The demand for pharmacy services
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.
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.
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.
The latest 2018-based population projections from the NRS show the projected size and composition of the population.
Between 2020 and 2030 the population of Scotland is projected to increase by 84,831.0 (1.55%). By contrast, between 2020 and 2030 the population of Scotland aged 50 and over is projected to increase by 5.02%.
Audit Scotland reported that the demand for pharmacy services was a function of the level of socioeconomic deprivation. The following chart and map show this relationship in two ways by linking the postcodes of community pharmacies published by PSD of NHS NSS to NHS NSS SIMD data. The chart reports the number of pharmacy contractors in May 2020 by SIMD 2020 decile.
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 were more community pharmacies in SIMD decile 1, the most deprived decile, compared to SIMD decile 10, the least deprived decile.
The shape and nature of pharmaceutical services is changing. Significant changes to practice are being driven through the evolution of pharmacotherapy services, automation of dispensaries and stores and digitisation of prescribing, development of large molecule medicine and personalised approaches to treatment choices, all of which will impact on the numbers and skills required by the pharmacy workforce in the future.
Following the introduction of the General Medical Services Contract, 2020 has seen a shift in pace around the introduction of Pharmacotherapy services resulting in significant numbers of experienced Pharmacy, Pharmacy Technician and Support staff being recruited from community and secondary care pharmacy teams. In addition, new pharmacy technician and pharmacy support worker roles within Pharmacotherapy services are now being explored.
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.
Since 2018, additional funding has also been made available over three years under the Scottish Government’s Primary Care Improvement fund, with HSCPs responsible for allocating a proportion of their funding to Pharmacy services.
As part of the commitment to establish a sustainable pharmacotherapy service in every practice, the 2018 General Medical Services (GMS) 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.
Scotland’s Integrated Health and Social Care Workforce Plan for Scotland contains a commitment to
create up to 120 more Pharmacists to work in primary care settings, increasing Pharmacy pre-registration training places by 40 each year over the next 3 years.
This 40 additional places per year is in addition to the 30 new places funded under the GMS contract.
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.
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.
Two universities in Scotland offer GPhC accredited MPharm programmes. There are 30 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 2020-21 SFC outcome agreement reports that the gross subject price for pharmacy for academic year 2019-20 was £9,734.
Students from the rest of the UK pay tuition fees set by each university. In academic year 2020-21, MPharm tuition fees for students from the rest of the UK were £9,000 at RGU and £9,250 at Strathclyde.
Non-EU students are not funded by the public sector. Fees for overseas students in academic year 2020-21 were £16,770 at RGU and £20,650 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.
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. We report the latest available data here which relate to courses starting in 2019.
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 has decreased overall at both Scottish providers since 2012.
HESA collects an annual record for each student in training from UK universities in September each academic year. We report the latest available data here which relate to academic year 2018-19.
Most students entered into year one of the programme but between 2014 and 2016 all new students at Strathclyde entered year two of a five-year integrated Masters programme. From academic year 2017 the University of Strathclyde enabled year 1 entry for some students under the Scottish Government’s Widening Access programme. These students follow the Biomedical Sciences curriculum in their first year.
First year intakes decreased from 300 in 2011-12 to 225 in 2018-19.
The mean age of students on entry to the four-year MPharm programme between 2005-06 and 2018-19 was 19.78 at RGU and 19.1 at Strathclyde.
The sex distribution has been similar at both providers during the sample period with females accounting for about 68.13% of first-year students on the four-year programme.
The percentage of Scottish-domiciled students was higher overall at Strathclyde (89.15%) than at RGU (65.79%).
The percentage of students entering Strathclyde from non-EEA countries was less than 10% in each year of the sample period. Between 2013 and 2016, RGU had admitted between 16% and 18% of first-year students from non-EEA countries; however, in 2017 the figure almost halved from the previous year and dropped slightly again in 2018.
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 2018-19 7.25% of students were from the most deprived 20% of areas, while 39% were from the least deprived 20%.
The probability of completing an MPharm course within four years was 0.78 at RGU and 0.85 at the University of Strathclyde. The probability of completing an MPharm course within six years was 0.91 at both Universities.
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.
NES receive funding from Scottish Government for a set number of PRPS posts each training year. Numbers of funded posts have been increased since 2018 in response to the increase in demand for Pharmacists working in Primary Care. A further increase has been agreed from 2020 to 235 funded posts for the training years commencing in 2021, 2022 and 2023 (creating an extra 120 Pharmacists over 4 years from a baseline of 200). The following table presents numbers of funded posts to 2022 and the latest available data on recruitment.
Each year NES asks the PRPS trainees to complete an exit survey about their career plans when they are about to finish their training.
There were 122 unique respondents to the Pre-registration Pharmacy Scheme exit survey, a response rate of 64%. Where an individual submitted more than one response, we report the second response only.
