Locum rates cropped up once again in C+D’s investigation into temporary closures, with pharmacies providing "locum could not be found" as the reason for having to close temporarily in 10,637 of the 20,924 instances NHS England recorded between 1 October 2021 and 30 September 2022.
Responding to C+D’s 2022 Salary Survey, locum pharmacists themselves had much to detail about their experiences working throughout 2022.
Rise in emergency shifts
Based on their responses, the path to securing a pharmacy shift was not a smooth one for some locums in 2022.
One described it as “a game of cat and mouse”, claiming that “several locums fight over the [same] shift on occasion” after “companies increase the rate for a particular shift”.
This was echoed by another locum, who said that “employers have reduced staffing and expect more and more workload and want to pay as low a rate as possible, often increasing very close to the day required”.
“No more game playing, just pay a fair rate,” they asked of employers.
One locum pharmacist claimed that agency online booking services operate “like an auction”.
“Locum shifts are offered initially at a very low rate, which gradually increases over time,” they explained. “The shift goes to whoever will take it for the lowest rate.”
They said that most locum shift slots only get filled “a few days beforehand, as locums wait for rates to increase to a reasonable level”.
“Locums are not selected based on quality of service, just whoever is the cheapest,” they claimed, calling the situation “a real mess”.
Up to employers to fix problems?
PDA director Paul Day told C+D that it is up to employers to “look at the environment and conditions they are asking pharmacists to accept”.
He continued: “Factors such as staffing levels, autonomy, physical safety, rest periods, the ability to raise concerns without negative consequence and being able to exercise their training matter to professionals.”
Ultimately, he said, employers must “collectively ensure the sector offers appropriate, good work…if [they] want to recruit and retain enough employees and attract the necessary volume of locums for a stable cost”.
But one locum respondent based in the south west said that most employers near them “are trying to drop locum pay by offering very low rates for advance bookings”.
“The shifts don't get taken, obviously, so we're in a situation where nearly everything becomes an emergency shift,” they added.
Another respondent pointed their finger at “multiples…capping locum rates” and “opting not to negotiate with locums on rates and rather close their branches temporarily”.
“Unethical and irresponsible decisions are being taken – these are commercial decisions that affect patient safety,” they said.
“Grossly understaffed”: Poor staffing levels add to stress
Multiple respondents said low staffing in pharmacies was an issue of concern.
One locum said pharmacies were “usually grossly understaffed”, while another said they had booked to do a shift one day, only to be told there would be no other staff working in the branch.
Another respondent reported being blindsided when arriving for a shift.
“Often when you get there, you are told that for a significant part of the day you will be working on your own,” they explained.
“Staffing levels are unsustainable with increasing workload,” they added.
A few compared staffing levels to previous years, with one locum saying they were “less than half compared to the levels 10 years ago and progressively reducing”.
“Staffing levels and working conditions are the worst I’ve seen in 30 years,” another stated.
Some 39% of 249 locums responding to the survey said they had reported more dispensing errors in the past 12 months.
Of those, 38% said ‘reduced staff’ had contributed to the increased dispensing errors. Another 35% pegged these to ‘increasing workload’.
Patients’ expectations of pharmacists
One respondent detailed their struggle with finding “a suitable work life balance”, as work “volume is increasing and patients’ expectations are at their highest level [they’ve] known”.
“Balancing that with finding suitable locum shifts is a skill,” they said.
"Public expectations are high,” another explained. “A lot of people want a fast-food type of service.”
They described struggling with this due to “stock shortages and once daily deliver[ies]”.
Patients are coming to pharmacies with unsuitable conditions, a respondent said, as “GPs are still not seeing patients”.
“We are having so many more people referred to us for things we can’t fix, like dislocated legs and hernias.”
In some instances, patients have even been aggressive when having to wait for prescriptions.
“There are days when I feel so tired and demoralised, I feel like leaving pharmacy,” one locum said.
“The patients are becoming more abusive because of the supply issues of medication.”
Would they recommend locuming?
Locum pharmacists responding to the Salary Survey were fairly evenly split on their feelings about their career choice.
Forty-one percent of 248 respondents reported being ‘happy locuming in community pharmacy’, while another 42% said they were ‘disillusioned with pharmacy as a career and would like to move out of the profession’.
Some indicated that they would continue locuming as long as rates remained high.
“I would happily stay in pharmacy with the current locum rates…otherwise I am already trying to find ways out of pharmacy due to scaremongering about rates reducing,” one said.
Another locum said they had “experienced the days of £17 an hour” for a shift, adding that they would “stay as long as locum pay reflects the high and intense workload”.
“It’s not surprising that many of my colleagues, especially people who have been working for over 15-20 years…are now looking for a new career. With the profession changed beyond recognition, many pharmacists do not see a place for themselves in this new environment,” a locum pharmacist wrote.
“For most of us, it’s a highly stressful and ungrateful job [and] abuse from patients has become a shameful standard,” they continued.
Many respondents said they intended to retire in the next year or two.
Sixty-six percent said they would not recommend pharmacy as a career, compared to 34% who would.
Something must change
As the PDA’s Mr Day points out, something has to change if community pharmacy is to hold on to the workforce it desperately needs.
“The objective should be for a sector where enough pharmacists are content to be employed, and where locum pharmacists are content to provide the essential workforce flexibility needed,” he told C+D. “However, there seem to be fewer and fewer pharmacists that will accept the jobs on offer.”
With emerging roles at PCNs understandably tempting many away from more traditional roles in the community, it’s true that employers are going to have to work harder to keep hold of their staff and locums alike.
But until the government shows willing to grant the sector the funding it so desperately needs, their chances of making community pharmacy a more enticing place to work seem limited.