Shared workforce model for pharmacists: optional guidance for employers

Optional guidance for employers. Version 2.0, 28 November 2023.

Note: this publication contains optional guidance only as to the potential contractual models available to facilitate a shared workforce; it is not a recommendation that shared workforce models are generally appropriate and/or that they should be implemented in any specific case.

NHS England will not be held responsible for any liability arising from this guidance and organisations should not place any reliance on it; individual organisations must seek their own advice before entering legal agreements for shared workforce models or other shared employment arrangements.

Introduction

This guidance document has been designed by NHS England and informed by local pharmaceutical committees and employer organisations. It sets out optional workforce models that community pharmacies and hospital pharmacy departments may wish to consider in collaboration with primary care networks (PCNs).

Shared workforce models may help to meet local system workforce needs, particularly where there are retention and recruitment issues. They also provide individuals with opportunities for varied portfolio careers which may realise benefits in integrated care and greater job satisfaction.

Benefits of shared workforce models

Employer/provider

  • Improved recruitment and retention
  • Cross sector insights that facilitate improved whole system patient care and strengthen working relationships
  • Fully funded education and training of PCPEP course can provide transferrable consultation and prescribing skills to all settings
  • Maintaining access to community pharmacies
  • Sharing of independent prescribing supervision resources; for example, PCN senior clinical pharmacists
  • Greater resilience to workforce changes (for example, by having two 0.5 whole time equivalent [WTE] posts versus a single, full WTE post).

Pharmacist

  • Improved job satisfaction
  • Professional development opportunities, such as fully-funded education and training of primary care pharmacy education pathway course, including independent prescribing qualifications
  • Job variety from portfolio working
  • Greater flexibility
  • Maintaining skills across different sectors of general practice, community pharmacy and hospital pharmacy.

Local workforce planning in systems should consider the needs of all relevant sectors. The process overview section provides a three-step guide to implementation.

Decisions for adopting shared workforce models should be based on the needs of individual members of staff, individual organisations and the workforce needs of local systems.

Shared workforce models between PCNs and other sectors employing pharmacists can be defined by contractual arrangements. Suitability of these contractual models and how they should be delivered operationally (for example, split roles, rotational) should be based on the needs of relevant parties.

Potential contractual models for shared workforce

Service provider model

  • Organisation A employs pharmacists.
  • Organisation A enters into agreement to provide pharmacy or pharmacist services to Organisation B (and C and D, etc, as appropriate), ordinarily in exchange for payment, whether on a commercial or costs-only basis.
  • The services are delivered by Organisation A’s employed pharmacists under the terms of the services agreement, as part of their duties and responsibilities for Organisation A.

Secondment model

  • Organisation A employs pharmacists and seconds some or all such employees to Organisation B under the terms of a secondment agreement(s), whether on a full or a part-time basis and whether or not on a paid-for basis (to be agreed between Organisation A and Organisation B).

Joint employment model

  • An employee pharmacist is appointed by more than one employer (eg Organisation A and Organisation B), and a single joint contract of employment is held between the employee and the relevant employers.
  • Employee works across both Organisation A and Organisation B.

Concurrent employment model

  • Employee pharmacist holds a separate contract of employment with each organisation for whom they are to provide work.
  • For example, an employee has two 0.5 WTE contracts: one with Organisation A, one with Organisation B.

Process overview

Step 1: Assess local workforce needs

Facilitated by integrated care boards (ICBs)/training hubs, workforce conversations should bring together employers from community, hospital and general practice to discuss how best to meet the needs of local systems, employers, pharmacists and patients.

Sharing of workforce data may help mutual understanding of local system interdependencies and inter-organisational opportunities.

Step 2: Agree workforce models

Contractual and operational models for how best to share the existing workforce should be agreed between all sectors.

This includes:

  • whether shared models applies to existing staff and/or to newly recruited staff
  • what work is to be done and the proportion of time to be spent by an employee(s) in each sector
  • apportionment of any payment/costs, annual leave entitlements and allocation of study leave.

Recruitment strategies should also be agreed upon.

Step 3: Implement agreed models

Implementation should be in accordance with agreed contractual terms (ie of employment, secondment and service agreements, as appropriate).

Where recruitment is required, this can be directly by the employers or supported by the system, for example the training hub.

Key considerations

Contracting arrangements

Employers of pharmacists should consider which contractual and operational models best suit their organisational and employee needs.

In the case of the service provider model, the service level agreement (SLA) should set out how organisations will work together within the shared workforce model while fulfilling the terms of employment contracts.

