Amish Patel insists he will continue speaking out on the big issues in community pharmacy despite recently suffering abuse on Twitter. As the Kent LPC chair tells Neil Trainis, he is determined not to let the trolls win...

It has rarely been easy to hold positions of influence because of the responsibility that usually comes with them but occupying the hot seat and expressing a personal view publicly can be hazardous.

Amish Patel is a case in point. He is a young pharmacist although it seems as if he has been on the pharmacy scene for decades given his achievements in a short space of time. He runs Hodgson Pharmacy in Kent, set up by his father in the 1980s, and has made his mark, winning industry awards for his forward-thinking approach to healthcare.

Amish has also become a familiar face on the pharmacy political scene, sitting on the National Pharmacy Association board (although he stresses his views in this interview do not reflect those of the NPA) and earlier this year he became chair of Kent LPC. His history is well documented.

He also speaks frankly. A few weeks back, he took to Twitter to have his say on a heated debate about locum rates and the possible reasons for the closures of some branches belonging to some multiples. He said a minority of locums had been guilty of “unprofessional blackmail behaviour” in trying to secure increased rates by deliberately delaying their application for a shift until a week or so before the start date when they would then contact that pharmacy with offers to work for more than the advertised rate, knowing the pharmacy would not be able to open without a locum. He insisted he had personal experience of this.

Shortly after Independent Community Pharmacist published a story on his allegations, he received insults and abuse from a group of locums on Instagram and Twitter. As we settle down to talk virtually, he admits the backlash came as a shock.

“Yes, to some extent, and to the level it was. I didn’t expect locums to necessarily agree with me and everything that I said. The annoying thing with Twitter is it’s a snapshot of an essay you could write.

“Do I have some great locums? Yes, I do but what else can you write in 140 characters or whatever it is now? I went to a wedding (one weekend) and it was notification after notification after notification. One weekend was enough.

“I expected some backlash to not to the severity that it was and I was surprised that locums who were biting back just weren’t seeing the other side of it at all.”

Amish did not want to get any individual in trouble or shame anyone. He had nothing against the locum sector. In fact, he suggests candidly that he could see the debate from both sides.

“I think I put a relatively balanced argument to it to say it was just a few locums that are behaving like this, it’s not all locums. And I fully support what they’re doing in the sense that they’re trying to fight for an hourly rate they believe in.

“Would I get out of bed for less than a certain amount? Probably not. I don’t blame them for it but equally, they’ve got to understand the contractor money is not there. They keep going on about contractors closing, profiteering and being the bad guys. No. Let’s work together on this. This is not right. You guys really need to open your eyes.”

Twitter should do more to stop the trolls

Amish had a right to be heard. His anecdotal evidence may also prove to be important in the attempt to get to the bottom of what continues to be a burning issue. Yet our conversation contains no desire to chew over what he had said about some locums or closures. At the heart of our chat is an exploration into what impact the abuse he experienced had on him and what pharmacy bodies, even Twitter itself, should be doing to stop people being subjected to online bile simply for voicing an honest view.

He reveals it was a long 48 hours following publication of the story. “When the story came out, that night, I was forever trying to respond on Twitter and make clear their misconception in the way they read the article. It died down after about 48 hours but for those 48 hours, or even 72 hours, I was glued to my phone looking at what people were saying, trying to see what else was being said, trying to follow all the different threads that were going on at the same time.

“I’m not a person who usually gets so into my phone like that. At the weekend, we went away for the wedding, we went to Bristol, and I’m forever thinking about my phone and what other people might be saying about me. Look, it’s social media, a lot of people hiding, none of them are coming out and showing their faces and names. Very quickly, I’d forgotten about it and by Monday morning it was a new week and I thought ‘let it be, it is what it is.’”

The Royal Pharmaceutical Society has written guidance on how its members should behave on social media but non-members are not bound by that. And in any case, as Amish points out, many of the trolls and abusers use anonymous accounts to launch their verbal assaults.

He felt powerless to do anything as the insults poured in. He did not know who to turn to. “At the time I was retching, I was almost like ‘do I report this to the GPhC?’ I had comments like ‘what a pile of shit’ and people reposting on Instagram. I had ‘what an absolute dickhead’ and ‘what an absolute pillock’ and I thought ‘is this name-calling really necessary? Let’s have a debate about it. Let’s have a conversation. But come on, it doesn’t need to go to those kinds of levels.’

“But then I also thought ‘GPhC, what are they really going to do?’ These are people hiding behind fake names and they’re never going to get anywhere with it.”

Amish says he didn’t tell the RPS about his experience because he felt they wouldn’t have been able to do anything about it. Much like the General Pharmaceutical Council.

“Again, what are they going to do? They can put out a general statement to reiterate that we should all be behaving professionally and so on but because there’s no way of identifying all these individuals, there’s nothing anyone can really do about it.”

He is adamant that his tormentors will not silence him. Why should they, he insists. If he has a view to make on an important issue in future, he will not be cowed.

“I had to ride it out for a couple of nights. It that going to stop me making comments again in the future? No. I learned my lesson in the sense of ‘don’t let it bother me so much.’ And if people want to make comments, I switch off my notifications for the evening. It dies down after 24 hours.

“As long as my point is well made and balanced, and I believe it was balanced, why should I hold back? Things like this do need calling out. Who else is going to put up a good fight? I also had a lot of people support me. I had a lot of people message me in private to say ‘I’m a contractor, thank you so much. Don’t let the trolls get to you.’

“They said it in private because they could see the trolling and didn’t want to be targeted themselves. I’m a contractor and on behalf of the profession and on behalf of contractors, I’ll continue fighting.”

