Hospital pharmacies have been hit by a serious recruitment shortfall, as the NHS pharmaceutical education and development committee highlighted in 1997.1
One reason is that the salary differential between community and hospital pharmacists has become more marked in the past few years. While a newly qualified pharmacist can earn 17,000 on coming into hospital pharmacy, in the private sector starting salaries of 25,000 are common. In addition, the advent of supermarket pharmacy has absorbed large numbers of pharmacist hours: the average supermarket pharmacy is open about 90 hours a week, requiring almost three whole-time equivalent pharmacists to staff the service.
The situation will become much worse in two years' time when the pharmacy undergraduate course increases in length from three to four years, bringing the total training time for pharmacists to five years, including the pre- registration year. In 2000, there will be no graduates from the schools of pharmacy, and, in subsequent years, numbers may be 25 per cent lower than at present.
Against this background the Horton General Hospital trust in Banbury lost three pharmacists within a short time. Meanwhile, the Sainsbury's store next to the hospital was struggling to recruit in-store pharmacists to cover the 90 hours required.
Pharmacists have invariably had to make a choice between developing their careers in the public or private sector. Hospital pharmacy has offered work in a clinical community, with good peer support and a strong clinical role, but poor salaries - especially in the early years. Community pharmacy offers higher starting salaries, a commercial environment and high patient contact.
Primary Care: delivering the future, the white paper published in December 1996, suggested developing partnerships in care, including wider roles for community pharmacists.2 The recent legislation on primary care groups again outlined a multidisciplinary approach to service delivery.3 There would therefore appear to be an increasingly important role for community pharmacists working with colleagues in primary care, undertaking extended roles in, for example, health promotion and medicines management.
The Horton General Hospital and the local Sainsbury's are situated within 100 yards of each other, near enough for collaboration to make more sense than competition. We decided to explore the creation of two joint full- time pharmacy posts.
This could help recruitment, allow pharmacists more integrated career development and be a base for exploring extended roles for pharmacists as outlined in the recent legislation. It could also offer opportunities to explore the pharmaceutical care of patients moving between primary and secondary care. For example, research could be done on communication of information on medication when patients are discharged from hospital.
Liaison with national and local Sainsbury's management exposed much common ground, although legal, human resources and financial issues had to be resolved. The idea of a unified contract was not adopted because of legal concerns on the part of Sainsbury's. Instead, it was agreed that the two post-holders would be employed by both organisations part-time. They commit half their time to each, and would work alternate weeks on each site.
At Sainsbury's, their role would be that of community pharmacist in a busy commercial environment, also looking to develop health promotion. The hospital role would include clinical and ward-based commitments, and some participation in the dispensary rota. We also tried to integrate the evening and Saturday hours of the Sainsbury's post with the hospital pharmacist emergency duty rota.
In January 1998, the posts were advertised in the pharmaceutical press under the slogan 'the best of both worlds'. Each post had a starting salary of 24,000, based on 22,000 for a C-grade hospital pharmacist and 26,000 for the Sainsbury's post. The advertisement attracted as much interest from other trust chief pharmacists as from potential candidates. It was clear from conversations with other senior pharmacy managers that the national recruiting picture was extremely bleak.
There were more than 20 expressions of interest, and a shortlist of candidates was drawn up. It included two pharmacists with MScs and one who had just completed a PhD. Most candidates had a community background with clinical interests as indicated by their postgraduate qualifications.
We had been worried that the commercial and health service workplaces would demand different skills and that the interviewing panel, which represented both sectors, would find it difficult to agree on the right candidates.
However, these fears were unfounded. Both organisations were looking for pharmacists who could succeed in demanding, constantly changing environments, with patient care as a priority. The decisions of the interviewers were unanimous.
One pharmacist took up post in February and the second in April. We believe this is the first time in the UK that such posts have been on offer, and the success of the scheme will be closely monitored.