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Features
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5/9/2011
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The Big Interview: Mark James
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Bringing pharmacy to the fore
Mark James, group managing director of AAH Pharmaceuticals, talks exclusively to Neil Trainis about community pharmacy's path into unchartered territory...
The Government's health reforms have been voficerously opposed and remain unclear. But as far as pharmacy is concerned, is this an exciting or worrying time?
It's probably both. I'd imagine people would be concerned over the level of uncertainty and that always causes worry. A lot of people find change worrying, so it's an uncomfortable feeling. There are a lot of opportunities opening up, in our opinion, moreso than many a year. Whether that makes it exciting or not, I'm not so sure. But there are opportunities. It's a bit of both.
From your experience do pharmacists have the appetite to actively engage with GP consortia or any other commissioning structures?
You generally get a mix. A significant number of people we've spoken to are really keen on promoting pharmacy, promoting the role, promoting the fact that you can do more clinical services. Then you also come across pharmacists who will sit there and think 'I'll wait until it all pans out and something happens.' In today's environment you cannot afford to do that. Maybe in the past things have come around and things have been delivered, but that's not going to happen any more.
What do you say to pharmacists worried they will be left out in the cold when it comes to service commissioning?
There are two answers to that. One is they need to support their bodies and professional associations and enable people who speak on behalf of pharmacy to negotiate on a national level. I believe one of the best ways of securing services for pharmacy is national services. There is more consistency, you get a chance to demonstrate the benefit and it can be negotiated at the right level. You then need the local involvement. You need a local structure you can get behind and support and not just expect it to do it for you. When you look at GP consortia, they are going to be on a local level. Local service delivery will only come about if you've got that structure and local involvement. Getting involved, getting support and getting your voice behind things is going to be important. It's no good thinking the job is going to be done for you.
There is no guarantee that pharmacy will be represented on service commissioning boards. How worrying is that from a community pharmacy perspective?
Representation would be nice but representation just for the sake of having a token pharmacist on the board is not going to do anything. They can put forward a view, they can argue their case, but if it's not supported once they get back outside the meeting, there's no benefit. There are two things. It's only going to be any good if pharmacy can prove its case and, whether they've got pharmacy representation or not, having the involvement with other people on the board will be much more beneficial than just expecting one representative to do a good job on his own. Secondly, the biggest challenge for pharmacy is how do you prove your case? How do you prove that your clinical service will deliver the benefit? That is the difficulty for pharmacy as a whole and a difficulty for the Government under the new structure. A lot of their ideas are around value-based pricing and proving you're getting value for money and no-one to my mind has really cracked how you prove the pharmacy service other than in small areas. Representation is important but is no good if the other people on the board don't understand the role of pharmacy. Having a representative almost makes it look too easy because you assume he's going to do the job for you. I go to a lot of meetings and usually you need to persuade other people on the body to work with you. That's a big call for one person on their own.
Andrew Lansley has been criticised for his plans to hand GP consortia 60% control of a £103 billion NHS budget. Is that a recipe for disaster?
There is a basis for the fact that (Lansley) believes the plan can work. Some GPs seem to be up for it and understand that having control of the budget gives them control of local health delivery. And you have other GPs saying 'we don't really want that, we're busy already and it's too much.' Somebody somewhere has got to do it. Are they going to do a better job than the PCTs or a worse job? Time will tell. At the moment we don't have enough detail about how it's going to work. It almost doesn't matter whether I think it will work or not – it'sgoing to happen. (It is a case) of finding a way to make it happen.
The delay in the Health and Social Care Bill has set the Government's reforms back further but how do you see the changes occuring over the next 12 months?
The details of how these reforms are going to work out are not ironed out and I think that next year there will be an awful lot of working out of details. Behind the scenes, people who move and start making things happen will succeed. You've already seen numerous GPs starting to form GP consortia even before they were officially recognised. You look at pharmacy and say ' don't wait for the detail, you're going to have to have good local relationships.' It has been a requirement for many years and it is going to get more important. Start to understand which GPs are going to be in which consortia, how that's going to work. Get behind it and look positive, talk to the right people about what you can do, so that when the detail comes, you are in the best place for commissioning consortia.
Can Pharmacy Voice really make a difference at a time when the profession is facing its greatest challenge?
