Shilpa Shah says her charity work has given her the ability to listen to and empower her contractors. The CEO of North-East London LPC talks to Neil Trainis…

“It’s good to talk,” the late actor Bob Hoskins cheerfully used to say on those uplifting BT ads in the 1990s. Independent pharmacists probably feel more like screaming right now as they struggle to keep their businesses afloat but those who are based in six London boroughs can take some comfort knowing they have someone who will listen. If they feel like talking, that is.

Shilpa Shah is the avid listener. She has been a pharmacist for over 20 years, has worked for Boots and LloydsPharmacy, once headed up Kent LPC and is now chief executive at North-East London. She says her role is not only to ensure the LPC operates smoothly and contractors are furnished with information and guidance but that they have somewhere to go if they want to let off steam. “Sometimes, all you need is an off-load,” she says over a Teams chat.

The idea of contractors ranting and raving might not appeal to some LPC chief officers but Shilpa is happy to provide a non-judgemental listening service. It could be argued she is playing out the role of therapist to contractors in North-East London and she is very good at it because she is trained to listen having worked for the Samaritans for the last seven and-a-half years. In December, she worked for Crisis at Christmas, helping the homeless and people facing a life on the street. Those experiences, she suggests, have helped make her an effective LPC chief executive – “a much better leader,” in her words.

“Working for the Samaritans, the reason I went for it in the first place, in my friends and family groups, I’m the one people come to when they’ve got a problem.

“The difference is Neil, if you came to me with a problem, as someone who knows you, I’d try to give you solutions, saying ‘have you thought about this, have you tried to do that?’ At the Samaritans, you don’t do that. You just listen. You don’t give advice.

“Say you were married, having some problems, and I was like ‘I think you should try and make it work, have some counselling, do this, do that,’ but I don’t know your side of the story. I don’t know if you’re actually getting beaten up every day and I’m giving you advice to stay and try and stick it out. As a Samaritan, we listen and we ask open questions so you can sort out what’s going on in your head.”

Listening to and empowering contractors

Listening patiently to people who have problems, Shilpa says, empowers them to make decisions. It is easy to see how that approach can help any individual in need, whether it’s a patient with health concerns, a pharmacy contractor or someone who is homeless.

“Sometimes, you know the decision. You know you’ve had this lump, it’s terrifying you, you know you need to go to the doctors. I could say to you ‘go to the doctors’ and you could go because I told you to go then you’ll be p**sed off if you find out it’s cancer and you’ll blame me because I made you go to the doctors.

“But actually, if you know the right thing to do and you have someone saying ‘what are you worried about?’ and you say ‘I’m worried it’s going to be cancer’ and I say ‘ok, well what support network do you have, etc,’ then it may empower you to go to the doctors.

“At Samaritans, we listen to try and empower people on their decisions and I’m finding that has helped me be a much better leader and in my life and any work I’ve done. It’s definitely helping me now in my role as an LPC chief officer because I’m able to listen to people, I’m able to ask open questions without giving them a solution.”

The art of questioning, when the time is right to ask questions, is crucial. Shilpa is aware the last thing contractors on her patch want is sympathy or a lecture. She is adept at asking the right questions in the right way.

“If someone comes to you and says ‘I’m not coping and I’ve been putting my own money into my business for the last six months,” the first thing I want to say to them is ‘stop.’ But what I actually want to say to them is ‘what’s making you do that? What’s important to you about your business?’

“We can then have a better conversation because I can then understand why. Before, I wouldn’t have done that. I’d have said ‘are you stupid? Why are you putting money into your own business? Sell up! Get out! Go and be a locum and earn loads of money.’”

She says the biggest problem facing her contractors in Barking and Dagenham, Havering, Redbridge, Newham, Tower Hamlets and Waltham Forest is workforce which she describes as “a massive challenge for community pharmacy.”

“Workforce is a challenge and not just community pharmacists but also support staff,” she insists. “During the latter part of 2022, the out-of-stocks and price hikes were a huge challenge for our contractors as well.”

It feels as though no amount of patient listening, intelligent line of questioning and subtle suggestion-making would work on a government that has been unwilling to support community pharmacy with fresh funding. Shilpa says there is “definitely a lack of understanding of what we do, what we should be doing and what we can do or are able to do.”

“We need to keep doing the work we’re doing but we really need LPCs and PSNC to keep on showcasing that great work and ensure that leads to remuneration. Accessibility is a big example of some of the local services I’ve developed in North-East London. An example is the vaccine hesitancy service we’ve developed and that’s about how we can act really quickly, how we’re accessible, how we’re quite adaptable and agile.

