The adoption of clinical pharmacists in primary care has been one of the most welcomed and popular addition to the team from GPs. The latest figures published in June show there are now 5,308 full time equivalent pharmacists hired through ARRS funding. It equates to 22% of the total ARRS staff employed by PCNs to date.
Yet this mass move of pharmacists into primary care has not been without controversy and has been blamed for a drain of staff out of community pharmacy. In May, the Health and Social Care Select Committee called for a review after noting the knock-on impact on staffing in the community pharmacy sector. Between 2019 and 2022, it was estimated that almost half of the money spent on ARRS roles related to clinical pharmacy recruitment.
The National Pharmacy Association agrees that many community pharmacies are experiencing real difficulties recruiting and retaining staff because of the migration of staff into general practice, including in towns and cities where this had never been a problem.
A spokesperson said they recommend ‘a robust local impact assessment prior to any further recruitment into GP or PCN sites under the ARRS programme. It should calculate the impact on other parts of the local NHS, including pharmacy contractors, and their ability to deliver patient care objectives, prior to any further recruitment under ARRS.’
They added that ‘forward thinking’ ICBs might even consider an ARRS scheme for local pharmacies ‘to enable services such as structured medicines reviews in convenient community locations’.
This large shift of staff in a relatively short space of time is reflected in our survey responses. Among community pharmacists, 45% of respondents said the introduction of the ARRS pharmacist had destabilised the profession and a third said it had created tensions between community pharmacists and GP practice pharmacists. Around 35% agreed that the introduction of ARRS roles had resulted in pharmacy closures and 70% said too many had moved from community pharmacy into general practice, creating a workforce shortage.
Likewise, responses from general practice pharmacists not in an ARRS role showed concern about the impact of the changes. In this group, 42% felt the introduction of the PCN pharmacist had destabilised their profession and half said it had created tensions.
Liam O’Sullivan, a community pharmacist in Southampton, said he has seen many of his colleagues move into PCN roles. It has also meant those working in community pharmacy having less opportunity to gain prescribing qualifications, he adds. With newer pharmacists now coming out of university with independent prescribing skills, this is causing concern.
‘I am unable to get GP support for a prescribing qualification. I have other colleagues who are travelling far to get supervision requirements. The Government needs to really push support for current community pharmacists who are eager to qualify before newly qualified pharmacists can “jump the queue” despite having less experience.’
But he also noted that some PCN pharmacists have had difficulty getting support for training. ‘If even employing pharmacists under ARRS is not enough incentive to invest the proper time in mentoring, I’m not sure what the answer is.’
The role of ARRS pharmacist
It is of note that PCN pharmacists responding to our survey do feel generally positive about their work and place within the team. In all, almost two-thirds said they were satisfied in their job.
Three-quarters of respondents said they had a formal induction into their role and 68% said they have a dedicated workspace for their job. In addition, 76% said they have had time for protected learning or ongoing training. A large percentage – 88% – also said they had been supported in their PCN role and the vast majority see patients as part of their role.
But there appears to be more negative responses around pay and career progression among our respondents. Only 38% said their pay was adequate for the job they were doing and 56% answered no when asked if there had been good career progression in their PCN role.
Robin Conibere, lead PCN pharmacist at the Beacon Medical Group in Plymouth, Devon, says the fact the pharmacists are the largest group of healthcare professionals employed through the ARRS scheme ‘demonstrates the value they bring to PCNs and the patients and communities that they serve’.
‘GP colleagues value the work we do and the contribution we make in terms of improving safety, optimising use of medicines and ultimately improving outcomes,’ he adds.
While there may be concerns about pharmacists’ movement from community to PCN roles, he believes this is, in fact, an asset, as PCN pharmacists can champion their colleagues’ work in supporting patients and improving access.
Most of our respondents worked across several practices, if not all across the PCN, and had been in the role for between one and three years.
The main focus for 40% of those responding who were in a PCN pharmacist role was carrying out medication reviews followed by phone or video calls with patients. Running face-to-face clinics with patients seemed to be a medium priority, the survey responses suggested.
When it comes to looking to the future, there did appear to be some uncertainty, with less than half of respondents believing they had job security. Overall, PCN pharmacists were positive about what the PCN had been able to achieve. The responses showed that 62% believed that the PCN had successfully freed up GPs time and 71% said patient care had improved through the work of the PCN. While this group were more evenly split on their views of whether PCNs had addressed health inequalities, they did veer more towards believing PCNs had been successful here and half said PCNs had improved joint working.
It was noted by one respondent, who did not want to be named, that the role of pharmacists in primary care had ‘strengthened the profession’ and provided opportunities but PCNs differed in how well they functioned.
O’Sullivan is one of those who believes that, on the whole, the more joined-up approach fostered by PCNs has improved service provision.
‘It has meant easier communication with PCN surgeries’, he says as well as simplifying the rollout of flu and Covid vaccination, Pharmacy First, and blood pressure screening services.
The limiting factor is ‘funding for GPs and community pharmacies in general’.
Conibere adds: ‘Future iterations of primary care contracting need to consider how we invest in these roles to ensure opportunity for career progression to retain and grow these valued and trusted professionals.’