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Calls to limit student numbers branded 'anti-competitive'

Practice Limits would impose needless costs on the healthcare system and place pharmacy students in a "privileged position", according to an academic who also labelled pharmacy a "relatively straightforward" profession.

Pharmacy student leaders have hit back at claims by Abertay University lecturer Kevin Smith that restrictions on the number of pharmacy students would be "detrimental on a wider scale".

Without managed supply and demand of pharmacists, students could be left "stranded" and "unable to complete their education", chair of the Pharmacy Schools Council John Smart and president of the British Pharmacy Students Association Vikesh Kakad have warned.

Their comments came after Mr Smith, a lecturer in genetics and bioethics, accused them of "special pleading" in a letter to the magazine Times Higher Education (TES).

Any restriction on the number of pharmacy university entrants would impose "needless costs on the healthcare system", Mr Smith wrote last week, following a TES article about plans to lobby the government to control entry for undergraduate pharmacy courses.

Pharmacy leaders claimed that, without managed supply and demand of pharmacists, students could be left "stranded"

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"Unless the profession's trade bodies manage (as they surely will) to fix salaries artificially, the economics of supply and demand would gradually drive down the remuneration of pharmacists to a more reasonable and socially beneficial level," he wrote.

And Mr Smith told C+D this week restrictions would place pharmacy students in a "privileged position" and constitute "anti-competitive" practice that would be "detrimental on a wider scale".

"It is a form of anti-competitive 'Spanish practice' of the sort that tends to emerge in vocational subjects, with economically detrimental and unjust effects," Mr Smith told C+D.

"Naturally professional bodies and other interested parties will try to defend their position, and attempting to restrict numbers is one way of doing this."

In his letter to TES, Mr Smith wrote that pharmacists' role was "relatively straightforward... entailing the provision of medicines that have already been packaged, measured and tested".

But hitting back in their own letter to TES, shown exclusively to C+D before publication this week, Professor Smart and Mr Kakad accused Mr Smith of possessing "limited knowledge" of pharmacy education and urged him to "pop down to his local pharmacy to find out what it does".

"The problem we highlight is that, unlike other healthcare professions, there is no mechanism to manage supply and demand in the educational process for pharmacists," they wrote.

"Mr Smith might be surprised to learn that matters have moved beyond ‘the provision of medicines that have already been packaged'," they added.

Speaking at the Pharmacists' Defence Association conference earlier this year, Professor Smart said there were more than 3,000 pharmacy graduates in 2011 – an increase of almost a third since 2008.

Do you think there should be limits on the number of pharmacy students?

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Freelance Pharmacist, Academic pharmacist

What a mess. The worst thing is that the leaders don't even want to recognise the problem.

Chad Harris, Community pharmacist

Don't dental and medical students have quotas in each establishment?
I suppose Kevin Smith is in a tenured academic postion for life?! So he's alright Jack?

David Miller, Hospital pharmacist

The 4 CPhO's stated at the BPC we need to develop and enhance the professional role as rampant commercialism e.g 3 for 2 offers are not in the interests of patients. We are not delivering a commodity and the control of excessive production of healthcare professions is not anticompetitive but a method of ensuring the quality of future pharmacists & meeting the needs of patients not the market. Pharmacy like medicine, dentistry, nursing, all AHPs needs high quality entrants, who provided they continue to maintain and enhance their knowledge can be assured of an opportunity to apply those skills within an on-going tdeveloping expertise, practise and career for patients.

Totally support the stance and arguments proposed by the BPSA

Neil G, Locum pharmacist

I'm not convinced that control of entry, new contracts and rising number of pharmacy students are intimately linked. Yes there is a case where we need to be looking at control of entry, but lets stick to the argument at hand.

Competition is indeed important in all sectors of life. Competition has to how ever have rules. At the moment there are no rules with regard to competition. Instead of locum positions and full time positions being decided by quality, we've got a fight of who is cheaper than the other.

I was talking this over with a very good friend of mine who runs his own business. He said if i need to win business then he needs to undercut the competitors. Now he sells air conditioning units. His advice was, cut your hourly rate and undercut your fellow pharmacists. Whilst some will agree this makes good business sense, I totally disagree this is good for the profession.

Pharmacy degree isn't a commodity its a bloody good service for the good of the nation!

And what level will we stop? Now a nurse (as reported today) earns £15p/hr. I know for a fact there are locum pharmacists who will accept £15p/hr. This in my opinion is ridiculous, dangerous and borderline unfair to the rest of us.

If you want to increase competition you must set the rules. I believe if the governing bodies dictated that the rate of pay cannot and should not fall to a certain amount then we will be able to force the recruiting companies to make sure they either accept that or give up the right to recruit pharmacists.

