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

Acknowledgements Liza Nichols – PhD Student Peter Noyce – other supervisor RPSGB – funding The pharmacists themselves For more information about our research please visit:

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

Number of pharmacists: 2002 to 2007

Age groups by gender (2007) 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) Data source:

Distribution of pharmacists elsewhere (2003/04 data) Data source:

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, , by entry route

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

45110 (100%) GB Register (89%) Home status (current address is GB based) (82.7%) GB 968 (2.1%) RECIP 1130 (2.5%) ADJ 864 (1.9%) EU Movement into Britain All overseas qualified = 6.5% 2003 data

Pharmacist emigration (100%) GB Register (89%) Home status (current address is GB based) (82.7%) GB 4831 (11%) Overseas Status (current address is overseas based) 968 (2.1%) RECIP 1130 (2.5%) ADJ 864 (1.9%) EU 3562 (7.9%) GB 1008 (2.2%) RECIP 112 (0.3%) ADJ 149 (0.3%) EU Movement into Britain All overseas qualified = 6.5% Movement out of Britain 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: ‘interviews’ postal and 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?

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

Pharmacist emigrant: a possible typology Travel/lifestyle migrant Occupational achievement, career preferences, job mobility, opportunities Retired migrant Spouse trailing/ tied movers Migrant partner Overseas nationals who qualify in GB - funded by their ‘home’ government Career migrant Migration from GB: GB-qualified exits from Britain Returning home migrant

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