Flexible working: Understanding the locum pharmacist in Great Britain

Article Outline

• Abstract
• 1. Introduction
  • 1.1. The British Pharmacy locum
• 2. Methods
• 3. Results and discussion
  • 3.1. Why work as a locum?—flexibility
    • 3.1.1. Time
    • 3.1.2. Place
  • 3.2. Other reasons for working as a locum
    • 3.2.1. Stress
    • 3.2.2. Maintaining professional competency
    • 3.2.3. Money
  • 3.3. Disadvantages of locum work
• 4. Limitations
• 5. Conclusion
• Acknowledgment
• References
• Copyright

Abstract 

Background

There is a growing trend in Great Britain (GB) for pharmacists to work as self-employed “locums” rather than as permanent employees. Despite this trend, little is known about their work patterns or why they choose to pursue nonstandard forms of work.

Objectives

The overall aim of the study was to explore why locums choose self-employment over a permanent contract and to explore a number of issues commonly associated with nonstandard working, such as marginalization and job satisfaction.

Methods

A qualitative interview study was undertaken. In-depth telephone interviews were conducted with 34 locum pharmacists randomly selected from the GB register of pharmacists. Locums from a range of age groups, different sectors of practice, and with different work patterns were selected to ensure that a wide range of experiences and views were covered.

Results

The need or desire for flexibility was the overriding factor for choosing to work as a locum. A wide range and variety of individual personal circumstances were important drivers, but a desire for work-life balance was fundamental to many. A variety of work patterns were found, ranging from those with more ad hoc working arrangements to those who worked in the same store on a regular basis. Avoiding stress, paperwork, and nonprofessional duties were among reasons for choosing to locum. Disadvantages associated with being a locum included being viewed and treated negatively by peers, and having fewer opportunities for training. No conclusive evidence could be found for locums being marginalized, except for the training issues for some pharmacists. The findings do suggest some cause for concern, with some locums selecting places to work on the basis of attitudes not congruent with socially inclusive approaches to public health care.

Conclusions

The locum workforce is far from homogenous or uniform. Freelance working of this kind has advantages for the individual: freedom and independence. But there may be risks for the profession if nonstandard work practices become more widespread: isolation, lack of social cohesiveness, and amoral attitudes. Improving working conditions and practices may prevent pharmacists from leaving permanent positions.

Keywords: Flexible working, Locum pharmacist, Great Britain

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1. Introduction 

The shift toward “nonstandard” or “flexible” forms of work in Western Societies over recent decades has been well documented in sociological and human resource management literature.¹, ², ³, ⁴ The definitional breadth associated with such forms of work is illustrated by Felstead and Jewson who cite a whole range of other types of “flexible” work in addition to “part time,” “casual,” “temporary,” and “self-employment” that may or may not overlap. A common overriding characteristic, though, is that they “diverge from the pattern which became regarded in mid-twentieth century advanced capitalist economies as the ‘norm.’ Such ‘standard’ jobs and careers were defined as full-time, permanent, open-ended and secure.”^3(p1)

Pharmacy locum work in Great Britain (GB) is particularly interesting with respect to such themes because it spans a variety of forms, such as “part-time work,” “full-time work,” “temporary work,” “casual work,” and “freelance self-employment.” The term “locum” is commonly used in GB and is understood as referring to those pharmacists who work on a freelance self-employed basis within pharmacy companies. They are often used at short notice to stand in for pharmacists who are ill or on holiday, or for those who leave the pharmacy premises for other reasons, such as to engage in “extended role” services. There are similarities here with the American “relief pharmacist.” However, locums in GB are also often “used” on a long-term basis, working more fixed and regular patterns of work month after month, or even year after year. Their hours of work can range from just a few hours a month, up to 50-plus hours a week. Their locations of work may be in the same single pharmacy store, in a combination of different stores for a single company, or in a combination of different stores across different pharmacy companies. They may also work as a locum pharmacist while having other jobs in other sectors of pharmacy, or other jobs outside of the pharmacy profession altogether. We come to this in more detail later in the article. In the context of flexible employment in Western Societies, the GB locum pharmacist in many ways epitomizes the concept of “flexible” or “nonstandard” employment. Little is known, however, about why this group of pharmacists have chosen to embark on such a flexible career path, and what, if any, are the consequences to professional pharmacy practice, as well as the individual, of such employment decisions.

