Hospital pharmacy workforce

EAHP Position Paper on the Hospital Pharmacy Workforce

Making a difference for the profession

Healthcare workforce shortages are felt across the globe in all professions. The WHO highlighted for its European region that countries are currently facing severe challenges related to their healthcare workforce that existed before the COVID-19 pandemic and that have been exacerbated by it.¹ In addition to individuals leaving the healthcare professions due to increasing workloads and unmanageable staffing situations, the healthcare workforce is ageing.² A demographic shift of a large section of the workforce into retirement age threatens to impact human resources in all European health professions. Response in the form of adequate workforce planning is urgently needed.

Scientific achievements, for example, in the field of advanced therapy medicinal products, are leading to increasingly complex medication-related problems, such as specific handling, preparations and related issues. In addition, new competencies and tasks widened the scope of hospital pharmacist involvement in multiprofessional teams in the hospital setting and beyond. Medicines reconciliation, medication optimisation, bedside counselling or being part of the antimicrobial stewardship team are just a few of the clinical pharmacy services that should be provided to all patients across Europe by hospital pharmacists as part of the multidisciplinary care team. A resilient workforce is required to ensure the availability of these vital services.

Other aspects necessitating a future-proof pharmacy workforce are the increasing individualisation of care, growing medicine shortage problems requiring interventions by the hospital pharmacy workforce, and rising healthcare costs. This can be addressed with the help of pharmacy expertise linked to the procurement of medicines and medical devices and through health technology assessments, but it is also associated with larger requirements for the workforce, such as handling the often very specific needs of patients. Another very important area for optimal patient outcomes and safety is the interface of care. There is a growing need for highly educated and specialised hospital pharmacists in medication and medication-related processes that can ensure the seamless transfer of patients between healthcare settings.

High-quality education in all European countries is of utmost importance for addressing the workforce problems of pharmacists to ensure that the profession remains an integral part of healthcare. Education needs to go hand in hand with hiring enough pharmacy personnel, including support staff, and training a sufficient number of students each year to robustly grow the pharmacy profession in each country.

For the European Association of Hospital Pharmacists (EAHP) it is clearly time to act for patients in all countries around Europe. Consequently, EAHP has put forward actions that should be taken at the local and national levels, including short-term measures for improving pharmacy staffing and long-term plans for securing a resilient workforce.

EAHP urges European governments, hospital administrations, healthcare professional organisations and other decision-makers, including the chambers of pharmacy, to consider the actions and measures put forward by EAHP in this position paper when addressing the grave shortcomings in planning and robustness for the pharmacy workforce.

Actual and future needs of the pharmacy workforce

The traditional role of the hospital pharmacist, which concentrated mainly on dispensing and compounding medicines, has evolved over the last decades. Today, hospital pharmacists are still dispensing products to patients and they are continuing to compound. But in addition to these fundamental tasks, other equally important ones such as performing quality controls, providing expertise on matters concerning pharmaceutical products and devices, procurement, engagement in clinical trials and carrying out clinical pharmacy services were added to the scope of hospital pharmacy activities.

Bedside clinical pharmacy services with their focus on patient education, medicines reconciliation and engagement in the multidisciplinary treatment team have become an important feature of hospital pharmacy practice in the 21st century. To prepare the hospital pharmacy profession for the future, EAHP adopted the European Statements of Hospital Pharmacy in 2014.³

In addition to the solidification of new roles, reinforcing the pharmacy workforce is essential, in particular for the seamless transition of care between healthcare settings. To this end, increased hospital pharmacy engagement and improved collaboration are needed to achieve a pharmacy interface model that connects the community to the hospital side.

To cater sufficiently for the current and future needs of the pharmacy workforce, actions at both local and national levels are needed that support the changing roles of the pharmacy profession.

Actual and future needs of the pharmacy workforce

Actions at the local level (pharmacists and their professional organisations, including the chamber of pharmacists)

• Promote the changing roles of pharmacists

• Emphasise the necessary cooperation between healthcare and social authorities, education system and payers

• Showcase the profession to make it more attractive

• Cooperate with universities on working with students

Actions at the national level (authorities and universities)

• Train a sufficient number of students each year to robustly grow the pharmacy profession in each country

• Invest in both the profession and the pharmacy infrastructure

  • use automation whenever possible and support the development of new IT technologies (artificial intelligence, machine learning) to help pharmaceutical teams in their decision-making and enable them to focus on the activities that require the most pharmaceutical expertise

  • promote task shifting and changing roles of the pharmacy profession.

