When Sandra Gidley took over as chair of the English Pharmacy Board in 2015, the Royal Pharmaceutical Society “didn’t really have a relationship” with the Pharmaceutical Services Negotiating Committee.
In fact, there was “not much of a relationship with any of the other pharmacy bodies” either.
That was particularly the case after Pharmacy Voice – an advocacy body that represented pharmacy owners at the time – went defunct.
Gidley said she initiated dialogue between the various national bodies of pharmacy as a priority.
“We got into that state where we started meeting and talking and bringing people together. The reason we are in a relatively better position now is because we, nearly all of us, have new chief execs almost at the same time, who regularly meet and talk to each other.
“As a result, cross-pollination between the various organisations feels much better now. We are still not a one voice but there are good reasons for that because different organisations have a slightly different slant.”
She said when the British Medical Association negotiated their new GP contract, there was a lot of work being done with the Royal College of General Practice.
“And they don’t seem to have the same silos that have built up over the years [in pharmacy]. And these are not the silos of our own making, these are of the Department of Health’s making.
“I don’t understand why the DoH don’t have a similar model for pharmacies involving the wider profession as they do for the GP surgeries.
“Nearly four years ago when we had the announcement of the pharmacy cuts, what government said at the time was that they wanted to do things differently.”
Gidley said that since the DoH hadn’t really worked out how they were going to do it, there was some opportunity for all national bodies to input at that time, to rise above the silo mentality and work together towards achieving a common goal.
“And now it’s as if that has been completely forgotten, which concerns me – because there is a use in ourselves and the other bodies in working together with PSNC on behalf of the community pharmacy sector.
“Where we are at the moment is DoH and PSNC seem to have gone back into their negotiating bubble and silo, and that I think is a retrograde step.
“We have gone backwards because we did reach a place where other bodies were included in some of the talks and discussions on what should the priorities be. At least we felt as though we were part of the story and we could see the direction of travel.
“Nobody goes into a negotiating room these days and there is very little disseminated outside [of] there. It is difficult. I don’t want this to be seen as a criticism of any individual but more as why the DoH should be looking at different ways of bringing the profession forward. There are multitudes of ways of doing things. It’s not the only way.
“We ought to be pushing for a more collaborative approach. Ultimately, they (PSNC) are the negotiators, they have got the overall responsibility, but it’s really useful if DoH allow other bodies to understand the direction of travel for a whole variety of reasons – some of it might be lobbying, some of it might be actually getting things ready.”
Views on CPCF
I met Gidley at the RPS headquarters in London on a beautiful autumn day – a reasonably rare one with a wall-to-wall sunshine. As I strolled along the bank of the River Thames, a gentle breeze whizzed past, reminding me of one that had only just swept past the uncertain world of pharmacy, in the form of a new national contract with a fixed funding deal for five years, which drew a mixed reaction from within the profession.
When asked what she made of the Community Pharmacy Contractual Framework, Gidley answered, “Clearly it’s not helpful to know that in effect you’ve got a year-on-year cut on your funding going forward. I work in different pharmacies as a locum and I can see the increased pressure.
“The CPCF is a work in progress. It’s very much a holding contract. I am hoping that we will see the introduction of more clinical services. What I would also like to see more of is pharmacists prescribing on a regular basis.” However, in theory at least community pharmacists can access training courses, but they have to be sponsored by somebody and there has to be a link to be able to prescribe in some way afterwards. How does it help? “It’s a chicken and an egg situation really: we need to get to a situation where we have prescribing pharmacists in the community who can supplement what’s being done and take some of the matter of the long-term condition off the GPs. But we are long way away from that.”
She praised one of her RPS predecessors, David Branford, for foreseeing the need of pharmacists in GP surgeries, almost in anticipation of the current model of integrated care.
“He went to the Royal College of General Practitioners and said, ‘Look, we have already got a workforce here who can help you with some of your workload, why not consider this?’”
The initiative, led by the then chair of the English Pharmacy Board, did take off as it was timed against a backdrop of declining GP numbers. But it also created a chasm between newly recruited practice pharmacists and their community pharmacy counterparts.
Gidley, however, is positive: “Where the two work together, it’s a real win-win. They can often work out what productive work the community pharmacists can take on, on behalf of the surgery.
“If you do it well, it goes a long way and you don’t feel you are just a cog in the machine. You know you are doing something that people would benefit from.”
Winds of change
Gidley, who began her career as a community pharmacist four decades ago, said her mission would be to raise pharmacy’s profile in the wider healthcare sector.
“We need to build on the good work that’s been done already with raising the profile of community pharmacy.”
But first she wants to see the skills of pharmacists utilised more, and the profession better integrated into the healthcare system.
“The current model of pharmacy has to change. The unique skills of community pharmacists need to be better utilised – their clinical and public health expertise. When it comes to minor ailments, long-term illness, case-finding – there is a whole host of things that community pharmacists can do.
“Not making use of the skills of the pharmacists who train for four years to be clinical practitioners and scientists is the biggest scandal in the health system.”
When asked whether it was utilising the skills of the pharmacists – one of the key goals of the NHS Long Term Plan – she replied: “Yes, it is, but it doesn’t mention community pharmacy.”
She strongly believes that community pharmacists can deliver on the clinical agenda and gave an example of very successful MURs for respiratory ailments recently done in Hampshire which significantly reduced hospital admissions.
