Paul Bennett arrives at the Royal Pharmaceutical Society as pharmacy fights for its future. The professional leadership body’s chief executive talks to Neil Trainis…
Paul Bennett is calmness personified, measuring up each question carefully, barely raising or lowering the tone of his voice. Just the kind of individual, you might think, the Royal Pharmaceutical Society, indeed community pharmacy, needs at a time of intense upheaval within an unstable NHS.
“I think it’s really important that the Society is clear on its position and the president has expressed a very clear view there to try and dispel any uncertainty,” the chief executive of pharmacy’s professional leadership body says as he contemplates the idea that every pharmacy should have a pharmacist present when medicines are being handled.
“I think it’s really important that where there are medicines that there is a pharmacist present and therefore it’s clear that in a community pharmacy setting, it’s really important a pharmacist is available to the patient at the point that they wish to seek advice and support.
“That’s a really important principle for us to hold clearly and to express clearly when we’re asked. And I don’t think we can put it any more clearly than that.”
In a quiet room somewhere in the RPS’s stylish east London headquarters, Paul confronts the thorny issue of technicians overseeing the supply of medicines when the pharmacist is absent.
It is an issue he and the other members of the Medicines Legislation and Pharmacy Regulation Programme Board will no doubt talk over when they meet on October 23. Rumour has it that the Board is in favour of the proposals.
“The technician workforce is a really important part of the pharmacy workforce overall. And I see it very much as a combination of skills in order to ensure the patient gets the best possible outcome,” Paul says.
“That’s about bringing the clinical skills of the pharmacist together with the skills that the technician workforce bring into that environment.
“There is a need for us to look very carefully and very clearly at how we can make the best use of the skills that each bring in order to take us forward as a profession.
“Pharmacists have ambitions to practice in many different settings to perhaps what has been the traditional environments and it’s important we utilise skills to do that appropriately.
“I have no fixed personal view on what supervision should look like. Policy is down to our national boards and the assembly to make and I look forward to start contributing into the work of the Rebalancing (Board). I’m really keen to understand what considerations have been put towards supervision.”
Hypothetical scenario: Paul is a patient whose pharmacist has handled his medication for years. He is told the pharmacist is unavailable and the technician will handle his case. Paul is asked if he would feel comfortable with that.
“I think ultimately the question is more how comfortable are patients, in a hypothetical scenario like that, and it’s really important medicines are handled safely.
“In a situation such as the one you’ve described, I think it would be critical to ensure that the pharmacist maintains the oversight and professional accountability for the activity that’s taking place in that pharmacy setting. Now you might call that supervision.
“Whether it’s direct supervision, whether it’s an oversight of supervision, whether it’s establishing the framework under which that pharmacy operates remaining the accountability of the pharmacist, I think is up for discussion and debate.
“So that definition of what is supervision probably goes right to the very heart of the discussion. My personal view is that it must remain the oversight of the pharmacist and that’s very important.”
An online letter signed this year by more than 650 pharmacists called on RPS presidential candidates to oppose Department of Health plans to empower technicians to supervise pharmacies.
“Anything other than a strong and robust opposition to these proposals by the RPS, its staff and elected officials will be seen as a betrayal by the thousands of community pharmacists in membership of the organisation and more than two million members of the public who signed a petition in support of community pharmacies and the service they provide,” the letter said. Strong words. Paul is asked if he will be opposing the plans.
“So my role as chief executive is to harness the talent within the organisation to deliver the policies that the national boards and the assembly determine. I think it’s really clearly expressed by the president that there ought to be a pharmacist present where there are medicines.
“It will be our job to put that point across strongly and robustly in any work of the Rebalancing Board.”
The letter went on to accuse the RPS of being fixated with pharmacists working in general practice and not doing enough for community pharmacists – “in recent years RPS has placed too much emphasis on this emerging role which even by 2020/21 will see pharmacists available in practices on average one day per week. Our professional body must stand up for community pharmacists and their patients,” it said. Was this fair criticism?
“I don’t think that’s a fair criticism actually,” Paul says in measured fashion. “The Royal Pharmaceutical Society has done a lot of very good work over recent time and before I joined the Society to extend the opportunity for pharmacists.
“And, I suppose I’m reflecting on my many personal years in the community pharmacy setting and environment, I clearly recognise the very great importance that pharmacists play in the community pharmacy setting.
“I actually think there’s a real opportunity for community pharmacy by working closely with pharmacists who are in new settings, environments and practice. Pharmacist colleagues who work in GP practice settings have a real opportunity to work collaboratively with their colleagues in the community setting.