91% of respondents qualified from a pharmacy school in Scotland.
66.39% of respondents identified themselves as British Nationals. 16.39% reported other nationalities and 17.21% did not respond.
Respondents indicated their intentions with regard to where they intended to work during the next stage of their career:
82% of respondents indicated an intention to work in Scotland only.
Respondents also indicated intentions with regard to the sector they intended to work in:
78% of respondents planned to stay within the same sector and 13% planned to work as a locum.
Respondents who indicated that they intended to stay within the same sector were asked to rate the importance of various reasons for doing so:
The most popular reasons related to job security, salary, greater independence and the opportunity to undertake an independent prescribing qualification in the future.
Pharmacists can register as an IP after completing a GPhC accredited course at either University of Strathclyde or Robert Gordon University. The courses are funded by NES. Courses typically take between 6 and 12 months to complete including academic and experiential components and requires sign off by a Designated Prescribing Practitioner (DPP). This year NES offered an additional 75 funded places, increasing the capacity from 140 to 215, to support implementation of the NHS Pharmacy First Plus service, through increasing the number of community pharmacist places. An additional course was commissioned, with three courses running at the University of Strathclyde and two courses, with additional places, at Robert Gordon University, 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 below shows the number of funded and qualifying IPs together with the cumulative number of trained and in training patient facing IPs in each year. 139 IPs qualified in 2020, an increase on the previous year. Of the 151 funded prescribers in 2020, 21 pursued their qualification through the MSc. route.
A national newly-qualified pharmacist curriculum and assessment programme is being implemented in Scotland in 2021 to provide a standardised approach to training across all sectors of pharmacy practice. Previously the NES Foundation Pharmacists programme was predominantly undertaken in Acute and Primary Care but will be extended into Community Pharmacy practice from Autumn 2021.This will support development of newly-qualified pharmacists prior to undertaking their Independent Prescribing qualification.
The following table presents data from 2020 NES Pharmacist Prescribing report showing IP training and activity levels across the three sectors of Pharmacy practice.
Registration with the GPhC as a Pharmacy Technician in Great Britain now requires completing the SQA accredited Diploma in Pharmacy Services at SCQF Level 7 (comprises of the Professional Development Award (PDA) in Pharmacy Services at SQA Level 7 (knowledge) and SVQ Pharmacy Services at SQA Level 8 (competency) qualifications) or those accredited by other awarding bodies such as City & Guilds and Pearson/Edexcel.
SQA shared data with NES on NC and SVQ certifications up to and including academic year 2018-19.
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.
Due to changes to the GPhC standards for initial education and training of pharmacy technicians the qualifications required to gain access onto the register can no longer be achieved consecutively, they must be undertaken concurrently. Whilst this has no impact on those employed as Pre-registration Trainee Pharmacy Technicians, it does mean that the Scottish further education providers cannot offer the course independently and will now require a commitment from employers to provide training placements.
The available data from the SQA includes Pharmacy Technician post-registration qualifications.
Numbers of certifications increased sharply in academic year 2017 but have been decreasing since then.
Pharmacy technician trainees in the managed sector are recorded in the NHS Scotland Staff and Vacancy Survey. The number of WTE pharmacy technician trainees in the managed sector has increased each year since 2014.
The numbers in training for 2020 are higher than expected. This is due to a large NHS Lothian intake of Pre-registration Trainee Pharmacy Technicians all of whom commenced their training in 2020
This chapter reports information on the labour market for pharmacy staff and includes information from the NHSScotland staff and vacancy survey, the 2020 Community Pharmacy Workforce Survey, the 2020 Aseptic Dispensing Workforce Survey and the average earnings of pharmacy staff in Scotland and the UK.
The following section presents WTE staff in post on September 30th 2020 for Pharmacists, Pharmacy Technicians and Support Staff (Pharmacy Assistants, Administration & Clerical, and Other). These figures do not include staff in training - numbers reflect trained staff only. Results are presented by region, NHS Board and sector.
There were 53 Band 5 Pre-registration Pharmacist trainees in post in 2020, a 10.4% change from the 2019 survey. Pre-registration Pharmacist Trainees are not included in the numbers of Pharmacists reported here.
The total number of WTE staff in post on September 30th 2020 was 3298.42, an 9.79% increase on the 2019 survey.
The WTE numbers by staff group were 1682.17 Pharmacists (a 12% change from 2019), 877.64 Pharmacy Technicians (a 8% change), and 738.61 Support Staff (a 7% change).
Each Regional grouping is a subset of all NHS Scotland Boards:
The number of WTE Pharmacists continues to increase, driven by increases in AfC bands 7 and 8A.
