Are concerns around MUR abuse a storm in a teacup? by Jennifer Richardson

Like any self-employed profession, working as a locum community pharmacist can be challenging at the best of times. And with plummeting rates of pay, changeable working hours, mounting workplace pressures and heavy competition for shifts in some parts of the country, it’s easy to see why.

C+D’s coverage of locum issues over the past year has done little to put a more positive spin on the situation for these pharmacists. Levels of pay have been falling steadily for the past eight years, and the latest figures have not bucked that trend. According to data from C+D’s Salary Survey 2016, average locum rates crashed from £24 an hour in 2008 to £20.50/hr in 2015.

Some commenters on the C+D website argue that once the cost of living and inflation are taken into account, the difference is even greater – citing estimates that locum pharmacists now earn just £16/hr in real terms.

According to Linda Yearsley, managing director of agency Team Locum, this means that locums are left at the “sharp end” of market forces, as demand for shifts rarely outstrips the number of pharmacists willing to take them.

Forced to look elsewhere

The pay squeeze has led to the creation of One Voice Pharmacy. The founders of this campaign group, which claims to have gathered more than 3,000 followers across different social media platforms since it was set up in June, says its aim is to challenge low rates of pay and poor working conditions across the sector.

Following Tesco’s announcement this summer that it would drop its daytime pay from £19.50/hr to £18/hr in certain supermarkets – the second year in a row that the supermarket had slashed its locum rates – One Voice organised a boycott for two weeks in September.

In a letter to Tesco’s commercial manager pharmacy lead Mark Raffaitin protesting the pay cut, One Voice wrote: “Unfortunately, due to the decision made, [the] majority of locum pharmacists now feel forced to look elsewhere for work, where better rates are offered, and places where their contributions and skills are recognised and valued.”

This is backed up by data from C+D’s Salary Survey 2016, which reveals just how bad the situation for locums across the UK has become. As well as dissatisfaction with falling pay, locum respondents reported unsafe working environments, mounting workloads and pressure from management to meet targets. Most damningly, over three-quarters of the 277 locums who responded to the survey said they would not recommend pharmacy as a career.

With the situation for many locums in such dire straits, it’s little wonder that one respondent to the Salary Survey commented that they had been made to feel that “locums are not important”.

A lack of financial reward

It seems unlikely that locums will begin to feel more valued any time soon. Of those who responded to the survey, 94% said they had not seen their rates increase in 2015, while 67% were dissatisfied with their current rate.

An oft-cited source of frustration is that the financial rewards from working as a locum do not reflect the level of training and qualifications they must possess.

“I’ve done five years training to become a pharmacist and at the end [I have] no permanent position and getting paid below £15 [per hour],” said one respondent.

For locums working in England, cuts to pharmacy funding are unlikely to help matters. Miraj Patel, chief executive of My Locum Choice – a pharmacy recruitment agency – says that pharmacy owners have approached the company asking how much they could reduce locum pay rates by. Mr Patel’s business was “pragmatic” in its response, bartering for higher rates because of the level of training the locums on its books have, he says.

Nevertheless, Mr Patel says he has noticed how much pay has tumbled in the last decade. Ten years ago, the average rate was likely to be in the region of £30/hr, dropping to £22-£23/hr around five to six years ago, he remembers. Nowadays, says Mr Patel, the “gold standard” locum rate is somewhere around £20/hr. Rates have “dropped a lot” and are unlikely to pick up any time soon.

Some locums urge their colleagues to resist falling pay rates. Pharmacist Hazel McCulloch-Smith told C+D: “Your locum rate only drops if you let it. If everyone says, ‘No, I want £24 an hour,’ then that is what you get. It’s when… newly qualified and other pharmacists [are persuaded] they are not worth it that the rate [falls].”

Under pressure

C+D’s analysis suggests that locums who have seen their salaries slide over the years are also likely to have noticed their workload increase to worrying levels. Data from the Salary Survey 2016 reveals that 42% of locums feel they are under pressure from management, and a further 48% say their workload is often unrealistic.

Locum Alex – whose name has been changed to protect his identity – says that while at work in pharmacies he is often faced with “mounds” of prescriptions, which take nine or 10 hours to check – after travelling 50 miles to get to some of his shifts in London and the Midlands.

“The job itself is not very varied at all. It’s all about numbers, it’s exhausting,” Alex says.

