Pharmacists need leadership skills training while the Royal Pharmaceutical Society needs to learn how to lead, says Hemant Patel. The North East London LPC secretary talks to Neil Trainis…

“My view is a personal view. It doesn’t represent my organisation,” Hemant Patel says unreservedly in the living room of his house in leafy Brentwood that doubles up as the office of North East London Local Pharmaceutical Committee (NEL LPC).

Where a view has needed to be expressed in the interests of community pharmacy, even if it meant shaking a few foundations, NEL LPC’s secretary has not been a shrinking violet.

He is in no mood to change now. We start with the Royal Pharmaceutical Society (RPS), which was criticised recently by pharmacists during a survey conducted by CIG Research over its lack of leadership and relevancy to community pharmacy.

Hemant, who sits on the English Pharmacy Board (EPB) and National Pharmacy Association (NPA) board and has immersed himself in pharmacy politics for years, tried to get elected as chair of the EPB this year to confront the RPS issue head on, only to lose out to Claire Anderson. The desire within him to force change seems as strong as ever.

“There is a huge disconnect between the Society and its membership. A lot of people have left the Society. That hurts. I want to reconnect, not only with the numbers but people who left in anger and disappointment,” Hemant says.

“We must take action to bring them back in because going ahead, we owe a duty to the next generation to hand our profession over in a better state than we found it in.

“I don’t think we have done it. I think we are in danger that we might not even have a professional body with the financial support to serve future generations of pharmacy at a time when professionalism is raising the bar all the time.”

He is asked what he might have contributed as chair that the previous incumbent Sandra Gidley, who took up the RPS presidency, did not.

“There is a clear void and that is related to connection, repositioning of pharmacy as a clinical profession and, much more importantly, not only looking at expertise in medicines but expertise in health,” he says.

“We are over-focused on medicines and we need a broader view which encompasses how we manage people’s health.

“If we look at where the 10-year plan is going, it is designed to promote prevention of illness so it is person-centred care rather than patient-centred care, the difference being a person becomes ill and then is defined as a patient and we look after them.

“If we engage with people earlier on, for example preventing diabetes, preventing obesity, preventing blood pressure, all those things are valuable to the Society as we go forward.

“Also, they have a narrow perspective which is focused around medicines and pharmacy. I think we need to have a broader perspective around communities and self-sustaining communities.”

Profound

One pharmacist, Mohammed Hussain, took to Twitter to exclaim that he did not run for election to the EPB because he thought individuals could not “make a difference when the system is designed to resist reform.” Hemant leans forward in his chair, giving the impression he is about to offer something profound.

“I have some sympathy with that view. However, I want to be part of change rather than sit on the side-lines and throw stones at them.

“We have to take a risk. The system itself is in need of reform. I have a different view of leadership. We need to have people-centric policies. I hope Claire (Anderson), our new chair, will consider that and I will support her in the work she is doing.

“I believe in collective responsibility but if there is conflict between collective responsibility and personal beliefs, then I will articulate them publicly.”

When asked what kind of reform should take place, Hemant insists the RPS is “very narrow” in its focus.

“Firstly, we need to ask a question; is the Royal Pharmaceutical Society an extension of the Department of Health and NHS? And then satisfy ourselves that it is an autonomous body concerned with pharmacists and, equally importantly, the public.

“That is why we’ve got a royal charter and that distinguishes us from trade bodies. There’s a balanced view we need to take. In terms of engagement with pharmacists, we need to do loads more.

“The third thing is the wider considerations of the Society’s needs. For example, do we have a policy on euthanasia? We’re a professional body and we’ve got medicines, do we have a policy on it and if not, why not?

“I think the maturity of a profession is displayed when we have considerations and have arrived at a mature response. That is what we’ve got the royal charter for, public protection, but also being modern in our views.

“I think our policy scan is very narrow, if it exists. I would like a broader policy scan which takes a whole range of stuff into account. Do we have a view about automation? Do we have a view about artificial intelligence? Do we have a view about genomics? Do we have a view about diet? What is a good diet? In my view, that is the first medicine.

“We are very narrow, our focus, compared to the GPs and that is why people take GPs more seriously than they take us. The Royal College of General Practitioners certainly does have a broader view about a whole range of stuff.

“In addition to a broader view, they are actively scanning the horizon and trying to be at a place where things haven’t happened yet. We are often reacting to things that happen. We have less control about where we go. They anticipate evens and then plan things.”

Expanding its focus is only part of the reformation process needed at East Smithfield according to Hemant, who describes the RPS as “timid” because “it doesn’t have a view on Brexit.”

Open and transparent

He says it needs to be more open and transparent. A good start, he suggests, would be to release all its “confidential stuff in the public domain” every three to five years.

“There are things like process issues which might require some confidentiality. Then there are sensitive issues which might require some confidentiality. But I’m of the opinion that the vast majority of the work we do should be open and transparent and done with the support and consultation of our members.

“Like any organisation, it could be more transparent. Our views about transparency are changing. If you look at parliament, I’m in favour of all confidential papers reviewed every five years and released, then people can understand what happened.

“After 30 years in parliament, all the cabinet papers are released. I wouldn’t wait for 30 years, I would say every three to five years, the RPS releasing all the confidential stuff in the public domain.

