In an exclusive interview, NPA CEO Mark Lyonette lauds pharmacists for their vaccination effort and talks about staffing, workload and financial pressures on contractors. He spoke to Priyankur Mandav…
The coronavirus pandemic has increased public understanding of the true value of community pharmacy. It has allowed pharmacists to demonstrate how they can ably assist with a public health emergency whilst maintaining the continuity of healthcare services and undertaking additional responsibilities to help in relieving pressure on other areas of the health service, such as general practice. There is now plenty of evidence that pharmacists can add value to immunisation programmes by improving patient choice, increasing uptake and widening access.
“I see community pharmacy as being the natural home for all vaccinations,” said Mark Lyonette, commending pharmacists for ‘stepping up to the plate’. “To have done a third of all Covid vaccinations through pharmacy-led sites in England is incredible,” gushed the CEO of the National Pharmacy Association over the sector delivering a staggering 22 million jabs
in just 12 months.
“I’d like to think somewhere in NHS England, somebody is reviewing the relative cost and benefit of all the different approaches to Covid vaccinations. And comparing apples with apples those vaccinations that occurred through community pharmacy would stand up very well in terms of cost effectiveness.
“I’ve had members who’ve participated in the programme suggest to me that the pharmacy element of this will compare very favourably with the big vaccination centres with lots of hidden costs.”
Mark praised contractors who ran the 1,500 pharmacy-led sites for ensuring that their Covid vaccination effort wasn’t going to be a distraction and that it didn’t adversely affect the delivery of core pharmaceutical services which are central to the national pharmacy contract.
“If I do less in my pharmacy in order to focus on vaccination then my pharmacy is going to suffer. It will earn less and I’ll have less money to cover my costs,” he said.
Quick to adapt
When given an opportunity, community pharmacies in across the UK have been able to adapt quickly to continue essential services and, whenever possible, they have gone above and beyond to offer critical advanced services. Latest evidence shows how successful pharmacists have been in providing a range of immunisation services including travel jabs and Hepatitis B vaccines for at-risk groups.
Last winter they administered a record breaking 2.6 million flu vaccinations as part of the NHS-commissioned advance service in England, which they’ve been a part of since 2015. The number is expected to rise even further when NHSBSA publishes its latest data later this year. Community pharmacists in Scotland, Wales and Northern Ireland have also achieved similar levels of success.
What is worth highlighting, however, is the fact that community pharmacies delivered this at the height of a global pandemic and right in the middle of a severe cash flow crisis. Yet they maintained steady dispensing volumes of over a billion items whilst also giving healthcare advice to more than a million people each week.
“To me community pharmacy looks like a great value in that space and it’s actually shown how well it can make that happen at scale across the country,” said Mark, adding: “I’m really hoping that NHS England do get it. You’ve set people a challenge, and they’ve lived up to it.”
Community pharmacies have already been saving well over 20 million GP appointments every year but latest estimates indicate that around 40 million GP appointments could be saved if patients with minor ailments went directly to pharmacists instead of visiting their doctors’ surgery.
“We can’t free up all these GP appointments without sufficient funding,” cautioned Mark. “But it’s not just about sufficient funding, we’ll also need sufficient workforce. If NHS England are keen to have pharmacists work at the top of their licence then they have to help us manage some of those workforce pressures and challenges which are growing by the day, compounded perhaps by post Covid recovery and the long NHS waiting list.”
GPs have been referring patients with minor illnesses to the Community Pharmacist Consultation Service (CPCS) since November 2020 but the service hasn’t lived up to expectations. It has yet to become the “gamechanger” that NHS leadership promised just months before the pandemic stalled its long-anticipated progress.
Mark said: “Clearly there are some issues with it and it’s been a slow burner, yes. But the really interesting thing is that it’s on fire in some parts of the country. If it works in one part it shows it can work in other parts too.
“In England we have to work together – pharmacy bodies, the NHS and the Department of Health and Social Care – to make sure that maximum effort is put into making services like these work well.”
Asked what he made of the recent media attention given to community pharmacy, Mark said: “I actually think it’s really good that pharmacy is able to make the news these days. I think some of that is connected to the pandemic but if we are in the newspapers and on national television as much as we can, we become harder to be ignored.