Because the way I see it, our rates will be slashed, our security will disappear & turmoil will descend on the profession.

If you as contractors cannot afford to pay pharmacists the rate which is agreed, then forfeit the right to the contract. Contractors in my opinion have taken the biscuit on how many pharmacies have been allowed to open. There isn't that much need in some areas & good on PCTs on making it difficult.

I know someone who has opened a new pharmacy, instead of caring about the patients, caring about his staff, building relationships with the GPs etc. he's only interested in opening more! Greed is the motivation factor, not patient care.

Its not just about opening new pharmacies to supply the demand, its about ensuring only the best pharmacists qualify. So look at the scoring system. A aptitude test is now given to dentists and medics. Why not have the same for pharmacists? Lets control the entry requirements, make it harder. So people recognise that we ARE SMART PEOPLE!!!! Not just counting 21 amoxicillin and sticking it in to a bottle.

I had a junior GP hang out at the pharmacy, she was amazed and what we do and now I get phone calls asking for my advice on a regular basis!

We need to change the perception on the lack of quality and start to promote how good we are and how valuable we are to society.

I predict in 10, 15 years down the line, the attitude will be, screw a pharmacist and dispenser. I've got remote supervision and a robot - job done!!

I reckon this debate could get deeper. I believe we have to question our governing bodies on how they have allowed the profession to reach such a state..

Only my opinion..happy hear some comments! :-)


Martin Astbury, Community pharmacist

I completely agree with what chair of the Pharmacy Schools Council John Smart and president of the British Pharmacy Students Association Vikesh Kakad have said, "The problem we highlight is that, unlike other healthcare professions, there is no mechanism to manage supply and demand in the educational process for pharmacists,"

Mr Smith does not appear to be fully pharmacy aware.

Amal England, Public Relations

Kevin what you say is correct to a degree. But beyond the point of saturation the profession is actually damaged, ultimately affecting care, which will increase the burden on the NHS. I feel you sitting there between four brick walls, in front of a wipe board, explains why you have no insight into the world of pharmacy. Perhaps you are getting your role as an academic mixed up with pharmacy?

Chris Pharmacist, Community pharmacist

Continued increases in graduate numbers added to the free movement of EU pharmacists, increasing retirement ages and reductions in the number of PCT pharmacists has created a pretty dire situation

The opinion of a genetics/ethics lecturer at an obscure university is irrelevant. What is important is the continued lack of action from the GPhC/RPS. Now is not the time to allow continued expansion of pharmacy places at existing universities or new schools of pharmacy. Why are no limits even being discussed or thought of?

The only beneficiaries are the multiples who have a plethora of pharmacists to choose from driving down salaries and allow them to impose worsening terms and conditions and working practices. Patients aren't benefitting as increases in workload (ever-increasing targets) rarely improve patient care or service.

I can only assume that the mulitples are influencing those in power to ensure pharmacy graduate numbers continue to increase. Meanwhile, pharmacists do more for less pay and stress levels soar.

Ahmed :-), Community pharmacist

If they want to increase pharmacy student numbers, then jobs within the profession must go to the increasing number of pharmacists. The heavy workloads within pharmacy should mean pharmacies employing more than one pharmacist to spread the work of providing services and checking prescriptions. Invest in pharmacists and patients will reap the rewards. Senior positions within multiples must go to pharmacists which will professionalise the industry and ensure it remains patient care centred. This will result in increased respect from other professionals and not the situation that we currently face where we are perceived to have a "relatively straightforward' job.
In the grand schemes of things, this is just one professional airing his views on our profession and we should not get too upset, he may just be upset because his local pharmacy didn't get his prescription collection and delivery exactly on time.
Recently during a chat with a dentist friend of mine, he asked me why it takes so long for pharmacies to get prescriptions ready...It re-enforced my view that the public has no idea of what happens in a pharmacy...we are seen as highly paid ACTs who stand in the way of the public from accessing highly needed codeine products and sleeping tablets for themselves and their pets(apparently some vets think we're allowed to sell medicines licensed for human consumption for patient's pets). Perhaps our professional bodies should focus on educating the public and other healthcare professionals on our true and potential role within healthcare.

Gordon Adamson, Hospital pharmacist

I see the points of both sides of the arguement. Thisis a huge issue for budding young pharmacists and employers alike.. One of my 4th year students raised if with me earlier today, and it saddens me so many many young graduands have little prospect in their chosen careers. Currently pharmacists, especially hospital pharmacists, are paid significantly less than than the other HCPs that require a Masters degree (e.g. Medics/dentists), thus adding to the great disilusionment within the profession. I suggest variety of measures as a solution:
1) more pharmaceutical industry pre-regs places
2) Vocational training schemes to allow pharmacy graduates to progress to in pharmaceutical industry/utalise skills in related careers but not nesaceraily qualify as a pharmacist.
3) All undergrad pharmacy courses should be integrated with prereg training similiar to that found in bradford. This would help to ensure supply meets appropraite demand/profession capacity.
4) increase entry requirments to the pharmacy undergrad course
5) generally better financial insentive to become a pharmacist within the profession.
5) PharmD as entry level requirment to prefession. This would help ensure only the most capable students get to qualify.