Short-term measures for managing workload and improving pharmacy staffing and recovery

To maintain appropriate staffing levels, hospital administrations need to:

• support the continuing education of pharmacists and pharmacy support staff that aims at task shifting and further implementing the changing roles of the pharmacy profession, and

• hire more supporting staff to ensure that the capacity of pharmacy personnel is used most efficiently.

In a labour market as interconnected as in Europe,

• invest in the free movement of the pharmacy workforce to support its flexibility, and

• increase attraction to the profession by setting clear career development plans and manageable workload, and improve (where needed) salaries and benefits which are paramount for the retention and recruitment of pharmacy staff.

Long-term plans for securing an adaptable, versatile and resilient workforce

Pharmacy workforce plans of European governments should:

• continuously expand the training capacity for pharmacists and invest in undergraduate education that provides basic professional knowledge in hospital pharmacy, and ensures that pharmacists can acquire the required competencies in hospital pharmacy when entering the profession

• establish clear career development pathways for the entire pharmacy workforce, including well-developed specialisation systems

• increase the support for experience-based training and exchange within Europe

• adapt the curriculum to integrate the changing roles of the profession to match the evolvement of pharmacy roles over time.

Actions at the local level (pharmacists and their professional organisations, including the chamber of pharmacists):

• Promote the changing roles of pharmacists

• Emphasise the necessary cooperation between healthcare and social authorities, education system and payers

• Showcase the profession to make it more attractive

• Cooperate with universities on working with students.

Actions at the national level (authorities and universities):

• Train a sufficient number of students each year to robustly grow the pharmacy profession in each country

• Invest in both the profession and the pharmacy infrastructure

  • use automation whenever possible and support the development of new IT technologies (artificial intelligence, machine learning) to help pharmaceutical teams in their decision-making and enable them to focus on the activities that require the most pharmaceutical expertise

  • promote task shifting and changing roles of the pharmacy profession.

Short-term measures for managing workload and improving pharmacy staffing and recovery

The pharmacy workforce comprises pharmacists and support staff, including but not limited to pharmacy technicians, assistants and other types of individuals that foster the delivery of pharmaceutical services. Support staff usually undertake technical tasks that are delegated under the supervision of a pharmacist or performed collaboratively.⁴ Both pharmacists and support staff contribute to the effective functioning of the pharmacy. For the provision of adequate care a well-functioning pharmacy is paramount. Healthcare staff shortages are, however, negatively impacting this equilibrium.⁵ To maintain appropriate staffing levels, hospital administrations need to:

• support the continuing education of pharmacists and pharmacy support staff that aims at task shifting and further implementing the changing roles of the pharmacy profession, and

• hire more supporting staff to ensure that the capacity of pharmacy personnel is used most efficiently.

Under-investment in healthcare, austerity measures and lack of focus on staff retention has considerably deteriorated the conditions for the healthcare workforce. The COVID-19 pandemic additionally contributed to the negative image of healthcare careers, consequently pharmacy is no longer an attractive career choice in Europe. The work–life balance of the healthcare workforce is an important connecting point that needs to be considered when taking short-term measures to improve the appeal of the pharmacy profession. In addition, the salaries of hospital pharmacists and pharmacy support staff should be competitive. In a labour market as interconnected as in Europe,

• invest in the free movement of the pharmacy workforce to support its flexibility, and

• increase attraction to the profession by setting clear career development plans and manageable workload, and improve (where needed) salaries and benefits which are paramount for the retention and recruitment of pharmacy staff.

Long-term plans for securing an adaptable, versatile and resilient workforce

Planning for the right number and mix of health workers is a task that healthcare systems across the globe have to consciously carry out. Poor forecasting can be detrimental. Continuous forward planning is needed to ensure that the healthcare workforce remains adaptable, versatile and resilient. In the pharmacy sector, proper planning entails factoring in the overall pharmacy workforce, covering community, clinical, hospital and industry pharmacy, and ranging from pharmacists to support staff. A key step towards a robust and future-proof pharmacy workforce in each European country is expanding the capacity of the education system to ensure sufficient training opportunities for all pharmacy positions.

Pharmacy workforce plans of European governments should:

• continuously expand the training capacity for pharmacists and invest in undergraduate education that provides basic professional knowledge in hospital pharmacy and ensures that pharmacists can acquire the required competencies in hospital pharmacy when entering the profession

• establish clear career development pathways for the entire pharmacy workforce, including well-developed specialisation systems

• increase the support for experience-based training and exchange within Europe

• adapt the curriculum to integrate the changing roles of the profession to match the evolvement of pharmacy roles over time.

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