“Many members have said to me that they don’t think the profile of the sector has ever been higher, and I think that’s quite right. It’s true for both the public and ministers’ perceptions of the sector.
“We have a great pharmacy minister in Maria Caulfield, a practising nurse, who understands how the health system works, how the NHS works. We’ve got Sajid Javid, who has already shown himself to be a big supporter of community pharmacy.
“I know there’s a scepticism from some members that warm words don’t pay the staffing costs, heating and wholesalers’ bills, but it’s still better than not to have any politician who understands the sector and supports us.
In the black
In June this year, Mark will have completed four years at the NPA. I asked him how the 17-member board and management worked together and if their duties and responsibilities were distinctly different.
“The vast majority of our board members are pharmacy owners, and therefore, by definition, they are people who come with significant management experience, be it running just one pharmacy or many more. We also have members who are managing directors of companies they don’t own.
“In theory, it could be hard to manage such for a board but we’re working really well together and there’s a growing understanding of the difference between managing and governing. The results are there for everyone to see: we were profitable as a membership organisation in 2021, for the first time in a dozen years. And our insurance business remains profitable too.
“The pandemic has been a challenge but I’m really proud of the way in which our board and management have worked virtually – probably in a closer way than ever. I’ve been really pleased at how quickly we’ve adapted and how well we’ve managed to keep the show running.”
Value for money
When asked how his association was demonstrating value for its customers and in what ways did it help members during the pandemic, Mark said: “In the first three or four months of the pandemic it felt like almost every day there was some new issue emerging from our members on the ground that no one had either thought about or the UK government had overlooked. We went and resolved those issues wherever possible.
“Along with other pharmacy bodies we lobbied different governments around supplies of personal protective equipment and the death in service benefit for pharmacists, which was an absolute classic for me. How do you produce a list of healthcare professionals that are going to be covered and somehow manage to leave off pharmacists – all pharmacists, not just community pharmacists – who are the third biggest group of healthcare professionals?
“It was a real eye opener for me actually, the amount of times we have had to raise what felt like very obvious things that needed addressing and how pharmacy was often overlooked. It helped me understand how we are perceived in the wider NHS England, although some of the issues at the time were UK-wide.
“Probably the biggest and hardest lobbying was to get the hundreds of millions of pounds of Covid costs paid to contractors in England. It was promised by Sir Simon Stevens (the then chief of NHS) and pharmacies had done what was asked of them in good faith – to make their premises Covid safe.
“It took most of 2021 – putting as much pressure as we could, running all sorts of campaigns – in the prime minister, the chancellors and the pharmacy minister’s constituencies, putting up posters in some pharmacies. We had to find a way to cut through – it just wasn’t fair for pharmacies to be bearing the cost of the pandemic.”
Pharmacy owners, big and small, needed to pay out of their pocket to implement measures to protect staff, patients and customers by introducing novels ways to minimise the risk of coronavirus transmission within their premises. Almost 95 per cent of contractors who made claims received a payment for the full value of their claim in October 2021.
“In the end we got a fair settlement to cover the actual costs that contractors incurred. But it took way too long. Funding negotiations are hard. How many different parts of government you’re having to persuade: you’ve got the NHS, the Department of Health and Social Care and the Treasury who hold the purse strings. And we, community pharmacy, need to be valued by all of those departments, the civil servants and their politicians and ministers. Otherwise, we will find it difficult to get funding for what we do all the time.”
Does Mark think that community pharmacy will find a seat on the boards of the newlyestablished integrated care systems?
“I don’t think it’s very likely that we’ll get a formal mandate at all to have pharmacists involved in ICS boards. I’m more optimistic though about the impact of ICSs generally for pharmacy because I hear that in some parts of the country the local pharmaceutical committees are already well engaged with those players as the new systems emerge.
“There will be opportunities arising out of these engagements – people are already beginning to develop new services in some parts of the country. That’s really exciting. I’ve heard some very optimistic things from people about what this can mean for them locally. Not everything is going to come from the national level, we need to be able to make the most of the local partnerships as well.
“We have to find other ways to make sure that pharmacy is both recognised and visible and it gets its share of the opportunities to deliver good service and good patient care on merit.”