Exclusive: Locums under pressure

Declining rates, increasing workloads, payment delays, and unfair contract changes— Let's delve into the complex challenges facing locums   

“Locums are a vital part of pharmacy to ensure branches can remain open and provide vital services to communities and patients across the country,” said Jonathon Clarke, CEO and founder of Locate a Locum.

In an exclusive email interaction with Pharmacy Business, Jonathon noted that while the demand for locums remains high, there has been a dip from the post-COVID peak, which is also reflected in their rates.

Due to the shortage of registered pharmacists, employers are actively seeking locums to cover gaps in their rotas.

“Legally, there needs to be a registered pharmacist on site or else a pharmacy is unable to open resulting in an NHS fine,” he highlighted.

Whether employed or working as self-employed locums, pharmacists face many issues on a day-to-day basis, such as insufficient staffing or commercial pressure to hit “targets”. However, locums also face several unique issues on top of these.

According to Jonathon, a significant challenge locums face due to the changing market environment in the UK is the “rising workload” associated with offering advanced services such as Pharmacy First.

In January 2024, Pharmacy First scheme was introduced and there was understandable concern within the locum market.

However, Jonathan noted that many of the services offered are already health conditions that pharmacists can advise and treat.

Decline in locum rates  

Locum pharmacist rates have also been a hot topic within the pharmacy industry for the last few years.

Jonathan said that a decline in locum rates has resulted in many pharmacists seeking full-time employment instead of working as a full-time locum.

The company's 2024 market rate report shows that the average rate for locum pharmacists across the UK is £33.80 per hour.

In England, the average hourly rate is £32.77, while Northern Ireland's is £26.50, Scotland's is £39.77, and Wales's is £38.18.

“The UK average rate decreased by 13.0% to £33.80 compared to last year’s report, with drops across all four countries of the UK following changes in the pharmacy market and tough economic conditions,” the company said.

The Pharmacists' Defence Association (PDA) also acknowledged that locum rates have generally decreased in real terms over the past decade.

At the 'Locum Matters' online event on June 25, PDA members addressed key challenges facing locum pharmacists, highlighting a concerning trend: employers pressuring locums to accept lower rates under the threat of potential pharmacy closures.

Additionally, the organisation has highlighted that locum pharmacists frequently face uncertainty regarding their work and encounter delays in payment.

 “Unlike employed pharmacists whose hours should continue in future, locums must constantly be securing future bookings and unfortunately sometimes getting paid for their work requires multiple reminders to the business that engaged them,” PDA told Pharmacy Business.

The organisation said it helped locum pharmacists recover more than £100,000 in unpaid fees last year.

Contractual breaches

In July 2024, the PDA advised locums to take screenshots of online agreements due to the growing risk of community pharmacy contractors altering agreed-upon contracts.

In some cases, such contractual breaches have even led to a fee deduction for locums.

The PDA cited an example where a locum found that their shift had been changed post hoc to include a 30-minute unpaid break, which was not part of the initial agreement. This alteration led to the deduction of half an hour from their pay, despite the locum working continuously without a break.

Due to a rise in such unethical practices, locums are strongly advised to document their agreements by taking screenshots to provide evidence in case of any unilateral changes made by the employer later.

Zhyar Said, founder of RevisePharma, also highlighted that contractors often delay locum payments or, in some cases, do not even pay them at all.

Zhyar wants the PDA to expose contractors who have mistreated locums. “I would like to see a register on the PDA website to name and shame the contractors that have mistreated locums so that people can stay well away,” he told Pharmacy Business.

However, Zhyar said that the major challenge facing locum pharmacists today is “the pressure to hit service targets” set by stores.

He elaborated: “Even when a pharmacist is working in their regular store, they may struggle to fit in extra services after a busy day of fulfilling prescriptions, so a locum who isn't used to the procedures would struggle more.”

“There are a few times where store managers have called in to ask why certain services haven't been done, whilst being swarmed with the basics of filling prescriptions.