To add to this stress, he feels certain employers pressure him to unnecessarily complete services, such as medicines use reviews (MURs), to bolster their profits.

While Alex recognises that profits are important, he points out that it should be up to pharmacists to decide which services are suitable to offer individual patients. “You shouldn’t shove [services] down people’s throats,” he says.

While some of the larger multiples have been accused of putting pharmacists under pressure to perform inappropriate MURs, “independents can be very aggressive as well”, Alex warns.

One respondent to C+D’s Salary Survey pointed out that, despite mounting pressure on locums to maximise profits from services, many pharmacies seem reluctant to provide enough staff to “compensate” for this.

For Alex, the feeling of being left in “the thick of it” due to lack of staff is familiar. “I work hard and I put up with it, but it’s become very difficult to get any time to yourself,” he says. “It is dangerous because you get very tired… overwhelmed, mentally exhausted – and you can make mistakes.”

Too many pharmacists

In certain areas, the pressure locums feel during shifts can be exacerbated by the difficulty of securing work in certain areas in the first place. Mr Patel points out that higher populations of pharmacists in certain regions, such as London, Leicestershire and the West Midlands, can make it harder for locums in these locations to find work.

Unsurprisingly, 35% of locum respondents to the Salary Survey 2016 said they were more worried about lack of work over the next 12 months than the previous year. For Alex, these concerns are familiar.

“Work is not always plentiful,” he says. We have to get up at 6am… and hope you get a call from the agencies. You’re at the mercy of the agencies in order to get work, which is deeply frustrating.”

When asked who they felt was most responsible for their falling pay rates, 18% of locums who completed the survey pointed to this perceived oversupply of pharmacists “flooding” the market.

Alex argues that there are “far too many pharmacists out there” and not enough work to go around, because large multiples do not seem to be expanding. He predicts that the pharmacy funding cuts in England could make the situation worse, as contractors may be forced to cut locum shifts or negotiate rates down even further to make ends meet.
Mr Patel argues there will always be a need for locums – even at rock-bottom pay rates.

“It ebbs and flows, because if you look at what’s going on now there’s a lot of focus on GP practice pharmacists, and there’s a lot of migration into the pharmaceutical industry. That opens up more locum opportunities,” he says.

But he points out that there are still probably too many pharmacists for the amount of work going, especially given cuts to overall funding.

Locum pharmacist John Randell tells C+D that locums need to have realistic expectations: “You have to be seen to provide value in this competitive environment. Good pharmacists who can do many services and are good with customers will never be dumped. [But] the days of just getting a certificate and expecting to coast through life are gone.”

For now, the oversupply of locums is having consequences on the mindset of some pharmacists. Alex says the knowledge that there were many other locums to take his place discouraged him from refusing shifts at a pharmacy where he felt he was badly treated.

“There was not enough work out there. And they knew that, too. They put far too much pressure on me and I felt bullied,” he says. 

Time to move on?

It’s little wonder, in the current climate, that locums are considering moving away from the role. One in four locum respondents to the Salary Survey said they felt so disillusioned with pharmacy that they wanted to move out of the profession entirely.

One of these pharmacists said they hoped they would only be required to work for five more years, before doing another job, “even if it’s… opening a kebab shop”. “At least then I will be happy,” they added.

This sentiment has also been expressed on the C+D website, where another locum pharmacist said: “I spoke to a couple of guys who have been on the register for one year and hate it already. [They] are talking of moving on.”

For the time being, despite facing many difficulties in his role, Alex says he can still see an upside to locum work.

“There are definitely benefits of being a locum,” he points out. “You’ve got freedom to pick and choose the days that you want to work.”

This sentiment was echoed by a respondent to the Salary Survey. “I have just sold my business and am now doing some locum work and a part-time practice [pharmacist] job,” they said, “which is a much better balance than full-time in my own business, when I was always at work.”

Faced with dwindling hourly rates, mounting workloads and increasing competition for work, it remains to be seen how many locums will see enough benefits of the role to stick with community pharmacy. It can only be hoped that with a new year round the corner, the whole sector will make a concerted effort to support locum colleagues to continue to make their valuable contribution.

If this happens, perhaps the results of C+D’s next Salary Survey, launching in 2017, will have some better news for the UK’s locum pharmacists.