Pharmacy Workforce Census: headline findings

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					 International health worker
    migration: the case of
       GB-registered
        pharmacists
     Professor Karen Hassell
Global health, Justice and the ‘Brain
Drain’ Conference, Keele University
        17th September 2007
          Acknowledgements

•   Liza Nichols – PhD Student
•   Peter Noyce – other supervisor
•   RPSGB        – funding
•   The pharmacists themselves


       For more information about our
            research please visit:
        www.manchester.ac.uk/cpws
         Presentation outline

• Some background about the pharmacy
  profession
• Data on the current stock of pharmacists
• Migration in and out of the profession
• Who emigrates and why
• Implications
      Some facts about pharmacy
•   Degree entry profession from 1967
•   Now a 4-year (MPharm) degree programme
•   1 year pre-registration training before qualifying
•   16 ‘established’ Schools of Pharmacy
•   Majority of pharmacists work outside the NHS
•   Large chains now dominate private sector
•   Changing professional role
•   The RPSGB (and PSNI) is currently the professional
    and regulatory body for the profession
Number of GB registered pharmacists:
           selected years
                                               26932
2007                                                                         47962

                                   20325
2001                                                              39,467

                           14259
1991                                                      32913

                    9432
1981                                             28,617

             6800
1972                                           26810


1964       5064
                                             26,629

       0            10,000         20,000              30,000       40,000           50,000
                                    All pharmacists    Females
Number of pharmacists: 2002 to 2007
                  Total number on regsiter by gender
 28000

 27000

 26000

 25000

 24000

 23000

 22000

 21000

 20000
          2002     2003         2004        2005       2006    2007
 Male     21912   22152        22396        21193      20949   21030
 Female   23355   24233        25182        25203      26119   26932
                       Demographic profile of all pharmacists on GB register (2007)

         Female                                                                   56.2
           Male                                                       43.8


          White                                                                               71.9
          Asian                             19.1
       Other EG           5.6
           Black        3.4


29 yrs and under                                 21.0
     30 - 39 yrs                                          27.1
      40-49 yrs                                    23.0
     50 - 59 yrs                        16.1
 60 yrs and over                     12.9

                   0            10          20             30    40          50     60   70          80   90

                                                                      %
           Age groups by gender (2007)
     35
                                  30.4
     30
               24.8
     25                                          23.9
                                         22.9
                                                        21.8
                                                                                    20.4
     20                                                               18.9
%                     16
     15                                                        13.8

     10
                                                                                7
       5
       0
           29 yrs and under     30 to 39 yrs    40 to 49 yrs    50-59        60 and over

                                            Female      Male

Data source: 2007 register (n = 47232)
 The pharmacy workforce in context

• Not largest health care workforce in GB:
  • Smaller than nurses and doctors
  • But larger than dentists and physios


• Size in comparison with other countries:
  • 249,642 (88/100k pop) in USA (2000 data)
  • 13,956 (72/100k pop) in Australia (2001 data)
  • 20,765 (67/100k pop) in Canada (2003 data)
Distribution of pharmacists in selected
          EU countries (2004 data)
      Malta
    Finland
        Italy
    France
      Spain
EU Average
          GB
Switzerland
   Denmark
    Poland
   Germany
    Norway
    Turkey
Netherlands
                0   50   100               150            200              250
                                                  Data source: www.fip.org
                         per 100,000 population
 Distribution of pharmacists elsewhere
                            (2003/04 data)


       GB

   Ethiopia

   Uganda

   Gambia

 Cameroon

   Nigeria

Bangladesh

    Kenya

              0   10   20     30        40          50       60         70        80
                               per 100,000 population



                                              Data source: www.who.int/whosis/database
      Immigration of pharmacists:
               Students
• How many?
  •    UCAS data: 1741 (1996); 2237 (in 2001)
  •    19% & 16% respectively were from
       ‘overseas’
  •    In 2001 majority (53%) were non-EU
• Trends?
• Why study in the UK?
• What happens after studying?
      Immigration of pharmacists:
             Practitioners

• There were three (but now two) routes
  for overseas pharmacists to enter the
  register of pharmaceutical chemists:
  •   ‘European’
  •   ‘Adjudicating’
  •   Reciprocity route abolished
  Number of foreign trained pharmacists
domiciled in GB, 2002 - 2004, by entry route

  1200


  1000


   800


   600


   400


   200


         0
             2002      2003          2004
 Recip.      961        968          1059
 Euro.       481        864          989
 Adjud.      975       1130          1244
 total       2417      2962          3292
        Immigration of pharmacists:
               Practitioners
•   Not a large number/proportion, but growing
•   Registration requirements vary
•   Source countries
•   Practitioner experience of working in GB?
    •   Exploitation?
    •   Work conditions?
    •   Language problems?
    •   Financial burden?
    •   Pre-registration difficulties
Pharmacist emigration
                  Pharmacist emigration
                                          45110 (100%)
                                           GB Register



                  40279 (89%)
                   Home status
          (current address is GB based)




