Interview: New NPA chief Henry Gregg on shocking realities of community pharmacy

In an exclusive first interview with The Pharmacist the new CEO of the National Pharmacy Association Henry Gregg discusses his priorities with editor Victoria Vaughan

Shocked on two fronts by both the financial pressure faced by pharmacy and the discord among pharmacy bodies, the new head of the National Pharmacy Association, Henry Gregg, is on a mission to fight for fair funding, unite the profession and work with other primary care professionals – GPs in particular – to make the most of the opportunities for community pharmacy presented by the 10 year plan.

10 year plan

Pharmacy and pharmacists were a core feature of the 10 year plan with a call for more services to be delivered by the profession and for pharmacists to be a core part of the neighbourhood health service.

Henry Gregg, former director of external affairs at Asthma and Lung UK, is enthused by the fact it’s the first time the government has talked about management of long-term conditions through pharmacy, which he says 'is really interesting’ citing obesity, high blood pressure and diabetes as other areas where community pharmacists can get involved. He highlights a pilot in the Isle of Wight which delivered asthma and COPD reviews through pharmacy reducing hospital admissions due to asthma by 50%.

‘That's a really interesting model. But the main thing that comes out of that, though, is we're going to have to work really closely with the rest of primary care and GPs,’ he says.

Mr Gregg, 44, is pushing for pharmacists to be involved in these new developments ‘right from the start’ to avoid any duplication of service or confusion for patients.

‘That’s my biggest message, we need to work really closely with the GPs, as it seems they are going to lead neighbourhood health centres. The danger is, if we're expanding services in pharmacy, and we're going to have Neighbourhood Health Services as well, unless they join up, we're potentially going to duplicate activity and be really unclear for patients as to where the best place is for them to go.

‘We really need to work with the GPs. I’m ready to do so, and the rest of primary care, to really make it happen, but to make sure it’s as patient centred and as easy for the patient as possible,’ he says confirming that he’s reaching out to the British Medical Association as well as the Royal Colleges.

Sickness to prevention

And while Mr Gregg applauds the increased involvement of community pharmacy he is clear that it must be fully funded.

‘If you think about the big shifts that the government's been talking about, especially the one from sickness to prevention that can be dealt with really well through [service delivery in pharmacy].

‘You've got vaccinations. You've got helping people with weight management, screening, blood pressure and cholesterol checks,’ he says.

Hospital to community

‘But also that shift from hospital to community. If we're going to achieve that, the only way to do it is to make greater use of the skills in pharmacy, and with all newly qualified pharmacists becoming independent prescribers, that's a massive opportunity we have to grasp, and we've only got a year in which to do that. It will enable there to be more capacity within the system. But it's really crucial that it's fully funded,’ says the Oxford Philosophy, Politics and Economics graduate.

Related Article: Plans to ‘modernise’ pharmacy supervision rules revealed

Analogue to digital

On the final shift featured in the 10 year plan, from analogue to digital, it’s the single patient record which will be a key driver in service delivery for pharmacists.

‘I know it's been talked about for a while, but that could make a big difference for pharmacists. A lot of these services are going to depend on having access to the patient record to know exactly what their history is and what they've had previously. It's moving in the right direction, but there's still a long way to go,’ says the father of two.

Pharmacy First

In terms of Pharmacy First Mr Gregg points to lessons from Scotland.

‘Scotland has obviously gone much further with Pharmacy First, I went to the oldest pharmacy in Scotland, which was opened in 1826, so it's 200 years old next year.

‘What was really striking was they just have a list of things that people can come see them about that they're trained to respond to, and so they don't need a referral. People could just walk in off the street, as long as it fits that criteria, they can help them directly.

‘There's more independent prescribers as well. It gave a really interesting vision of what can be done,’ he says, adding that the challenge there is around managing the volume of patients coming through the door.

‘They were really busy, but definitely able to expand their services side a lot more, which is part of what the government's vision is in terms of that transition talked about in the 10 year plan, from a focus on dispensing to delivering more clinical services,' he says.

Funding model

A striking take-away for Mr Gregg during his two days a week in pharmacies around the UK, in Belfast, Edinburgh, Cardiff, Cambridge and Birmingham so far, is the precarious nature of their finances and the lack of have stability and predictability in the income from dispensing.

He points out that in order for pharmacists to make investment in service delivery, such as building a consultation room, they need to be able to know their income – which is currently not the case.

‘If you don't know what's going to come in the next two or six months to a year. It's really hard to take out a loan and put in a consultation room or buy a robot, because you don't know you’re going to get the income in to pay back that loan,’ he says.

Currently around 95% of pharmacies have a consultation room, but many will need to upgrade in order to deliver more services, according to the NPA.

Mr Gregg is clear that it isn’t a trade-off between dispensing efficiencies one side to pay for service delivery on the other.