For all other models, a memorandum of understanding or other form of ‘collaboration agreement’ between the organisations who are parties to the arrangement (that is, the employers and the sending and receiving organisations) should be prepared.

This should document how the organisations will co-operate within the chosen shared workforce model, while also satisfying statutory and contractual obligations to the affected employee(s).

Risk

There will be a range of commercial and legal risks associated with each of the contractual and operational models

Organisations should take their own independent professional advice regarding the risks – and options for mitigation – when considering the suitability of any of the potential shared employment models and before proceeding with a shared workforce model in any case.

VAT

Below are outlined the usual VAT implications of each of the four contractual models identified:

Service provider model

The starting point in assessing the VAT liability is determining whether the supply in question is a supply of staff or an exempt supply of medical services.

A supply of staff where the staff member comes under the direction and control of the recipient is usually taxable at the standard-rate of VAT.

The key determinant is who exercises operational control because this determines where and when the staff work, which patients they see, and the practices and protocols which govern their clinical decision-making.

If a clinical professional can be moved from task-to-task by the recipient, then this will indicate that operational control rests with the recipient. If so, there is a supply of staff which is subject to VAT.

There are a few exceptions to this rule including a mechanism that enables staff that are seconded between NHS bodies to be treated as outside the scope of VAT and therefore not liable for VAT.

Secondment model

There is a supply of staff when one party makes available its employee to another party – normally, through secondment of the employee – in return for consideration.

However where an employer seconds a member of its staff (the employee) to another business which:

  1. exercises exclusive control over the allocation and performance of the employee’s duties during the period of secondment
  2. is responsible for paying the employee’s remuneration directly to the employee and/or discharges the employer’s obligations to pay to any third party PAYE, NICs, pension contributions and similar payments relating to the employee

Then, to the extent that any payments within (b) above form the consideration (or part) for the secondment of the employee to the other business, they are disregarded in determining the value of seconding the employee.

Joint employment model

In cases of joint employment, there is no supply for VAT purposes between the joint employers.

Staff are regarded as jointly employed if their contracts of employment or letter of appointment makes it clear that they have more than one employer. The contract must specify who the actual employers are.

Staff are not jointly employed if their contract is with a single employer even if it requires them to work for other organisations.

Concurrent employment model

There is no VAT on payroll. Salaries paid via the PAYE system are outside the scope of VAT, meaning they don’t appear on a VAT return.

Guidance on accounting for VAT

HMRC guidance provides advice on how to account for VAT on goods and services
provided by registered health professionals, including pharmacists.

The Network Contract Directed Enhanced Service (DES) VAT Information Note may help guide providers, who should take their own advice in relation to the VAT implications of their preferred shared workforce model before implementing any such model.

Delivering the Network Contract Direct Enhanced Service (DES)

Where PCNs are reimbursed via the Additional Roles Reimbursement Scheme (ARRS), they must ensure recruitment of clinical pharmacists is in accordance with the Network Contract DES.

Both employers should be aware of these requirements, which includes the requirement to undertake and qualified from an approve training pathway such as the 18-month PCPEP course.

Education and training requirements

The demands of education and training in both sectors should be discussed and agreed by employers and pharmacists prior to starting cross-sector models.

Most pharmacists recruited under the ARRS are contractually required to undertake the Primary Care Pharmacy Education Pathway (PCPEP) as specified in the Network Contract DES. Where this applies, it is recommended that a split role (eg 0.5 WTE in each provider every week) is adopted to allow continuity of learning in general practice.

Rotational models (ie blocks of consecutive weeks/months at each employer) are more suitable for clinical pharmacists who have qualified from the PCPEP course or equivalent.

A requirement of the PCPEP course is that 28 days’ study leave must be given to the PCN clinical pharmacists, regardless of their WTE in the PCN.

Full-time and part-time staff are expected to complete the PCPEP course in 18 months.

Study leave arrangements should be contractually agreed between both organisations prior to commencement of roles. An equivalence/exemptions route can be applied as outlined in the latest version of the Contract DES guidance and specifications.

Expediting the independent prescribing training is generally not recommended.

There is recognition from the delivery of the PCPEP programme, by completing PCPEP prior to independent prescribing pharmacists are able to complete the independent prescriber training within the context of the patient needs of their locality.

NHS England has set up Primary Care Training Hubs in England to support workforce planning, retention, education, training, and development of primary care roles.

The hubs may have websites with specific sections dedicated to pharmacy professionals which provide online resources to guide organisations and pharmacists.