Hope some of these are helpful, and maybe someone more influential than I could help inplement them.

Raymond Lee, Community pharmacist

There has to be a sensible and logical debate on student numbers. Producing more pharmacists than is required is detrimental to the profession as a whole. All healthcare professions have a limited number of students - eg dental schools have around 60-70 students per year.

There are only a finite number of pre-reg training posts available - there is simply no point having say, 3000 graduates when there are 1000 pre-reg posts!

Limiting the number of pharmacies is completely a different debate - don't mixed the arguments together!!!! The main discussion should the role and future roles of the pharmacist. Define the function and then the process, not the other way round.

S Morein, Pharmacy Area manager/ Operations Manager

The issue of control of entry and limits on pharmacist numbers are inherently linked. For the profession to flourish and develop the ridiculous limits on new contracts need to be scrapped by the new awarding committees. It is obvious that in all localities new pharmacies are urgently needed. Just look that the overwhelming evidence of pharmacists surveyed in this journal unable to cope with a rising workload.
If PNA rare to be met then its obvious that significant extra contractors must be allowed. If unknown advantages are to encouraged then new contract again have to be allowed.
Limiting the numbers of pharmacists is as detrimental to the profession as contract limitation. It appears that greed self interest and a huge amount of humbug or hypocrisy is evident by both contractors and those organisations that claim to represent them.

Yo Palumeri, Community pharmacist

Market conditions rule hooray. Academics must also remember that it applies to them also.
Once the market is over supplied salaries will drop to a level which may or may not be attractive. If it is not attractive then the £36k for an education will surely dampen demand for pharmacy places when there is little chance of suitable rewards or employment. If this happens and we see academic pharmacy departments fail what then?
This impact won't be felt for at least 4 years in academia so get planning now
On the postive side you can always work a technicians wage and get rid of those pesky atc's

Neil G, Locum pharmacist

Interesting article! This statement is interesting...

"the economics of supply and demand would gradually drive down the remuneration of pharmacists to a more reasonable and socially beneficial level,"

What does he consider to be more reasonable and socially beneficial?

I should also like to much his salary is a year? Is that socially beneficial and more reasonable?

Does everyone think that we mint a few bob?

So confused. the perception is totally inaccurate. Does anyone know if there have been any new dental or medical schools opened? Is the opening at the same rate as Pharmacy?

Can anyone just apply now?? Didn't we used to have to prove that we cared for the health of others? That we wanted to make a difference?

I think Mr Smith hasn't done his homework. Anyone else think his statements are rather flippant and misguided?

follow me @neilgathani

Career Miss Take, Locum pharmacist

I couldn't agree more Neil. But will we really need to limit numbers. Any well informed intelligent graduate would think carefully before entering a once fabulous career, particularly as it is in the state that it is in now.After paying ridiculous tuition fees they can look forward to a woeful salary and and a life of stressful multitasking and basically being treated like ****.

Din Patel, Manager

Well what about control of entry/contract limitation? Isn't this also anti-competetive? Scrap control of entry and let all pharmacists compete with other on a fair and equal basis. Let leap frogging return. The choice is simple: treat an employee fairly, with respect and pay a fair salary or he may open next door.

Dipesh Patel, Community pharmacist

I agree but guess what every Pharmacy contract costs the DoH in the region of £70k. Do you think the taxpayer can afford this. Obviously No so let's use the network we have at present and make them improve.Don't forget some of these pharmacist have devoted their life to this profession by owning their own pharmacy therefore must be rewarded for the service they have provided.

Chris Pharmacist, Community pharmacist

Dipesh and Din, this thread is regarding the rising numbers of pharmacy graduates not control of entry.

Have you read the article?

Din Patel, Manager

C Farrell, I guess you cannot see the link between rising numbers and control of entry and the effect. They are not mutually exclusive and the original article mentioned "anti-competitive", exactly what control of entry is. This anti-competitive argument is pointless.
Also if pharmacists cannot get a job they may not be able to pay back their student loans and the country suffers a loss. Doctors, dentists and opticians regulate university places. But then again pharmacists have the lowest "A" level grades for entry and thus are the most stupid and are paid less. They have to be stupid to select pharmacy! I suppose the truth hurts. Why waste 4 years at University to earn peanuts? Have the sense and leave pharmacy.

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