“I do despair of pointing out time and time again that they are missing a trick with a trained workforce who can deliver on some of this stuff in the community, accessible for patients and good quality.”
Make it work
Calling the new advanced service, Community Pharmacist Consultation Service, “a step in the right direction,” Gidley said, “Community pharmacy has to make CPCS work and prove that it can deliver this service. If we don’t deliver on this why would our employer (DoH) waste time and money developing further services for us?
“It might not be what everybody wants to do, but if we are going to have a vibrant community pharmacy sector, I think it’s important that we try and make it work.”
She said the Royal Pharmaceutical Society would look at how it can support pharmacists in that.
Talking the talk
“We have got the job of promoting the role of the pharmacist. The frustrating thing is, people are talking the talk now, but not changing that into reality. While they are talking about ‘Yes, pharmacists can do more’, particularly in England, we do not see as many opportunities as there should be, which is frustrating.”
She admitted that there was a much better use made of community pharmacy in Scotland and Wales: “We ought to be learning from that and get better at promoting our pharmacists.”
Asked why those successful models were not emulated in England, she explained that it was because England had a bigger, more complex and more bureaucratic system at the top.
“I think it’s fair to say that in Wales and Scotland you’ve got a much smaller health system. Everybody knows everybody, and it’s much easier to effect change in a smaller health system. It is challenging to effect change in a large and more complex system.”
Support for members
After stepping down as chair of the English Pharmacy Board in June, Gidley was elected in July 2019 as the first female President of the RPS since it became a professional leadership body.
A former Liberal Democrat MP from Romsey for 10 years, she has never taken a step away from the profession of pharmacy. Even now, while at the helm of a leading national body, she works as locum in several pharmacies in Hampshire whenever she gets an opportunity.
“I enjoy the challenge that somebody comes in with something – particularly after 40-odd years in pharmacy, and the insights you develop around meeting people are invaluable,” the RPS president confides.
Now that Gidley is at the helm, she says the real focus of her two-year presidency will be on membership, which has recently been dwindling “a little”, as she put it, for various reasons.
She said she would be taking a closer look at and a deep interest in the findings of a recently launched membership survey so she can deliver more of what the members, who are the lifeblood of the organisation, want. “Membership will be my focus. I want people to really appreciate the value of membership and to feel more part of the organisation than ever. I would urge members to get involved in all our activities.”
Gidley said revalidation was an area where she thought RPS members would like support.
“As well as providing lots of help and information on the topic, we’ve now got a great system which means you can transfer your CPD records from the RPS website to the GPhC revalidation portal.”
“Our new mentoring platform launched recently helps pharmacists to help each other and the profession. Mentees can receive invaluable career support and advice and mentors can use their knowledge and experience to give back to the profession. We’d love Pharmacy Business readers to sign up and be part of this great initiative.”
Ties with NHS
The RPS president gets frustrated when people accuse the society of being close to NHS England.
“We have very robust arguments and discussions with people at NHS England. But we also work with them when they have created positive changes for the profession, for example expanding the roles of pharmacists in GP practices and in care homes, where thousands of new jobs have been created.
“But there is no way they say jump and we say how high; it’s more like they say jump and we say why?”
Gidley was of the view that the current direction of travel towards integrated care systems and primary care networks was going to be a challenge for not just pharmacists but all national bodies.
“That’s very difficult for a national body to mastermind or achieve. But we will try and help pharmacists engage at those levels because it’s really important,” she added.
Although one can argue that workforce pressure is not unique to any sector, there can be no denying that community pharmacists will need a lot of support to manage some of their day-to-day stress and workload pressures.
Gidley responded: “We know it’s tough out there for all pharmacists, and workforce wellbeing is a real issue. We received a huge response when we surveyed pharmacists on this topic recently – over 1300 responded in just two weeks. Some of their stories are heart-breaking.
“We’re going to present our report to government and are campaigning for all pharmacists – not just those directly employed by the NHS – to get equal access to support that’s funded by the health service.”
Diversity & inclusion
“We’re developing a programme on inclusion and diversity to recognise, celebrate and encourage all voices and experiences across the profession, led by Asif Sadiq MBE. We’re working towards a strategy for pharmacy that is inclusive of everyone and values difference, which will be published in March 2020.
“I’m proud to say for the first time this year we had an official presence at Pride in London and have also held events on Women in Leadership and Black History Month.”
Gidley thinks the young graduates coming out of university today want to use their clinical skills.
“The new generation of pharmacists are used to learning differently, doing things differently, eyeing things differently. They are a different generation and I don’t think there is anything particularly different about pharmacy to any other area.
“We have a generation who understand work-life balance and are not always solely focussed on one area of life. What I do see though is that there are a lot of committed, very bright, eager young individuals. If they are not able to use what they have learned in university, you are not going to get the best people in community pharmacy.
“At the moment the Oriel system, which all students have to go through, sadly, it is seen as almost a failure in some areas to go into community pharmacy. You are seen as ‘odd’ if you don’t want to go to a hospital.”
She said pharmacy needed to get to a situation where all different parts valued the other parts of the profession equally.
“I couldn’t do what a specialist cardiac pharmacist could do. And a specialist cardiac pharmacist couldn’t do what I do every day in community pharmacy, where it’s ‘bring it on’ and anything can come through the door.
“Sadly, we don’t actually celebrate skills of the community pharmacists enough because they are the ultimate specialist generalists.”
This article also appears in the December/January issue of Pharmacy Business.