Can you describe you career pathway?
I started in hospital pharmacy, doing my pre-reg at the now closed General Hospital in Nottingham before moving on registration in 1982 to Queen’s Medical Centre down the road. After a short and unhappy (workwise) six months in 1984 at the Norfolk & Norwich Hospital, I applied for and got a job writing on Chemist & Druggist.
Seven years later I took a successful punt on an ad in the PJ and for the next four years worked as a civil servant in the Department of Health in London as part of the pharmacy policy team (including contract negotiations). I left there in 1995 to join what was then Moss Chemists as the company’s first Professional Services Manager, where I built a team concentrating on new pharmacy services.
I was at Moss, and then Alliance UniChem in its international retail division, for more than eight years altogether. For the last three years there I led on professional services development in new businesses in Norway and the Netherlands as a part of the wider business development team researching entry into new markets across Europe.
I left AU to join the RPSGB as its first (and only) Director of Corporate & Strategic Development, where I had responsibility for policy, research, corporate governance, the secretariat, human resources, business intelligence and science. I was persuaded to leave the RPSGB to join the Company Chemists’ Association as its Chief Executive in 2007, and from 2010 to 2015 I did that role concurrently with the role of CEO of Pharmacy Voice.
Like three of my colleagues, I was made redundant earlier in the year when Pharmacy Voice was closed down by its trade association members after the NPA decided to give notice of its intention to withdraw from the collaborative.
What’s been the greatest achievement in your career so far?
I’ve always tried to add something wherever I’ve been – new and different is what motivates me. So whether that is introducing new features to C&D or coming up with the idea that put the Moss tender for a multi-million pound prison contract ahead of the competition, I’d like to think I’ve added something in all the things I’ve done.
The Pharmacy Voice team was the best I’ve ever had a hand in building, although the Moss prison pharmacy team and the Alliance Apotek management team in Norway were pretty special.
However the one achievement that sticks out for me, and I cannot personally claim credit for huge chunks of it, was the 13 year journey that delivered the New Medicine Service, from an idea in Nick Barber’s room at the School of Pharmacy, to an NHS service in community pharmacy.
Most of the credit is Nick’s but I was there at the start, kicking off with the pilot study of the original research in 25 Moss pharmacies in 1999. When I joined Alliance UniChem’s European business the following year I lost day-to-day touch with progress – as a result I’m a co-author on the first of the five key published papers only – but Nick never stopped asking me, when the research was complete and it showed we had a major potential advance on our hands, what had come of the output.
By rights it should have been promoted to DH as part of the “new contract” discussions in 2004/05 – it was a better evidence base than MURs have ever delivered – but the potential service lay on the shelf for almost six years.
But, in February 2008, a year into my time at the CCA, we got a meeting with the then Director General for Commissioning and System Management Mark Britnell, to contribute views for the forthcoming community pharmacy White Paper. I took Nick along as part of our team to present this work; we had a hospital pharmacist too I remember.
Mr Britnell was delayed by urgent matters at Number 10, so we presented to the Chief Pharmaceutical Officer. The upshot was 24 hours later a request from within DH to provide the research papers, and six weeks later the service was included in “Community Pharmacy: Building the Future”. If you think about it, the New Medicines Service is medicines optimisation/pharmaceutical care in action. It’s proactive, meets a defined need, and it works.
Is there anything you would have done differently?
I have one regret with the NMS stuff. In spite of plenty of advice on how to manage a change/implementation programme, and goodwill across the whole community pharmacy sector, the implementation was botched, take-up was slow, community pharmacists continue to question its value, and NMS scraped over the line in the evaluation (the latest report was published in the last few weeks).
I think I/we should have been more insistent with those who thought they knew best that we needed a proper plan for delivery, and one that included achieving effective buy-in as a first step.
Community pharmacy in England’s serial lack of focus on implementation is a mistake we addressed in the original “making it happen” section of the Community Pharmacy Forward View, which Pharmacy Voice submitted unilaterally to NHS England and the Department of Health as part of our response to the “2016/17 and beyond consultation” in May last year.
So, in terms of NMS, we should have also insisted that the valuable lessons from the pilot study and scoping research were learnt properly. The pharmacists who delivered many of the interventions in the original work could and should have had input to the service design. They did not.
I’ve had occasion to reflect very recently on another issue where trying to work with reluctant others on something vitally important consumed too much energy and eventually prevented us delivering an important piece of work. We should have just done it anyway. Generally I think there is a lot in the advice “Don’t seek permission; ask for forgiveness afterwards”. I use it regularly myself to others.
What career advice would you give to other pharmacists?
See the last two sentences above!
