Graham runs two pharmacies in Lambourn (Berks) and Shrivenham (Oxon). He is a former Leader of West Berkshire Council (05-12 and 17-19) and former Chairman of West Berkshire Health and Wellbeing Board. He currently sits on the Public Health and Pharmacy Forum advising PHE.
We can live without take-aways, but we may die without our medication. Unlike some sectors of the economy which have been paid to close, pharmacies have gone into debt to stay open and save lives.
The last twelve months have been both the toughest but also the most rewarding of my professional career. For those involved in any aspect of healthcare the workload has been demanding and the challenges of continuing to deliver first rate services during shortages and lockdowns immense.
Maintaining safe services for public-facing staff and anxious patients has not been easy, and I am proud of the way my team, and others across the country, have reacted to the health and social challenges facing our communities.
While many industries have been paid to furlough workers, pharmacy has had the opposite problem of how to adapt and continue with decreased footfall with many income streams closed. A £370m Covid-19 advance (not grant) to the sector has helped with short-term cashflow but high lights that following a new contract in 2016, which saw funding reduced by 7.5 per cent and then frozen, much of the network is unviable in the medium and long term.
Whilst both Matt Hancock and Boris Johnson said they did not wish to see closures during the first eight months of 2020, there were 136 closures net. Before coronavirus, without change to the current funding model, Ernst and Young predict that by 2024 the sector will be £497m in debt with almost three quarters of the network trading at a loss. Covid-19 has accelerated pharmacy towards the tipping point.
As a community- and patient-focused service pharmacy, like others delivering healthcare, has been sustained by tremendous public support (not always good for the waistline). Whilst GPs have largely converted to online consultations, community pharmacies have absorbed the increase in demand for advice and been able to maintain an open door as a first point of health contact, offering reassurance human contact and continuity to local communities.
Pharmacy teams are drawn from the communities they serve, and community pharmacy has great depths of social capital which has proved invaluable in reaching out to those isolated by the pandemic. With a remarkably diverse profession and workforce, pharmacy can reach deep into local communities. Those isolating value not just the delivery of medication to their homes but the known face providing a point of reference to the outside world.
Being a community pharmacist in Lambourn was a huge asset as a West Berkshire councillor. Whatever we may think about the strength of our political brand, “Trust me I’m a pharmacist” always worked better than “trust me, I’m a politician”. The chemist counter proved a much better bridge to the community than any amount of campaigning. The trusted position of a pharmacist is invaluable as a community leader and champion who can bust so many of the myths surrounding vaccination. As the Prime Minister recognised “Community pharmacies provide an outstanding healthcare resource… people trust pharmacies, they know where to find them”
Jackie Doyle-Price, the Chair of the All-Party Pharmacy Group (APPG), said the pandemic has “highlighted what a pivotal role” pharmacies “played and continue to play in delivering frontline care when many doctor surgeries were closed”.
Over the last few years, a lot of the emphasis for providers of NHS services has moved from competition towards co-operation and integrated care. For primary care this means the establishment of “Primary Care Networks” or PCNs. Between pharmacy and GP surgeries this has meant a much more collaborative and less siloed approach to providing services.
For example, we now work much more closely and to deliver flu jabs ensuring the vulnerable target groups get vaccinated. I am delighted to vaccinate alongside GPs, practice nurses, and many others providing Covid-19 vaccinations at a GP-led hub, whilst elsewhere in the country it is pharmacists who have taken the lead. The positivity of patients and NHS workers and volunteers at the hubs is incredibly uplifting and shows what we can do when we come together.
Vaccination hubs are a national success. As the programme progresses it needs to evolve to how we can deliver vaccinations in the community and how we sustain vaccinations into the future as new variants emerge and modified vaccines are needed.
This is where a local pharmacy can deliver: we are already the “boots on the ground” with premises approved for vaccinations. If all pharmacies delivered 100 vaccines a week (a realistic target) we could be adding one million doses a week close to where people live and work. As this becomes a rolling (maintenance) campaign with similarities to the flu vaccination service, pharmacy could be delivering for the nation.
I have steadily moved my pharmacies away from retailing toiletries to progressively becoming an ever more clinical service offering vaccinations, public health advice, addiction services, et al. Whilst my clinical skills and knowledge are better-used now than they were when I qualified, pharmacy remains an underused resource. Whilst he has now fortunately gone from the political scene, when former MP and minister Philip Lee described pharmacists as “smarty counters” he displayed an ignorant and out-of-date attitude which still exists in some quarters.
The National Health Service is all too often a National Illness service, treating disease not maintaining health. Pharmacy should have a much bigger role in “wellness”. Coronavirus has changed thinking on many aspects of healthcare and accelerated changes that were already underway, and whilst this is very much the case for pharmacy the sector needs a clear commitment and vision from government.
In the short term if, as Johnson says, numbers are to remain the same, then finance needs to be stabilised and Covid-19 costs covered. Full use needs to be made of the pharmacy network to sustain a vaccination programme in the community into the future. Longer term primary care needs to be looked at holistically, with increased cooperation between GPs and pharmacists – rather than negotiate different contracts at different times, these need to be integrated.
As a community resource pharmacy has much to offer beyond its clinical services, pharmacy has a pivotal role in bringing together health and wellbeing and so maintaining wellness.