Widespread processes such as “downsizing” and “outsourcing” have, since the 1980s, been instrumental in organizations that were previously structured in a hierarchical, pyramid fashion becoming flatter and more flexible, encompassing a stronger demand for flexibility in the forms of labor they employ. In relation to supply, this demand for flexible or nonstandard workers requires an adequate source of people who gravitate toward such forms of employment, such as women with childcare commitments, people at the beginning or ends of their working lives, people with “portfolio” working patterns, or just people who in general seek a greater “work-life balance.”⁴, ⁵, ⁶

A leading commentator on such changes in the structure of work, Charles Handy, has paid particular attention to the growth of the freelance worker and coined the phrase “portfolio working.”⁷ In a more recent book, Handy uses the analogy of the elephant (large multinational organization) and the flea (the independent, freelance individual) to illustrate how the two relate to each other in the contemporary economic landscape.⁸ He visualizes a future where different forms of paid work are only a part of multifaceted lives that also include voluntary or civic work, alongside domestic work and leisure time. Handy contends that the advantages of independence, freedom, choice, and creativity will have to be negotiated against the disadvantages of insecurity, isolation, lack of social cohesiveness, and the subsequent potential for selfishness and amorality.

The extent to which nonstandard workers, particularly those within professional occupations, are marginalized within the workplace with respect to unequal pay, training, and career opportunities is a contemporary theme debated within the literature on broader forms of flexible employment besides portfolio or freelance work.⁹, ¹⁰, ¹¹ The extent to which the nature of such work can lead to low job satisfaction,², ³, ⁴, ⁵, ⁶, ⁷, ⁸, ⁹, ¹⁰, ¹¹, ¹², ¹³, ¹⁴ and the extent to which choice is a key issue for those who engage in such forms of work, particularly women, are also widely debated.¹⁵, ¹⁶, ¹⁷, ¹⁸

Considering the extent of academic interest in how the world of work in general and career patterns in particular have undergone profound change over recent decades, there is a surprising scarcity of material on the experience of career change itself from the individual's perspective. As Cohen and Mallon stated in 1999, “…there is a dearth of empirical, qualitative studies that seek to understand how individuals experience changing careers.”^19(p330)

This article reports on empirical findings from a study conducted on locum pharmacists in GB. In the context of workforce shortages in the pharmacy labor market in GB and general concerns that pharmacists were experiencing low levels of job satisfaction, the study principally aimed to explore why locums choose their particular work patterns.²⁰ The study was conducted in 2004 and funded by the Royal Pharmaceutical Society of Great Britain. This article reports the findings that help illustrate how the contemporary employment themes described above apply to locum work within British community pharmacy by examining locum pharmacists' motivations for choosing their work patterns and what they see as the advantages and disadvantages of locum work. The article also discusses the implications of the findings for professional issues.

1.1. The British Pharmacy locum 

A key finding of the first British pharmacist workforce census in 2002 was that a substantial proportion of the pharmacy workforce in GB comprises pharmacists who work on a locum basis.²⁰ Of those on the “home” register (ie, those residing in England, Scotland, and Wales) who were actively working, 28% reported working as locums. This increased to 38% when taken as a proportion of the community pharmacy sector's workforce. Those who reported working as a locum in the workforce census were self-defined. This definition was in contrast to other positions such as being a “relief” or “second” pharmacist, where the pharmacist is a contracted employee of a specific company. A defining characteristic of being a locum pharmacist is the tendency to work on a self-employed basis.

In gaining an understanding of the locum workforce, an appreciation of its heterogeneous nature is essential. A previous article based on the census findings in relation to locums²¹ speculated that pharmacists involved in locum work were likely to include young pharmacists who have recently qualified, women with childcare responsibilities, and people with “portfolio” work patterns who have other pharmacy jobs besides their locum work, most often either an academic post or a post working for a Primary Care Trust (National Health Service organizations in England that commission health services for local communities). People who locum also include older pharmacists, probably those “winding down” toward retirement, people of all ages who work as locums on a full-time basis, as well as those who simply work less hours to attain a greater “work-life balance.”

In GB, factors that contribute to the demand for locum pharmacists include extended pharmacy opening times; the expansion of pharmacies into supermarkets; reported recruitment problems into permanent positions in the community and hospital pharmacy sectors; the provision of “extended role” services by community pharmacists (such as medication review, blood glucose monitoring, emergency hormonal contraception schemes, smoking cessation initiatives); and the creation of new roles for pharmacists in the primary care sector. These all enhance demand for pharmacists at a general level and subsequently lead to an increased demand for locum cover.²²

In the British literature, small-scale general workforce studies confirm shifts toward locum work over recent years, with one survey, conducted in the West Midlands, establishing a trend away from permanent community posts to locum work in all age groups except those between 41 and 50.²³ Despite their growing size, the locum pharmacist has not yet been the subject of dedicated study. Advantages of locum work have been highlighted, but mostly in anecdotal accounts of why people choose to work as locums rather than from systematic empirical research. Reasons include the ability to work when and where one likes, avoiding paperwork, not having targets to meet, avoiding the stress of being a pharmacy manager, and being able to gain a broad range of experiences that would not be as possible in a permanent position.²⁴, ²⁵, ²⁶ This resonates with job satisfaction studies in community pharmacy where perceived lack of control was a major source of stress.²⁷ In light of this, having control over one's hours and place of work while not being overtly controlled by company politics and managerial pressures would explain a key attraction of locum work.

