Pharmacy Rebel with a Cause
A profession entering a critical phase in its history needs strong guidance, leadership... and brutal honesty. North East London LPC secretary Hemant Patel seems to be the man to provide it, writes Neil Trainis...
A plush restaurant embedded in a tranquil corner of Brentwood in Essex, its old England-style wooden beams reinforcing a sense of harmonious retro, hardly feels like the appropriate backdrop to ponder the tumult pharmacy faces but Hemant Patel does not care.
There are few settings capable of stifling a man with a propensity to speak candidly and, in the process, ruffle a few feathers. The North East London LPC secretary polarizes opinion within the pharmacy industry, many finding his candour provocative and others holding him up as the kind of inspiring firebrand a sometimes moribund profession needs, someone unfraid to cut through the waffle.
His frankness has a refreshing effortlessness. “We have got grey people,” he insists with characteristic bluntness as we sit down at a table. He pushes some cutlery to one side, cutting a man with a purpose. “The reason for that is there is no contrasting opinion. People are either lazy or afraid to offend and I seek to offend nobody. But I do have a passion for my profession.
“Somebody has to articulate the concerns expressed at grassroots level. Unfortunately, when you look at the national organisations, is there an outstanding person there who speaks on behalf of members? At LPC conferences, is there somebody standing up, making a point that needs to be made?
“I have looked at the motions submitted at BMA (British Medical Association) conferences and there is genuine passion and genuine depth of understanding of their situations. And they have long debates, over two days, about all kinds of issues. At LPC conferences, we want to finish it in two hours, network and bugger off home.”
Pharmacy is awash with individuals in influential positions but it suffers from a dearth of leaders with the ability to make ripples with incisive, intelligent debate when the majority choose to hold their tongue. Hemant is pretty unique in that regard.
“There is a lack of activity at local level, due to ignorance and probably a lack of passion, and combine that with the type of people we have attracted into the profession who are good at being grey,” he says. “We had a Prime Minister who was good at being grey...Major. Pharmacy has got thousands of John Majors. We need a few Maggie Thatchers.”
It quickly becomes apparent why Hemant has held a variety of high profile pharmacy posts. The four-time former president of the Royal Pharmaceutical Society of Great Britain, vice-chairman of the Pharmaceutical Services Negotiating Committee and chairman of the National Pharmacy Association does not mince his words.
Unflinching
He has some sympathy for the plight of pharmacists, given what he regards as inadequate funding in the face of challenging health reforms, yet Hemant is unflinching in his view that many of them are failing to help themselves.
“All the changes we are facing are surmountable and we can survive. The only challenge I'm worried about is pharmacists' mindset,” he asserts. “It is the biggest obstacle in our progress to be a part of an effective primary care.”
A shrewd familiarity with the workings of pharmacists has given him the sense that many of them are wary about competing for the right to provide services and happy to evade the necessary evolution from dispensers of medicine to active healthcare clinicians.
“People talk about challenges, people talk about closed environments, ie, doctors won't allow us to compete. But at the same time we say 'open the doors elsewhere for competition but close our doors to competition.' We can't have it,” he says.
“I have got experience of dealing with pharmacists at a local level and at a national level. I think they have been used to a regulated environment where competition from outside was stifled and even internally, they wanted to have protection. Those things are going to disappear.
“They think that this fad called change will disappear but I don't think it's going to. And they are going to be very surprised. One of the things I'm worried about is their mindset, they are not getting ready for the future. And the future is coming faster and faster towards them.
“I think the stress levels in community pharmacy will force many people to either suffer ill health or cause all kinds of stress-related problems. I'm already seeing some evidence of stress-related illness in pharmacists. They cannot cope because they have not prepared and they do not think they have got a strategy.”
It is tempting to think of Hemant as an attention-seeking dramatist but his passion masks a sobering pragmatism. At ground level and local level, he has his finger on the pulse. He is unmoved at the mention of an Independent Pharmacy Federation survey last year revealing that, of 127 pharmacists randomly polled, 78% admitted they did not understand the NHS reforms.
“I think the figure is better than expected,” he says with a sobriety that could almost be mistaken for deadpan wit. “In some ways, change has occurred and there are already lessons. If you look at what happened to the American Indians when a new, aggressive, well equipped group of people came, if you look at the Afrikaans and the Boers, the same thing happened.
“This is just another, gentler form of how human evolution works. This time, the technology, politics, public expectations and the internet are coming together in a very unique way and humans have not seen anything like it before.”
He believes there are pharmacists who are hard-working but, fused into the heart of their communities and perhaps sensing protection from change, are procrastinating. Pharmacists, he suggests, require prompting and guidance.
“I think, nationally, people are good at telling people what to do. One thing they're not good at telling is how to do it. We have spent an enormous amount of time in North East London working with pharmacists, particularly around the New Medicine Service. We had to work very hard to try and change their mindsets.
“Engagement from pharmacists is required on three levels. The first level is the strategic level, trying to understand what is happening in their environment and understanding what kind of decisions need to be had with their commissioners and the GPs.
“The second thing is a practice issue, what kind of things should they be talking to the doctors about other than a prescribing error. The third type of engagement is building up a team around them that will support them to deliver an extended role. We have been going on about an extended role since the Nuffield inquiry if not before. It seems to me that the message has still not reached many people. As a result, I think opportunities will be lost.”
