four-year programme.

The percentage of Scottish-domiciled students was higher at Strathclyde (91.53%) than at RGU (66.94%).

The percentage of students entering Strathclyde from non-EEA countries was less than 10% in each year of the sample period. However, in the last three years of the sample period 18% of first-year students at RGU were from non-EEA countries.

The SIMD combines a set of indicators across domains including income, employment, health, education, skills and training, housing, geographic access and crime and is available for students who were domiciled in Scotland on application. SIMD Q1 represents students from the most deprived 20% of areas. Between academic year 2005-06 and 2015-16 6.69% of students were from the most deprived 20% of areas, while 38.47% were from the least deprived 20%.

The probability of completing an MPharm course within four years was 0.79 at RGU and 0.84 at the University of Strathclyde. The probability of completing an MPharm course within six years was 0.92 and 0.89.

Unless the completion probabilities increase, the reductions in the intakes to the MPharm courses in recent years will result in reductions in MPharm graduates.

3.3 Pre-Registration Pharmacist Scheme exit survey

3.3.1 Introduction

To register and practise as a pharmacist in Great Britain, pharmacy graduates have to successfully complete a 12-month pre-registration training scheme and then pass a GPhC registration assessment. The PRPS was introduced in Scotland in 2006 and has three main components: a centralised recruitment process, a standardised training programme and quality management processes for premises and tutors. NES pays a training grant to the employers of the PRPS trainees, which covers trainees’ salaries at AFC band 5 and any additional employment costs. The pharmacists who successfully complete the PRPS in Scotland are therefore one source of inflow into the pharmacy workforce in Scotland.

Each year NES asks the PRPS trainees to complete an exit survey about their career plans when they are about to finish their training.

3.3.2 Results

There were 159 respondents out of a possible 200 to the latest PRPS survey, a response rate of 79.5%. Only 5 respondents qualified from a school of pharmacy outside Scotland; 143 respondents described themselves as UK nationals; 115 respondents were placed in the community sector; and 5 were modular programme.

Most respondents, 81%, planned to remain in Scotland only.

In the latest survey 62% of respondents planned to remain in the same sector after completing PRPS compared with 53% in 2015-16. About 25% planned to work as a locum following PRPS compared with 25% in 2015-16.

Of the 98 respondents who planned to remain in the same sector 57.14% planned to remain with their PRPS employer.

The most important factors relating to respondents’ decision to remain in the same sector were close and ongoing patient contact, job security, a greater support network and a desire to work for a particular employer.

3.4 Post-registration training

3.4.1 Independent prescribing training

Pharmacists can register as an IP after completing a GPhC accredited course at either University of Strathclyde or Robert Gordon University. The courses typically take between six and 12 months to complete including academic and experiential components and requires medical supervision and sign off. The fee for the course is £1,300. NES offers funding for between 160 to 200 places per year, with two courses at each School of Pharmacy per year. Pharmacists completing either the PGDip course at RGU or MSc course at Strathclyde may also complete the IP module as a part of these courses. The chart shows the number of funded and qualifying IPs together with the cumulative number of trained and in training patient facing IPs in each year.

NES’s Pharmacy Prescribing Report for 2017 describes the activity of pharmacist prescribers across NHS Scotland and in individual territorial Health Boards compared to the same period in 2016 and is available from NES on request.

3.5 Pharmacy technician training

Registration as a pharmacy technician in Great Britain involves completing knowledge, NC in Pharmacy Services, and competency-based, SVQ Pharmacy Services Level 3, qualifications accredited by awarding bodies such as the SQA, City & Guilds and Pearson/Edexcel.
SQA shared data with NES on NC and SVQ certifications up to 31st March 2017.

Since 2014 the name of the course provider has been withheld. Currently the NC is delivered by Edinburgh College (formerly Edinburgh’s Telford College), West College Scotland (formerly James Watt College) and Glasgow Kelvin College (formerly Stow College) whilst the SVQ Pharmacy Services Level 3 is delivered by Edinburgh College and NHS Highland SVQ Assessment Centre.

