Sandra Gidley, chair of the RPS English Pharmacy Board, speaks to editor Gemma Collins about pharmacists’ battle with GPs and how the profession may need to change its focus to survive.
It’s undoubtedly been a difficult year for community pharmacy. As well as the usual pressures of working in a pharmacy and juggling the mounting workload, funding cuts have been threatening pharmacy businesses.
So now more than ever, pharmacists are looking to their representative groups to fight their corner.
Sandra Gidley is certainly someone you want on your side. The chair of the RPS English Pharmacy Board is a former Lib Dem MP and still works as a locum pharmacist. She talks passionately about pharmacists’ role within the NHS and is reassuringly honest as she discusses how the profession may need to make changes if it’s going to get the recognition it deserves.
One big move so far this year has seen the RPS join forces with the National Pharmacy Association and Pharmacy Voice for the first time to create the Community Pharmacy Forward View, outlining a vision for the profession.
Gidley insists the rhetoric is starting to get through to commissioners, but she may still have a long way to go if she plans to persuade the rest of the NHS that pharmacy is worth investing in.
Do you think the RPS has done enough to fight the funding cuts?
As a professional body, we’re in a difficult place because we don’t represent contractors – we represent pharmacists. But we have worked with the other pharmacy bodies so that the profession is presenting a united front to the outside world, which I think is important, because traditionally everybody has been saying completely different things and it’s not helpful for the sector. We haven’t just said ‘no cuts’, we’ve turned it around and said ‘This is why we think it’s wrong because of the impact it has on patients’.
Why do you think the Government is making these cuts?
Why should pharmacy be exempt when every other part of the health service is losing money? What is disappointing is that for some years now, the Government has talked up pharmacy but there’s been no will to match rhetoric with reality. So rather than just wielding the accountant’s pen, why don’t they look at what pharmacy can deliver for patients, how it can take the load off GPs and A&E, and think about investing in pharmacy? There’s huge potential out there.
Do you think PSNC should be a better negotiator?
I don’t think I should comment on PSNC. It’s easy to criticise these things from an outside position. Ultimately they can only negotiate so far if the Government is only willing to fund so much. PSNC, Pharmacy Voice and the RPS all signed up to the Community Pharmacy Forward View and it’s a clear direction of travel. Whether the Government wants to fund some of those things is the 64,000-dollar question.
Why do you think commissioners seem reluctant to commission pharmacy?
Because commissioning groups are run by GPs. GPs commission for themselves. Although having said that, there are some areas – usually where they’ve got energetic and lively pharmacists - that want to do things differently.
Do you feel like GPs are really that reluctant for pharmacies to take on a bigger role?
It’s changing; they don’t mind pharmacies taking on new roles, but they don’t want to lose any of their money. There’s a crucial difference. I think it’s only by having GPs work with pharmacists more closely that we’ll get more commissioning of services from community pharmacy.
Do you see more pharmacists going into general practice?
There will be more, because there’s a drive to do that. But that’s only one role. What I would like to see is pharmacists using their clinical skills. There are days when I work in community pharmacy and I don’t feel I’ve used a lot of what I’ve learned because of mundane tasks.
Do you think there should be more focus on services in pharmacies?
Absolutely, and some pharmacies are very good at it. They’ve banged on doors, they’ve got commissioned, but it’s an ongoing struggle because we’ve got clinical commissioning groups (CCGs) decommissioning services. It’s a double whammy for pharmacy because it’s not just the contract money that’s dried up - it’s public health money from other sources, where pharmacies are ideally placed to provide public health interventions.
Pharmacy has done well with the flu vaccination service.
It has but there have been problems. In some parts of the country they’ve come to an agreement where they’ve said: ‘Okay doctors, you vaccinate everybody up until the end of October/beginning of November, then let’s work together and target the ones who need vaccines and get them to come in wherever’. People will still come to us if they want to – we won’t turn anyone away – but we won’t actively recruit or chase patients until we’ve reached that point, but then we’ll target them and we’ll do it together. [In those cases] the total number of vaccinations go up which is better for society overall.
Do you think it’s about better communication between GPs and pharmacies?
Yes, that’s what we are not good at as a profession. GPs are sometimes frustrated. I think the multiples have to give some thought to this. In a multiple, staff get moved around so you develop a relationship with a GP and then you move, and the GP has to develop a relationship with somebody new. Independents tend to have better relationships with the GP and it’s then easier to suggest things.
Should pharmacists start preparing now [for the cuts] and thinking about what’s going to happen?
They should have prepared by 18 December, because you can’t assume that the petitions and lobbying are going to have an effect. The previous minister was very sympathetic: he could understand that there’s a lot pharmacy could do, but I think he was between a rock and a hard place because he had the Treasury and pharmacy, and in that situation you have to please your boss – your paymaster.
What do you think pharmacists should now be focusing on?
If I was a pharmacist starting out today I would do a clinical diploma, and then I’d get a prescribing qualification. I think that’s the future.
But still working in pharmacies?
Absolutely. What you have at the moment is a very trusted brand in community pharmacy; people have a higher appreciation rating of pharmacists than a doctor. Now we’ve got people thinking ‘I’ll go to the pharmacist first’ because we’ve started to get the message out that here’s your accessible healthcare professional on the high street who you should speak to first. Wales has got it right - the GP surgeries are turning them away if they haven’t been to a pharmacy first.
It’s all very well saying that pharmacists should become independent prescribers but surely it’s up to the Government to give that control?
At the moment it’s chicken and egg – nobody is commissioning anything because there aren’t enough of them. So if we can get to a critical mass, we can take some of that load. But we’ve got to keep shouting about what we can do.
But how do you change the attitude quicker?
I think the focus on best spend of the NHS pound will force some of this thinking. We can’t carry on doing what we’ve always been doing. So the profession has to adapt, take on these new roles, and most pharmacists I meet would like that. They’d like to feel more involved in patient care.
What’s RPS’s plan now?
We will be working with the other pharmacy groups. We’re [also] turning our attention to the integration fund, which is £20 million this year, increasing by £20 million a year, totalling £300 million. We’re looking at how we can implement that so we end up with real evidence about how pharmacy can make a positive and a cost-effecting difference.