Although the United States (US) appears to have no direct equivalent of the British pharmacy locum, there do appear to be definite areas of convergence between the US and GB, such that there appears to be a similar general movement toward increased forms of flexible pharmacy work in both countries. In addition, a number of American studies have identified similar reasons for choosing more flexible forms of pharmacy work. In a quantitative study by Quinones and Mason, for example, the most common reasons for working part time given by pharmacists with one job included “to keep skills up to date,” “like the work,” “looking for greater flexibility,” “need for child rearing,” “better fit of leisure time with work time,” but also a high proportion of “other” reasons suggesting a diversity and complexity difficult to capture by quantitative study alone.²⁸ The study also found that people's reasons for wanting flexible work were very much linked to demographic factors, such as age, sex, and number of dependents. Also, pharmacists who had one part-time job were different from “moonlighters,” who worked part time in addition to other jobs: “better fit of work and leisure” was found to be more important to the first group, whereas “moonlighters” were more likely to cite reasons such as “professional enrichment” and “financial reward.”²⁸

The need for well-developed “work-life balance” in pharmacy, essential for reducing work-related stress, has also been linked in other US studies.²⁹, ³⁰ What contributes to an increased demand for flexible cover in pharmacy in GB also seems to apply to the situation in the US. For example, Knapp et al found that there was a sustained unmet demand for pharmacists throughout the US between 1999 and 2003.³¹ Additionally, research has identified that like pharmacists in GB, pharmacists in the US would prefer to devote more time to consultation and drug use management and less to dispensing and business management duties.³²

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2. Methods 

Two focus groups comprising 8 and 6 locum pharmacists, respectively, and semistructured in-depth qualitative interviews with 34 locum pharmacists were conducted. For the interviews a purposive sample of 15 male and 19 female pharmacists was selected from a list of locum pharmacists who had agreed to be interviewed for the study. The list consisted of a 10% sample of all locum pharmacists who were on the Pharmaceutical Register of Great Britain at the time the study was conducted.²⁰ To help increase the validity of the findings, the purposive sample was selected to represent a broad cross section of locum pharmacists, covering a spread of age groups, ethnic groups, sectors of practice, and hours of work. No incentives were offered to the pharmacists. The same methodology was used to select pharmacists for the focus groups.

The interviews were conducted via telephone and recorded. Permission for the interviews to be tape recorded was gained at the beginning of each interview, and notes were also taken. Telephone interviews rather than face-to-face interviews were chosen because they were more economical, allowed a wider geographical coverage of respondents, and were the preferred option for many of the interviewees, fitting in better with their busy, and often fairly ad hoc work practices. Although telephone interviews are poor at capturing nonverbal forms of communication, such as facial expressions and the body language of respondents, and can be more difficult in establishing rapport with the interviewee, the research team felt that for this particular study, the advantages outweighed the disadvantages, allowing the study, which had fairly limited resources, to be conducted more economically.

An interview guide (shown in Box 1) was used to ensure that the same preselected topics were covered in each of the interviews, but the order in which topics were addressed remained flexible. The interviews averaged 30 minutes in length. Twenty-nine of the interviews were conducted by one researcher. A second researcher conducted five of them.

The interviews were transcribed, and the data analyzed as the study progressed using a “grounded theory” approach.³³ This included modifying later interview content to pursue in more detail certain issues that emerged from analyzing previous interview data. All interview material was put to optimum use; 2 researchers listened to each of the tapes several times, making conceptual and substantive notes while drawing out key themes and issues arising out of the narratives; a “map” of key data themes was drawn up for each interview, interlinking key points and themes were cross-checked across interviews, and both researchers independently coded transcripts first, before comparing and contrasting coding to verify the veracity, plausibility, and consistency of the findings and interpretations made of the data. The overall methodological principle used was what Schwandt terms a constructivist or interpretivist approach, a key aim of which is to “elucidate the process of meaning construction and clarify how meanings are embodied in the language and actions of social actors.”^34(p222)

The focus groups were conducted to pursue in further detail specific unprompted issues that arose in some of the interviews. For example, several interviewees mentioned “bad locums,” and others were exercised by recent regulatory changes in the profession and continuing professional development. These topics seemed to provoke strong reactions in some, and the research team felt they would be best discussed in a group situation. An incentive of £70 was offered to focus group respondents, largely to cover travel expenses. The focus groups were facilitated by 2 researchers; one led the discussion while the other took notes. They were also recorded and transcribed, having gained permission from the participants first. Both focus groups lasted approximately 90 minutes.