More candidates are registered to undertake the NC than the SVQ Pharmacy Services Level 3 because it provides access to further training in nursing or one of the allied healthcare professions.
Trainee pre-registration pharmacy technicians employed in the managed sector undertake the NC on a two-year day-release basis.
The majority of those undertaking the SVQ Pharmacy Services Level 3 are also from the managed sector with a small number from community, as the majority of contractors use the distance learning format delivered by alternative training providers such NPA or Buttercups.

Demographics

NC students were older than SVQ students.

3.5.1 Pharmacy technician training in the managed sector

Pharmacy technician trainees in the managed sector are recorded in the NHS Scotland Staff and Vacancy Survey. The number of first-year pharmacy technician trainees in the managed sector increased each year between the 2014 and 2017 surveys. The number of trainees by NHS board is reported in the appendix.

3.6 Summary

The ratio of applications to acceptances for four-year MPharm courses in Scotland seems to have been decreasing since 2012.
the number of first-year students on MPharm programmes in Scotland decreased from 290 in 2011-12 to 250 in 2015-16. This may be partly due to a decrease in overseas student intake by the University of Strathclyde.
the percentage of first-year Scottish-domiciled MPharm students at RGU increased each year between 2013-14 and 2015-16 and the percentage of first-year Scottish-domiciled MPharm students at Strathclyde decreased each year between 2013-14 and 2015-16;
the probability of completing the programme in Scotland was over 0.75 within four years and over 0.85 within six years;
the latest PRPS survey found that most students qualified from a school of pharmacy in Scotland and more than 80% planned to remain in Scotland;
112 pharmacists qualified from an independent prescribing course in 2016 compared to 58 in 2015; and
there were 43 pharmacy technicians in training in the managed sector in 2017.

4 Labour market information

This chapter reports information on the labour market for pharmacy staff and includes information from the NHSScotland staff and vacancy survey, the 2018 Community Pharmacy Workforce Survey, and the average earnings of pharmacy staff in Scotland and the UK.

4.1 NHSScotland staff and vacancy survey

Each year a data collection template is sent to the Director of Pharmacy in every NHS board to record WTE establishment, staff in post and vacancies in each AfC band on September 30th. These data are submitted to NHS NSS to report in its National Statistics publication. After publication, NHS NSS send these data to NES to include in this report.

4.1.1 Staff in post

The following section presents WTE staff in post on September 30th 2017 for Pharmacists, Pharmacy Technicians and Support Staff (Pharmacy Assistants, Administration & Clerical, and Other). Results are presented by region, NHS Board and sector. Full results by NHS Board, Sector and AfC band, are included in the Appendix.

There were 46 Band 5 Trainee Pharmacists in post in 2017. Trainee Pharmacists are not included in the numbers of Pharmacists reported here.

The total number of WTE staff in post on September 30th 2017 was 2612.3, a 3.63% increase on the 2016 survey.

The WTE numbers by staff group were 1242.57 Pharmacists (a 5.28% increase on 2016), 746.89 Pharmacy Technicians (a 0.57% increase), and 622.84 Support Staff (a 4.16% increase). Each Regional grouping is a subset of all NHS Scotland Boards:

North Region consists of NHS Shetland, NHS Orkney, NHS Western Isles, NHS Highland, NHS Grampian, and NHS Tayside
East Region consists of NHS Lothian, NHS Fife, and NHS Borders
West Region consists of NHS GG&C, NHS Forth Valley, NHS Dumfries & Galloway, NHS Ayrshire & Arran, and NHS Lanarkshire

The composition of staff in post by group and AfC remained broadly similar between 2016 and 2017. The number of WTE Pharmacists continues to increase, mainly driven by increases in AfC bands 7 and 8A which reflects the increase in demand for pharmacists in GP practices.

The slight increases in WTE Pharmacy Technicians in 2016 and 2017 appear to have been driven by increases at AfC Band 5, which reflects the increase in demand for Pharmacy Technicians in GP practices. The Support staff increases since 2015 reflect increases in WTE Pharmacy Assistants and roles coded as Other in the survey data, while numbers of WTE Administration & Clerical roles have been decreasing since 2014.

A comparison of WTE staff numbers across survey years indicates increases in Pharmacist and Pharmacy Technician WTE in Primary Care since 2013. This increase does not appear to be at the expense of other sectors within the Managed Service and may be due to movement of staff from the Community Pharmacy sector.

