The big interview — Rob Darracott (part 2)

Professor Rob Darracott

 

Does the government not see the value in community pharmacy?


I believe it does. But we only demonstrate our value, or come up with “savings”, when pushed. We’ve resisted change; we’ve even argued against the principle of a level playing field in one area, something I think has to be a first in representation anywhere.

I’m still not sure we have a clear idea of where we want to be. The Community Pharmacy Forward View was designed to deliver that, but can you honestly say that the energy that led to its creation, in a 40-person 24-hour strategy meeting followed by four weeks of intense distillation and drafting, has been followed through?

Some of the sector’s leaders can barely bring themselves to say its name. Three months from initial submission to agree the publication text; a further five months to find a compromise position we could agree on publishing for the implementation chapter? We’re now a further eight months on.

In years to come, do you think community pharmacy will regret the demise of Pharmacy Voice?


I don’t think that’s for me to say.

I think a single representative organisation for the trade sector bodies was the right approach; its formation was widely welcomed by most stakeholders. We tried to do some good stuff. Some of our consultation responses and our position papers are object lessons in referenced, thoughtful and well-argued policy making and positioning.

Our working groups, through which members came together to make the decisions on our approach to IT, workforce, professional practice, produced some of the finest discussions I’ve been privileged to witness in 20+ years doing this kind of thing.

We ran award winning campaigns, on our own and working with others from outside the sector, we got involved across Government – Home Office, BIS, DfE – in issues which our members wanted us to get involved in. And, given the anguish which our closing down was met with in some quarters, then I have no doubt that moves will be made in the future to create a united voice again.

I was told the opening up of the discussions with the sector in 2016 was an attempt by Government to “divide and rule”. We could have avoided that by working better together as organisations when facing the threat, but the end result was that we ended up dividing ourselves.

What difference did Pharmacy Voice make?


Time will tell.

Our work supporting the patient safety agenda – great to see this now crystallised in a new website www.pharmacysafety.org – was ground breaking, and shows what can happen when people work together and share problems and solutions.
Our input to Health Education England’s pre-registration revamp, including the Oriel system, shows what can happen when you get constructive representation right.

Our two Forum meetings were designed to be constructive and future-looking, although the second one could have done with not being almost the last external facing thing we ever did.

I genuinely hope that the organisations will try to take forward the Community Pharmacy Forward View, a piece of work which was 100 per cent Pharmacy Voice in origin and 90 per cent Pharmacy Voice in execution, all put together and led by the fantastic Elizabeth Wade.

The CPFV was a piece of work that should have taken six months which was completed in six weeks. We would have had a major engagement phase in the six month programme, but it was vital to include a vision/strategy in our response to the “2016/17 and beyond” consultation.

I’d also like to think that Pharmacy Voice demonstrated that complex professions need a range of skills working in its institutions. Pharmacy Voice drew its staff from the NHS, from commissioning, from the best pharmacy organisations overseas, from high end PR, public affairs expertise from the water industry, specialist organisation management and governance expertise from the third sector.

It was a small team, but one built to a thought through blueprint with outcomes in mind. I’d never worked with any of the team before we hired them. Without exception, we got great people from great fields at interview.

How well do the various organisations work together/collaborate in pharmacy?


Next question…

Some work well with others – the three organisations in Pharmacy Voice worked well together for more than six years. Others talk collaboration more than they practise it. Some of our meetings with senior officials were subject to FOI requests which can only have come from organisations or individuals we were supposed to be working with.

Are multiples driving the agenda at the expense of independents?


My experience has always been that there is more that unites pharmacy businesses than divides them.

I know it can often look that way, and of course the multiples try and drive the agenda at times; they are considerably invested in the sector. The investment of the four largest companies in the Community Pharmacy Future service development has been characterised as an attempt to drive the agenda. That work fell out of the first Pharmacy Voice “Blueprint” document and, had things been different, might have been developed as a cross-sector piece of work by PV.

The companies however, agreed to invest as a means of making much faster progress, have involved independents (from the start in CPF project 2) and have explored some really interesting models for the future development of the pharmacy service.

I think the multiples v independents argument is a sideshow to a much bigger concern. It is often said that the UK has one of the most sophisticated and efficient supply chains for medicines in the world. That may be the case, but with efficiency comes “just in time” inventory, and therefore potentially a lack of resilience when things go wrong in the system.

Too many pharmacists spending too many hours sourcing product tells me the system is well and truly broken.  It’s prone to gaming at many levels; pharmacies and patients are both the losers.

