By Ade Williams, superintendent pharmacist, Bedminster Pharmacy, Bristol

I vividly recall when the scale of the unfolding crisis first dawned on me – Sunday 15 March 2020. The emergence of the coronavirus in China, a human catastrophe, was seemingly very far away. Now it was ravaging lives in Italy, Spain and France. I was no longer a casual bystander: it was here.

That Sunday evening, I sent out messages to a variety of local contacts – local politicians, health care colleagues, community organisers and leaders. It was a simple message: ‘How will we protect our community?’

I had a flurry of responses. GP colleagues replied to explain what was happening – full triage and behind doors working – and politicians detailed contingency plans. But amongst all these, I remember the most uplifting response I received. Our community had set up a mutual aid group on Facebook – 780 names so far – could I join the steering team to lead this?

Maybe it is the trauma of this year, or just mental and physical exhaustion, but I do not see my old phlegmatic disposition coming back soon. I find now that I have a deep hollow feeling of emptiness, akin to failure, instead. I’ve been considering why this is. 

The last few months have been the best for the pharmacy profession – particularly community pharmacy. That’s not to say we have been doing badly before this of course. But events have put the spotlight on us. Healthcare is certainly no beauty pageant – no tiara and sashes – it is a collective toil, and in this great hour of need, the versatility, ingenuity and dependability of community pharmacy has shone brightly. Most people have stories of how many community pharmacy colleagues have stepped up to the mark during this crisis.

I think that reconciling the reality of how perilous pharmacy stands is behind my disappointment, and has created my air of melancholy.

‘Too many times it has felt as though we were forgotten’

My life has always shaped by two distinct societal cultures. Growing up in Nigeria, West Africa, one of the enduring legacies of my childhood was African proverbs – the pithy expressions that conveyed deep insights and truths.

My mum was especially skilled at using these – always modified to cater for me being the exception in a society of polyglots.

I now go to her words to help explain how I feel, maybe because they offer clarity in the emptiness and complexity where erudite policies and well-written papers have failed.

Here’s one good example: ‘It is never the person who commends how well you carry your burden that is a friend; it is always those that help to relieve it.’ If a particular aphorism could become a drumbeat to march through life, this is it.

For community pharmacy, I fear we have not always grasped this. Looking back at the last few months, I cannot help but feel that we have many people who appreciate what we do, but who will not cross the road to give us a hand. This is no criticism, but a reality. I have for a while erroneously cast community pharmacy as a wallflower, maybe even deliberately maligned. I am now reappraising this.

Two things that seem glaringly obvious to me – our gaping deficit of political goodwill, and the awkward distance between us the other NHS health care professionals. Too many times it has felt as though we were forgotten. My now nuanced view of recent years disproves a straightforward (for/against us) binary catch-all narrative. Even worse is not to identify as friends those whose commendations are not the loudest. Real maturity of thought places actions above words and seeks wisdom in criticism. 

‘We must navigate ourselves to the centre of the NHS with urgency’

‘Pass Me Not, O Gentle Saviour’ is not to be sung sitting down. This is not a mantra for an impossible self-sufficiency mindset, but a rallying cry to harness collective self-initiative and agency.

Engaging the support offered by our local community has been the lifeline of our pharmacy team during the pandemic. However, this is no sustainable way to function as part of one of the largest healthcare systems in the world, even if community innovation and resilience keeps our head above water for now. Now we must navigate ourselves to the centre of the NHS with urgency.

Leaders within the profession should now be able to use their goodwill to steer this journey – with local and national efforts from colleagues forming part of the road-building blocks. At the same time, community pharmacy has to take a highly self-critical look and cast off anything that is an impediment.

Here is another useful proverb: ‘As the seamstress with the catering side hustle proves – enterprise will always find a way.’ I have waited most of my professional life for the untapped clinical expertise of community pharmacy to support long term care to be realised. Our primary customer, the NHS, however, is not looking to purchase this from us. That being the case, we need a different tack.

This year Apple became the first company to be valued at over 2 trillion dollars. The company will arguably not have survived its existential challenges of 1996 if not for two things – the return of Steve Jobs to the company and the arrival of Bill Gates via Microsoft’s $150milion investment. Given the ‘history’ between the two men, the August 2017 Time magazine cover had a picture of Jobs on a cell phone to Gates saying: ‘Bill, thank you. The world is a better place’. An iconic moment. Ever dynamic and emotionally explosive, the pharmacy profession has a great cast of champions crippled by uncongenial relationships.

‘Covid-19 is proving the ultimate stress test’

I do not seek to cast myself merely as a polemicist. Covid-19 is proving the ultimate stress test. Our way of life will never return to the same; likewise, many things w­­­­­­­­­­­­­­­­­­­ill not even survive. Alongside the unveiling of weaknesses are opportunities to seize and advance. I certainly feel with the enormity of all the societal weakness exposed – community pharmacy, and by inference, the pharmacy profession, must advance or wither.

I am convinced that we must also look at how we engage in repositioning ourselves – engaging meaningfully with this government, that has a thumping majority, to carry forward primary NHS legislature to reposition our offering. This is undoubtedly worth pursuing, especially as upending the status quo is much in vogue. We will, however, need a broad, inclusive, evidence-backed proposition—a singular united Pharmacy position with all professional stakeholders in agreement.

Seeing greater collaboration between the Royal Pharmaceutical Society and the Royal College of General Practitioners alongside Health Education England, and overdue plans to restructure the MPharm programme, offers faint hope. But we still urgently need many Jobs and Gates moments, especially as I do not doubt that the ultimate apparition of the free market spirit, Jeff Bezos, may yet redefine pharmacy and our role, robbing us all of the means to be what we earnestly desire - the best for our patients, communities and the NHS.

This blog is part of our reflections on Covid-19 series. If you would like to write about your experiences, please contact [email protected]