The future of independents appears a little more secure with the relaunch of the IPF but Hemant fails to give the impression he is overwhelmed with excitement and gleefully opts for brutal realism.
“Independents are actually dependents. They do sod all in terms of thinking and they need somebody to think for themselves because they have relinquished responsibility for forward planning,” he says.
"The new contract is not serving community pharmacy any longer and the sooner it is dispatched and replaced with something which is negotiated with input from more grassroots pharmacists, the better it will be...I cannot remember when PSNC consulted pharmacy about anything.” Hemant Patel
“Independents are financially independent but strategically dependent on others to think for them. That creates a need for well informed people to make representations on their behalf. I'm glad to see an organisation dedicated to speak on their behalf but independents need to realise they have a time-limited opportunity to form a united voice or perish.
“I predict that if you fall below 30% in terms of minority, you will lose a significant voice and others will dictate to you what happens in future. Is IPF as strong as it can be? It is not because more people need to take interest, more people need to give it resources and more people need to give it passion than I would like to witness. It is a necessary structure that needs to develop its identity, a clear, consistent, strong voice.”
Hemant's confrontationalist tendencies have a purpose. His criticisms are a by-product of an intense desire to get pharmacy to fulfil its potential as a high quality provider of healthcare. In his eyes, the profession is suffering from a contract that “is not serving community pharmacy any longer and the sooner the new contract is dispatched and replaced with something which is negotiated with input from more grassroots pharmacists, the better it will be.”
He is annoyed that the PSNC, in his view, consistently fails to consult pharmacists on its community pharmacy funding negotiations with the Department of Health. He believes the PSNC is failing the profession in that regard.
“It would be unfair to put the responsibility on one person only,” he says. “It is an organisation that has failed. Internally, if people are unable to express their views, what the hell are they doing there? I would not blame a single individual. I would blame the organisation collectively.
“The processes at PSNC are completely opaque. Things being discussed in Parliament, you have a chance to follow them, you have a chance to input into the processes of the consultation. Similarly with BMA, I now sit on an LMC and LMC colleagues sit on my LPC and when I was talking to them about how they prepare for their annual conference and what kind of atmosphere there is, there is debate, there is passion, there is heat sometimes. At LPC conferences (run by PSNC), it's like going to a wake.”
Hemant is fiercely defensive of the work LPCs like his own do. When the pharmacist and NHS Future Forum vice-chairman Ash Soni told the NPA conference last year that LPCs are “not fit for purpose,” lacking negotiation and communication skills, it struck a raw nerve.
“It was ill-advised and on record I would say he was appointed to listen, not to lecture,” Hemant says. “In an evolving situation, everybody is in a learning environment. Some are ahead of others but I would be very surprised if any LPC is not responding to the change.”
There is, however, the recognition that LPCs must “ensure that, strategically, they are linked with key stakeholders, not just the commissioners. It needs to go beyond commissioners. It needs to include the local authority, it needs to include public representatives, voluntary organisations, so there is a huge task there.”
Under Health Secretary Andrew Lansley's blueprint for healthy competition, health services will be opened up to private enterprise, sparking a tendering process between what the government has rephrased “qualified providers.” That should raise the bar for community pharmacy to flourish but Hemant remains sceptical about pharmacy's ability to rise to the challenge as it tries to earn the right to provide services.
“This is the strange thing about pharmacists,” he says. “They're afraid of the competition, they're afraid of collaboration and quite frankly, we need to address those issues.” Collaboration, Dr Howard Stoate, the chair of Bexley's Clinical Cabinet, observed at the Avicenna conference in Oxfordshire last year, should involve pharmacists and GPs setting up joint bids for clinical services to cover a particular area.
“I think Howard is giving good advice because what commissioners are looking, and will be looking for increasingly, is a care pathway where a patient is looked after with the least amount of expenditure and the highest quality,” Hemant says.
“In order to do that, you need to improve communication because an integrated model requires communication. If you take a diabetic patient from diagnosis to treatment, the whole care pathway needs to be negotiated jointly, with each one knowing their part in the care of the patient. It is crucial that everyone understands the local care pathway for each disease and are able to work with the GPs to develop that care pathway.”
Pharmacy's struggle for survival will largely rest on its ability to prepare attractive bids for services as competition intensifies. “Those are real possibilities but the way to prepare for that is not by drawing bridges up and try and create a fort because we will not succeed,” he says, raising an eyebrow.
“What we really need to do is to be more efficient, more effective and more professional than we have been. It is a tremendously big challenge. We need to rise to it by developing self confidence, skills and ambition.
“Competition is there in every walk of life and we have to accept it. There will be less and less protection as we go forward. Having some kind of competition in some shape or form will happen. I would be happy for regulated competition. Any willing, competent provider...I'm happy with that.”
Hemant's CV
Secretary of North East London LPC, a Fellow of the Royal Pharmaceutical Society and former president of the RPSGB. Was given the Charter Award for 2011 by the RPS for his outstanding contribution to pharmacy. Has represented the RPS at European and international level.
As president of the RPSGB (four times), he was instrumental in creating the report ‘Making Britain a safer place to take medicines.’ Has been vice-president of the Commonwealth Pharmacists Association, chairman of NPA and vice-chairman of PSNC. Enjoys photography and spending time with his family.