4.1.2 Vacancies

The vacancy rate provides an indication of an employer’s demand for labour.

The vacancy rates in Scotland on 30 September 2017 were 6.32% for Pharmacists, 6.30% for Pharmacy Technicians and 5.79% for Support Staff. This was a slight increase on 2016 for Pharmacy Technicians. The vacancy rate for Support Staff increased by almost 1%.

The following tables present vacancy rates for the three staff groupings of Pharmacists, Pharmacy Technicians and Support Staff (Pharmacy Assistants, Administration & Clerical, and Other). Results are presented by region, NHS Board and sector. Full results by NHS Board, sector and AfC band, are included in the Appendix.

There is considerable variation in the vacancy rate between NHS boards.

The vacancy rate for Pharmacists is highest in the Primary Care sector.

There was variation in the number of WTE staff per capita between NHS boards but the variation is similar between surveys.

4.2 Community pharmacy

In 2018 a second Community Pharmacy Survey was undertaken by NHS Education for Scotland (NES) in conjunction with Community Pharmacy Scotland (CPS). Independent community pharmacies and pharmacies in the Company Chemists’ Association (CCA) were asked to supply information on staff and vacancies for the week of Monday 19th to Sunday 25th February 2018.

Eleven out of fourteen Boards achieved a 100% response rate. The overall response rate was 98%.

The estimated Community Pharmacy workforce (including Central staff) comprised the following: 1484.86 WTE Pharmacists, 959.24 WTE Pharmacy Technicians and 2797.78 WTE Support Staff. These figures do not include staff in training - numbers reflect trained staff only.

Data from non-CCA pharmacies was subject to weighting in the 2016 survey due to lower response rates, and so results from the two surveys are not strictly comparable. Data for Central Staff was also not collected in 2016. Bearing this in mind, there was an estimated reduction in WTE numbers between 2016 and 2018 for Pharmacists (-131), Pharmacy Technicians (-346), and Support Staff (-630).

The estimated number of WTE vacancies and the vacancy rates for these roles in Scotland, including Central Staff, is 76.3 (4.9%) for Pharmacists, 25.1 (2.5%) for Pharmacy Technicians, and 66 (2.3%) for Support Staff.

It should be noted that pharmacist vacancies do not result in the closure of community pharmacies. Pharmacist cover would be provided by pharmacist locums.

More detailed results from the 2018 survey are available from NES on request.

4.3 Shortage Occupations

An occupation that appears on the Shortage Occupation List indicates that there is a shortage of skilled workers in the UK. There were no pharmacy occupations on the latest shortage occupation list.

4.4 Earnings

The earnings of 1% of UK employees is published as part of the ASHE by SOC 2010 code. Therefore these data include employees in both the hospital and community sectors. Between 2011 and 2016 real median gross hourly pay for pharmacists in Scotland decreased at about the same rate as the UK. Since 2014 real median gross hourly pay of pharmacy technicians and dispensing assistants in Scotland increased relative to the UK.

4.5 Summary

The 2017 NHSScotland staff and vacancy survey (covering Acute, Central, Mental Health and Primary Care) showed a 3.36% increase in the number of WTE staff compared to 2016.
The number of WTE pharmacists was 1242.57 and the number of WTE pharmacist vacancies was 84.
Since the last Staff and Vacancy survey, WTE numbers increased for Pharmacists, Pharmacy Technicians and Support Staff. The vacancy rates for Pharmacy Technicians and Support Staff also increased slightly.
There was variation in the number of WTE staff per capita between NHS boards but the variation is similar between surveys.
The second Scottish Community Pharmacy Workforce Survey was undertaken in February 2018 and found that there are an estimated 1484.86 pharmacists working in the Community sector and 76.34 WTE pharmacist vacancies.
There were no pharmacy occupations on the latest shortage occupation list.
Between 2011 and 2017 median gross hourly pay for pharmacists in Scotland increased at about the same rate as the UK and since 2014 median gross hourly pay of pharmacy technicians and dispensing assistants in Scotland increased relative to the UK.

Pharmacy workforce Report 2017

NHS Education for Scotland