“I’ve used those key successes of what happened during Covid, setting up Covid vaccinations and Covid testing, etc, using all of that to go ‘what about this great service we could use?’”

Sell the vision to the government

One idea she came up with last year was to get the NHS to pay £60,000 to every pharmacy that dispenses over a certain number of items (pro rata for fewer) for a second pharmacist and support the development of both pharmacists. Given the government’s poor record when it comes to supporting community pharmacy, it is put to her that the idea, although inspired, is unrealistic. Shilpa resolutely suggests “we should keep on trying to sell that vision to the government so they eventually resource us that way.”

“It’s an ambition, it’s a vision, but actually, it’s never going to get off the ground if we don’t get the funding. But I still stand by that. If we had two pharmacists in some of our heavier dispensing businesses…I’ve seen it work in the past. You will, as a business, make that money back, you’ll save the NHS that money.

“By spending £60,000, you’ll save on long-term conditions getting worse, you’ll save on hospital admissions and you’ll save that money somewhere else. But if not, some of these (additional roles reimbursement scheme) roles which are funded by NHS England, could some of that funding be given to us? It’s not even about extra funding, it’s moving funding.”

The government clings to the belief that the future of healthcare in England is bright even as the NHS writhes in turmoil as nurses strike over pay and working conditions, ambulances containing patients are left stranded outside hospitals and the sick who make it inside are left on trolleys in corridors. Whisper it gently but there has also been talk of pharmacists striking.

Number 10 remains confident that integrated care systems are the answer because they will alleviate the pressure on hospitals by moving care out into local communities. And yet it feels like quite a jump to expect community pharmacists will be involved in the development of services locally under ICSs and be at the heart of those discussions in years to come. After all, they weren’t widely involved in clinical commissioning groups as part of the Lansley reforms 10 years ago. Shilpa doesn’t agree with that view.

“Just because it hasn’t happened before doesn’t mean it shouldn’t happen now because we’ve got some new leaders in pharmacy who can think differently, who can think outside the box and I think pharmacy has also changed so much, maybe in the last two or three years than it has in the 30 before that.

“What happens when you’ve got a bunch of clinicians in a room though, what you sometimes lack is that real key leadership. What I always think is maybe you need some business managers in there, people that run other organisations that aren’t healthcare-led.

“You could have input from clinicians but maybe have other people to lead the conversation to provide blue-sky thinking and say ‘this is what good looks like,’ and then for the clinician to go ‘leading that would work’ or ‘ethically, that’ll work’ or ‘no, that won’t work.’ We’re so busy thinking ‘we need to have a GP on that group, we need to have a pharmacist on that group.’

“I just don’t think we should get fixated on, if we’re not there yet, throwing our toys out of the pram and stop doing the great stuff we’re already doing.”

Position on ICB not important

Shilpa says she doesn’t mind if she hasn’t got a position on the ICB. In her view, it’s all about ensuring her voice is “heard in the places that matter.” And, of course, listening attentively to GPs, other members of primary care, provider trusts and local authorities and any other individuals on those Boards.

“I don’t think you need to be an aggressive leader. You can be friendly and personable. That’s the way I go in. I tend to use my skills as a Samaritan to listen, to stop and think ‘what are they saying the problem is?’ and can community pharmacy provide a solution to that and, if they can, what’s it going to be remunerated at, what are we going to be paid and is that something we can go back to them with a clear plan?

“And once they get something they really like, if they want to see a draft service spec or a draft idea, just to make sure you act with pace to get back to them, that’s something that’s really important to me.”

Shilpa says that while it’s vital she works “at pace” to get information on any ideas “floating around” back to her contractors, it’s just as important not to spend too much time on an idea that doesn’t have legs. In short, as she puts it, “give up when it’s not happening.”

“If there’s something that’s not happening, stop trying to spin a plate that’s broken and focus on spinning the ones that aren’t and putting some new plates on there,” she says.

“If you form some really good relationships with various people within ICBs…something came through recently when a director said ‘you might want to invite Shilpa Shah, CEO of North-East LPC’ and he copied me in…there’s another King’s Fund vision that we’re doing around community pharmacy and they invited one of our chief pharmacists and she said ‘I don’t think I’m the right person but Shilpa is one of our community pharmacists, she’s the expert on this sort of stuff, so would you like to invite her instead?’

“So, for me, being visible, being supportive, being firm and fair, has led to building great relationships where I’m valued by the ICB even though I’m not on the Board. They love me basically.”

