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1/11/2012
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Remote pharmacy
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The sun rises on the north west coast of the Llŷn Peninsula.
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Will Hughes had no passion for pharmacy as a youngster but he has become a crucial healthcare provider for the people of picturesque Nefyn, a small Welsh town on the north west coast of the Llyn Peninsula. Neil Trainis talks to the Pharmacy Business Enterprise Award winner...
A sense of seclusion has allowed Will Hughes to flourish. He works in a part of the world which appears to be cut off from the rest of society but he is indefatigably connected with the demands placed on modern pharmacy.
Nefyn is a town on the north west coast of the Llyn Peninsula in Gwynedd, Wales, and has a population of 2,619. It is an intimate setting where Welsh is the first language for about 80% of its inhabitants. That, Pharmacy Business's roving judge Richard King observed, “adds a real sense of community to this beautiful location.”
The region's beauty is not in doubt and its healthcare is in good hands too. There are six pharmacies in all on the peninsular, two belonging to Will and four Rowlands pharmacies. “It's kept us on the ball. We're always having to think ahead, be inventive, proactive,” he says.
He bought his first pharmacy, RJ Jones Pharmacy, in 2003, one month before the birth of the first of his three children, and relocated it in 2007, “100 yards down the road” from the old premises to “a custom-built, brand spanking new pharmacy” with a consultation room and a large dispensary.
“We moved to address the demands of the Pharmacy Contract and the changes in the NHS,” he remembers. The cost of the relocation was £200,000. He acquired his second business, H.L Taylor Pharmacy, in 2005. “I bought my first pharmacy one month before my first child was due. It was a challenging experience becoming a boss and a father,” he adds with a chuckle.
At the age of 36, Will's accomplishments are impressive but he gives you the sense that there is so much more to come. “It's nice to have won the award,” he says almost self-effacingly. He attained his pharmacy degree at Cardiff University in 1997 and did his Pre-registration in 1998 at a small firm called WL Jones Ltd which consisted of five pharmacies and six pharmacists. “Two pharmacists owned it,” he recalls. “It was a great little firm to work for.”
He has no family background in pharmacy. His mother works in a care home, his father is a carpenter joiner. “I have no pharmacy background in the family. I was completely new to it. It was a new avenue for me,” he says.
Passion
As a youngster, he had no natural affinity or passion for pharmacy but loved science and health and regarded those as the perfect combination for what is quickly becoming a rewarding career. “I always wanted to be a health professional. I don't know what drove me to that. I saw others come out of university and I was adamant I wanted a profession that would give me a clearer avenue and allow me to do something with my life,” he says. “I had a drive for health, not necessarily a passion for pharmacy, so I wouldn't say that. I had a passion for science and health and that paired together well with pharmacy.”
Pharmacy has fulfilled him even though he had his doubts about embarking on that particular journey. He envisaged becoming a successful pharmacist and saw Nefyn as the ideal canvass for his work. He briefly left the area to live in Cardiff where he spent four years before returning to Nefyn. “I moved back to the area after a few years in Cardiff. Nefyn is a great place to bring up kids,” he suggests. The appeal of the picturesque peninsular had proven too fierce to resist.
“We have a beautiful peninsular,” he enthuses. “The geographical area for our patients stretches 20 miles up one side of the coast and 10 miles up the other side of the coast.” There are four pharmacists working between the two pharmacies and three drivers covering the peninsula for their delivery service. The two pharmacies also look after all the care-homes in the peninsular.
“I always wanted to be a health professional. I don't know what drove me to that. I saw others come out of university and I was adamant I wanted a profession that would give me a clearer avenue to do something with my life.” Will Hughes
“We were the first to do the delivery service on the peninsula and Rowlands followed suit,” he says with more than a hint of pride. “We started it in 2005 and we now cover all care and residential homes on the peninsula. We never rest on our laurels. We want to get better and better.
“It provides a vital lifeline. We've got so busy, we'll do one section of the peninsula first, then the other section of the peninsula.”
The three drivers covering the two pharmacies are supplemented by one pharmacist who provides home deliveries to patients. Will observes that, even though it proves to be a lot of work for such a small team, “it's been a terrific lifeline for the community.”
RJ Jones Pharmacy is relentless as it strives to give the people of Nefyn high quality healthcare. It provides a plethora of services, including a needle exchange programme, smoking cessation, a morning after pill service, diabetes testing and asthma and methadone monitoring. He also attends local food festivals where he offers blood tests and health advice.
The pharmacy was closed on just a solitary day last year – December 25. It was open 364 days in 2011. “It was a challenge for us logistically because we have four pharmacists working between the two pharmacies,” he says.
Will has also had meetings with local community groups about sexual health and he suggests that RJ Jones's sexual health services are a “work-in-progress.” He adds: “Pharmacy has a massive role to play here.”
Clientèle
The clientèle Will and his team cater for are almost on opposite ends of the spectrum. “We have either very young or elderly,” he says. “We don't get many people in their 30s for example, although we do have every age group of course.”
Innovation has been a large feature of RJ Jones pharmacy. It was the first to pilot the All Wales Smoking Cessation Scheme in north Wales on behalf of Public Health Wales. “We're very proud of that,” Will says. “Patients come into the pharmacy and use the programme and that's where our consultation room comes in. There they can access councillors.