GPhC can also do more to stop online abuse

He believes the battle against the trolls can be won but only if Twitter, which might possibly be too wrapped up in its heavyweight legal wrangle with Elon Musk to focus on much else at the moment, finally comes up with a way to rid itself of intimidators, name-callers and stalkers once and for all. After a brief pause, he decides the General Pharmaceutical Council might also be able to do something after all.

“The GPhC should have a record of anyone who claims to be a pharmacist online and link Twitter handles to your GPhC registration. Instagram has all that kind of stuff so if you ever thought of being unprofessional, it can be reviewed,” he says.

“And fake accounts should be taken down. If you’ve got one account that’s trolling people, Twitter should just be taking it down and blocking these people. The IT is there, they can see IP addresses, they can see which phones are being used. It shouldn’t be hard to make it a better place to be. But it’s everywhere. It’s the sad world we’re living in.”

Never mind the online nuisances, it’s hard to think of anything deterring Amish from speaking out on issues that are close to his heart or progressing his career. He is progressive and enterprising and quick to spot an opportunity. He’s delved into private services, he’s an independent prescriber and a few years ago he ventured into non-surgical aesthetics, providing services such as Botox and dermal fillers.

An aesthetic artist

He’s been described as an “aesthetic artist” and an “aesthetics practitioner” and has made quite a lot of money from it. Independent pharmacists won’t be able to survive solely on dismal NHS income, so Amish is ahead of the curve. So much so that he thinks he’ll be able to quit pharmacy in the not-to-distant future and concentrate on medical aesthetics.

“It’s a good return on investment and it’s definitely an area I want to expand on as much as possible. I’m at a point where I’ve ringfenced that pot of money and I’m continually reinvesting that into further development of myself and my training of aesthetics and so on.

“I’ve not yet taken a salary or an income from that money just yet. It’s been continually reinvested to a point where I can maybe one day say ‘right, no more community pharmacy. I’m full-time medical aesthetics.’ And that’s what I’m trying to work towards at this time.”

He chuckles when asked if he’s a long way from that. “I hope not. I really hope I’m not too far away from it now. I hope in the next three or four years I’ll make that big jump across. But it’s a scary jump. My community pharmacy is my bread and butter. It’s my comfort. We know the sector in general is struggling but it’s my core income at the end of the day.

“As much as I love pharmacy and I keep doing all these other roles, I am at a point where I don’t enjoy pharmacy as much as I used to if I’m being brutally honest. That’s why I’ve moved more into this private sector world. But weirdly, even though I don’t enjoy it, it just keeps drawing me back and I keep finding new ways to take my pharmacy forward.”

It feels sad to think of Amish walking away from community pharmacy because the sector, struggling for government recognition, needs pharmacists like him; pharmacists with an entrepreneurial flair and the ability to innovate.

Pharmacy traditionalists may balk at the idea that pharmacies can provide beauty treatments as well as healthcare but Amish has clearly seen the former as a pragmatic solution to bolstering revenue. He set up a company called Intrigue Cosmetic Clinic through which he provides anti-wrinkle and dermal fillers. “It’s more of a branding exercise than anything else. Hodgson Pharmacy Aesthetics doesn’t have a good ring to it,” he says pointedly, offering advice to other independents considering the aesthetics route.

“Firstly, do your independent prescribing. That’s the most important thing of all. Then look into aesthetics. Start off small, maybe do a foundation course. It’s not cheap, it does take a lot of investment. It’s not as simple as putting a poster up in front of the pharmacy and hoping you’ll get a ton of people through the door.

“It’s not like other pharmacy services, it’s not for everyone. Doing flu jabs, injecting into the shoulder, it’s easy, everyone can do that. Aesthetics is a bit of an art form shall we say. It’s not all just technical. To be successful in it, you need to have a skill or a talent in it and I think I finally found my one talent.”

My worry is there's pharmacists in every GP surgery

Amish concedes the future of pharmacy in England is not completely gloomy and the government not totally unsupportive. It is, he suggests, “good that they’ve put out funding for independent prescribers, that’s quite a positive step.” But he is cautious.

“We need to see how it progresses. Had you talked to me 10 years ago, I’d have been like ‘yep, I’m so optimistic’ and it would’ve been the best thing in the world. Now, I’ve fallen into what my dad’s generation of pharmacists are thinking in the sense that ‘been there, done that, got the T-shirt, we do all these things but it’s always the status quo with minor tweaks, we just keep doing our usual day in, day out.’

“Even now, you look at the services that have come to community pharmacy, the Discharge Medicines Service, GP CPCS, the hypertension service, has it really changed my day-to-day? Probably not. I had two GP CPCS consultations in a week (between August 15-22) and before that, nothing since April.

“DMS, I think we’ve done two in the whole year since it’s been launched. It’s the status quo, nothing seems to change and I’m not the only one saying it.”

Amish hopes the chief pharmaceutical officer David Webb “can find a way to keep patients coming to community pharmacy” even as more and more pharmacists seem to end up in GP practices.

Amish also thinks pharmacy representation in NHS community-based structures is an issue. “I think it’s crazy that we’re not on an ICS board. The GPs are there. They keep talking about pharmacies being integral to primary care and yet we’re never at the table,” he says.

“My worry is there are pharmacists in every GP surgery now near enough, so how long before services go directly to in-house pharmacists? How long before the supply of medicines gets taken out to national hubs?

“There’s actually very little roll-out there for community pharmacy. And nowhere are we protected at the moment. That’s my biggest worry.”

This interview took place before the LPC conference.