Pharmacy

Medicines are a big part of how we keep people well from long-term conditions to acute care. Our pharmacy workforce have deep expertise in how we use pharmaceuticals to best effect and with greatest safety, and are responsible for dispensing: ensuring people receive the right medications.

There are around 4,150 pharmacists working in New Zealand, based on 2023 Pharmacy Council data, as well as a significant allied workforce of around 3,200FTE pharmacy technicians. Our number of technicians includes accuracy and checking technicians (PACTs) – we think around 200 – 250 – who have additional roles in dispensing and checking medicines, supervised by a pharmacist. We have poor data on our allied pharmacy workforces, as they are not registered professions under the Health Practitioners Competence Assurance Act.

Our pharmacy workforce is overwhelmingly community-based, with around 76% of pharmacists practising in the community and 13.4% in our hospitals (with the remainder across other settings).

Both our hospital and community pharmacy sectors have indicated that they need growth to meet demand, based on how we practice today.

The most notable trends in our pharmacy workforce are declining enrolments in pharmacy programmes, and the unusually high rates of attrition out of the workforce from pharmacists relatively early in their careers. While there might be many contributing factors to this – including rates of pay in the community, and levels of support once pharmacists finish their internships – we think one factor is decisive.

Pharmacists train to be exceptionally skilled in understanding pharmaceuticals and in pharmacology: how medicines work on people, including how they work together. But these skills often are not the focus of pharmacists’ work. We think there is a major expectation gap between what new graduates want to use their pharmacist skills for, and the kind of work they get to do in many pharmacy roles.

This is a big problem for pharmacy. If we can’t keep new pharmacists, we can train more but won’t build the capacity we need.

With this problem comes a huge opportunity. Pharmacists are skilled professionals who can help address some of the emergent drivers of poor health among New Zealanders, including:

• Older people who are on many medicines, and can have these medicines optimised to produce better results or to reduce side effects. This can lead to better management of overlapping (or ‘comorbid’) conditions and better quality of life; and reduces the risk of events like falls for people experiencing frailty.
• Providing over-the-counter care to help lift load off general practices, and manage more conditions at the point of dispensing.

While these practices are already happening in some pharmacies, our funding models are not oriented towards these kind of services. This means that they can be sporadic, and pharmacy business models usually still rely on a blend of dispensing and retail to operate sustainably.

Pharmacy technicians and PACTs are versatile workforces which can do a lot if we create the right roles for them, taking over much of the repetitive (but important) work of dispensing, under appropriate supervision.

There are also some opportunities that technology will create: for example, there are now machines which can accurately dispense medicines at volume. But these technologies would require big change to our pharmacy sector to make a difference in most cases; New Zealand’s small size means that there often aren’t economies of scale in using these technologies in individual pharmacies, and as our sector is currently arranged.

Given high rates of new graduate attrition and struggles to fill our pharmacy training places in tertiary training, just “more” is not going to achieve sustainability for our pharmacy workforce. This means our focus for the next three years needs to be on:

• Making better use of our pharmacists’ skills. Pharmacists are experts in how medicines work and help us manage illness – but these skills are can be underutilised in some community pharmacies.
  To make better use of our pharmacists’ talents and retain new graduates, we need to create roles for them to do more over-the-counter care and medicines reviews. To make this sustainable, we will also need to shift community pharmacy funding models to incentivise these same activities in the community. These roles will both improve care and make pharmacy more attractive, addressing our capacity and attrition problems.
• Growing technician and top-of-scope roles. Making better use of our pharmacists across the health system will require more pharmacy technicians and PACTs to support dispensing – so we need to train for this future capacity.

We expect that the above changes will make a significant difference to our rates of retention, and long-term sustainability of our pharmacy workforce. But if they do not have enough of an impact, we may also need to look at whether we have the right economies of scale for the provision of pharmacy services – and whether we could organise our pharmacy sector differently to make the most of our pharmacy workforce.