Dr Karen Hassell

1
Workforce challenges and skill mix

• Dr Karen Hassell
• Director of Centre for
• Pharmacy Workforce Studies
• www.cpws.man.ac.uk
• BPC
• 27th September 2005

2
Outline

• Policy background and drivers for change
• What is skill mix
• The evidence base
• Challenges in implementing skill mix

3
Policy

• liberate the talent skills of all the
  workforce so that every patient gets the right
  care in the right place at the right time.
• From Delivering the NHS Plan, 2002

4
What is/should the pharmacy workforce be doing?

• Dispensing supply roles
• Medicines management
• Supplementary prescribing
• Supporting self-care and OTC use
• Dispensing repeat prescriptions
• Smoking cessation
• Sexual health services
• Patient safety

5
Who is there to do these things?

• Pharmacists
• 23,500 community pharmacists (2003, GB)
• 7,000 hospital pharmacists (2003, GB)
• 2,600 PC pharmacists (2003, GB)
• Other staff
• 5,000 hospital technicians (2001, England)
• 8,500 community pharmacy technicians
• 22,500 dispensing assistants
• 40,000 MCAs

6
Are there enough?

• Staff shortages
• Best estimates suggest a shortage of 1700
  pharmacists
• Increasing demand for staff
• Recruitment and retention problems

7
Drivers for change

• Pharmacist shortages
• Increasing workload
• Legislation/regulation
• Technological innovation
• Quality improvement?
• Cost containment?

8
Whats the solution?

• More staff
• Same staff with new skills or roles
• Different staff with different roles
• ie, changing skill mix (enhancement innovation)

9
The evidence base?

• Skill mix abroad
• Review of evidence of skill mix initiatives in
  community pharmacy in GB
• Feasibility survey of support staff
• Observation study of the activities and roles of
  support staff

10
Lessons from abroad

• Advanced basic training
• Political drive
• Clarity over division of labour and organisation
  of work
• Size of organisation
• Strong systems approach common
• Long-range supervision the norm

Source Skill mix review, 2002 (DH)
11
Closer to home

• People generally unfamiliar with the terminology
• General consensus for making better use of
  pharmacy support staff extending their roles
• Divided views concerning what pharmacists should
  do with time freed up. A key barrier being that
  workload is highly variable and unpredictable
• Other barriers to implementation

Hassell et al, Skill mix review, DoH, 2002
12
Barriers to implementation

• Physical/environmental
• The political/legislative framework
• The workforce itself
• lack of shared vision
• capacity/availability of staff
• aspirations and attitudes are varied
• no clarity about tasks/roles

13

• There is also a stark contrast within
• pharmacy in terms of the skills and
• educational profile of different staff, yet a
  substantial overlap in terms of the tasks
  performed

Hassell K, Shann P, Noyce P (2002) Pharm J, 269
851-4
14
The reality

• Some pharmacies operate without a PT (47) or DA
  (16)
• Highly feminised workforce
• Generally a very experienced workforce
• but dichotomised in terms of educational
  background and future aspirations
• Recruitment and retention issues apply

Source Feasibility study on deployment of
support staff, Sept. 2004 (DH)
15
Finally, whats needed to make it work?

• Clarity of vision shared vision
• Professional regulation/legislation
• Education and training to underpin change
• Incentives to train, and suitable recognition for
  additional qualifications or accreditation
• One model not sufficient