Can you describe you career pathway?
I started in hospital pharmacy, doing my pre-reg at the now closed General Hospital in Nottingham before moving on registration in 1982 to Queen’s Medical Centre down the road. After a short and unhappy (workwise) six months in 1984 at the Norfolk & Norwich Hospital, I applied for and got a job writing on Chemist & Druggist.
Seven years later I took a successful punt on an ad in the PJ and for the next four years worked as a civil servant in the Department of Health in London as part of the pharmacy policy team (including contract negotiations). I left there in 1995 to join what was then Moss Chemists as the company’s first Professional Services Manager, where I built a team concentrating on new pharmacy services.
I was at Moss, and then Alliance UniChem (AU) in its international retail division, for more than eight years altogether. For the last three years there I led on professional services development in new businesses in Norway and the Netherlands as a part of the wider business development team researching entry into new markets across Europe.
I left AU to join the RPSGB as its first (and only) Director of Corporate & Strategic Development, where I had responsibility for policy, research, corporate governance, the secretariat, human resources, business intelligence and science. I was persuaded to leave the RPSGB to join the Company Chemists’ Association (CCA) as its Chief Executive in 2007, and from 2010 to 2015 I did that role concurrently with the role of CEO of Pharmacy Voice. Like three of my colleagues, I was made redundant earlier in the year when Pharmacy Voice was closed down by its trade association members after the National Pharmacy Association (NPA) decided to give notice of its intention to withdraw from the collaborative.
What’s been the greatest achievement in your career so far?
I’ve always tried to add something wherever I’ve been – new and different is what motivates me. So, whether that is introducing new features to C&D or coming up with the idea that put the Moss tender for a multi-million pound prison contract ahead of the competition, I’d like to think I’ve added something in all the things I’ve done.
The Pharmacy Voice team was the best I’ve ever had a hand in building, although the Moss prison pharmacy team and the Alliance Apotek management team in Norway were pretty special.
However, the one achievement that sticks out for me, and I cannot personally claim credit for huge chunks of it, was the 13 year journey that delivered the New Medicine Service (NMS), from an idea in Nick Barber’s room at the School of Pharmacy, to an NHS service in community pharmacy.
Most of the credit is Nick’s, but I was there at the start, kicking off with the pilot study of the original research in 25 Moss pharmacies in 1999. When I joined Alliance UniChem’s European business the following year I lost day-to-day touch with progress – as a result, I’m a co-author on the first of the five key published papers only, but Nick never stopped asking me, when the research was complete and it showed we had a major potential advance on our hands, what had come of the output.
By rights it should have been promoted to DH as part of the “new contract” discussions in 2004/05 – it was a better evidence base than MURs have ever delivered – but the potential service lay on the shelf for almost six years.
But, in February 2008, a year into my time at the CCA, we got a meeting with the then Director General for Commissioning and System Management Mark Britnell, to contribute views for the forthcoming community pharmacy White Paper. I took Nick along as part of our team to present this work; we had a hospital pharmacist too I remember.
Mr Britnell was delayed by urgent matters at Number 10, so we presented to the Chief Pharmaceutical Officer. The upshot was 24 hours later a request from within DH to provide the research papers, and six weeks later the service was included in “Community Pharmacy: Building the Future”. If you think about it, NMS is medicines optimisation/pharmaceutical care in action. It’s proactive, meets a defined need, and it works.
Is there anything you would have done differently?
I have one regret with the NMS stuff. In spite of plenty of advice on how to manage a change/implementation programme, and goodwill across the whole community pharmacy sector, the implementation was botched, take-up was slow, community pharmacists continue to question its value, and NMS scraped over the line in the evaluation (the latest report was published in the last few weeks).
I think I/we should have been more insistent with those who thought they knew best that we needed a proper plan for delivery, and one that included achieving effective buy-in as a first step.
Community pharmacy in England’s serial lack of focus on implementation is a mistake we addressed in the original “making it happen” section of the Community Pharmacy Forward View, which Pharmacy Voice submitted unilaterally to NHS England and the Department of Health as part of our response to the “2016/17 and beyond consultation” in May last year.
So, in terms of NMS, we should have also insisted that the valuable lessons from the pilot study and scoping research were learnt properly. The pharmacists who delivered many of the interventions in the original work could and should have had input to the service design. They did not.
I’ve had occasion to reflect very recently on another issue where trying to work with reluctant others on something vitally important consumed too much energy and eventually prevented us delivering an important piece of work. We should have just done it anyway. Generally I think there is a lot in the advice “Don’t seek permission; ask for forgiveness afterwards”. I use it regularly myself to others.
What career advice would you give to other pharmacists?
See the last two sentences above!
Right now, especially for young pharmacists, the world is your oyster. What do you want to do? Because you can create a valuable role that utilises pharmacists’ skills pretty much anywhere across the healthcare system right now.
