Evaluation of Trainee Pharmacist National Recruitment

Currently there are approximately 2800 preregistration pharmacists trained each year in England and Wales. In 2015 Health Education England launched a Pharmacy Education Reform programme to improve the quality of pre-registration pharmacist training. A key project within this was the development of a Pre-registration Pharmacist Recruitment Scheme for England and Wales. The scheme was introduced in 2017; mandated for all HEE funded posts and optional for community pharmacy places funded by NHS England.

In year one,the majority (2161 of approximately 2800) of pre-registration pharmacist posts were advertised via this route. Pre-registration pharmacist recruitment and selection should be reliable, valid, acceptable, feasible, cost effective, fair and have a positive impact on education, training and quality. The aim of the Pre-registration Pharmacist Recruitment Scheme was to eliminate variation in recruitment into these training posts and bring it into line with other professions, notably medicine, dentistry and health care science. Applicants submitted a single application using the Oriel IT system and were allocated their highest preference place, based on their performance in selection centres.

This report provides a short-term outcome evaluation exploring the immediate impact of the new recruitment scheme and with a particular focus on the reliability, validity, fairness and acceptability of the selection methods used as part of the recruitment process.

Overall, findings suggest that the pre-registration pharmacist recruitment scheme is effective, fair and supports all applicants who exceed threshold interview scoresto stay in the selection process. The selection methods utilised within the scheme were evidence-based, demonstrated good levels of quality and difficulty and were able to effectively differentiate between applicants. There were good levels of acceptability for both applicants and interviewers. The fill rate
overall was 75%. All places were filled in hospitals. In community pharmacy it was lower than expected (62%) and in some subgroups e.g.medium sized community pharmacy businesses, less than half of advertised places were filled. Twelve percent of applicants deemed appointable followingthe selection process did not have a pre-registration training place offer at the end of the recruitment process. These applicants can be clearly categorised as either requiring tier 2 sponsorship or not preferencing enough programmes. Through the National Pre-registration Pharmacist Recruitment Scheme, places were offered and accepted for approximately 60% of all pre-registration pharmacist posts in England and Wales due to commence in August 2018. Action planned as a result of this evaluation will aim to ensure the scheme achieves increasing fill-rates over subsequent years.

In 2015, Health Education England (HEE) launched a Pharmacy Education Reform programme to improve the quality of pre-registration pharmacist training. A key project within this was the development of a National Pre-registration Pharmacist Recruitment Scheme for England that was extended to Wales. The scheme was introduced in 2017; mandated for all HEE funded posts and optional for community pharmacy places funded by NHS England. In year one, the majority (2161 of approximately 2800) of pre-registration pharmacist training places were advertised via this route. The 2017 recruitment scheme achieved an overall training place fillrate of 75%, with approximately 60% of all pre-registration pharmacist posts across England and Wales filled (including 100% of hospital pre-registration pharmacist places).

HEE undertook a short-term outcome evaluation exploring the immediate impact of the new recruitment scheme, particularly the reliability, validity, fairness and acceptability of the selection methods used as part of the recruitment process. Findings highlighted that fill-rates could have been affected by how applicants preferenced prospective training placements.

This evaluation undertaken collaboratively between HEE and the University of Birmingham explores applicant preferencing behaviour through the analysis of applicant preferencing data from the 2017/18 recruitment cycle, and identifies factors that influenced preferencing of prospective training placements by the applicants through survey and focus groups. A Survey invitation was sent to all Schools of Pharmacy in England and Wales in May 2018 asking all students who were eligible for application to the recruitment cycle 2017/18 to participate. Students who expressed an interest were invited to participate in a focus group.

Pattern of applicant preferencing of pre-registration training programmes
Preferencing data from all applicants of the 2017 HEE recruitment cycle was analysed. A large majority (86%) of applicants preferenced pre-registration programmes across both NHS Acute Hospital and Community Pharmacy sectors. However, 11% 3% applicants preferenced pre-registration programmes in either NHS Acute Hospital or Community Pharmacy sectors respectively only. 83.9% of applicants ranked NHS Acute Hospital pre-registration programmes as their first ranked preference. 16.1% of applicants ranked community pharmacy programmes as their first choice. A total of 80.6% and 19.4% of the total top 10 ranked preferences related to preregistration programmes within NHS Acute Hospital and Community Pharmacy sector respectively. Similarly, a total of 75.7% and 24.3% of the total top 30 ranked preferences related to pre-registration programmes within NHS Acute Hospital and Community Pharmacy sectors respectively.

