Pharmacists tell the Royal Pharmaceutical Society they want to do more but there are often system barriers, says Robbie Turner. Its director of England talks to Neil Trainis…
Community pharmacists’ futures are flashing before their eyes. Time is moving fast. Yet Robbie Turner gives the impression there is no need for pessimism or panic.
The assured young director of England at the Royal Pharmaceutical Society (RPS) seems to take it all in his stride, be it sustainability and transformation partnerships (STP), decriminalisation, service commissioning, community pharmacy’s future.
In a quiet room deep in the RPS’ East Smithfield headquarters, he ponders how the fate of pharmacists and their teams up and down the country will play out over the next few years as STPs and accountable care organisations form the shape of healthcare in localities.
Much has been made of STPs in particular. They are the government’s way of moving care out of hospitals and into communities but community pharmacies have struggled to engage with them for a variety of reasons. Robbie reveals the RPS has appointed four regional liaison pharmacists to support pharmacists’ involvement with STPs, one for the north, south, midlands and east and London.
A well-paid position with an annual salary of £55,000, each one will, as the job description said, “support areas to identify and develop pharmacist system leaders and work with local, regional and national networks to help celebrate and spread good work” as well as “advocate for the involvement of pharmacists at all levels (including strategic planning) of STPs and new forms of delivering health care across their region and provide support where necessary.”
The four, who will report to Robbie, are embarking on an important – he describes it as “exciting” – challenge but it is tempting to question whether four individuals can have a telling impact when it comes to community pharmacy engagement with STPs, given it is surely down to individual pharmacists to make things happen on their patch.
“It is but the RPS has done some fantastic work before and since I arrived creating a national picture that is painting a really positive picture of the future of the profession,” Robbie says.
“So, the profession is seen now in a light that it’s never been seen in before. We’ve got policy-makers, we’ve got politicians, we’ve got other healthcare professionals but most important we’ve got patients crying out for pharmacists to do more, to support them better in the way they use medicines.
“We’ve created this national picture and if we use prescribing as an example, prescribing has been around for almost a decade for pharmacists and what we’ve not seen is a translation of that into the transformational, different way of delivering healthcare at a local level through the pharmacy profession.
“We’ve still got the same issues around medicines use, waste is still too much, the numbers are still around £300 million a year of waste medicines of which half are avoidable. We’ve still got around 8% of admissions are due to medicines-related harm, we’ve still got 50% of people not taking medicines in the way we expect them to.”
Some 55% of LPCs claimed during a Pharmacy Business survey that their STP was not interested in community pharmacy, 31% said they had been unable to secure a meeting, 62% said they had not been invited to participate and 45% said they could not find the right people to talk to. None of which, Robbie insists, came as a surprise to anyone at the RPS.
“The problems are still the same problems. What we’ve tried to do is answer them with national solutions. And the devolved nature of the NHS in England means we can create opportunities and continue to do fantastic work advocating for the role of the profession,” he continues in full stride.
“But unless commissioners, the people who employ or the people who commission the employers to use the profession in a different way, then we’re not going to make the best use of the skills that are available. What we see in the current structures of the NHS is that STPs are where lots of these conversations are happening.
“So, redesign of care pathways around long-term conditions, redesign of urgent and emergency care systems, looking at the workforce issues we have across all of the professions in health is the responsibility of STPs. I took a view with the English Pharmacy Board that we needed to do something about it.
“We don’t know particularly what the answer is. There are lots of really good examples of areas where, actually, they are making things happen. They are so different that there’s no one answer. What these roles will give us the opportunity to do is try some different ways of working at that system leadership level, STP level.
“So, they are going to make an impact, they are going to do some great work. The people we have employed are passionate, they’re switched on, they’re already networked into the systems that they work in.”
“Are they going to fix pharmacy and fix the NHS? Then it’s probably no. But they will make a significant change to the health economies they work in.
“What they will then do is give us a range of models that we and NHS England, NHS Improvement, other pharmacy bodies, can use to think ‘actually, that model works, let’s replicate it across a whole region or the whole of England.’ So, this is about us doing the right things for the right reasons and giving some things a go.”
Robbie reveals that pharmacists “are regularly telling us they want to do more but there are often system barriers.” The reason pharmacists can’t do more, he says, “is because of the system around them.”
