In his first interview since becoming National Pharmacy Association chairman, Nitin Sodha tells Neil Trainis he is focused on the needs of independent pharmacies…even if some think that might be difficult…
There was a time when Nitin Sodha was not preoccupied with community pharmacy.
“I was in the RMC (Royal Army Medical Corps) as well as a reserve in the TAs (Territorial Army) from 1975 to 1984, so nine years,” the National Pharmacy Association (NPA) chairman says softly pondering the past.
“The base was in Birmingham but my recruits course was in Aldershot and there’s a place called Winterbourne Gunner where they have the NBC (Defence Chemical Biological Radiological and Nuclear Centre) laboratories now. My training was mostly there and we had to do weekends away. The summers I would be out exercising these guys but I placed in the Royal Army Medical Corps.
“I never saw any combat but the only thing that happened during my period was in 1983 when we had the General Belgrano sunk by the Argentinians, the Malvinas as they used to call it. So that was the only time but I did my nine years, right through my university years as well.”
The battleground has changed somewhat. Nowadays Nitin’s working life revolves around assisting pharmacists as they try to navigate their way through an assault course of an NHS which is making efficiency savings at every turn and putting up all manner of walls for pharmacists to scale.
One of 11 siblings, he has long had a passion for pharmacy. At one time it looked like being dentistry – “I couldn’t bear the thought of actually looking at people’s teeth all the time” he says with a hint of amusement – but clinical medicine fascinated him.
“I came to England in 1975. I had worked as a voluntary teacher in Kenya. In Kenya they introduced what was called Kenyanisation. My wife was a Ugandan refugee, I came from Kenya. What the Kenyan government did was they said ‘if you don’t take on Kenyan citizenship you cannot work here. You can live here but you can’t work.’ So how do you survive? And you can’t own anything.
“In Kenya it was a different way of…it made our life difficult but I’ve got nothing against the Kenyans. They are fantastic people, great community, I go there regularly, I’ve been there many times. It’s just politicians and all that, that’s what happened.
“When I came to (England) in 1975 I was hoping to be a dentist and I got a chance to go to Newcastle University because I’d just done my A Levels in Kenya. But I couldn’t get a grant because in those days you had to wait three years before you got a grant. My father…we didn’t have any money so it was quite difficult. So I got a job in a clinical biochemistry lab in Birmingham. I was 19.”
He did not know he would end up in pharmacy at that stage. “Next door was the mental hospital and I realised dentistry was not for me. It gave me an opportunity to figure out what not to do. Clinical biochemistry was phenomenally interesting.
“It was formative for me really in terms of the importance of science. During those days the early discoveries of DNA were coming through. I’ve always found that fascinating. And as soon as I got a grant I decided I wanted to do pharmacy.
“I thought when I qualified I would be doing all sorts of great advice and all sorts of things. I did my pre-registration at Boots but those days it was more selling everything, toiletries and all that stuff and I didn’t like that. I don’t enjoy that, so I decided to set out on my own and I got a government grant to start a business on the enterprise allowance scheme.
“It was £40 a week. Michael Howard and all that … I got £40 a week for one year in 1983. I started my first business in a portacabin in Redditch, Knights Pharmacy.”
It is faintly ironic that a Conservative government helped Nitin get his pharmacy off the ground given the party’s desire to slash community pharmacy funding more than three decades on. Yet things have moved on. And pharmacy must move on.
The last few weeks have been pretty frenetic. There have been hotly contested elections at the Royal Pharmaceutical Society and NPA. Nitin won the race to be the latter’s chairman. The result did not satisfy everyone.
Mike Hewitson’s resignation from the board in protest was quickly followed by a statement on Twitter in which he said he could no longer contribute to the leadership of the NPA on principle because, as he saw it, “the NPA has surrendered moral leadership on the critical issues of price gouging by wholesalers, stock shortages and the precipitous decline of service levels by vertically integrated wholesalers.”
Nitin is asked how he felt when he saw Hewitson’s remarks. “I’m young enough not to take these things personally. Mike is a fantastically able guy, he had done a great amount of work for the NPA. I am focused on issues regarding the NPA.”
In one sense Hewitson’s angst was understandable. After all, how can the director of a wholesaler, in this case Lexon UK, fight community pharmacy’s corner on issues such as the rising cost of medicines and concessionary pricing, not to mention service provision, when those issues may not be high on the list of priorities for wholesalers?
A report by the National Audit Office released after this interview revealed the price of generics greatly increased in 2017-18 and there was an unexplained “unexpected growth” in the margins of wholesalers.
Nitin is unmoved by the suggestion his chairmanship of the NPA will be hamstrung by a conflict of interests.
“As regards to generic shortages and generics concessions and what’s its impact on pharmacy, it’s much more complex than just one issue. The impact is on the cuts by the Department of Health of £170 million. So it’s a triple whammy, the cuts, then we had Category M clawback and at the same time we had these generic prices going up.