It has a tremendous opportunity to do so. There are many people who will talk about the fact that pharmacy has had a disjointed approach to representing themselves and there are people who will say it is irrelevant. If you look at Pharmacy Voice, there are three organisations that, if they can work together, can put forward a good view of what pharmacy can do. The fact that it involves the NPA is a very positive move. You've got some really good people. You've got Ian Facer, you've got Mike Holden, Peter Cattee. You couldn't get three better representatives of what pharmacy can do. Add to that you've got Rob Darracott trying to lead it. You've got all the right ingredients. The challenge will be ensuring that the NPA is perceived to have the level of voice within that organisation that it requires, and I think Mike will do a good job ensuring that happens. And can they work with PSNC in negotiating the next contract? Are they going to welcome it with open arms and say 'actually, that makes us stronger?' Or are they going to see it as a competitor? I hope it will be the former because it has the potential to be a much stronger voice.
Some pharmacists have questioned the role of the NPA. Indeed, during the Numark conference in Delhi, one pharmacist posed the question 'apart from insurance, what does the NPA do for us?' Is the NPA becoming obsolete?
The NPA has struggled in the last couple of years to put across what it does do and I can understand why independents are (questioning its role). My view is that when it comes to supporting the role of pharmacy, it has to be done as a complete group. For instance, AAH would like to support its customers and we try and do as much as we can to support pharmacy, but we only have a part of the constituency, ie, our customers. Other providers, other wholesalers, will have a similar situation. The NPA is the only body that can stand up nationally and speak on behalf of independents. That's a real important role. We've been more than happy to support the NPA in generating the demand for pharmacy and pharmacy services. That's what they can do. What we can then do is support the delivery of those services once they have been agreed. The NPA knows what it needs to do.They've got to play the role of the national voice of the independent.
Is community pharmacy still hindered by a lack of decisive leadership despite the presence of Pharmacy Voice and the NPA?
Having a clearer, single voice would be useful. When you look at all the different elements that represent pharmacy, I don't think there is a great deal of dissent. There maybe differences in emphasis or subtle differences in the way people want to go about things, but the general direction has to be agreed. My problem is the public image of 'not being one', that's the difficulty. At the
BMA there are a lot of different areas but people recognise them as being very strong when they talk. By all means, have as many arguments as you like behind closed doors, have as many representative bodies, but when it comes to presenting your view to Government or to people who are going to commission services, get the message straight. There will always be plenty of views and sharing them will (generate) better, innovative ideas. I don't have an issue with the number of bodies, I have an issue with the fact it tends to be done in public.
What do you say to pharmacists concerned they will have to work twice as hard for less in future?
It would be a lovely world if that wasn't the case. I haven't met anybody yet in any industry, in any job, not saying the same. Unfortunately, it's a fact of life. What can you say? When something comes up, make the most of it. There's nothing you can do about the world you live in. You can choose not to be a pharmacist and do something else but I don't see anything else looking any better. That sounds a bit harsh but none of us are in any different position. I would like to meet the guy who can say 'I've been able to cut back my hours because I'm earning a fortune.'
Could independent pharmacies close in light of the recent announcement on Category M, coupled with an increased workload?
Our customers are pharmacists, so if the numbers are decreasing it's a concern. Mechanisms like Cat M do not reward the people who are putting the effort in. The pathfinders, the people really keen on doing the right stuff, where's the reward for them when then quarterly Cat M comes around and there's a blanket approach that says you're all the same? Cat M is an unfair, erratic system that doesn't reward the things the Government protests they want to reward. It is a crude mechanism. The factors that influence it are really complex but you then get this sweeping outcome. People doing the right things should get a bigger share of the pie. It doesn't work that way, does it.
How is AAH helping pharmacists during this time of tremendous transition?
On a day-to-day basis we try and do the things people expect us to do as a wholesaler and provide additional support. That has never changed. What we've tried to do in the last few years, wherever possible, is influence the way things are going for pharmacy. James (Lindsay ), for instance, will do a lot of work ensuring our local MPs, where we've got a branch, are aware of the issues in pharmacy and how that may affect patients in their constituency. Having those branches all over the UK gives us the ability to speak to MPs on those issues. We also try and sponsor as much attempt to influence the decision-makers as is possible.
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