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3. Results and discussion 

Demographic and socioeconomic details of interview and focus group respondents are given in Table 1, Table 2, respectively. The youngest pharmacist was 25 years old, and the oldest was 73. Most worked part time or had flexible patterns of work, with roughly a third working full-time hours. A few worked in more than one sector of practice.

Table 1. Interviewee characteristics

Sex	Age	Working patterns
Male	33	“Locum manager,” 39-48h per week (retail)
Male	45	2d per week with PCT, and 2d per week—retail locum
Male	62	40-55h per week—retail locum
Male	36	40-50h per week—retail locum
Male	41	40-50h per week—retail locum
Male	41	38-42h per week—retail locum
Male	27	45-50h per week—retail locum
Male	73	4-5 mornings per month—retail locum
Male	33	Full-time PhD student+2d per week—retail locum
Male	27	Full-time postdoc academic+6h per week—retail locum
Male	61	2d per week—retail locum
Male	49	Very rare locums+director of British Association of Pharmaceutical Wholesales+proprietor
Male	68	Only works when people need him (28h last week)
Male	28	32h per week—mainly retail locums, some hospital
Male	65	Approximately 6d per month—retail locum (purely ad hoc basis)
Female	62	Retail locum 1d per week
Female	64	Retail locum 4h per week
Female	52	Retail locum 1day per week
Female	68	Retail locum 4-5d per week
Female	46	Retail locum 10h per week
Female	56	Retail locum 2d per week
Female	41	Retail locum plus Primary Care Trust prescribing support as a locum
Female	25	Full-time med student+retail locum 4h per week
Female	47	Retail locum 25h per week
Female	29	Retail locum 26h per week
Female	62	Retail locum 15h per week
Female	42	Retail locum 12h per week
Female	39	Retail locum 38h per week
Female	56	Locums for PCT
Female	27	Now works as a full-time hospital employee+occasional retail locum
Female	52	Retail locum 16h per week
Female	36	Retail locum 4h per week, +2d per week with acute trust, +2d consultancy with GPs
Female	57	Portfolio pharmacist (3 jobs)
Female	28	Hospital locum 37h per week

Table 2. Focus group participant characteristics

Sex	Age	Working patterns
Female	49	Hospital & retail locum 3d per week
Male	55	Retail locum 2d per week
Male	58	PC full-time plus retail locum—emergency cover
Male	57	PC plus retail locum 1d per week
Female	40	Hospital locum, retail locum+primary care
Female	48	Retail locum 3-4d per week
Male	33	Retail “locum manager” 38-49h per week
Female	38	PC+retail locums 2 Sat mornings per month
Male	27	Retail locum 30-50h per week
Male	61	Retail locum 2d per week
Female	54	Retail locum 30h per week
Female	44	Retail locum, PC and academic journalism
Female	63	Retail locum 30-50h per week
Male	42	Retail full-time employee+weekend locum

Given the research questions and the main aim of the study, the findings reported below reflect the main areas the study intended to investigate. Why interviewees worked as a locum and what if anything precipitated the decision to change their employment status is addressed in detail first. Findings on the disadvantages of locum work are then reported and discussed. Quotes, selected from a wide range of interviewees and focus group participants, are used throughout to help illustrate the themes that were identified from the transcripts.

3.1. Why work as a locum?—flexibility 

When the central issue of why pharmacists work as locums was explored, there was always a combination of factors at play. Usually, a short narrative was offered, which comprised personal circumstances or life events along with career history and a number of factors about locum work that they saw as particularly advantageous. The personal circumstances or life events ranged from the common and unsurprising, such as having children, to the more exclusive, such as buying a house to renovate or pursuing another career.

Locums' working patterns were very diverse and occasionally quite complex. Although it was previously known that their hours of work varied from a few hours a month up to and above “full-time” hours, this study provided very detailed data on locum working patterns to show that virtually every conceivable pattern of work was represented. The locations where people worked included single stores within a large chain, any number of stores within the same chain, a combination of stores across different companies and different types of companies (independent and major), as well as hospitals and a wide variety of jobs in other sectors of pharmacy. Furthermore, the basis of being hired ranged from long-standing regular arrangements to purely “emergency” bookings, to a combination of both.

Although reasons for working as a locum varied according to personal circumstances, a number of common overriding themes did emerge. The most common was that people wanted, or needed, the flexibility that locum work offers. The statement “I can work when and where I want” arose on numerous occasions. Unpacking this notion of the need or desire for flexibility showed that, for locum pharmacists at least, “time” and “place” are constructs integral to the notion of flexibility.

