As a child of a pharmacist and independent community pharmacy owner, I decided to follow in my father’s footsteps and qualified as a pharmacist in the UK, subsequently going on to experience life and pharmacy practice overseas.
For over 30 years my career included a variety of community and hospital pharmacy roles in Australia, always working as a locum, either through agencies or, as I built good relationships with employers, I was booked directly too.
Having retained my British pharmacist registration throughout my time away, I decided to return to the UK in 2019. Although as an existing registrant there was no regulatory requirement for me to undertake any familiarisation assessment or skills evaluation upon my return, I decided to work under the supervision of a pharmacist for the first 6 months to ensure I was competent in UK PMR systems and e-prescriptions, contractual services, and to undertake any necessary training.
Pharmacy is a global profession, however, since I returned to practice in UK community pharmacies, I have observed a very different approach to the locum workforce compared to what I had come to expect as standard practice and have experienced a worrying variation in the quality of some of the working environments. I still see job offers for locum posts in Australia which has prompted me to reflect on the significant differences between current practice as a community pharmacist on opposite sides of the world.
In the UK
In the UK I regularly have little knowledge about the working environment, workload or services provided before I arrive at a pharmacy. The levels of support staff are minimal, and they are often inexperienced as turnover can be quite high due to low pay and lack of investment in development and training.
Being the RP, I’m responsible for conducting checks to secure the safe and effective operation of the pharmacy on my arrival, and I regularly find the support staff unable to assist me in locating the necessary documentation or to brief me on matters around what is happening in the pharmacy. These are important steps in my accepting the responsibility for the pharmacy, however, sometimes these interactions can feel humiliating and hostile.
The pharmacy environments, including the areas accessed by members of the public, are often not cleaned, as this is seen as an additional cost to the business, and staff toilets are frequently used as additional storage areas. I have even experienced a CD cabinet located in a toilet. One must ask how this passes GPhC premises standards.
As a locum, it is difficult to raise safety concerns with superintendents and management about premises and professional standards for fear of there being repercussions around future work opportunities.
I am offered a relatively flat hourly rate, starting at the lowest possible end of the scale regardless of the number of prescriptions I am expected to dispense, the number of services I am required to provide, or whether I am managing support staff. Those booking locum cover just seem to be interested in filling the spot for the cheapest rate possible without concern for quality or retention.
In Australia
Ahead of accepting any booking in Australia, it is standard practice for the locum to be provided with a detailed job description and to know what training they are expected to have undertaken. They will also know the number of additional pharmacists and other support staff on duty (including their level of qualification), the number of prescription items the pharmacy typically dispenses, what services are offered and which the locum would be expected to provide, which IT systems are used and whether any management of support staff is required. Locums in Australia are more likely to experience a rate of pay that fairly reflects the complexity or volume of work required, along with any extras such as expenses. This approach supports the provision of high-quality locum cover and a willingness and commitment to return for future bookings.
This level of up-front information makes it clear what is required and, as a locum, it meant I was explicitly aware of what I would be personally responsible for. It was not unusual to work alongside other pharmacists throughout the day who would also be working in the dispensary, providing vaccination clinics or other services, as well as teams of highly qualified support staff who undertook regular mandatory training (during protected learning time) to keep their knowledge and skills up to date.
The working environments are of a much better standard, with hygiene a priority, as you’d expect in a clinical setting.
Improving safety
While the health care system in Australia is different to the UK, with more private insurance-funded provision, the basics around investment in clean and well-equipped premises, adequate numbers of well-trained support staff and providing locum pharmacists with the level of information they need to undertake the role should be essential in providing safe patient care.
Locum pharmacists are essential to the UK community pharmacy network, and I suggest that there are a few basic things which could vastly improve the situation here if decision-makers committed to make it happen.
Firstly, full advance transparency around the workplace, workload and staffing should be an essential part of advertising a locum vacancy and agreeing a booking.
As a practical change, every pharmacy should have its own basic morning checklist with information for anyone working as the RP in that premises, to ensure an effective signing-in process on the day and avoid later surprises.
Finally, it is essential that the statements that say locums should be able to confidently raise concerns about safety or premises standards without fear of detriment must become reality.
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