Ash Soni, President of the Royal Pharmaceutical Society
Who, or what inspired you to choose to study pharmacy?
I wanted to be involved in healthcare, but also had a desire to engage in business which meant that pharmacy fitted the profile of the right career. Subsequently once I bought my pharmacy in South London I realised that the way to attract business was to provide extended hours and ensure I provided the best care I possibly could as that would create more demand by word of mouth. I also went to the local surgery to talk to the staff as what they saw as the weaknesses in the service at the pharmacy that they had heard or seen.
What is your five year plan?
Over the next five years I would like to see the Royal Pharmaceutical Society become a Royal College, maybe the Royal College of Pharmacy and Medicines. We are already behaving in many ways as a Royal College but there is an importance in demonstrating our equivalence to the medical and nursing royal colleges.
I want to get the profession so well recognised for the important role it plays in health, wellbeing and care that when anyone talks about the NHS they don’t just talk about doctors and nurses then talk about pharmacists, doctors and nurses.
As the profession becomes better recognised for everything it does I want to see pharmacists seen in all types of settings, including, for example, GP surgeries and care homes. It is really important that this integrates care across the system from hospital to community and that we see the role of all pharmacists extended as care givers.
I want the RPS Faculty and Foundation to become the gold standard of continuing fitness to practice that enables faculty and foundation members to, effectively, automatically meet the standards required by GPhC and records would only be called to assure them.
I would like all pharmacists to see the value of being part of the professional body and want to be members to contribute to the output from the professional body. The RPS is a membership organisation and is only as strong as that membership makes it. I should be seen as the place that helps members to improve quality and outcomes by supporting and promoting best practice.
I want to see all pharmacists becoming prescribers and ideally built into the undergraduate programme and during the first two years of practice pharmacists undertake any prescribing under supervision and subject to demonstrating sufficient competency will then be entitled to prescribe independently. To achieve this pharmacists will need full read/ write access to the patient record to ensure all relevant information is available to all involved in supporting the public’s health and wellbeing, with patient consent.
What is your practice area of interest?
I am a generalist and I feel it’s important to maintain that as a key part of my work. At the same time, as a prescriber I have particularly looked after upper GI, asthma, hypertension and some diabetics. I also have prescribed for travel health and smoking cessation when needed as part of my wellbeing role.
If we met at a conference and were not allowed to talk about pharmacy or the weather, what topic would you choose?
I enjoy watching most sports so would look to find an area that we both found of interest. Football, rugby, cricket, darts, golf or if we get stuck we could try tiddlywinks! I would want to know more about you as a person and what your interests were outside pharmacy. I’m sure we could talk about that as I enjoy listening and learning from anyone I come into contact with.
What is your opinion on read/write access to patient records in the community pharmacy?
As I said above I believe that access should be available to all involved in care with patient consent. This will make care safer and enable community pharmacists to better contribute to quality of care. I have had such access since I qualified as an independent prescriber and never had any issues when I’ve asked to use the record. In fact most patients were surprised that access didn’t exist anyway.
Having access to the record with read/write would also enable pharmacists to show how much they do in supporting care and completes the cycle between what is prescribed and what is dispensed when. It would also all the other services that community pharmacists provide being recorded within a single patient record.
How do you feel the community sector fits alongside the drive to place pharmacists in the GP practice setting?
The community setting retains a very important role. As a community pharmacist myself I was the pharmacist that also worked in and with the GP practice so this cannot be precluded as a model. The role of the pharmacist in these circumstances is about looking after a caseload and managing discharge medication queries and queries that may be raised by the community pharmacist.
A GP I know estimates he spends an hour a day managing medication issues which can be better managed by a pharmacist. With full read/write access the pharmacist may not need to be in the surgery except to be part of case conferences and clinical management meetings to support the needs of more complex patients.
Community pharmacy continues to open for longer hours than GP practices and are able to support the public to main their health and wellbeing and these will continue to be the responsibility of community pharmacists. Also the pharmacist in the GP practice can only see certain numbers of people compared to the number that see a community pharmacist. This means services like MURs, NMS, vaccination, smoking cessation, health checks must be delivered by community pharmacists but adding that to the patient record as part of these roles.
Community pharmacists need to recognise the increased clinical role they need to undertake which is supported by being responsible for medicines supply. However, supply becomes part of care rather than supplementary to care.
What is your top tip for newly qualified pharmacists?
The most important thing is to make sure that you’re passionate about providing the best care for patients and the public. If you always endeavour to do the best you can you will be valued by those that seek your support for their health needs. It is important to see pharmacy and being a pharmacist as a vocation rather than a job because it is all about care not just being there.
Also it is important to be open to all the potential roles for pharmacists going forward and to think about the potential in any of them to be able to provide the best care.
Do you think non-medical prescribing pharmacists are capable of managing patients in a community pharmacy setting?
This must be part of the direction of travel. Why does a hypertensive patient need to go back to their GP to have their blood pressure checked every six or twelve months? If the community pharmacist did that on supply then they would refer back when there observed some deterioration or another symptom presented that requires medical intervention.
The same can apply to any singular long term condition or for those who have developed and enhanced their skills there is the opportunity to manage greater multimorbidity. This is not to undermine the role of someone that is medically qualified but rather enables them to deal with greater complexity which better utilises their skills or those of other clinical professionals. Ultimately we should all be building care around the person rather than around the clinician. Right person with the right skills in the right place at the right time.
Do you think paying community pharmacies by dispensing volume is the future?
It is important to recognise how efficient the current supply system is and not to lose that value. I believe that supply must not be lost in any changes made as it enables community pharmacists to have regular contact with patients. This enables pharmacists to make every contact count.
However, there is a need to recognise that additional care is the direction of travel but this will need to be funded with additional resource. There is a challenge about access to resource in a flat funded system but I believe that if pharmacy participates and contributes to research we have the evidence to show improved outcomes and savings elsewhere in the health system which releases the funding.
It is also important to recognise that the national contractual framework is only one source of funding. For general practice a significant part of their funding comes outwith their national contract and pharmacy needs to recognise it has to look to these alternate funding streams.
Do you think pharmacists should be allowed to hold partnerships in the surgery much like GPs do?
This is a more complex question than it appears. If GPs can own pharmacies or have significant shareholding it’s only fair that pharmacists have the reverse opportunity. It must be really clear about ownership and/or partnership and declared conflicts of interest. Also there will be pharmacists who are partners who have no interest in a community pharmacist and why should we prevent that opportunity as that enables recognition of status and equivalence in the relationship. What is critical in any of this is ensuring patient choice and not allow some of the misdirection and management of leaflets making it clear about relationship with a surgery.
If the change in the model happens provision of care will become central to the role of community pharmacists and hopefully this will negate some of the current challenges between general practice and community pharmacy.
Why should non-members join the RPS?
The RPS is THE professional body for pharmacists and is there to serve the needs of members. If the RPS is to continue to develop and lead the profession the voice of the profession must inform the organisation. If you don’t want to be part of it that’s a personal choice that should be respected but I ask anyone that feels aggrieved by the RPS to express that but then allow the RPS to respond and justify its decision on behalf of the whole profession. Ultimately being a member takes all of the single professional voices and produces a louder collective voice.
In your opinion, who are the top 5 influential pharmacists in the UK right now?
I’m afraid I’m not going to answer that as I believe every pharmacist is influential and we need to support every pharmacist to maximise their influence. It falls on all of us that have the ears of larger organisations to promote the role, skills and capabilities of pharmacists and support those individual pharmacists to be more influential.
Ash Soni was interviewed by Johnathan Laird