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Features
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11/14/2011
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The Big Interview: The IPF - fighting for independent pharmacy
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Claire Ward and Fin McCaul, spearheading the Independent Pharmacy Federation, tell Neil Trainis about their vision for the future of the sector...
“We are the exclusive voice of the independent pharmacist. There is no other organisation that exclusively represents independent pharmacists,” Claire Ward says with the convincing air of a politician attempting to snare voters. The former Labour MP for Watford these days campaigns vociferously on behalf of independent pharmacists as chief executive of the Independent Pharmacy Federation. As we locate a quiet spot in the foyer of the Thistle Grosvenor Hotel in Victoria to talk about the future of independent pharmacy alongside her colleague at the IPF, its chairman Fin McCaul, it soon becomes apparent that the profession's cause has reignited the fire within her, having quit politics after losing her seat at the 2010 General Election.
“I'd spoken at the Sigma conferences in previous years and one of the common themes, as someone from the outside, was that independent pharmacy didn't seem to have a very strong voice,” she says. “Following the Sigma conference this year in Mauritius, a number of buying groups and independent pharmacists got together and talked about how they could strengthen that voice and that's why I was asked to get involved and rebuild the IPF.
“By the very nature of what I've done in the last few years, I like to believe in something. I don't want to work for an organisation when I don't believe in its core purpose. I believe there's so much more that independent pharmacy can do to provide a service to patients and improve public health.”
A burning desire to propel independent pharmacy forward has not been cultivated by any real pharmaceutical influence in Claire's life, just a determination to see that people get the most from their healthcare services and a natural instinct to fight in something she believes in.
“At the moment, there is no official recognition of the role pharmacy will play,” she asserts. “It's not clear. The Government have given warm words but they haven't been terribly warm. They haven't been concise about the engagement of pharmacy. That's a concern, not just for independents but right across community pharmacy.” The recent petition by the IPF urging the House of Lords not to push through the Health and Social Care Bill failed to gain the desired effect but Claire insists the towel will not be thrown in.
“We encouraged independent members to show their views to the House of Lords so there would be greater scrutiny,” she says. “That's obviously failed but there will continue to be scrutiny as it goes through the House of Lords committee stage and it's important that we are there expressing those concerns.” That fighting spirit has given rise to intense hope. Pharmacists embedded in their communities and far removed from the hectic city existence of parliamentarians feel the IPF can uniquely stretch their voice all the way to the top table. Fin offers a smile and leans forward. “I think what sets us apart is that we're purely for independents,” he says. “Traditional pharmacy organisations, the NPA, the PSNC, they're there for the collective voice of pharmacy and while they have some independents on them, they don't have a sole independent view. That's the frustration many contractors have.” Claire interjects. “What's important is that we're taking their views to the people that count, whether the decision-making is at Governmant, whether it's at PSNC or other places within the NHS or pharmacy sector,” she says. “It's not just about one area, not just about Government. It's about much more than that. The IPF is able to drive forward and collect the views of independent pharmacists to the decision makers.”
Anticipation
If the IPF does operate to the backdrop of fierce anticipation and hope, it is not surprising. Claire joined them in June and its relaunch at the House of Commons earlier this year was supposed to signal a watershed moment for independent pharmacy. At long last, pharmacists anticipated, here was a body with critical contacts and the ability to promote pharmacy's role in a restructured NHS to the highest levels of Government like no other body before it.
The IPF, Sigma Pharmaceuticals managing director Bharat Shah said at the relaunch, was “lucky” to have someone with the political knowledge and contacts Claire boasts. So how does she go about using those contacts? “Firstly, it's about defining the message, what it is we want to say on behalf of the IPF and using that in a range of different ways. For example, I've been to see the shadow Health Minister (John Healey) in the House of Lords and talk to Baroness Thornton about pharmacy and independent pharmacy in the context of the Social Care Bill. There will be lots more opportunities to talk to other members of the House of Lords about the concerns of independent pharmacists,” she says.
The IPF has seven board members, five of whom are independent pharmacists and two who are not; Claire and Shafique Govani, marketing director at Beta Buying Group. Interest in the body is growing too. The IPF had 1,200 members before adopting a subscription model. Genus Pharmaceuticals, Sigma, Crescent Pharma, Wockhardt, Arrow Pharmaceuticals and Medreich have all committed funding and Claire insists that “we are in discussions with a number of other companies. We'll have a much bigger list by the end of the year.”
Yet as well as being able to reach Government ministers, the IPF is in touch with independent pharmacists on the ground. It has its finger on the pulse, even if concern throbs away that some independent pharmacists are not aware of what it offers them.
“I won't be satisfied until we have 100% people involved in it,” Fin says. “It's extremely early days for what we want to do and we recognise that independents are probably one of the most valuable (groups) in pharmacy but definitely the hardest-to-reach group. We've not doubt that we have an uphill challenge.”
“They've got a growing recognition of (what we do) and they see that we're about a lot more since the relaunch,” Claire volunteers. “They're particularly concerned at the moment and the reason why the decision was taken to relaunch the IPF was taken was because so many independent pharmacists felt they had views on key issues taking place at the moment but nowhere that satisfied them in being able to express those views. In that sense, we are the solution to their problem.”