The information on these sites is from local and national NHS, and external organisations so organisations should look at seeking their expertise to support the education/training needs of their pharmacists.

They can also be contacted directly for advice if you are unable to find what you are looking for on the training hub website.

Go to the NHS England website to find your local training hub.

Supervision

Pharmacists reimbursed through the ARRS must be employed under appropriate supervision arrangements, as outlined in the Network Contract DES:

  • Each clinical pharmacist must receive a minimum of one supervision session per month by a senior clinical pharmacist or advanced practice pharmacist.
  • The senior clinical pharmacist must receive a minimum of one supervision session every three months by an advanced practice pharmacist or GP clinical supervisor.
  • Each clinical pharmacist will have access to an assigned GP clinical supervisor for support and development.

For further information on recommended supervision, see the NHS England guidance document on PCN supervision.

Delivering general practice services from a community pharmacy

Shared employment models support staff to take on varied roles, help employers and systems manage local workforce needs and enable closer integration of providers.

They can also include staff working in a range of settings in the delivery of their role. For example, pharmacists may work part of their time in PCNs, and part in community pharmacies.

Clinics may be delivered in either setting to make best use of the pharmacist’s time and the available estate.

If pharmacists are delivering general practice services from a community pharmacy setting, they are unlikely to be able to contemporaneously deliver pharmaceutical services in the community pharmacy contractual framework (CPCF). They should therefore not normally be the responsible pharmacist.

A consultation room must always be available to deliver commissioned CPCF services.

Other considerations

All practical aspects of the management of employees within the shared model will require careful consideration and should be discussed and agreed prior to entering a shared employment agreement.

As non-exhaustive examples:

  • hours and location of work
  • line management responsibilities
  • practical arrangements for weekend, late and bank holiday rotas
  • absence reporting
  • raising and dealing with employee complaints and performance concerns.

All parties should satisfy themselves (with an appropriate audit trail) that their proposed arrangements will enable and support the pharmacy professionals involved to meet the General Pharmaceutical Council’s Standards for Pharmacy Professionals.

The Clinical Negligence Scheme for General Practice (CNSGP) covers clinical negligence activities (that occur after 1 April 2019) including those of PCN pharmacists. Separate indemnity arrangements are required for CNSGP exclusions and community pharmacy activities.

It must be always clear which role the professional is working in, and therefore which indemnity arrangement applies.

Employers should ensure that employment is equitable to honour the Equality Act 2010. Decisions on chosen employment models should take into consideration the
impact on protected characteristics.

Employers should seek to engage with trade unions and staff representatives, where appropriate.

Illustrative example: joint employment model – PCN and community

Key benefits

  • Potential to improve staff retention in community pharmacy sector by providing varied roles.
  • Pharmacists have the flexibility of conducting clinics from general practices, virtual clinics from home, or virtual/face-to-face clinics from community pharmacies.

Workforce

  • A pharmacist works between community pharmacy and a PCN as required.
  • There is one contract of employment for the employee with both the community pharmacy and PCN organisations identified as the ‘joint employers. The employment contract documents the pharmacist’s role across both organisations. Practically, one employing organisation would be the nominated payee and receive DES funding, run the payroll, and pay the employee. As a shared employment contract, there is no supply of staff between different organisations and so no VAT issues (see also Key Considerations: VAT).
  • There is freedom within this joint employment model to either agree an appropriate allocation of the employee’s time as between the community pharmacy and the PCN or else to adopt a more flexible approach which allows the employee to direct their time spent in each sector according to changing service need.

Governance

  • For operational management reasons, the employment contract should document which organisations policies and procedures will apply and who will be the pharmacists line manager on a day-to-day basis.
  • The pharmacist is line managed by their respective employers during such times as they are performing work under the employment contract with that respective employer. Supervision during PCN work is by a PCN senior clinical pharmacist, advanced practice pharmacist, or GP to meet the requirements of the Network Contract DES.
  • Face-to-face clinics should ideally be conducted from a GP practice consultation room to reap benefits of closer working with the PCN team. Virtual clinics conducted from home must be in a room that protects privacy and patient confidentiality. If this is not possible, the pharmacist must conduct clinics from another secure location.

Illustrative example: concurrent employment model – PCN and community

Key benefits

  • Potential to improve staff retention in community pharmacy sector by providing varied roles.
  • Pharmacists have the flexibility of conducting clinics from general practices, virtual clinics from home, or virtual/face-to-face clinics from community pharmacies.