“If we think about high blood pressure. Pharmacists out there know they’ve got a significant number of patients who have high blood pressure who don’t know about it. They’ve really stepped up with their identification of high blood pressure. We know there are really good examples of services through community pharmacy that are identifying people with high blood pressure.
“What we also know is the treatment of people with high blood pressure isn’t as good as it should be. In many places the variation in the treatment and outcomes of treatment for people with high blood pressure is too great. It could be better.
“The system that we’re pushing (people) into, we’re not sure that’s a good system. We could overwhelm the system by finding the five million people with high blood pressure in England and putting them into general practice.
“What we can do is help those pharmacists who want to do something different and recognise where they can have a big impact. If we use these regional liaison pharmacists to help the leading lights in a local area to work with the commissioners of the hypertension pathway or primary care or whatever that looks like, they can design the system for their local area.
“What has been shown to rarely work is to come up with a service design at national level and try and impose that at local level.
“This needs to be about helping support people at a local level, work with people who are at that system leadership level across sectors – this isn’t a community pharmacy thing, this isn’t a general practice pharmacy thing, this isn’t a hospital pharmacy thing – this is a ‘how can the profession best help patients and how can we as the RPS help that to happen to help people negotiate around the barriers that they are telling everyone who asks them are there.’”
Earlier this year Robbie went on record as saying he was concerned there was not enough pharmacy involvement with STPs. He is asked why he thought there was a lack of involvement.
“The job of the RPS now is to move down a level and start to work with STP leaders to get them to recognise, not that they should be using pharmacists, but that they have a significant issue with medicines use in their area and a significant issue with the safety of medicines in their area. There is no area in England that doesn’t have an issue with the safety of medicines.
“When we start to help them realise that, I passionately believe and I’m confident that, as we’re seeing at a national level and the very local level, they’ll be crying out for more pharmacists to help them because they’re going to look for a healthcare professional who can redevise their systems with medicine and the use of medicines having a renewed focus and the benefits that’ll bring in the cost reduction later on through people getting better outcomes.
“I believe that’s where we’ll start to see more pharmacists involved at that level of an STP.”
He says it is the responsibility of everyone within pharmacy, not just LPCs or the RPS, to tell that narrative to STP heads.
“We’ve got an opportunity now as STPs continue to form. This can’t be left up to any one person, one organisation, one group, one sector of pharmacists. This needs to be professionally-led.
“This is not about replacing the great work that LPCs, LPNs (local professional networks), LPFs (local pharmacy forums), that groups of hospital chief pharmacists do, this is about working with them, picking the best bits and helping to build networks where there aren’t networks and strengthening networks where they need strengthening.
“In some places it’s working well. We see in the North East some really good work going on, in Greater Manchester there is some good work going on, so this isn’t about starting from zero. We know in the NHS it is traditionally very hard to spread good practice. It doesn’t happen by osmosis. It needs people in there who can grasp examples of good practice and help people understand how they can implement that in those areas.”
Still, concerns around the competitive nature of STPs persist. Dr Chaand Nagpaul, chair of British Medical Association council, told a parliamentary health select committee this year that procurement could “thwart the ability to create the sort of collaborative arrangements meant to occur through STPs.” Robbie is unmoved.
“STPs are the answer that we’ve got,” he says dryly. “They are the structure that we have to work with and we need to work with them in the best and most effective way we can. I think the work that we are doing is a real step forward in being able to work with them more constructively.
“The issues raised about procurement are one barrier that’s been raised that we haven’t move forward as quickly as perhaps we thought we would have with STPs. The Royal Pharmaceutical Society thinks there needs to be a better utilisation of the pharmacy profession and a greater focus on medicines and that’s the area of STPs that we will be working with.”
Robbie is asked if he agrees with Dr Nagpaul.
“I’ve not got a view… procurement is not an area that I’m not particularly cited on so it’s not something that I would pass comment (on). I know that we are focused on the use of medicines and role of pharmacists in supporting that medicines use with patients.”
• Director of England at the Royal Pharmaceutical Society (RPS).
• Joined the RPS in January 2017.
• Was chief executive officer for Community Pharmacy West Yorkshire.
• Was regional manager for Assura Group and before that worked in a number of positions in community pharmacy.
• Graduated from University of Bradford in 1999.