I spent some time out and about last summer, talking to pharmacists about the cuts, the responses and the future. I was not surprised how many of those frontline professionals I met were interested in the patient facing directness offered by some of the new roles working with general practice.
I was struck by how many young pharmacists were keen to keep their employment status relatively fluid to be able to move across the system easily if an opportunity arose. The challenge for community pharmacy is to create an effective, thought through and implementable case for developing and using those skills across the pharmacy network, where they would be even more accessible to the public that needs them.
Against that background, I would also offer the following advice: be true to yourself as a professional, remembering that at the heart of the “contract” between society at large and a profession is that the members of that profession will use their specialist knowledge first and foremost in the interests of the patient/consumer or member of the public they are serving at the time.
It may be easy for me to say as someone who last worked in a patient facing role in 2000, and it may have been easier for me to withdraw my labour as part of a team who refused to work in conditions we considered were unsafe for patients 30 years ago, but that’s a call professionals have to make time and again.
Will the next stage in your career be within pharmacy?
I really don’t know.
I have had lots of kind messages from former colleagues and people within the profession I have been involved with in various roles over the years asking me “what’s next?” and wanting to talk about what needs to be done.
There are a number of things we were not allowed to pursue directly as Pharmacy Voice, or where we were reliant on others to do the right thing; there were also areas where I think community pharmacy should have been better prepared by working out policies in advance based on likely options – for example, I’ve wanted to develop a policy for scenarios relating to the delisting by the NHS of OTCs/common conditions for the last three or four years.
Now it’s happening almost by stealth in the NHS in England and pharmacy does not seem to have a coherent policy: do we want to defend the right of individuals to receive the right treatment, regardless of its statutory classification? Should we make the case for a genuine safety net for those of limited means? Or, would we really like to advocate more direct care delivery by pharmacists and pharmacy teams, which might lead to innovation in costing/funding models?
I’ve never really had a career plan, so the last few months have been a little weird. I’m not retired – I know exactly what 10 years’ statutory redundancy terms equate to, which means I can’t afford to – but I’m also not rushing back into anything full time right now, so (plug) I am available in the short term to look at problems out there.
I joined the governing body of a School/College for children with considerable physical disabilities a couple of years ago. Seeing the amazing achievements of kids against all the odds, and the work of the teachers, therapists and technologists that helps that happen is really inspiring and I hope to give that a little more time over the next few months too.
What would be your ideal job role?
I always wanted to run a quirky cinema, a multiplex like the Ritzy in Brixton (sorry for the London reference, but if you know it, you’ll know what I mean). If I’d gone into that rather than get diverted by science A Levels I’d like to think I would have come up with the mix of blockbusters, small screen arthouse, community populism that puts backsides on seats in an 18-hours a day, 7-days a week social asset that Picturehouse can run so well. And I’d like to think I’d have done better to avoid the pay disputes they’ve had there in recent years too.
Community pharmacy in England is facing tough times. What changes need to be made to turn things around?
Community pharmacy needs to understand the context it operates in, and needs to place itself within that context appropriately. In England, the defining document – still, two and a half years on – for the NHS right now is the Five Year Forward View.
This represents the collected system leadership’s view of the challenge facing the NHS in England post the 2015 election, and what is needd to try to square the circle of funding in the face of technological change and demographic pressure building up in the system, while improving quality.
Some organisations have still failed to address the asks of the system in this document. People were told not to get involved in major developments such as the Greater Manchester devolution programme. I was told five years ago when I suggested we work together to support local commissioning discussions that “local isn’t important”.
Clearly, as Simon Stevens has been saying for some time, Sustainability and Transformation Partnerships are “the only game in town”: the jury is out on whether they are working, but they are today’s context. The centre has decided command and control cannot deliver across the different geographies in England. Local leaders are free to experiment, on the grounds that some of them might come up with some answers that actually work.
The clear message from the 5YFV is that the same old stuff won’t cut it if the NHS in England is to get even vaguely close to keeping on an even keel over the medium term. Yes, this may be what our political masters intend with continuing austerity, but pretending this is all someone else’s problem is missing the point.
Pharmacy needs to build its alternative model. That model needs to be credible, relevant, and achievable. Most of all, it needs to show not just what is possible, what pharmacy can do to play its part in meeting the challenges of the next 10 years, but how those possibilities will be achieved. Innovation is important, but the ability to deliver and to achieve a demonstrable impact on patients, on costs to improve value, and on future pressures are the real keys to the future.
On reflection, could anything have been done differently to avoid the current scenario?
Yes. See above. It might also have been useful if genuine differences of opinion about the appropriate response to the challenge brought home in the notorious December 17 letter had been explored properly.
Several organisations were brought into the process this time. No-one seemed to want to understand why that was, and to use the opportunity to work out how the various interests and perspectives might genuinely contribute to achieving a better outcome for all.
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