As might be expected, a common reason for pharmacists wanting to choose flexible hours of work was family commitments. Many of the women who were interviewed mentioned that having children was an important factor, either at present or when they first started working as a locum. Interestingly, some women claimed that once their children had grown up, they continued with locum work because the flexibility of their working arrangements continued to suit them for other reasons. These other reasons included being able to take holidays when they wanted, or that they did not want to feel obligated to work. For example, the following woman began working as a locum 15 years ago but continued because she likes the flexibility of it: “Well If I don't want to work one day, I don't have to” (Female, age 46, community pharmacy locum, 10 hours per week).

Caring for sick parents or grandparents or simply wanting to spend more time with family at weekends or holiday periods was also mentioned by interviewees, male and female alike: “There was just a series of family events, my grandmother was ill, and the flexibility of being a locum was fantastic, it was like I could work these days and these days I've got to go here and do that” (Focus group participant, male, age 33, community pharmacy “locum manager,” 38-49 hours per week).

In addition to family-related commitments, a wide range of leisure pursuits were cited as being important factors in wanting flexible working patterns, suggesting that many interviewees had a well-developed sense of what is termed “work-life balance.” The types of leisure pursuits commonly cited were taking holidays when desired, taking time out to go traveling, as well as activities such as being involved with a county cricket team and playing golf during the week: “The other factor is that I play golf all week” (Female, age 64, community pharmacy locum, 4 hours per week).

Besides family commitments and leisure pursuits, a range of other commitments were mentioned as being influential in the need for flexible working arrangements. These included being a full-time student, having other jobs in pharmacy with which they balanced their locum work (such as working for a local Primary Care Trust in an advisory capacity), or having other jobs outside of pharmacy, such as being a part-time chemistry teacher or even a professional singer in one case. A number of locum pharmacists were involved with various boards and committees, not just ones related to pharmacy or health care, but also community or local voluntary groups, often involving unpaid work.

The interviewee who was a professional singer had 2 other pharmacy-related jobs: one as an employee working one regular day per week at the same pharmacy and one as a “pharmacy assessor” for pharmacy technicians. On the need for flexibility because of her singing work, she commented, “I still do it a wee bit but not as much as I used to, so I used to be able to be free for concerts in the evening and such like, so if I was going away to the North of Scotland I could easily take the day off without a problem” (Female, age 57, “portfolio pharmacist,” 22 hours per week in total).

This illustrates how many respondents had busy multifaceted lives that meant that being able to control when they worked was a necessity. Such descriptions of working patterns resonate well with Handy's vision of the changing nature of work in people's lives: “The elusive work/life balance would actually be a mixture of different forms of work, seasoned with a touch of leisure and pleasure.”^8(p4) Indeed, in such cases, the boundaries between “work” and “leisure” become blurred, which demonstrates that although the term “work-life balance” is conceptually useful, like most dichotomous analogies, it can have limited currency.

Although this strong need and desire for flexibility in terms of time was common, other people had more tightly structured, consistent working patterns. There were many people who only worked in the same stores for the same amount of hours on the same days each week, and had done so for a considerable length of time. Given the regularity of the work in these cases, we explored why such people did not just work as part-time employees. Again, the extra flexibility, of feeling more able to say no to work, was the main reason: “Because I can choose when I go on holiday. I just say, ‘this month I'm not working. October I'm away for three weeks’” (Focus group participant, male, community pharmacy locum, 20 hours per week).

Importantly, it emerged from one of the focus groups that this need for flexibility has 2 dimensions, with some managers or owners preferring the flexible benefits of using locums. Several locums in the study reported that they have never been asked to work the same hours as a part-time contracted employee: “But I've never had anybody ask me to work on a part-time basis, sessionally and I've worked some locums for twenty something years” (Focus group participant, female, age 49, hospital & community pharmacy locum, 20 hours per week in total).

As well as working when they wanted, interviewees frequently said it was also important to be able to select where they wanted to work. Thus, place is an important element of flexibility in addition to time. In this context a common response from numerous interviewees was: “If I don't like a place I won't go back.” When this was explored further, it emerged that a number of factors would discourage locum pharmacists from returning to certain pharmacies. Poor organization, chaotic systems of working, and inadequate support staff (both poorly trained or not enough) in pharmacies, all acted as a disincentive to return to a particular place. Having to travel long distances to work, working in socially deprived areas, with a high number of methadone users, and witnessing illegal or unethical practices were also reasons for choosing not to work in certain pharmacies. One woman mentioned how there was an informal “blacklist” in her area, and locum pharmacists discussed with each other where not to work: “You do meet other locums and sound out about other shops and, you know… ‘don't go near that place!’ (laughs) Yes, there is a black-list” (Female, age 47, community pharmacy locum, 25 hours per week). Being able to “cherry pick” in this way nicely demonstrates how much the pharmacy labor market currently favors employees.