I first asked an audience of pharmacy owners whether pharmacy should make the case to get out of owning medicines in the mid-1990s, just before I left the Department of Health. By definition in an averaging system half the players are going to do worse than the average, and the incentive to beat the average has delivered huge savings in the drugs bill to Governments over the years.

I’m not an expert, but it seems to me that the workings of the Category M mechanism over recent years represent a triumph of spreadsheets over reality. When pharmacy owners who I think run a tight ship, and who are trying to do their best by patients, are telling me they don’t know where the numbers in the system are coming from, then something looks seriously wrong.

What’s your view on allowing pharmacy technicians to join the RPS?


Why not?

The CCA response to the consultation on the future RPS, when the GPhC was splitting out from the then RPSGB, suggested that the new RPS should aim to be THE Royal College for pharmacy and medicines. Taking a leaf out of the book of the Royal College of Physicians, whose Faculty of Public Health means the RCP gets income from non-doctors as well as its doctor members, we envisaged a pharmacy organisation owning the medicines space in its entirety, including drug discovery, prescribing and medicines use in addition to acting as the professional leadership body for pharmacists.

It should not be beyond the whit of the Society to embrace associated professionals, and those with the broadest of interest in medicines, including pharmaceutical scientists, pharmacy technicians, and prescribers, regardless of professional background. What form “membership” these groups might take would be open for discussion, but they don’t need to be “equal” to pharmacists in status within the organisation.

There’s been a lot of scaremongering around roles: all the stuff about a Rebalancing Board plan to allow pharmacy technicians to supervise pharmacies. I was a member of the Board for more than four years. It’s not true.

This is not the place to go into this in detail – it’s a lively debate right now elsewhere, but I think precision in language is important, and exaggerating or extrapolating too far to make a point doesn’t help the profession as a whole come to conclusions about the future of practice, when in many places, and sometimes as a result of purely political decisions, we are being faced with squeezing a quart into a pint pot.

What will primary care look in 10 years’ time?


This really is anyone’s guess. Go back 10 years from here and who would have predicted some of the advances we now take for granted. In 10 years technology will provide the public with more information at their fingertips than ever before.

Smart devices, particularly wearables, will give people who want it detailed information on their health status, at any time.

Personalised medicines will be more common; medicines will increasingly be matched to genetic profile; is it possible that 3D printing technology will produce medicines for individual patients and we’ve seen the end of standard dosages?

The role of the professionals will be increasingly about interpretation, navigation and support for behavioural change. Fortunately for the immediate future of pharmacy, while the younger generations are losing voice communication in favour of keypads, for the main users of medicines, the elderly, we still have plenty to go at in terms of improving their use of medicines to get the improved outcomes they want.

I believe the face-to-face role of pharmacists has a way to go yet; medicines administration in care homes in this country has barely improved since I did my third year student dissertation on the scale of the problems in care homes in Derby with Dr Peter Rivers in 1981.

Are you optimistic for the future of the profession?


Yes.

Never in my 35 years on the register has so much hope been invested in pharmacy and pharmacists within the NHS. New roles are opening up in urgent care, NHS111 centres, A&E departments and GP practices. In the central scheme in England alone, the ambition is to have an additional 1,300 pharmacists in GP practice teams in the next few months.

We have a new plan of action in Scotland with plenty of pharmaceutical care focused around community pharmacy; I’m looking forward to hearing what’s next for pharmacy in Wales.

As for community pharmacy in England, I don’t know what happens next. Pharmacy Voice consistently argued for a real partnership between community pharmacy and NHS England on developing a joint plan for the future.  In an ideal world, the Community Pharmacy Forward View would, like the GP Forward View, have been a co-production between pharmacy and the NHS.

The courtroom is not the ideal place to build a partnership. I understand the argument that all avenues had to be exhausted, but I think it’s clear from my earlier answers that I didn’t think that where we ended up was an inevitable conclusion to the events triggered by the December 17 letter.

I’ve been privileged to meet and serve many fabulous pharmacists and their teams over the last 10 years. I had the opportunity to give more of a platform to some of the very best; it’s great to see people like Anjella Coote, Reena Barai and Ade Williams shine on public platforms and in front of politicians at Westminster. They can bring to life the great things pharmacists do day in day out better than any representative officer can ever do.

The Anjellas, Reenas and Ades are the people we were working for. They deserve our very best efforts. It’s a real shame that pharmacy contractors in England will not have the chance to see what we were working on when we had to stop.

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