Right now, especially for young pharmacists, the world is your oyster. What do you want to do, because you can create a valuable role that utilises pharmacists’ skills pretty much anywhere across the health care system right now.
I spent some time out and about last summer, talking to pharmacists about the cuts, the responses and the future. I was not surprised how many of those front line professionals I met were interested in the patient facing directness offered by some of the new roles working with general practice; I was struck by how many young pharmacists were keen to keep their employment status relatively fluid to be able to move across the system easily if an opportunity arose.
The challenge for community pharmacy is to create an effective, thought through and implementable case for developing and using those skills across the pharmacy network, where they would be even more accessible to the public that needs them.
Against that background, I would also offer the following advice: be true to yourself as a professional, remembering that at the heart of the “contract” between society at large and a profession is that the members of that profession will use their specialist knowledge first and foremost in the interests of the patient/consumer or member of the public they are serving at the time.
It may be easy for me to say as someone who last worked in a patient facing role in 2000, and it may have been easier for me to withdraw my labour as part of a team who refused to work in conditions we considered were unsafe for patients thirty years ago, but that’s a call professionals have to make time and again.
Will the next stage in your career be within pharmacy?
I really don’t know.
I have had lots of kind messages from former colleagues and people within the profession I have been involved with in various roles over the years asking me “what’s next” and wanting to talk about what needs to be done.
There are a number of things we were not allowed to pursue directly as Pharmacy Voice, or where we were reliant on others to do the right thing; there were also areas where I think community pharmacy should have been better prepared by working out policies in advance based on likely options – for example, I’ve wanted to develop a policy for scenarios relating to the delisting by the NHS of OTCs/common conditions for the last three or four years.
Now it’s happening almost by stealth in the NHS in England and pharmacy does not seem to have a coherent policy: do we want to defend the right of individuals to receive the right treatment, regardless of its statutory classification, should we make the case for a genuine safety net for those of limited means, or would we really like to advocate more direct care delivery by pharmacists and pharmacy teams, which might lead to innovation in costing/funding models.
I’ve never really had a career plan, so the last few months have been a little weird. I’m not retired – I know exactly what 10 years’ statutory redundancy terms equate to, which means I can’t afford to – but I’m also not rushing back into anything full-time right now, so (plug) I am available in the short-term to look at problems out there.
I joined the governing body of a School/College for children with considerable physical disabilities a couple of years ago. Seeing the amazing of achievements of kids against all the odds, and the work of the teachers, therapists and technologists that helps that happen is really inspiring and I hope to give that a little more time over the next few months too.
What would be your ideal job role?
I always wanted to run a quirky cinema, a multiplex like the Ritzy in Brixton (sorry for the London reference, but if you know it, you’ll know what I mean). If I’d gone into that rather than get diverted by science A Levels I’d like to think I would have come up with the mix of blockbusters, small screen arthouse, community populism that puts backsides on seats in an 18 hours a day, 7 days a week social asset that Picturehouse can run so well.
And I’d like to think I’d have done better to avoid the pay disputes they’ve had there in recent years too.
Community pharmacy in England is facing tough times. What changes need to be made to turn things around?
Community pharmacy needs to understand the context it operates in, and needs to place itself within that context appropriately. In England, the defining document – still, two and a half years on – for the NHS right now is the Five Year Forward View. This represents the collected system leadership’s view of the challenge facing the NHS in England post the 2015 election, and what is to try to square the circle of funding in the face of technological change and demographic pressure building up in the system. While improving quality.
Some organisations have still failed to address the asks of the system in this document. People were told not to get involved in major developments such as the Greater Manchester devolution programme.
I was told five years ago when I suggested we work together to support local commissioning discussions that “local isn’t important”. Clearly, as Simon Stevens has been saying for some time, Sustainability and Transformation Partnerships are “the only game in town”: the jury is out on whether they are working, but they are today’s context. The centre has decided command and control cannot deliver across the different geographies in England. Local leaders are free to experiment, on the grounds that some of them might come up with some answers that actually work.
The clear message from the 5YFV is that the same old stuff won’t cut it if the NHS in England is to get even vaguely close to keeping on an even keel over the medium term. Yes, this may be what our political masters intend with continuing austerity, but pretending this is all someone else’s problem is missing the point.
Pharmacy needs to build its alternative model. That model needs to be credible, relevant, and achievable. Most of all, it needs to show not just what is possible, what pharmacy can do to play its part in meeting the challenges of the next 10 years, but how those possibilities will be achieved. Innovation is important, but the ability to deliver and to achieve a demonstrable impact on patients, on costs to improve value, and on future pressures are the real keys to the future.