These findings could raise some cause for concern, particularly for service provision in deprived areas. Although the following sentiment was by no means a view voiced by the majority of respondents—“And then again, it depends where they are, if it's a grotty area, a tough area, I think ‘Well, why should I?’ …I can be very choosy and I just do where I want and what I want, you know” (Male, age 68, “community pharmacy locum,” 8 hours per week)—it could be interpreted as evidence in support of Handy's claim that the downside to freedom and independence can be a lack of socially responsible attitudes.⁸ Another locum indicated a reluctance to work in a pharmacy that had a high number of methadone users: “Sort of thirty odd addicts…it's not ideal because obviously the more that you have, the more chances there are of being a problem, compared to if you've only got sort of a handful of addicts. So that would put me off” (Male, age 27, community pharmacy locum, 30-50 hours per week). Another interviewee elaborated on what he saw as the problems with such service users: “No, they'll screw you blind, they'll twist you, they'll try…. It's just added stress which we tend not to want, I suppose. If we can get away with it we don't do it” (Male, age 61, community pharmacy locum, 20 hours per week).

Attitudes such as those expressed above could hardly be said to be entirely congruent with socially inclusive approaches to public health care. Many of those interviewed recounted stories about so-called bad locums and bad pharmacies. “Bad” locums were portrayed as only ever working in “nice” stores, which included stores with low prescription volumes or stores without “undesirable” customer groups; bad locums practiced unethically and were lazy. On a more positive note, a number of interviewees specifically mentioned that they liked working in deprived areas and found it more professionally satisfying, suggesting that the less acceptable attitudes are not shared by all locum pharmacists.

3.2. Other reasons for working as a locum 

Besides flexibility, a number of general reasons for working on a locum basis arose repeatedly in the fieldwork. One particularly interesting finding was that among the ex-owners and ex-managers, many reported that they quit their previous jobs or sold their business because they were stressed and disillusioned by having too many targets to meet and too much paperwork and administrative tasks to take care of. The following is a typical statement from an ex-manager: “…I did feel as though I was being put under more pressure…. I just didn't seem to have enough time to do the paperwork, etc etc. So management pressure was part of the reason” (Female, age 56, community pharmacy locum, 20 hours per week). When discussing what she preferred about her current locum work, the same woman commented: “…I am dealing more with the patient, which is what I enjoy.” This is an interesting point that links well with an early GB study on stress in community pharmacy.²⁷ A key finding of the study was the extent to which helping the public was what pharmacists liked most about their work.

For ex-pharmacy owners as well as ex-managers, excessive stress was a particularly strong reason for choosing to work as a locum. The following statement was made by an ex-owner of an independent pharmacy to explain what originally made him decide to sell his business and work as a locum: “…too much paperwork was coming in, all sorts, and that made me decide that no, this is not for me, I need to relax a little bit and take it easy” (Male, age 41, community pharmacy locum, 38-42 hours per week). Likewise, another ex-owner commented that stress was a major reason for selling his business and after he did this he was able to sleep properly for the first time in years: “There's no point in being the richest guy in the graveyard” (Focus group participant, male, age 55, community pharmacy locum, 20 hours per week). This confirms existing literature on excessive stress being a key element in why people are turning to locum work.²³, ²⁷

Besides wanting to avoid stress, paperwork, and the “nonpharmacy” duties that came about from working as a manager or an owner, another important reason given for choosing locum work was to maintain professional competency. The phrase “It keeps my hand in” was a recurring statement. This was not just from older pharmacists approaching retirement as might be expected, but also commonly cited by people who needed to keep up to date with developments in the community pharmacy sector, such as those who were studying for other qualifications, but more especially those with more than one job in pharmacy, the “portfolio pharmacists.” As one woman whose other job was in an advisory capacity for a Primary Care Trust explained, “One of the things I like about it is it sort of helps my regular job in that I still work in the community and I still know what it's like to try and plough through a load of scripts when you're getting hassle…. And I often think when you get advice from people who've only ever done hospital pharmacy and PCT work, they've got no idea of what it's like on the ground” (Focus group participant, female, age 38, “portfolio pharmacist,” approximately 34 hours per week in total).

Conversely, many “portfolio pharmacists” also commented on how their other jobs provided them with skills that complemented their work as a community pharmacy locum. For example, the following statement was made by a woman who worked as a locum in a community pharmacy while discussing her other job as a “prescribing support pharmacist” for her local PCT: “It helps me on the clinical side, because I think as locum you see, you're very dependent on your own momentum, so it's really improved my clinical skills, which I think if I'm just being a locum, like a community locum, I wouldn't have had” (Female, age 42, “portfolio pharmacist,” 28 hours per week in total).