Analysis of the number of applicants selecting at least one pre-registration programme in a given HEE local area and geographical sector (county) was undertaken. HEE London was the most popular HEE local area with approximately 4 in 5 applicants preferencing at least one programme from within the area. Only just over half (56.2%) of all applicants preferred a pre-registration programme in Wales. HEE Thames Valley followed by HEE Wessex had the biggest ratio in terms of applicant to number of available places. Analysis of the preferencing data across the geographical sector (counties) suggested that programmes within North Central London, South London and North West London areas were preferred by most applicants. Data pattern shows applicants often preferenced employers in the same HEE region as their Schools of Pharmacy.

Significant variations in the preferencing pattern across gender groups, ethnic categories and applicants from different Schools of Pharmacy were identified.

Results: survey of students on factors associated with applicant preferencing decisions
A total of 307 responses were received giving a response rate of approximately 11%.

The majority of the respondents (66.2%) reported preferencing between 1 and 100 preregistration programmes. When asked ‘overall, how satisfied were you with the preferencing process?’, approximately a third (31.8%) of the applicants expressed dissatisfaction. Higher satisfaction with the preferencing process was significantly associated with respondents’ choice of ‘community pharmacy- large chain multiple’ as the highest ranked preference, receipt of an offer through HEE and the hierarchy of the ranked choices for which offer was received. Respondent age, gender, ethnicity and number of training programmes preferenced were not associated with global satisfaction.

Long-term career aspirations for working in a particular sector was the factor rated most highly by the respondents in their preferencing decision, followed by proximity to the respondent’s permanent home or where they would like to live long-term. Information made available by the employer about their organisation and training programme was also important for many applicants. Respondents were generally satisfied with the length of the time they had available for preferencing decisions although approximately 1 in 6 perceived the decision making time not being adequate. A high majority of the respondents (72.9%) were either satisfied or highly satisfied with the offer of the training programmes they received through the HEE. The most common reason for declining the offer related to having a training place outside the national recruitment scheme.

Results: qualitative data on factors associated with applicant preferencing decisions
Qualitative data on factors associated with preferencing decisions were obtained through open ended comments from the questionnaire and two qualitative focus groups with student participants and analysed. Data collection tools were designed based on the literature, expert panel discussion and theoretical domains framework (TDF). TDF is a theoretical framework of determinants of behaviour which combines 33 theories of behaviours into 14 domains. The domains can be used to explain the factors that are associated with a particular behaviour and these include knowledge, skills, environmental context and resources, capabilities, belief about consequences and social influences

A total of nine potential factors (TDF domains) were identified as being key to participant preferencing decisions. These included knowledge about the training programmes and prospective employers, opportunity for skills development (skills), perceived environmental context and resources of the potential employers, perceived identification of and aspiration towards a career path, optimism/pessimism about the prospect of obtaining a training programme offer, belief about consequences of preferencing decisions, social influences from family and peers, decision process and applicant motivation and goals.

Participants alluded to the importance of the information from employers in informing their preferencing decisions and described reading the information sources carefully before making a selection. While participants did speak highly of information from some of the employers, in particular from NHS acute hospital trusts, they felt that others lacked key information they were looking for. Size of the employing organisation was a key factor in preferencing a community pharmacy preregistration programme with most participants preferring large chain multiple pharmacies over independent community pharmacies. Such preference was mainly down to the perception that the training programmes offered by the large chain multiple pharmacies would be ‘better in quality’ compared to the independent pharmacies.

The way preferencing was done was perceived to have an important impact on the outcomes. Selecting NHS Acute Hospital only pre-registration programmes were deemed to put the applicants at a disadvantage given the competitive nature of these programmes. Greater number and range of post training opportunities after pre-registration training were perceived to be important factors in their preference of bigger cities and urban areas over rural areas. Participants were generally positive in their feedback on the preferencing tool available through the Oriel system. Most demonstrated an understanding of how the preferencing system worked and spoke highly of how the listing of the employers and filtering system were laid out.