On reflection, could anything have been done differently to avoid the current scenario?
Yes, see above.
It might also have been useful for genuine differences of opinion about the appropriate response to the challenge brought home in the notorious December 17 letter had been explored properly. Several organisations were brought into the process this time. No-one seemed to want to understand why that was, and to use the opportunity to work out how the various interests and perspectives might genuinely contribute to achieving a better outcome for all.
Does the government not see the value in community pharmacy?
I believe it does. But we only demonstrate our value, or come up with “savings”, when pushed. We’ve resisted change; we’ve even argued against the principle of a level playing field in one area, something I think has to be a first in representation anywhere.
I’m still not sure we have a clear idea of where we want to be. The Community Pharmacy Forward View was designed to deliver that, but can you honestly say that the energy that led to its creation, in a 40-person 24 hour strategy meeting followed by four weeks of intense distillation and drafting, has been followed through? Some of the sector’s leaders can barely bring themselves to say its name. Three months from initial submission to agree the publication text; a further five months to find a compromise position we could agree on publishing for the implementation chapter? We’re now a further eight months on.
In years to come, do you think community pharmacy will regret the demise of Pharmacy Voice?
I don’t think that’s for me to say. I think a single representative organisation for the trade sector bodies was the right approach; its formation was widely welcomed by most stakeholders.
We tried to do some good stuff. Some of our consultation responses and our position papers are object lessons in referenced, thoughtful and well-argued policy making and positioning. Our working groups, through which members came together to make the decisions on our approach to IT, workforce, professional practice, produced some of the finest discussions I’ve been privileged to witness in 20+ years doing this kind of thing.
We ran award-winning campaigns, on our own and working with others from outside the sector, we got involved across Government – Home Office, BIS, DfE – in issues which our members wanted us to get involved in. And, given the anguish which our closing down was met with in some quarters, then I have no doubt that moves will be made in the future to create a united voice again.
I was told the opening up of the discussions with the sector in 2016 was an attempt by Government to “divide and rule”. We could have avoided that by working better together as organisations when facing the threat, but the end result was that we ended up dividing ourselves.
What difference did Pharmacy Voice make?
Time will tell. Our work supporting the patient safety agenda – great to see this now crystallised in a new website www.patientsafetylearning.org – was ground breaking, and shows what can happen when people work together and share problems and solutions.
Our input to Health Education England’s pre-registration revamp, including the Oriel system, shows what can happen when you get constructive representation right. Our two Forum meetings were designed to be constructive and future-looking, although the second one could have done with not being almost the last external facing thing we ever did.
I genuinely hope that the organisations will try to take forward the Community Pharmacy Forward View, a piece of work which was 100% Pharmacy Voice in origin and 90% Pharmacy Voice in execution, all put together and led by the fantastic Elizabeth Wade. The CPFV was a piece of work that should have taken six months which was completed in six weeks. We would have had a major engagement phase in the six month programme, but it was vital to include a vision/strategy in our response to the “2016/17 and beyond” consultation.
I’d also like to think that Pharmacy Voice demonstrated that complex professions need a range of skills working in its institutions. Pharmacy Voice drew its staff from the NHS, from commissioning, from the best pharmacy organisations overseas, from high-end PR, public affairs expertise from the water industry, specialist organisation management and governance expertise from the third sector. It was a small team, but one built to a thought through blueprint with outcomes in mind. I’d never worked with any of the team before we hired them. Without exception, we got great people from great fields at interview.
How well do the various organisations work together/collaborate in pharmacy?
Next question.
Some work well with others – the three organisations in Pharmacy Voice worked well together for more than six years. Others talk collaboration more than they practise it. Some of our meetings with senior officials were subject to FOI requests which can only have come from organisations or individuals we were supposed to be working with.
Are multiples driving the agenda at the expense of independents?
My experience has always been that there is more that unites pharmacy businesses than divides them. I know it can often look that way, and of course the multiples try to drive the agenda at times; they are considerably invested in the sector.
The investment of the four largest companies in the Community Pharmacy Future service development has been characterised as an attempt to drive the agenda. That work fell out of the first Pharmacy Voice “Blueprint” document and, had things been different, might have been developed as a cross-sector piece of work by PV. The companies however, agreed to invest as a means of making much faster progress, have involved independents (from the start in CPF project 2) and have explored some really interesting models for the future development of the pharmacy service.
I think the multiples v independents argument is a sideshow to a much bigger concern. It is often said that the UK has one of the most sophisticated and efficient supply chains for medicines in the world. That may be the case, but with efficiency comes “just in time” inventory, and therefore potentially a lack of resilience when things go wrong in the system. Too many pharmacists spending too many hours sourcing product tells me the system is well and truly broken. It’s prone to gaming at many levels; pharmacies and patients are both the losers.