“The generic prices have gone up because it’s been a perfect storm in the industry. Community pharmacy and pharmacy has, through its negotiations and the way the system is set up, has driven prices down as low as possible. And then we had Brexit and when Brexit happens, the pound collapses, 20% the prices of products go up.
“And then we had a couple of large pharmas making lots of medication and they had regulatory issues. New manufacturers stepped in but because of their regulatory issues, they are claiming that the cost of ingredients went up and the third thing was the government’s concessionary prices doesn’t catch up.
“So it’s not an individual kind of thing where a small wholesaler is involved in doing something. We are amongst the small wholesalers, we are minnows compared with the very large ones. There’s no one industry, it’s a global supply chain. These prices change on a day-to-day basis.
“I’m not exactly aware of what the prices were. I don’t see any conflict of interest because Lexon has got its own independent customer base as have other small independent wholesalers and they still buy. It’s all to do with service and value. And if they are there providing the service and value, I can’t see what’s wrong in that. I have no criticism of Mike at all.”
Hewitson described Nitin’s election as “an insoluble conflict of interest.”
“His concerns, if he feels right, would be ok but actually my job, I don’t think the full picture has been taken into account and you need to understand the full picture of how the generic industry operates,” Nitin suggests. As for Lexon, he maintains he does not “actually have an office there anymore.”
“I used to chair Lexon until two years ago. As a non-executive director, I don’t actually have an office there anymore. We moved out. I look after the retail business, the community pharmacy business because that’s where my interest is. Lexon was actually set up to support independent pharmacy.
“If you asked me to buy something, I’d be the first person to get ripped off. When you are technically and scientifically-minded you want to deal with the patient. I don’t deal with purchasing and all that stuff. My nephew joined Knights Pharmacy, Pritesh (Sonpal), he came into the accounts office and said ‘everybody is robbing you.’
“I said ‘well you deal with the buying.’ And so Lexon was set up from my office because we went to local chemists in the area and said ‘look, if we buy together then the idea (is) to buy economies of scale for others as well and create value for others.’ And that’s how Lexon was there, to support independents. And its slogan is ‘supporting your independents.’
“Pritesh and myself came in and Anup (Sodha, who runs Lexon) came along afterwards. I was the original person who funded it but then I gave them the shares. I have a minority share. I have never run it. The day-to-day operations, I have no idea. But I’ve chaired the organisation I suppose partly because they have been looking at me at me like a parent.”
Nonetheless, the cost of generic drugs, supply issues and the Department of Health and Social Care’s (DHSC) ridiculously late announcement of price concessions each month continues to cause tremendous difficulties for pharmacists. The PSNC wants a fairer system in place. Nitin considers what that should look like.
“They are looking for transparency aren’t they. Transparency in prices. They’re looking at different models of how to get transparency. The government is saying ‘maybe we’ll have to look at manufacturers’ prices.’ I’m not in a position to comment on the PSNC’ negotiations. What I would like to do is see that our members get fair reimbursement straight away.
“That should happen quicker. The system is a bit archaic and not catching up quick enough. It’s unfair for somebody to supply a product to somebody at a loss. It’s not right. It’s fundamentally wrong so what we need to do is speed up the processes and that’s up to the PSNC. We have made our case to the PSNC. We have encouraged our members to report price increases immediately.
“I myself in our own retail business would actually complain to Lexon and say ‘why has that price gone up?’ And they would say ‘because we’re being charged more by these people.’ So it’s a supply chain issue. That’s how dysfunction happens.”
The DHSC has been trialling the use of manufacturer prices rather than wholesaler prices to inform its decision-making on concessionary pricing. Nitin is asked if this is the right approach or whether data from wholesalers should continue to be used.
“My view is that it should be the right prices whichever way. I am not an expert at pricing but it should be fair pricing. I can’t give you an exact answer because I can’t dictate market forces. The NPA’s position will probably follow the PSNC’s position because they are in the negotiations about pricing.
“The NPA does not get involved in price negotiation. What we would say is, just like any other independent, we would collate the voices of independents. We get lots of phone calls all the time.”
Nitin is adamant the NPA will lobby the PSNC on the issue of price concessions. “Yes, we will be constantly pushing that and they are aware of that. We’ve got two of our NPA board members on the PSNC, so we would actually tell them. And we want more transparency.”
There appears to be reason for optimism. The government said it will open talks with the PSNC on shifting the focus of the community pharmacy contractual framework from dispensing to a service-based contract that will cultivate the sector’s role in providing care for people with long-term conditions. Although no date has been set for those talks.
Nitin believes the NPA is well positioned to communicate the ideas of its independent members to the government.
“Yes, yes. The NPA is already involved in it. We work well with the PSNC and we will work with other pharmacy bodies too. We are working on a hypertension project that we will be able to roll out soon. We are aware of what the PSNC has proposed as the clinical project to the DH, we will talk to RPS, we will make sure all those elements will be acted on because we need to up-skill the workforce and make sure the proper training is there.
