Global pharmacy workforce and migration – recipient perspective

Professor Karen Hassell

EuroPharm Forum

Bratislava, Slovakia

13th October 2007

The GB pharmacy workforce

• Third largest professional group in the health care sector in GB:• 47,692 registered pharmacists in 2007• estimated > 77,000 support workforce

• 23 schools of pharmacy (8 are new)• 57% of practising pharmacists are female• 2604 pharmacists joined the register in 2006• But 1932 left the register in 2006• Average 2% increase in number per year

Distribution of pharmacists in selected EU countries (2004 data)

Data source: www.fip.org0 50 100 150 200 250

per 100,000 population

NetherlandsTurkeyNorway

GermanyPoland

DenmarkSwitzerland

GBEU Average

SpainFrance

ItalyFinland

Malta

But workforce shortages exist…

• Multiples taking up to 10 weeks to recruit

• Vacancy rate of 10% in large multiples

• 12% of hospital pharmacists posts vacant or

occupied by a locum (2006 data)

• High turnover and exit from the hospital sector

• Geographical inequalities: rural & urban

• Not confined to qualified pharmacists

Impact of shortages?

• High(er) workload

• Non-store staff provide cover

• Reduction in leave/training

• Work longer hours (owners)

• Increased stress and dissatisfaction at work

• Closure of community pharmacies

• Cessation of current services

• Failure to take up new services

Why do these shortages exist?

1. Demand for pharmacists and pharmacy services increasing:• Increase in dispensing volume

• More older people

• Client expectations (‘demanding consumer’)

• More OTC and P medicines available

• New national pharmacy contract (in 2005)

• Provision of enhanced and advanced services

• ‘Professionalisation’ agenda

2. More ‘chain store’ pharmacies:• 16% of the total in 1971; 57% in 2007

• Open longer hours

• Provide more services

3. More employment markets for pharmacists:• Eg, primary care

• Increases competition between sectors

4. Behaviour and socio-demographic changes in the workforce:• More women (and fewer men)

• Baby boomers versus Generation Y

• Changing expectations and attitudes to work

• High proportions not practising pharmacy at all

• 32% work part-time (2005 data)

• A substantial number migrate overseas

Emigration of GB trained pharmacists

• In 2007 4718 pharmacists on the GB register were domiciled outside GB

• Most (66%) were GB-trained (but not necessarily GB nationals)

PULL: lifestyle, career opportunity, returning home, & partner’s job were main reasons for leaving GB;

most are working in retail pharmacy; many have no intention of returning to GB in the

short term.

1. Expand student intake

2. Implement skill mix – ie, utilise technicians

3. Utilise technology/automation

4. Improve workforce satisfaction

5. Encourage leavers to return

6. Recruit foreign-trained pharmacists…

Solutions to the shortages?

Foreign-trained pharmacists in GB

• There were three (but now two) routes for overseas pharmacists to enter the register of pharmacists:

• ‘European’• ‘Adjudicating’• Reciprocity route abolished in 2006

0

200

400

600

800

1000

1200

1400

1600

Recip. 961 968 1059 1095 1245 977

Euro. 481 864 989 1075 1278 1545

Adjud. 975 1130 1244 1312 1302 1277

total 2417 2962 3292 3482 3825 3799

2002 2003 2004 2005 2006 2007

Foreign trained pharmacists domiciled in GB, by entry route

Source countries

• Through EU route: Spain (and Poland)

• Through Reciprocity route: Australia and New Zealand

• Through the Adjudication route: ?

Distribution of pharmacists (2003/04 data)

Data source: www.who.int/whosis/database

0 10 20 30 40 50 60 70 80

per 100,000 population

Kenya

Bangladesh

Nigeria

Cameroon

Gambia

Uganda

Ethiopia

GB

Issues for GB as a recipient

• Recognise that GB is a donor as well as a recipient

• Need some open debate:

• The good and bad of migration• Should GB be taking pharmacists from

countries with shortages of their own?• The individual’s right to migrate?

What should GB be doing?

• Employer responsibilities:• Awareness of situation in donor countries• Guard against exploitation and poor work conditions• Devise strategies for successful integration

• Responsibilities of policy makers:• Raise awareness• Meaningful HR planning• Have a co-ordinated policy approach to the recruitment of foreign-

trained pharmacists• Sign up to an ethical code of recruitment

What should the professional body do?

• Continue to invest in ‘workforce research’ – but more needed on migration patterns; and more on monitoring movement

• Establish mechanisms to mitigate the adverse impact of migration on donor countries, eg:• Assist donor countries to expand their capacity to

train and retain staff • Encourage ‘partnerships’ between countries of

origin and GB

Thank you

Please visit our website:

The Centre for Pharmacy Workforce Studies

www.manchester.ac.uk/cpws