I first asked an audience of pharmacy owners whether pharmacy should make the case to get out of owning medicines in the mid-1990s, just before I left the Department of Health. By definition in an averaging system half the players are going to do worse than the average, and the incentive to beat the average has delivered huge savings in the drugs bill to Governments over the years.
I’m not an expert, but it seems to me that the workings of the Category M mechanism over recent years represent a triumph of spreadsheets over reality. When pharmacy owners who I think run a tight ship, and who are trying to do their best by patients, are telling me they don’t know where the numbers in the system are coming from, then something looks seriously wrong.
What’s your view on allowing pharmacy technicians to join the RPS?
Why not? The CCA response to the consultation on the future RPS, when the GPhC was splitting out from the then RPSGB, suggested that the new RPS should aim to be THE Royal College for pharmacy and medicines.
Taking a leaf out of the book of the Royal College of Physicians, whose Faculty of Public Health means the RCP gets income from non-doctors as well as its doctor members, we envisaged a pharmacy organisation owning the medicines space in its entirety, including drug discovery, prescribing and medicines use in addition to acting as the professional leadership body for pharmacists.
It should not be beyond the wit of the Society to embrace associated professionals, and those with the broadest of interest in medicines, including pharmaceutical scientists, pharmacy technicians, and prescribers, regardless of professional background. What form “membership” these groups might take would be open for discussion, but they don’t need to be “equal” to pharmacists in status within the organisation.
There’s been a lot of scaremongering around roles. All the stuff about a Rebalancing Board plan to allow pharmacy technicians to supervise pharmacies. I was a member of the Board for more than four years. It’s not true.
This is not the place to go into this in detail – it’s a lively debate right now elsewhere, but I think precision in language is important, and exaggerating or extrapolating too far to make a point doesn’t help the profession as a whole come to conclusions about the future of practice, when in many places, and sometimes as a result of purely political decisions, we are being faced with squeezing a quart into a pint pot.
What will primary care look in 10 years’ time?
This really is anyone’s guess. Go back 10 years from here and who would have predicted some of the advances we now take for granted. In 10 years technology will provide the public with more information at their fingertips than ever before.
Smart devices, particularly wearables, will give people who want it detailed information on their health status, at any time. Personalised medicines will be more common; medicines will increasingly be matched to genetic profile; is it possible that 3D printing technology will produce medicines for individual patients and we’ve seen the end of standard dosages?
The role of the professionals will be increasingly about interpretation, navigation and support for behavioural change. Fortunately for the immediate future of pharmacy, while the younger generations are losing voice communication in favour of keypads, for the main users of medicines, the elderly, we still have plenty to go at in terms of improving their use of medicines to get the improved outcomes they want.
I believe the face to face role of pharmacists has a way to go yet; medicines administration in care homes in this country has barely improved since I did my third year student dissertation on the scale of the problems in care homes in Derby with Dr Peter Rivers in 1981.
Are you optimistic for the future of the profession?
Yes. Never in my 35 years on the register has so much hope been invested in pharmacy and pharmacists within the NHS. New roles are opening up in urgent care, NHS111 centres, A&E departments and GP practices. In the central scheme in England alone, the ambition is to have an additional 1,300 pharmacists in GP practice teams in the next few months.We have a new plan of action in Scotland with plenty of pharmaceutical care focused around community pharmacy; I’m looking forward to hearing what’s next for pharmacy in Wales.
As for community pharmacy in England, I don’t know what happens next. Pharmacy Voice consistently argued for a real partnership between community pharmacy and NHS England on developing a joint plan for the future.
In an ideal world, the Community Pharmacy Forward View would, like the GP Forward View, have been a co-production between pharmacy and the NHS. The courtroom is not the ideal place to build a partnership. I understand the argument that all avenues had to be exhausted, but I think it’s clear from my earlier answers that I didn’t think that where we ended up was an inevitable conclusion to the events triggered by the December 17 letter.
I’ve been privileged to meet and serve many fabulous pharmacists and their teams over the last 10 years. I had the opportunity to give more of a platform to some of the very best; it’s great to see people like Anjella Coote, Reena Barai and Ade Williams shine on public platforms and in front of politicians at Westminster. They can bring to life the great things pharmacists do day in day out better than any representative officer can ever do.
The Anjellas, Reenas and Ades are the people we were working for. They deserve our very best efforts. It’s a real shame that pharmacy contractors in England will not have the chance to see what we were working on when we had to stop.