An overriding factor regarding “portfolio pharmacists” was that without exception they all seemed to really enjoy their working lives. Job satisfaction in all of their jobs was reported to be very high. This appeared to be due to a combination of reasons such as different aspects of different jobs complementing each other, as mentioned, having the flexibility and control to balance work with other commitments, and not being stressed by excessive pressures associated with standard community pharmacy employment opportunities. In many ways, the data that emerged here were a great advert for the advantages of the “portfolio life.”

Finally, the other advantage of locum work mentioned on numerous occasions and by most of the interviewees was that it pays well. In GB the hourly rates for working as a locum are often higher than those received for working as a contracted employee. It has to be said, though, that those who mentioned money as an advantage usually mentioned it after listing a number of other advantages, such as those related to flexibility; it was very rarely the overriding reason for working as a locum.

Many older locums mentioned how the money was useful in “topping up” their pension: “Because of this locum work I can go out on a Saturday night; I'm lucky I've got pals from fifty odd years ago, go down the local pub and have a couple of pints and really enjoy it” (Male, age 73, community pharmacy locum, approximately 20 hours per month). This comment also illustrates again how working as a locum plays an important role in people's “work-life balance.”

Only one person overtly stated that money was the only reason for working as a locum, otherwise they would retire, as they were in poor health and had difficult financial circumstances. However, a number of people, particularly older pharmacists, also mentioned that money was not an issue for them at all and they worked because they enjoyed it, they enjoyed the social contact it gave them and the sense of self-worth and professional satisfaction to be able to “contribute” and help people.

The respondents who did seem the most financially motivated were the locums who worked the most hours and were slightly older. For example, one 41-year-old locum who worked between 40 and 50 hours a week mentioned the lack of remuneration that pharmacists get, in his opinion, many times throughout the interview and claimed that “pharmacists might become cheaper than cleaners at some point” (Male, age 41, community pharmacy locum, 40-50 hours per week).

3.3. Disadvantages of locum work 

Poorly organized and chaotic stores, lack of support staff or lack of adequately trained support staff, and unfamiliar or “difficult” computer systems were the most commonly cited disadvantages of being a locum. For example, “Not knowing the computer system when you are there and not having any support staff that even know how to turn the computer on, let alone how to use it is a bit of a bummer” (Focus group participant, female, age 48, community pharmacy locum, 30 hours per week).

Lack of continuity, in relation to not knowing what has happened before their shift and not being able to see things through to their conclusion after finishing work, was also a common disadvantage mentioned by many of the locums interviewed in the study. People spoke of “living from notes left for you” or not being informed properly about changes: “You don't tend to get told things, things change and you don't know” (Female, age 47, community pharmacy locum, 25 hours per week).

Although by no means prevalent across the whole study, several locums discussed the perception of being treated in a negative light by both other staff and patients because of being “only a locum.” A more commonly cited drawback that has possible implications at a policy level was that some locums felt isolated in terms of support for training and development. This was mostly in relation to continuing professional development, where people felt that they received less support and guidance than they would if they were employed by a large company, but also in relation to training for extended role activities. One man mentioned how when new initiatives are developed and training is organized in his area he is “never invited to the party” (Male, age 65, community pharmacy locum “on an ad hoc basis”). Conversely, a few locums talked about how they had made the most of training opportunities, but that one had to be proactive in seeking them out. However, the fact that some still feel they are overlooked indicates it's an issue that deserves further attention. Isolation with regard to training is a somewhat ironic problem as Handy claims that the need to continue learning, growing, and developing is greater as a freelance individual.⁸ Other disadvantages associated with the extrinsic nature of locum work, such as no sick pay, no holiday pay, doing your own income tax returns, and the possibility of unwanted quiet months, were also highlighted.

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4. Limitations 

The qualitative nature of this study means that it is likely to have limited generalizability. We cannot judge how common or widespread the findings will be among the whole locum workforce. Nevertheless, it maps out and identifies some very important issues and points the way toward areas for further study. The findings suggest there is a need to investigate further whether locum pharmacists are marginalized with respect to training opportunities, explore whether their professional commitment is undermined because of their desire to maintain a work-life balance, and explore whether isolation is experienced on a widespread scale and to what extent this undermines delivery of pharmaceutical care.

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5. Conclusion 

One key finding of the study is that it confirmed the heterogeneity that is perhaps the most defining characteristic of the locum workforce. In fact, the pharmacy locum is perhaps almost a perfect example of how the nonstandard workforce is far from “homogenous and uniform.”^13(p51) Whereas our previous research²⁰, ²¹ demonstrated that there was huge diversity in the types of people who work on a locum basis in terms of key demographic factors, this study illustrated that the reasons why such people choose to work as locums are equally diverse. It has demonstrated that these reasons are complex and comprise a number of cross-cutting themes, encompassing personal circumstances, work history, and different needs and expectations of work. The overall diversity and complexity is characterized by the variety of the work patterns found and described.