 LPCs undergoing change

However, LPCs like Shilpa’s are undergoing a process of self-reflection. As part of the Wright reforms, the change they need to go through may sting a little (the contributions LPCs make to PSNC rising by an additional £1.5 million a year by April 2024, for instance) but, as Shilpa rightly suggests, it’s ultimately for the benefit of contractors. And she has already made changes at NEL LPC.

“I’ve always been very supportive about the RSG reforms because I think that if we, as a sector in pharmacy, are ever going to change, we need to change. We need to think differently, we need to give our contractors the best return on investment.

“When I was at Kent LPC and (during my time) at North-East London LPC, some of the work I’ve done around re-budgeting, giving levy holiday and making sure income is coming in for contractors has always been about giving them better return for investment.

“I believe some of these reforms we’re being asked to work through will ultimately give our community pharmacies good return on investment. They’ll also give them the right level of representation within their local systems as well as being able to support the national team to be able to hopefully negotiate better and put some bodies into working up national workstreams and national projects.”

Shilpa says that when it comes to the quality of LPCs across England, it’s a pretty mixed bag, suggesting some are “brilliant” and some “need a bit more support to get to that level” because they are “quite small” or don’t have “enough funding to employ a bigger team to support them to do everything they need to do.” NEL LPC, she insists, is well-resourced.

“Whilst I was trying to deal with the ICB and talk to them about what we can do to support our contractors with antibiotics, I’ve got a team member who I can hand over to and say ‘can you jump on that meeting for me because I’ve got an antibiotic meeting.’ Now, if you’re a one-man band, you can’t be in three places at once.”

Being strong, Indian, female leader has threatened some

Interestingly, she says her “first experience into LPCs, both as a member and employee,” wasn’t particularly positive and suggests that being “a strong, Indian, female leader” might have “been a slight threat to some people I’ve been working with.”

“I’ve been at North-East London for about a year now and it’s been really refreshing to work for a London LPC that is quite forward-thinking and I feel the committee really respect me as a strong female, Indian woman in leadership.

“Some LPCs have massively evolved and changed and the LPC I currently work for celebrates me and supports me in my role. I feel appreciated and respected.”

As a member of NHS England’s Inclusive Pharmacy Practice Advisory Board, Shilpa is eager to help ensure everyone working in pharmacy has an equal opportunity to progress their careers and earn a good salary.

Last year, the Pharmacists’ Defence Association urged black and minority ethnic (BAME) pharmacy staff and women who feel they are being unfairly paid less and treated worse than their white, male counterparts to contact it after its research with the Equality Trust found women earned less than men in nearly every role including pharmacist, pharmacist manager and general practice pharmacist.

The research also revealed pay discrepancies between white British and ethnic minority groups, with locums from BAME backgrounds earning 10 per cent less while BAME relief managers, clinical pharmacists and community pharmacists also earned less.

“In North-East London we are a very diverse area of England, if not London as well. Our chief pharmacist is a strong black leader, we’ve got me as CEO, an Asian woman,” Shilpa says.

“However, and I don’t know other people’s pay, but I can say that from past experience, I worked in an organisation where my predecessor and my successor were both men and they both got paid significantly more than I did. One was a white man, one was a black man.

“It’s awful. It’s a really difficult situation. I think traditionally, they say that when a woman applies for a job, they want to hit every single point on the person specification. When a man applies, they just think ‘I’m going to apply for that job, I’m going to do it’ and there is definitely still discrepancy in pay.

“North-East London is very diverse but I don’t know what the NHS paying structures are, so I don’t know about pay. We are a diverse area and that’s a good thing but is the pay representative of that? I’m sure I’m afraid.”

Shilpa suggests men are better at negotiating when it comes to pay than women but says that could be down to men enjoying “years of getting what they always want. And women don’t.”

“I don’t want to be an anti-man person, I’m not at all. I just think it’s intrinsically built into us. From an ethnic point of view, definitely my culture, as an Asian woman…my parents came here with nothing, they built themselves up, they worked hard but it’s very much ‘keep your mouth shut.’”

Shilpa says “the Asian culture is very ‘keep quiet, don’t cause a fuss’” and suggests “we’re quite a timid, mild group of people.”

“As an Asian female, my upbringing has been very much around ‘just work hard and do a good job. If your pay is not where you want it to be, don’t worry, the reward will come through.’ That’s very much my parents’ attitude.”

Yet she is sure the younger generation “is a bit more feisty.”

“I look at my niece now,” Shilpa says with a little smile. “She’s not going to put up with getting paid less than her twin brother.”