“If parliament sees democracy as a way of managing sensitive issues after a certain period, who made what decision and how it was made, I see no reason why that is not applied, not only to RPS, but PSNC, NPA, everyone.”

He insists that kind of transparency should be applied to “every democratic organisation because they are doing things in the name of pharmacist owners who have a right to know whether there was mishandling of issues or mishandling of monies.”

Hemant says he wants a review of how the EPB connects with pharmacists and suggests the Board should draw on the expertise of RPS Fellows who have “a lot of experience and a lot of desire to give back to the profession.”

“The English Pharmacy board meets four times a year and there’s a whole lot of stuff to go through. Unless we see some changes, connection with their members will continue to weaken. That’s my big concern and that’s the reason I wanted to stand.

“I want a review of how we connect with the members and then come to a collective view about ways in which to strengthen links with individual pharmacists, whether they’re employees, locums or owners.”

Despite his concerns about professional leadership, Hemant believes there is nothing disconcerting about primary care networks (PCNs) and the potential for independent community pharmacists to get involved.

“Primary care networks will require capacity and capability which will not be there. If you look at what’s happening in the GP world, there will be fewer doctors, there will be fewer surgeries. It has dropped from 8,500 surgeries to less than 6,900,” he says.

“There will need to be a change. My guess is there will be even fewer pharmacists as well. Having said that, we can create a clinical hub and spoke system where the GPs are aggregated into larger centres and community pharmacies remain in communities to serve patients in terms of their urgent care needs, their stable long-term conditions, rapid prescribing and prevention.

“I’m encouraged at a local level where our commissioners have given us opportunities to sit on relevant boards, make contributions, take our ideas and build that into the five-year local plan.

“I think our local commissioners see community pharmacy as an important part in making sure local communities have accessible, high quality and affordable services.”

Hemant is asked how community pharmacies in north-east London are engaging with PCNs.

“From an LPC point of view, we have engaged very well, not only with the commissioners but with the pharmacists and that includes employees as well as owners.

“They’ve had three meetings about primary care networks which were extremely well attended. There was a lot of participation and discussion. We have formed a clinical army that has got ambition that is ready to up-skill and ready to engage with the primary care network.”

Unrealistic

However, Hemant has had concerns about funding, recently insisting that LPCs across England collectively need £3 million annually to engage with PCNs.

“We will have 44 primary care networks (in England). I haven’t at this time got a clue how LPCs are going to be able to afford sending people there because nationally, it will take £3 million-plus to attend all 1,200 meetings a year. The working arrangements have still not been defined.

“I’ll be pushing hard but knowing full well that the full picture will not emerge clearly until about autumn time.”

Given that government budgets are being tightened, one might suggest that £3 million a year is unrealistic. Hemant looks unimpressed. 

“Why not? How much money have they spent supporting GPs? They’ve supported federations, they have lent staff to start federations, they have given doctors time to prepare for it.

“If we are going to be an integral part of the primary care network, where have we asked the Department of Health (and Social Care) for equal treatment?

“Not a single body, to my knowledge, either professional body or a trade body, have articulated a need to support pharmacists and need for backfill.

“A big failure in pharmacy is a failure to engage with pharmacy users who are going to be critically important in local decision-making. Every surgery has got a patient participation group. Pharmacies have got nothing.

“They are able to articulate the views of the surgery users through the patient participation groups. Pharmacy has nothing. At a time when local democratic decisions are going to influence decision-making, we not only have no money, we do not even have organised support to back us.”

He is asked if pharmacies in north-east London will struggle to get involved with PCNs if sufficient funding does not materialise.

“Definitely because the government has already squeezed every last penny. Many pharmacies are struggling to make ends meet. They are making a loss in plain terms.

“How do you expect people who are making a loss to attend meetings and still have a backfill? That is nonsense. If you want pharmacy to fail, don’t invest in supporting them with PCNs.”

Hemant was given an unsettling glimpse during a training session into the difficulties community pharmacists may face in a PCN meeting where feelings could be running high.

The problem, he suggests, is community pharmacists have had “no leadership training and no negotiation training.”

“We had a session in north-east London. What I observed was that there were people who were very uncomfortable with the type of meeting because we were simulating meetings and negotiations.

“They were sat on a group of eight per table and they had to agree who was going to be the leader and they had to negotiate with other tables to come to an agreement.

“And if there was agreement, both made money. If there was no agreement, neither of them did. What I learned from that was that pharmacists were very good at reading and learning or going to a lecture and learning and then doing something which has been taught to them, ie, somebody has done the hard work of producing a solution and they want to just replicate it.

“But when it came to sitting in a group and looking at different perspectives and coming to an agreement through negotiations and creating co-produced solutions, they were very, very uncomfortable.

“(In a PCN meeting), they would say ‘in our locality, here is the problem, ie, we have got a hundred people who are suffering from high blood pressure. Now, how do we go about reaching them, how do we go about providing a service and how much do we pay people providing the service?’

“Those kind of questions would cause real problems. They are clinically competent but in terms of the leadership and negotiation, there are serious weaknesses because we are used to a formulaic approach rather than a socially co-produced approached.

“What I observed (in the session) was some people sat there and withdrew mentally. Others tried to dominate the discussions and others were happy to allow the dominant personality to carry on and be told what to do.

“Solutions are not going to be ready-made. The solutions will need to be influenced and co-produced, so there’s a whole set of new skills needed to go forward.”