“We also use the pharmacist to treat depression. We use Cognitive Behavioural Therapy (CBT) for people with mild to moderate depression.” CBT is a psychotherapeutic approach, or to put it another way, a talking therapy. It attempts to solve problems relating to dysfunctional emotions.
RJ Jones Pharmacy has been piloting this since September 2010. “It's early days. There are small scale funding issues but we are seeing positive results. I hope people see this as an alternative avenue for them.” Any concerns raised about the well-being of any individual are communicated to mental health specialists in Bangor.
The workload pressures never cease but it keeps Will on his toes and he thrives. Pharmacists across England are coming to terms with the New Medicine Service but their counterparts in Wales are contending with the Discharge Medicines Review (DMR). Under the service, the pharmacist checks the accuracy of discharge medicines received by the patient and attempts to synchronise the prescription period with any existing medicines.
The service also provides for an MUR to check the patients' understanding and use of discharge medicine, with a follow-up intervention 10 days later. It is demanding work but Will maintains his poise and determination. “We're just getting used to the paperwork. We've just started it but we'll get there,” he says.
“I bought my first pharmacy one month before my first child was due. It was a challenging experience becoming a boss and a father.” Will Hughes
There are various demands placed on the shoulders of pharmacists and pharmacy teams as a modern NHS fit for the 21st century takes shape. Will, for one, is unnerved at the prospect of having to complete 400 MURs a year.
“They definitely have an important role to play,” he maintains. “Certain therapeutic areas also need addressing. We have what we call frequent fliers; people who are in and out of hospitals. Pharmacy can help those people with their medicine and we've been achieving our targets.”
When he is asked whether 400 MURs is too much for an overworked pharmacist to do, his reply is instant. “I don't think 400 a year is unreasonable. When you think about it, it's 30 to 35 a month, five or six a week. That's not too bad. And you need to do that to provide a good service.”
Will has left few stones unturned as he seeks the utopian pharmacy. He considered the layout of RJ Jones after acquiring it. “We were involved in the architecture of the pharmacy. I would describe it as clinical, not sterile. It has a professional feeling to it, a welcoming feeling,” he says.
There is even a touch of psychology to help make patients feel at ease. That, in turn, can prompt them to talk more freely about their problems when they might clam up in other settings. “The wall behind the pharmacist is pink,” Will reveals with a touch of humorous satisfaction. “We've found that the colour actually calms patients down. It's all about subtle psychology. People have to feel comfortable to open up.”
Squeeze
In Will's eyes, there is always scope to improve but amelioration, as is habitually the case in business, is linked to finances. He would like to ensure there are at least two pharmacists in each of his pharmacies every day but the profession is feeling the economic squeeze just like everyone else.
“We really could take it to another level,” he suggests. “We could get two pharmacists working here every day. It's quite an isolated profession. We need a commitment from the NHS long term to allow us to have two pharmacists working every day. But we need to prove ourselves before the NHS will commit to services and show faith in us.”
He struggles to conceal a sense of frustration that any progress pharmacy as a profession, and first point of contact for many people in the community, makes is dependent on funding. “We're never going to say it's good enough,” he says. “The pharmacy can go much further in becoming the first port of call for people. Pharmacy organisations and the government need to work together to bring that message forward. Nurses do a good job in the NHS but (health commissioners) are still missing a trick.”
He believes pharmacy can “hold its own” as competition for services is opened up to large scale corporation and private enterprise, although he wants the establishment to show more faith in pharmacy and for the profession itself to shout louder and clearer about its offerings.
“Pharmacy can prove itself in cost efficiency. We can be innovative and competitive,” he says, the emotion building within him. “The government needs to take a leap of faith but I think pharmacy can hold its own. If services are opened up it has to be a proper, true level playing field. Pharmacy can prove itself dynamic and innovative but we need a strong political voice from the likes of the RPS (Royal Pharmaceutical Society).”
He harbours a concern for the future of pharmacy. He regards the profession as akin to a cloudy, polluted lake from which onlookers fail to see their reflection. “I'm concerned there's too many voices. We need one strong message. When you look at it from the outside, pharmacy can look murky. You've got the NPA, CCA, RPS, Pharmacy Voice, PSNC. If I was a politician that might murk my decision-making. That concerns me.”
Still, Will is happiest when he is rushed off his feet in the pharmacy. He is anxious about the future but thrives on the here and now.
For a moment, he allows his mind to drift back to his days as a student agonising over what path to direct his career. A familiarity with the demands of life as a pharmacist has put him in a position to offer advice to any young buck looking to carve out a career behind the dispensary. Or, as the demands of a modern NHS dictate, a career as an active, holistic healthcare clinician.
“You need enthusiasm by the bag-full. It's a hard career. You never get a moment to yourself,” he says. “I always say that community pharmacists must be plate spinners. You can't devote all your attention to one thing.”
There is a pause. It is as if a series of snapshots of Will's career course through his mind during that brief silence. Then he speaks. “If you can juggle and spin all those plates, it can be a very rewarding career.”
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