‘Any expansion of new services has to come with new funding. We need to make the income as stable as possible and predictable as possible on the dispensing side, because that's what's stopping people from really doing the expansion that they want to do,’ he says.

Drug tariff

He highlights the drug tariff as a key barrier preventing financial planning. And although the rate of closures has slowed there’s still an average of two pharmacies closing a week, say the NPA. Put this alongside the government’s big plans to better utilise community pharmacy – things just don’t add up.

‘At the moment a lot of members are saying to me, “I haven't taken a salary for years” or “I've had to take out a loan”. Some of them have drawn down pensions, taken out mortgages.

‘That's really shocked me, because I think if the public knew how much personal sacrifice some of these pharmacists are taking just to deliver a crucial NHS service they'd be really shocked.

‘How precarious it is, and how close some pharmacies are to closing and in this environment it's very hard for people to invest in improving their premises, or bringing forward automation, or investing in hub and spoke when they're right up against it, in terms of just paying the wholesaler bills,’ he says.

Medicines shortages

Medicines shortages is a huge issue with creon ongoing until next year. Here Mr Gregg also points towards the drug tariff as part of the problem.

Related Article: Cloud-based dispensing system Titan reaches 1,000-pharmacy milestone

‘We have very low medicine costs, the lowest in the OECD. But as a result, the UK is often the last country to be supplied of medicines. Obviously, if you're paying the least amount for the medicines, that's the country you're going to supply last,’ he says, acknowledging there are other issues at play such as Brexit.

‘What we don't want is to have a situation where we just can't get hold of the medicines. The main issue is the impact on the patient but the other aspect of it is that it's wasting huge amounts of pharmacist time as they try to get hold of medicines for patients.

‘I'd like the government to look at the drug tariff. And that's certainly one of the things we're pushing for. I haven't heard that they're looking at it as yet,’ he says.

A key thing Mr Gregg is calling for, which happens in Scotland, is to have ‘sensible substitutes'’ without patients being sent back to back to the GP, because pharmacies don't have a particular medicine.

‘Patients really hate that.

‘Sometimes the GP has to call the pharmacist to say, “What have you got in so I can prescribe it” or the patient has to go back to the GP. Allowing pharmacists to make substitutes would reduce the level of frustration among patients,’ according to Mr Gregg.

‘Pharmacists are experts on medicine. They'll know exactly if we don't have this particular medicine, we can safely substitute for this one. It just a clear waste of patients’ time,’ he adds.

Collective action

The NPA ruffled feathers when it threatened collective action prior to the March contract uplift and  while Mr Gregg is very much looking to bring unity, he says further collective action is not ‘off the table’.

‘I think we never take any options off the table, but given that we've just had a 10 year plan, which sets out quite an interesting role for pharmacy I would see that as an opportunity,’ he says.

Infighting

Another core mission for Mr Gregg is to bring the various pharmacy bodies together – ideally around a written manifesto.

‘I've been really shocked at the infighting within the pharmacy sector.  What I know from my work at Asthma and Lung UK is when we were working on a smoking ban and banning smoking outside hospitals, schools and playgrounds, is while there were lots of different organisations involved and we had different positions on different areas, we agreed on the key areas that we can coalesce around. And then we went to the public, to the government with those messages, because if you don't do that, then it's just easier to be ignored.

‘Health is such a crowded space. If you want to get your voice across you can't be asking for different solutions and disagreeing. And I would even say that you can't be asking for the same things in different ways, because it just doesn't resonate.

‘What I'd really love to do is be able to come together with a manifesto or a document that everyone can stand behind,’ he says, adding that it’s a good moment to try with him as the new CEO and the new NPA chair Olivier Picard also recently appointed.

Related Article: Abidec Multivitamin drops out of stock

New prescribers

A key development for the sector is new independent prescribers (IPs) beginning work next year and Mr Gregg wants to ensure members are ready to make the most of this measure. ‘That's a really big burning platform for me,’ he says.

‘The big danger is that newly qualified independent prescribers don't have the opportunities to use those skills, it's not just going to be a frustration to them, but it's a missed opportunity, and it may mean that we lose them to other sectors,’ he says.

To address this, the NPA is providing master classes, is about to send out an information pack on independent prescribing and is running a future pharmacy programme. Currently there are 2,513 IPs (headcount) or 1996 (FTE) in community pharmacy in England, a 34% increase between 2023 and 2024 – however already not all are actually getting an opportunity to use these skills.

Future

Mr Gregg’s vision for community pharmacy is that all staff are able to use their full skill set and that ‘community pharmacy is bringing care into the community by allowing people to come in, to get their vaccinations, to get the support they need for smoking cessation, but then also to manage their long term conditions in a way that then really frees up capacity in the rest of the rest of the system’.

But he is clear that the funding needs to be there for both dispensing and medicines and for any new services, so that pharmacies are sustainable for the longer term.