Workforce

  • A pharmacist works between community pharmacy and a PCN. Role essentially comprises two split roles under two separate but concurrent contracts. Two separate contracts of employment are drawn up between the employee and each of their community pharmacy and PCN employers.
  • An SLA is agreed between the two employing organisations setting out how they will work within the shared workforce model whilst fulfilling the terms of employment contracts.
  • A typical weekly rota could be that the pharmacist does a 3 day/2 day alternating split between the two sectors. Alternatively, there could be 0.6 WTE (PCN) /0.4 WTE (community pharmacy) split.

Governance

  • The pharmacist is line managed by their respective employers during such times as they are performing work under the employment contract with that respective employer.
  • Supervision during PCN work is by a PCN senior clinical pharmacist, advanced practice pharmacist, or GP to meet the requirements of the Network Contract DES.
  • Face-to-face clinics should ideally be conducted from a GP practice consultation room to reap benefits of closer working with the PCN team. Virtual clinics conducted from home must be in a room that protects privacy and patient confidentiality. If this is not possible, the pharmacist must conduct clinics from another secure location.

Illustrative example: service provision model between hospital and PCN

Key bentfits

  • Hospitals and PCNs potentially improve staff retention by providing varied roles.
  • Experience and understanding of different sectors to improve integrated system working e.g. maximised benefits of Discharge Medicines Service to community pharmacy.
  • PCNs can access supervision and clinical expertise from hospital pharmacy departments.

Workforce

  • Hospital trust and local PCNs implement a clinical pharmacy service comprising clinical pharmacists employed by the hospital trust.
  • Pharmacists work under the direction and control of the hospital trust, delivering the clinical pharmacy service to the PCNs as part of their day-to-day role with the employing Trust.
  • This is reflected operationally and contractually to be consistent with providing a service (see also Key Considerations: VAT).

Governance

  • SLA is agreed, between the hospital trust and the organisation(s) in the PCN to which it will provide the pharmacy service, setting out how the service will be delivered. For example, if delivery of the service will require hospital trust employees working on or from PCN places of work, the SLA should document any applicable practical arrangements that will apply (e.g. whether the employees must comply with PCN policies, wear uniform, have certain qualifications etc).
  • The employing hospital trust will remain responsible for its employees at all times.
  • A senior pharmacist, advanced practice pharmacist, or GP must supervise during PCN work as specified in the Network Contract DES. In this scenario, it is a senior or advanced practice pharmacist from the employing hospital trust who is also the line manager. The line manager familiarises themselves with expectations of the Network Contract DES prior to managing the cross-sector pharmacist. In agreement with the PCN’s clinical director, the line manager directs and controls the work of the cross-sector pharmacist. The line manager is debriefed regularly and contactable throughout the working day to provide support as required. A named GP should be designated to provide additional support whilst working in the general practice.

Illustrative example: secondment model between hospital and PCN

Key benefits:

  • A good solution where temporary resource is required.
  • Hospitals and PCNs potentially improve staff retention by providing varied roles.
  • Experience and understanding of different sectors to improve integrated system working e.g. maximised benefits of Discharge Medicines Service to community pharmacy.
  • PCNs can access supervision and clinical expertise from hospital pharmacy departments. 

Workforce

Variation on the Service Provision Model. Likely to be more appropriate in circumstances where a PCN needs specific additional resource, perhaps for a limited time or to fulfil a particular task.

In this example, and subject to the required need:,

  • Single pharmacist employee of the hospital trust would be provided to the PCN on a seconded basis.
  • Essentially made available and put at the PCN’s direction or control for the specific task / time period, either full or part time.
  • For the remainder of the time they continue to work in their day to day employment for their employing hospital trust.
  • Arrangement must be reflected operationally and contractually to be consistent with a secondment.

Governance

  • Secondment agreement entered into between the employing hospital trust and the recipient or ‘Host’ PCN / organisation.
  • Documents the purpose and key terms of the secondment (e.g. who/what will be seconded, to whom, where, for how long, how the secondment will work in practice, how payment will be made for the secondment (if applicable).
  • Trust remains the employer, responsible for all liabilities and obligations to the employee under the contract of employment. Trust and the receiving / ‘Host’ PCN should seek to agree and document the practical arrangements that will apply to the management of the employee while they are working in their seconded role (e.g. whose policies apply, how and by whom performance concerns, absence etc will be dealt with).
  • Trust would ordinarily document the employee’s agreement to the secondment and any associated variations to the employee’s employment contract arising from the secondment, in a formal letter of secondment to the employee.

Publication approval reference: PR1225