“That’s part of our role in training and professional development. We want it to be sustainable. It needs to be commercially sustainable because you cannot expect more and more and more from community pharmacies whilst they are doing this and trying to do more without adequate remuneration.
“We would actually lobby that. We’ve got our own NPA board members on the PSNC. We are in constant communication with the PSNC and we would say ‘these are our concerns.’
“And the pharmacists on the PSNC themselves who are independent pharmacy owners and other owners will say whether something is practicable, doable and can be done at scale.”
How does the NPA chairman go about ensuring the government takes on board the views of independent pharmacists?
“The best way of working is to work collaboratively. Work out what are the needs. The NHS has got a crisis. We know they need to save £22 billion. We know there are so many elderly people and we know there are issues about long-term care, so would you not use the third largest force in the industry doing approximately a hundred million interventions a year to strengthen that network? Would you not invest in that?
“Our solution would be to tell the Department of Health ‘look, you have vanguard sites around the country, pilot sites for testing out different models of care, so would you not consider doing the same within community pharmacy? Let’s test them out around the country and see what works.
“And if it works, scale it up. It’s collaborative working but you don’t want an imposed solution which doesn’t work because you’ve not consulted us properly. We want a shared agenda. I’m putting my arm out to everybody, all the stakeholders. I want to understand what the Welsh have done. The Welsh are incredible. They have done an amazing job. The Scots have done an amazing job. In England we can do it, we just need to work together.”
Nitin makes the future sound enticing. Exciting even. How does he see independent community pharmacy services evolving over the next five, 10 years?
“That goes back to the day I qualified. I used to sell paracetamols all the time day in, day out and it was depressing. This is a fantastic opportunity now for community pharmacy if the government also looks at it in the same way. What we need to do is explain to them that pharmacy does a lot more.
“There’s a clinical services agenda coming up. If it’s embraced full heart with the government working with us collaboratively, we can find the solutions that would make it much more fulfilling for professions. So my job in the NPA is to make sure our members are fulfilling the profession and are commercially successful.
“I will use all my clinical and technical background to make sure they are supported that way and I will do everything in my commercial skill-set to make sure members are managing their revenues, increasing their revenues, managing their cost base, having great leadership and having some creative thinking.”
Nitin’s colleague at the NPA Gareth Jones recently said pharmacies are too often overlooked by sustainability and transformation partnerships (STPs). That was reinforced by a Pharmacy Business survey in which 55% of local pharmaceutical committees (LPCs) said their STP did not value pharmacy.
“STPs is close functional between different NHS departments, from Health Education England, to delivery, to CCGs. The purpose of the exercise is to speed up processes. I think it’s terrible and I think the Department of Health also thinks the same,” Nitin says.
“I have personally made representation about that to DH. I was in a meeting where I personally made a representation, that it was a terrible shame that pharmacists are not represented on STPs. They were surprised. They were saying ‘aren’t they?’
“So there seems to be a bit of dysfunctionality between national and STPs. How can you make decisions about patient care if you don’t have community pharmacists within it? There are examples where it is happening and I have chaired an LPC for 16 years and recently I met an STP leader who is a pharmacist in our STP in Birmingham. He’s quite active, quite involved in trying to find cost-effective solutions. There are positives. It could be huge.”
Nitin adds somewhat mysteriously that he “personally met with the team at DH about that element (in) January but I can’t discuss any more about these things.”
LPCs, he insists, are pushing pharmacy forward locally with STPs. “All LPCs are doing that but it’s like a closed-door session because pharmacy, sadly, is seen as an underdog amongst the bigger picture in the health arena locally as well. Pharmacy is sometimes not respected enough.
“It’s incumbent on all of us within the profession to say ‘explain what pharmacy does’ because I don’t think they fully understand. They’re not just dispensing, they are doing so many interventions, they are looking after the delivery of patients, they are looking after elderly people.
“We need to be able to sell our proposition in a compelling manner and find those elements. And one of my ambitions in the NPA is to do exactly that.
“LPCs need to be co-terminus with STPs. That’s my personal view. In Worcestershire which I chaired for many years, we managed to merge our LPC with a very small one in Hereford and used our chief officer to work with other LPCs so we could get a creative feel of what’s happening in our area.
“I was at a meeting (a few weeks ago) about issues in terms of boundary lines of dispensing doctors and they want to look at how the boundary lines are going on, where they can dispense and where they can’t dispense.
“And that’s not fully clarified in the country. It was just by pushing for that and saying ‘why hasn’t that been done’ because it’s got to be clearer.”
• Started career in a clinical laboratory and the Royal Army Medical Corps.
• Qualified as a pharmacist in 1981 from Leicester and worked for Boots.
• Is managing director of regional multiple Knights Pharmacy and director of wholesaler Lexon (UK).
• Is member of the Association of Independent Multiples and chairman of Worcester LPC.
• Was elected to NPA board in 2007 – became NPA chairman in 2018.