The increase in WTE Pharmacy Technicians between 2019 and 2020 has been driven mainly by increases at AfC Band 5. Numbers of WTE Support staff at AfC Band 2 decreased between 2019 and 2020 while numbers at Band 3 increased.
A comparison of WTE staff numbers across survey years indicates continued increases in Pharmacist and Pharmacy Technician WTE in Primary Care since 2013. WTE numbers of Pharmacy Technicians in the Acute sector have been decreasing since 2015 but at a slower rate than the increases in the Primary Care sector.
There was variation between NHS boards in the number of WTE staff per 10,000 of the population.
The vacancy rate provides an indication of an employer’s demand for labour.
The vacancy rates in Scotland on 30th September 2020 were 7.9% for Pharmacists, 8.5% for Pharmacy Technicians and 6.6% for Support Staff. All three staff groups saw an decrease in vacancy rates since 2019.
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.
There is considerable variation in the vacancy rate between NHS boards.
N.B. Four boards had no staff in post or vacancies for Pharmacy Technicians and Support Staff. The null vacancy rate in these cases is denoted by a dash (“-”).The vacancy rate for Pharmacists and Pharmacy Technicians is highest in the Primary Care sector. The Support Staff vacancy rate is highest in the Acute Sector.
The 2020 Community Pharmacy Survey was undertaken by NES in conjunction with CPS</abbr). Independent community pharmacies and pharmacies in the CCA were asked to supply information on staff and vacancies for the week commencing 21 September 2020.
There were 1,379.7 WTE Pharmacists, 867.0 WTE Pharmacy Technicians and 3,409.72 WTE Support Staff in post. Pharmacists accounted for 16.9% of the overall WTE. The largest staff group was Dispensing Assistants which accounted for 28.9% of the overall WTE.
Numbers of WTE Pharmacists have decreased steadily since 2016. Possible reasons for this include the displacement of Pharmacists from Community Pharmacy to new NHS Primary Care roles, and an increase in Community Pharmacists leaving the profession.
There has also been an overall reduction in the number of WTE Pharmacy Technicians working in the Community sector since 2016 and a reduction in the number of Trainee Pharmacy Technicians since 2018. This may be due to a number of Pharmacy Technicians moving to NHS Primary Care and employers recruiting more Dispensing Assistants to fulfill certain functions of this role. Numbers of Dispensing Assistants working in the Community sector have increased over the same period.
The GPhC collects data on the number (headcount) of registered Pharmacists and Pharmacy Technicians in Scotland. The table below shows the headcount of registrants in September 2020 compared to headcount numbers of these roles employed in the NHS and the Community Pharmacy sector.
*Source: General Pharmaceutical Council, NESThere are approximately 1,100 more Pharmacists in Scotland registered with the GPhC than there are employed in the Community and NHS managed sectors.
Data on the Aseptic Dispensing Workforce is collected annually to support workforce planning for a new service model within NHSScotland Boards. NES collects data on staff in post, vacancies, length of service and the distribution of aseptic dispensing tasks across AfC bands.
On 30 September 2020 there were 211.2 WTE aseptic dispensing staff in post, an increase of 7.3% from September 2019. Of these staff 53.8% (113.7 WTE) were Pharmacy Technicians, 25.5% (53.8 WTE) were Pharmacy Support Workers and 20.2% (42.7 WTE) were Pharmacists.
48.3% of Aseptic Dispensing staff in fixed posts have been working in NHSScotland for 10 years or more. Roughly half of Pharmacists and Pharmacy Technicians have been in post for 10 years or more; for Support Workers the proportion is just under a third.
There were 8.5 WTE vacancies, a decrease from the 16.8 vacancies the previous year. Of these vacancies, around two thirds (5.4 WTE) were for Pharmacy Technicians.
An occupation that appears on the Shortage Occupation List indicates that there is a shortage of skilled workers in the UK. Employers who wish to recruit an individual from outside the European Economic Area (EEA) and Switzerland to fill a vacancy that is on the shortage occupation list may issue a Tier 2 certificate of sponsorship (CoS) without the need to demonstrate that a resident labour market test (RLMT) has been carried out.
There were no pharmacy occupations on the most recent update to the shortage occupation list as of January 2021. However, Pharmacists are among roles that have been recommended for addition to the list following a review by the Migration Advisory Committee in 2020.
The earnings of 1% of UK employees is published as part of the Annual Survey of Hours and Earnings (ASHE) by SOC 2010 code. Therefore, these data include employees in both the hospital and community sectors. We report the latest available data here which relates to 2019.
Real median gross hourly pay for pharmacists decreased between 2018 and 2019 in both Scotland and the UK, although the decrease was greater in Scotland. Real median gross hourly pay for pharmacy technicians in Scotland decreased in 2019 following several successive years of increases. Earnings for Dispensing assistants rose slightly in 2019 in both Scotland and the UK.