For a man used to zipping around “at 110mph,” Fin, a British rally champion and man who incited the IPF's inception in 2006, is well versed in the kind of rapid twists and turns that pharmacy has had to endure. The profession's evolution from dispensers of medicine to holistic health clinicians, he believes, has been and will continue to be abrupt.
“Dinosaurs disappeared. The Dodo disappeared. Kodac... gone. There is nothing of right in this world any more,” he says. “We have to adapt, change or die. We don't have a right to the delivery of medicines. There are organisations looking at it. Some of the big pharma have looked at going direct to patients, DHL have sniffed around, there are lots of other models out there. When we look at virtually every innovation that's happened in pharmacy, it has started with independents. What we now need to do is encourage independents to be even more innovative.”
“Dinosaurs disappeared. The Dodo disappeared. Polaroid gone. There is nothing of right in this world any more. We have to adapt, change... or die,” Fin McCaul
Hope, nonetheless, burns among pharmacists that the IPF can penetrate Government with the message that pharmacy must be a part of the NHS. Claire is adamant that the IPF is not driven by any political agenda, only a desire to ensure pharmacy is recognised at a national and local level.
They both smile when it is put to them that the IPF is valued by more pharmacists than Pharmacy Voice. “We've made it absolutely clear right from the beginning that we recognise the importance of working with Pharmacy Voice,” Claire says. “Obviously, we have a different view. Our members are coming from a different standpoint but there will be areas where it's in everyone's interest to show a united front and that we're together. We're not seeking to destroy Pharmacy Voice or undermine it but at the moment, nobody is providing that exclusive representational voice for independents.” Fin enters the debate. “I think they claim they're the voice of pharmacy. I'm not sure they're the voice of independents,” he says. “If we look at the fundamental structures of pharmacy, we haven't got a proper alignment of what's required, especially when you compare it to something like the BMA (British Medical Association). We all get criticised for having these arguments amongst ourselves but we need to have these discussions, open and frank as they are, as to what the right way forward is.”
Any sense of overlap with Pharmacy Voice seems like a footnote when compared to the assertion recently made by Hemant Patel, former RPSGB president, that many pharmacists have not engaged with the New Medicine Service and are content merely to “stick labels on bottles” and earn a profit.
“It is quite concerning but that's the reality of what we've been trained to do for the last 20 years,” Fin remarks. “Changing that approach is part of the challenge and Hemant is dead right. It's what people are content to do because it's in their confidence circle.” Claire steps in. “And it's worked in the past. But it's not going to work in the future. Dispensing of services might have been okay as the core part of the business to date but as the shift takes place from dispensing and OTC to more service-based, they're going to have to be part of that. It's a great opportunity.”
The notion of “healthy” competition as proposed by Health Secretary Andrew Lansley in health service commissioning has generated a sense of unease and, in some instances, urgency within pharmacy. “Competition is good provided it's set against the right background. Competition should be about quality outcomes rather than quantitive outcomes,” Fin says.
“If we look at the situation pharmacy is in at the minute, part of the rule of the 100 hours was to enable some competition and an expansion of the service at a local level. The reality is that it's become a fight-for-all and having a huge impact on the quality of services being delivered.
“It's given a negative impression of pharmacy at PCT level, it's impacted on pharmacy budgets at PCT level where they no longer wish to work with pharmacy, so competition is good but we've got to understand what we're competing for. If we talk about minor ailments, pharmacy wants to deliver it but GPs are contractually paid to deliver it. So why pay two people to look after the same thing? That's where we go back to the scrutiny we're trying to achieve and if we get that, we can have proper competition at a local level.”
“There is no official recognition of the role pharmacy will play. The Government has given warm words but they haven't been terribly warm. They haven't been concise about the engagement of pharmacy,” Claire Ward
Claire detects a lack of confidence among pharmacists about what they can offer the NHS. “Many independent pharmacists hide their light under a bushel,” she says. “They are not confident about just how important they are in public health and primary care. As the most accessible healthcare professionals to the public, they should be shouting it from the rooftops.
“The British public has been hoodwinked for years in thinking that GPs are part of the NHS in some sacred form in delivering services. Actually, they are private contractors, just the same as pharmacists. But if you asked someone in the street today, they would probably think of the GP as part of the NHS and the pharmacist as a business person running a retail outlet. What we really need to do change that perception.
“Independent pharmacy has a greater potential to change that perception than, perhaps, a Boots or a Lloyds, because what that independent delivers is the personal healthcare service that people respect and want. People, increasingly, want to see that in a non-medical environment such as GPs.”
Fin believes “local authorities don't have a clue what pharmacy can deliver. Public health, in some areas, are really proactive in pharmacy and there's huge opportunity for development of, not only new business, but extending the existing business.” The IPF, he suggests, will “support contractors in having those discussions and enabling them to move forward. I suspect that will need a change in approaches from some LPCs to enable the support of the delivery of this as well.”
Evolution is critical for pharmacists and especially for all those pharmaceutical procrastinators. “Unless we change, we ain't going to be there any more,” Fin says somberly. “If we deliver on Healthy Living Pharmacies, NMS, MURs and optimisations, there's a much bigger pie for us to go for but we sill have to retain the distribution of medicines.
“The challenge for independents especially is to see how they can work smarter, be it technological or systems approaches, and that we maintain patient safety but take ourselves away from the (dispensary) and operate in a different fashion. Make it an even more efficient service.”
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