“I envisage many examples where patients seen in the general medical practice setting can be seen, referred to a community pharmacist, whether it’s for a New Medicine Service, Medicines Use Review, those pharmacists in the community setting often see those patients very regularly.
“Long-term condition patients are supported in their communities by those very professionals, those colleagues working alongside their colleagues who are now based in general practice settings.
“I would like to see greater collaboration across those two settings and pharmacists working in such a way that it’s enhancing patient care. So I think that is an unfair allegation. I think the Society should be congratulated for the great work that it’s done and continues to do to build opportunity for pharmacists to practice in new settings while not forgetting the very important contribution that pharmacists make in the community setting. I believe they are complimentary.”
One community pharmacist who put himself up for election to the English Pharmacy Board (EPB), Altaf Vaiya from Leicester, did so because he felt the RPS did not effectively represent all community pharmacists. The accusation, once again, was that the RPS was more interested in GP pharmacists.
“I come from a role working at a local pharmaceutical committee where I spent a lot of time working with and for and on behalf of community pharmacy owners and that’s taken me into contact with very many pharmacists in community pharmacy settings of all sizes,” Paul offers.
“And I recognise how difficult it is at the moment in community pharmacy in England given recent funding arrangements and the challenges that exist. The role of the Royal Pharmaceutical Society is to support pharmacists wherever they may practice and whatever stage they are at in their career.
“We’ve got to do more to listen to what our members are saying and to listen to those who are currently not members and use those insights to help inform and shape our approach, whether it be development of services or products that support them to ultimately be the best pharmacist they can be.
“We’re agnostic in that sense, whether it’s in a community pharmacy or hospital setting, academia or a pharmacist practising in a GP surgery. The role of the Royal Pharmaceutical Society is to support those pharmacists to be the best that they can be. And I think we’ve got to work harder at doing that.”
Turnout for the national pharmacy board elections this year was down on previous years. The boards in England and Scotland saw a combined average turnout of 10.9%, lower than the 11.5% turnout in 2016 and 11.7% in 2015 according to RPS data.
It suggested pharmacists had grown apathetic when it came to choosing who they wanted to represent them. Paul suggests the election process could be reviewed.
“I was personally a little disappointed with the number. We’ve got to understand why we’re apparently not attracting the level of interest in the election process as perhaps we might.
“I don’t think the number is particularly is inconsistent with that that might typically be experienced by a professional leadership body but it would of course be better if it were higher. I think we need to engage better with our membership and do more things which are exciting them and encouraging therefore greater participation in the electoral process.
“I think there’s an opportunity presented to us here to re-examine how the election process is conducted in terms of, ultimately, the ambition to ensure that it’s set up in such a way to ensure that more of our members are encouraged to participate in it.
“I don’t know what the answer to that question is yet but I think it would be appropriate for us to examine that carefully with a view to encourage greater participation in the election process.”
Naturally it is important for Paul and the RPS to develop and cultivate relationships inside and outside of pharmacy. Nevertheless, he is asked if he thinks Dr Keith Ridge, the architect of hub and spoke who has divided pharmacy with his policies, is a good chief pharmaceutical officer.
“I’m very much looking forward to working with the chief pharmaceutical officer for England as I am for the chief pharmaceutical officer for Scotland and Wales,” Paul says with characteristic poise.
“I think it’s very important that, as the chief executive of the Society, I have a very good relationship with all of the chief pharmaceutical officers and I’m really looking forward to working with Dr Ridge on a number of different things.
“I’m more concerned with policies than personalities. I haven’t yet had the opportunity to sit down with Dr Ridge since I started at the Society and I’m very much looking forward to doing that.”
Mention of Ridge’s name at last year’s Local Pharmaceutical Committee conference drew jeers, a sign of dissatisfaction among some members.
“Clearly there are a number of policies which he has pursued on behalf of the Department of Health which are unpopular and it’s perhaps not unexpected that the sort of reaction that you’ve mentioned to me has been forthcoming from pharmacists,” Paul says.
“I think it’s really important that we look to the future. I’m mindful of a phrase from the chair of the English Pharmacy Board Sandra Gidley used which was about the opportunity to reset the relationship with government.
“And the chief pharmaceutical officer is clearly an agent of government and it’s important that we establish an appropriate forward-looking dialogue and I’m, looking forward to doing that when I get the opportunity to sit down with him.”