“Additionally, there are a few locums who do the bare minimum in the case where a store relies on locums most of the time, if you had one of these locums the day before, you will have an unfair amount of workload.”

Would you support minimum pay rates for locums?  

The issue of minimum pay rates for locums is highly debated. Supporters argue that minimum rates would provide financial stability, prevent exploitation, and ensure fair compensation for locums' skills and responsibilities.

However, opponents, including some locums, believe that introducing minimum rates would undermine the flexibility of the free market. They fear it could set a low benchmark, giving contractors more leverage to pay just above the minimum, potentially reducing overall pay rates.

Zhyar believes that introducing minimum pay rates for locum pharmacists would be a “very bad” idea.

He argued: “Firstly, it should be a free market and one of the responsibilities you take on as being a sole-trader is to negotiate your own rates. If a minimum rate were to be introduced, I think it will set the benchmark that most contractors would want to pay. Once there is a minimum set, it gives the contractors more leverage if they are paying slightly over. Unless the minimum is set at something high, then the rates will drop.”

To avoid exploitation by employers, Zhyar advises locum pharmacists to gather all necessary information before accepting a shift.

“At the end of the day, locums are self-employed so I would say if you didn't like working somewhere, don't work for them again - there are plenty of good contractors too,” he said.

The PDA is open to negotiating nationally agreed rates for locum pharmacists, but it acknowledges that “structural changes” are necessary to make this feasible.

It emphasised that first, employers and locums would need to agree to honour such rates, but there is currently no structure or evidence that any employer would agree.

In addition, it would need to be confirmed whether minimum rates would also imply fixed rates, such as maximum rates or a single rate for the job, the PDA added.

Another challenge to achieving nationally agreed rates is that the Competition and Markets Authority (CMA) expects locum rates to remain subject to a free market where rates are freely negotiated.

The PDA highlighted that there have been multiple instances in recent years where groups of locums have tried to agree on minimum rates, only to be instructed by the CMA to stop or face penalties.

“This topic is something the PDA have looked into significantly and if the circumstances changed and it were possible, the PDA would of course be prepared to negotiate collectively for locums under an agreed process,” the organisation told Pharmacy Business.

Lack of training and development

Furthermore, the PDA highlighted a lack of professional development opportunities for locum pharmacists.

It stated that as the NHS only liaises with the representatives of businesses and not the workforce, locums could be often overlooked in important areas such as training and development.

For example, during COVID-19, the PDA had to advocate for locums' access to priority vaccinations and PPE, supporting all locums, not just its members.

The PDA has been advocating for locum pharmacists, aiming to ensure they receive opportunities equal to those of their employed counterparts.

The organisation is currently engaged in discussions about access to Designated Prescribing Practitioners (DPPs), with a strong emphasis on including locums.

The PDA encourages locum pharmacists to advocate their collective interests and reach out to the organisation for advice and support based on their situation.

“Employed and self-employed workers do have different rights at work, and in both cases the PDA is there to help members understand and exercise whatever rights they have,” it noted.

Locums’ expectations from the government

When asked what locums expect from the new government, Jonathon said: “I believe locum pharmacists and the wider pharmacy industry will want sufficient funding from the government to support the rising workload in community pharmacy.”

He noted that pharmacists are clinically trained to act as frontline support which in turn reduces demands on GPs and the NHS.

“With additional funding, pharmacists can continue serving communities to the highest standard without the concern of reduced staff and higher demands,” he added.

How to avoid payment disputes

Jonathon explained that at Locate a Locum, they offer employers a payment product that automates fees.

Pharmacies can upload their terms of service and provide instructions for setting up locums in their system.

“Our Locum Success Consultant team is available during core working hours, as well as evenings and weekends, to assist locums with payment queries,” he said.

Given that payment processes can vary depending on the company, with payments typically made within 7, 14, or 30 days of a shift, Jonathon recommends requesting this information when submitting invoices for any worked shifts to manage payment expectations.