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The Big Interview: Sue Sharpe

By Neil Trainis

PUBLISHED: August 8, 2017 | UPDATED: August 8, 2017

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Whoever takes over as head of the PSNC will need a “hide of leather” says Sue Sharpe. The outgoing chief executive of pharmacy’s negotiator talks to Neil Trainis

 

“It’s the first time anybody’s asked me that…no,” Sue Sharpe says, appearing to have been taken aback when asked if, after 16 years as head of community pharmacy’s negotiating body, she had taken her role as PSNC chief executive as far as she could.

The post at times must have felt like a poisoned chalice. Trying to convince stubborn, frugal governments to invest in community pharmacy has been an unenviable task. Fighting pharmacy’s corner but not being able to make everyone happy. Negotiating when there seems to be no legroom. Imposition rather than negotiation, as the late Kirit Patel once described it.

The PSNC has shouldered its fair share of criticism down the years. Yet as Sue prepares walk away from it all at the end of the year she insists her hunger for the toughest role in community pharmacy has not lessened. Even if there is the sense that she is glad to be moving on.

“I think the answer is there’s always a massive amount to do. For me it’s age. I’m past retirement age and I thought it’s really important to go before I was sort of easing off but no, there’s masses that needs to be done,” she says in a quiet room in the PSNC’s headquarters almost a stone’s throw from Smithfield Market.

“The passion and the drive is undimmed but I think it’s important to me for my own life to just say ‘ok, now is time to move on, do different things.’ And I would hate to be in the position of being in a sort of sad decline.”

The timing of her departure, she insists, was to give PSNC ample opportunity to find a suitable successor. Sue balks at the idea that a decade and a half in the role has left her exhausted but concedes the thought of finally letting go is proving difficult to handle even though she is keen to open a new chapter in her life. Little surprise given community pharmacy has consumed her for so long. And after all, there is unfinished business, such as the wait to see if the PSNC and National Pharmacy Association’s appeal against a high court decision on the government’s funding cuts will be successful.

“No, I think I’ve said it’s relentless and it’s tough but it’s really important. I’m a great advocate and believer in community pharmacy but I’ve also got two little grandchildren and if I don’t spend time with them I’ll regret it,” she says.

“(I have) other calls on my time and, this is well away from pharmacy, I didn’t want to neglect things in my personal life that I think are really important too.

“I’m finding it very difficult to contemplate letting go at the end of the year but I’m absolutely sure that this was as right a time as it could have been to have a change. We have this sort of marker, the end of the judicial review period even if we’ve still got the appeal outstanding and, as I say, I’ve got other personal things I want to do.

“Yes, it will (be tough to let go). And I’m already finding that I’m really anxious to spend my last few months doing as much as I can. But it’s also really important in a job like this that you know, when you go, you leave the path clear for your successor because the very worst is to be standing on the side-lines saying ‘oh, I wouldn’t have done it that way.’”

The PSNC and NPA made compelling arguments in the high court as it tried to sway the judge that the government had acted unlawfully and recklessly in imposing its cuts to pharmacy funding. Sue describes Lord Justice Collins’ ruling in favour of the government as “disastrous.”

“Yes, we were surprised and disappointed. I think (it was) still a battle that we had to fight and it seems to me that we’ll need long and careful thought in the next few months to see whether we have a government that will listen to us and work properly with us as they always used to in the past because this is disastrous. It’s disastrous for us but more importantly it’s disastrous for the NHS.”

Irritation creeps into Sue’s voice as she considers whether the PSNC’s talks with the government is more imposition rather than negotiation.

“It’s a very, very fair assessment of what happened last year. There was no negotiation and we ended up with an imposition. It’s not how I would have described it a few years ago.

“Obviously if you look at it all the power sits with the people who control the funding so it’s about influencing and negotiating from a position of respect of using knowledge and understanding and being clear about what pharmacy can offer.

“But it’s not at all the same to negotiate purchasing a pharmacy or to purchase some medicines from a wholesaler because then you could just say ‘I’m not going to buy that pharmacy’ and you can walk away and let it go.

“If you’re negotiating with a wholesaler and you can’t get an acceptable price you can go off and try somebody else. This is very different. It has always been about building the expertise and credibility and being able to get influence that way.”

Influencing ministers who are listening to the Treasury instead of evidence pointing to the damaging consequences of their actions has been a struggle. Last year the PSNC commissioned PricewaterhouseCoopers to produce a study of the social value of community pharmacy in England. The report said the sector contributed £3 billion to the NHS, patients, public sector and wider society in 2015 through just 12 services.

“I still don’t think they have understood what the PricewaterhouseCoopers study shows them, that costs are going to incur elsewhere in the system if pharmacy services go down,” Sue says.

It seems ministers did not even look at the report.

“Well, the trouble is the die had been cast I think. By the time it was published, because it took a lot of time to do, they had got past the point of no return.

“That report is going to be immensely powerful as we carry on lobbying in the future. I said at the beginning of this, after we saw the December 17 letter (in 2015 announcing the cuts), that this was a three-year campaign. Another government, it could be a five-year campaign. It’s the end of the beginning, not the end.”

Yet it feels disheartening that despite all the campaigning, all the tub-thumping, the NPA’s petition presented to Downing Street complete with 1.8 million signatures, the government remains unmoved.

“I think for the next few years cuts and making the budgets balance are going to be the predominant thing. I think we’re in for a very grim time but I think they’ll start to turn around when they realise that stuff we put to them but they wouldn’t hear, they’ll realise the cuts they are making to pharmacy are leading to much greater expense elsewhere.

“Even after what they were doing to us, if you look at last year when they got in a real panic about A&E falling over, the emergency services, demands through the cold and flu season, what did they do? They started to invest money in pharmacy. Pharmacy is a great safety valve for them.