 37317         968        1130         864
(82.7%)      (2.1%)      (2.5%)      (1.9%)
  GB         RECIP        ADJ             EU


       Movement into Britain
       All overseas qualified = 6.5%


                                                         2003 data
                  Pharmacist emigration
                                          45110 (100%)
                                           GB Register



                  40279 (89%)                                      4831 (11%)
                   Home status                                   Overseas Status
          (current address is GB based)                 (current address is overseas based)




 37317         968        1130         864         3562           1008          112             149
(82.7%)      (2.1%)      (2.5%)      (1.9%)       (7.9%)         (2.2%)       (0.3%)          (0.3%)
  GB         RECIP        ADJ             EU       GB             RECIP         ADJ            EU


       Movement into Britain                                Movement out of Britain
       All overseas qualified = 6.5%                        All =11%; GB qualified = 8%


                                                                                                       2003 data
        Pharmacist emigration:
            why study it?
• Emigration thought to be
  exacerbating workforce shortages:
  •   Demand for services increasing
  •   More chain-store pharmacies
  •   More elderly people
  •   Higher levels of prescribing and use of OTCs
• Movement out > than movement in
• Dissatisfaction with their profession?
• Will they return to GB?
       Pharmacist emigration:
          a research study
• Literature review
• Secondary analysis of existing data:
  •   UCAS data on students
  •   RPSGB pharmaceutical register data on
      pharmacists leaving and joining
• Primary research about GB-trained
  pharmacists who reside overseas:
  •   email ‘interviews’
  •   postal and email survey (Jun–Dec 2003)
  •   55% response rate (n=1947)
           Research questions

•   Who is leaving?
•   GB nationals?
•   Why are they going?
•   Where are they moving to?
•   What are they doing?
•   Will they return to GB practice?
            So who are they?
• Men are over represented
• Most (82%) are working
• ‘Top’ destination countries:
  • USA, Australia, Ireland, Canada, Hong Kong,
    elsewhere in the UK; (Malaysia, New Zealand,
    Kenya).
• Over a quarter (27%) are non-GB
  nationals
• Reasons for leaving vary: push and pull
  factors feature, but ‘pull’ more prominent
                                    Why leave GB?

                                                       15.1
                                                       14.7
        All overseas
                                                  13.8
                                                 13.3



                                                                                                   34.8
                             2.1
          Hong Kong
                                                        15.6
                                   6.7



                            1.1
                                                12.2
Economically inactive
                                               11.8
                                                                                            31.4


                        0                10                      20                    30                   40          50
                                                              Top 4 reasons: % of respondents


                   Partner's job              Career opportunity                   Lifestyle              Return home
          What are they doing?
• 18% is economically inactive:
  •   includes retired, carer, travelling/education
• 8% of ‘economically active’ work outside
  pharmacy
• 29% of ‘pharmacy’ employed don’t work in a
  health care setting:
  •   Over half (52%) of these work in industry, 12% in
      academia, and 10% in marketing
  •   Industry work is more prominent among the
      emigrating pharmacists (14% cf 4%)
• Most (49%) work in community (retail)
  pharmacy
                     Future intentions of those
                         who’ve emigrated
                                     11.2
Eventually want to return
                                                   21.3
         to GB                         14.1



                                                            27.9
Stay long term (2 yrs +)                                                            46.5
                                                    22.6



                                                                           37.9
  Depends on personal
                                                                                  44.5
    circumstances                                                   33.8



                                                                                              53.6
      Stay permanently                                    25.2
                                                                                                      59.7


                            0   10            20             30            40            50          60      70   80
                                                                  % of respondents

                                                    Not working       Hong Kong      All overseas
                      Pharmacist emigrant:
                       a possible typology
                            Migration from
                                  GB:
   Travel/lifestyle         GB-qualified exits           Retired migrant
   migrant                    from Britain



   Returning home
       migrant                                               Migrant partner
Overseas nationals who          Career migrant            Spouse trailing/ tied
qualify in GB - funded by                                 movers
their ‘home’ government     Occupational
                            achievement, career
                            preferences, job mobility,
                            opportunities
                   Summary
• Number of foreign-trained pharmacists in GB is not
  large, but it is increasing
• A sizeable proportion of GB-trained pharmacists
  emigrating are non-GB nationals
• Over half intend staying overseas permanently
• Pull factors more prominent than push for
  emigrating pharmacists as drivers to leave
• Emigration mainly driven by social & career factors
• Most work in commercial healthcare setting
               What next? (1)

• For policy?
  • System of recording and monitoring movement for
    workforce planning purposes and research

  • Should professional body assist developing
    countries to expand their capacity to train and
    retain staff?

  • Should the RPSGB consider not taking
    pharmacists from under served countries?

  • Liaise and learn from other health care regulators
    and professional bodies
               What next? (2)

• For research?
  • Describe and understand migration into GB
  • Consider impact of movements on receiving
    countries and countries ‘losing’ pharmacists


• For employers in GB?
  • Employer responsibilities?
  • Consider their role in inducing talent exit?
  • Retention or return to (GB) practice initiatives
Thank you

				
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