For pharmacy policy and practice, the study has raised some important issues that perhaps deserve further attention. In terms of the extent that locum pharmacists are marginalized in the areas of unequal pay, training, and career opportunities, the findings are equivocal. In terms of pay, locums are arguably not marginalized, because although they forego the benefits of holiday and sick pay, they do appear to earn more than employee pharmacists. In relation to training, the evidence suggests that whereas some locums are proactive in seeking out training opportunities, others fell through the gaps and were very critical about being left out or ignored by those who provide training. In terms of career opportunities, again some respondents were successfully taking advantage of the changes pharmacy is undergoing and independently carving out rewarding careers for themselves. This was particularly the case with portfolio pharmacists. However, the issue of career opportunities is dependent on what people want and what stage of their working lives they are at. For many respondents, career opportunities were simply not an important priority in their lives. This links well with the work of key modern “macro” sociological theorists on the changing shape of work in society, with German theorists such as Beck³⁵ and Offe³⁶ contending that paid work and career were becoming “decentralised” to the margins of people's biographies and becoming less central in shaping people's lives.

With regard to the issue of job satisfaction in flexible or nonstandard work, it is clear that many pharmacy locums are achieving high levels of job satisfaction from their work and again this is particularly the case for those with portfolio work patterns. Although we recognize that choice is a complex issue, and not always one that can be exercised fairly, the issue for pharmacy locums appears very simple. The respondents in this study could choose to work as employee pharmacists if they so wish (whether part time or full time). They choose instead to work on a locum basis because they prefer the extra flexibility it gives. In this way, many of the findings clearly resonate with the “big issues” discussed by leading commentators such as Handy.⁷, ⁸ The advantages of freelance portfolio working patterns are strikingly evident for some locum pharmacists in terms of freedom, independence, and creatively mapping out successful career paths for themselves, providing professional satisfaction and a healthy “work-life balance.” Handy's positive vision of the future was evident from the number of respondents who participated in the types of “socially responsible” activities that he claims are necessary for the new work society to function healthily, such as being involved with various committees, voluntary groups, and local government boards.

However, Handy's caution about the downside of this new work society—of isolation, lack of social cohesiveness, and amoral attitudes—is also evident, in that health care pharmacy professionals are choosing not to work in deprived areas and eschewing working with drug users. “If the other side of freedom's coin is aloneness—then the obverse of independence is selfishness. For living up to the possibilities within yourself can mean ignoring the possibilities in anyone else.”^8(p202) The anecdotal accounts of “bad locums” gives credence to another of Handy's concerns: “A world of independent fleas and small enterprises can become an amoral world…. Maximise your own advantage and why not? What else could be more important?”^8(p205)

Sociologist Emile Durkheim was concerned with the very same issues in the 19th century. He believed that as societies evolve, they need different types of social cohesiveness in order for them to function properly. Although Durkheim saw the shift to industrialized societies and their associated characteristic of increased individual freedom as positive in general, he viewed it as a potential threat to social unity. Durkheim viewed the downside of too much individuality as the dissolving of a sense of duty and responsibility toward others. Interestingly, Durkheim saw occupational associations playing an integral role in binding economic activity to moral regulation.³⁷

Perhaps the same holds still for a “postindustrial” society. The pharmacy profession may need to give some thought to balancing the needs of the individual with the needs of the profession. What is good for one may not be good for the other. If independence for the locum pharmacist means people slip through the net in terms of access to training, regulation, and Continuing Professional Development, patient safety, particularly in busy, high-prescription-volume stores that lack adequate support staff, could be compromised and compounded when a locum, who is unfamiliar with the general setup of a store, is on duty. This is not strictly just a locum issue, but one of “skill mix,” but it nevertheless needs to be acknowledged and managed because it may get worse if the locum workforce continues to increase in size.

The high degree of flexibility that locums seek and require is perhaps simply a reflection of changes taking place in wider society. However, if the pharmacy profession wishes to limit the growing numbers of people turning to locum work, it may also require employers to review employment policies, to allow for a greater degree of flexibility for people who want the security of working on an employee basis with stronger ties to companies rather than negotiate the occasional insecurities and other disadvantages inherent in the life of a freelance locum. Socially inclusive attitudes may be easier to encourage and nurture if pharmacists are more fully embedded in their own professional culture.

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Acknowledgment 

The authors wish to acknowledge the Royal Pharmaceutical Society of Great Britain for commissioning the study on which this article is based.

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