“Sadly for us, they were looking at budgetary cuts. They made a stupid, profoundly unevidenced first decision that they could cut funding out of pharmacy and by the time we knew about it they were so hellbent on it they wouldn’t listen which was why the negotiations were so abysmal. Cuts was the main thing.”

The idea that the government has little interest in developing the community pharmacy network has been fuelled not only by the cuts but its apparent disregard for community pharmacists as clinicians, GP pharmacists excepted – “that was gratuitously offensive I thought,” Sue insists.

The government is also yet to respond to the 11 recommendations of the Murray review which include maximising the use of electronic dispensing and redesigning medicines use reviews. Sue is a little more philosophical.

“You won’t often find me apologising for the government but of course we’ve had the election, the judicial review which I think they probably felt put a bit of a block on moving forward.

“And before we got the end of the judicial review we had Theresa May calling an election and now we’ve just got, recently, new minsters…when they go off on recess and ministers getting into the role, so very frustrating because they talked in the December 17 letter about this bright, clinical future for community pharmacy.

“They produced nothing. We asked them what their proposals were and they said they had none. So (they) listened to ours but we didn’t feel ours got a fair airing through the early months of 2016. We got the Murray recommendations and it’s siting there and you think ‘so where is this bright future?’

“A lot of Murray’s recommendations absolutely point the right way forward. One of the things we’re very keen to do…is trying to make the case for taking Murray forward so that it doesn’t end up on the government shelf.”

How long should the PSNC be prepared to wait? “Realistically you’ve got nothing much going to happen until the early autumn, parliament gets back, ministers get going, until this government sorts out its policies. But we would hope to see progress early in the autumn.”

Sue pauses when asked if she thinks Dr Keith Ridge is a good chief pharmaceutical officer, the architect of hub and spoke dispensing whose name was jeered during the LPC conference last year.

“I never like getting into personalities in these areas,” Sue offers. “I know there’s been a lot of criticism of Keith and I have been very unhappy that I didn’t think he stood up for or really appreciated what was the core of the community pharmacy service and how it could be developed.

“So I have my criticisms of Keith. Absolutely I have no doubt that he has criticisms of me but I’ve been very disappointed. First of all I don’t agree with him that there will be huge efficiency savings (with hub and spoke). I think that’s pie in the sky.

“So far as I know the efficiency savings are not remotely proven and yes, I disagree with his policies. For me the difficulty is to have somebody who has not worked with us to examine his concerns, examine and test out the efficiency savings.

“We’ve still never seen anything to suggest they’re real, they’re there, that they’re deliverable, that they work for patients and address the risks inherent in them. It’s fine having remote supplies and I occasionally order things from Amazon and if they come on Tuesday when they’re supposed to come that’s obviously great, if they don’t come until Thursday nothing much happens.

“That’s not so much the case if it’s a medicine you’re dependent on and to equate them I think needs to be done with great care and ensure you’ve got the safety valves in place.”

Sue is asked if she thinks Dr Ridge has been reckless with his policies.

“I don’t know. I don’t know him well enough, if he’s reckless or just pursued something, a policy and a proposal and listened to some evidence without testing it properly. Maybe I’m completely wrong and he has done a full analysis and tested it and if we could see it we would agree with him. I haven’t. Intuitively I would say people’s health and access to medicines is too important to risk.

“The influence we’ve had with the Department (of Health) has been based on expertise and integrity in our relationships with the Department of Health. I would have expected a proposal like this would be one where they would be prepared to share the evidence and analysis with us.

“We wrote repeatedly after we saw the December 17 letter asking to see the evidence and analysis. What we basically got back is that there is none. And that’s what makes me really scared. That is reckless.

“But of course, Keith is not the policy-maker, Keith is the adviser. The decisions are made by other people. Anybody can put forward ideas but the NHS has responsibility not to take ac-tion foolishly or irrationally.”

Would she like to see Dr Ridge replaced as chief pharmaceutical officer?

“I really don’t want to get into the personalities. The NHS and the Department of Health need access to good quality informed advice about the community pharmacy sector.

“I think it’s implicit what we’ve said they’re not getting. Whether they get it from the chief pharmacist, whether they get it somewhere else, I don’t know, but it has clearly been lacking.”

Sue disagrees too with a remark by Alistair Burt, the former pharmacy minister, who said too many voices in pharmacy weakens the profession’s base for negotiations.

“If I can brutal I don’t think he knew what he was talking about. He didn’t understand because it’s not his job to understand. I don’t think he had the faintest idea they were all represented on PSNC.

“And let’s be clear, at that time it suited the government to criticise the other side. I’m not saying no reform (of PSNC) is necessary. We are trying to build the best possible engagement but our focus has to be getting other stakeholders, getting that relationship with them.”

It seems the old argument that there’s too many voices in pharmacy is a redundant one. “I think the first time I heard it was from a former minister who I think was excusing their failure to do anything about pharmacy when they were minister who was then advising a large pharmacy company,” Sue says with an air of mischief.

For now she is committed to the PSNC and community pharmacy and says, somewhat cryptically, she will “continue to keep an interest” in the sector after stepping down.

“If opportunities come along, I will look at them, do those where I feel I can make a contribution, make a difference.” Offering a chuckle, she adds “because I’m not ready to watch day-time TV.”

Who would she like to see replace her at the PSNC? Sue offers a smile.

“Someone with a hide of leather I think.”

 

Sue’s CV
• Qualified as a barrister.
• Adviser to Attorney General – involved in reform of legal profession.
• Joined Royal Pharmaceutical Society in 1991 as director of legal services.
• Joined PSNC as CEO in 2001.
• Oversaw introduction of 2005 community pharmacy contractual framework, Medicines Use Reviews and New Medicine Service.