Ade Williams’ image was once projected on to Piccadilly Circus’ giant screen but he insists it’s all about the community pharmacy collective. Bedminster Pharmacy’s superintendent pharmacist talks to Neil Trainis…

For the Queen, Madonna, David Bowie, Kate Moss and Leonardo DiCaprio, read Ade Williams.

The community pharmacist and poster boy for the NHS shares such illustrious company because he too has tasted the limelight, even though he didn’t necessarily enjoy his proverbial 15 minutes of fame.

The portraits produced by acclaimed photographer of the rich and famous Rankin to mark the health service’s 72^nd birthday included an ICU consultant, critical care nurse, midwife, general adult psychiatrist, hospital porter, ward cleaner, paramedic, GP, district nurse, 111 call centre worker and a pharmacist – Ade Williams. When the portraits were published three years ago, Rankin said he wanted to honour frontline healthcare staff for their “resilience and courage in the face of real adversity” during the Covid pandemic and there was Ade, staring back at the camera with the hint of a smile.

The image was projected on to Piccadilly Circus’ iconic billboard screen. A few passers-by might have recognised him from his frequent appearances on national, regional and local media. Those who tune into BBC Radio Bristol's breakfast show might know he’s its resident pharmacist. He was also awarded an MBE for services to the NHS and his community in South Bristol where he is superintendent pharmacist at Bedminster Pharmacy.

“No. Really not,” he says over a Teams chat when asked if he enjoys the attention. “One of the most rewarding parts of what I do is working as part of our team and my wife is a pharmacist. After I qualified, I was exploring all the options that could distract you from pharmacy, including going to Canada, doing a photographic collection in Yukon (a territory in northwest Canada), taking pictures for six months, I was really into all of that.

“She was in her community, serving patients. When the funding cut came in 2016, she was, and still is, really disappointed. I remember she said ‘nobody cares about what we do, particularly the social value. They don’t really know what it means to the patients to have us there.’ And that really struck a note with me.”

Ade recounts a chat he had around the same time with one of his trainees who had decided to leave community pharmacy to pursue other things. The trainee hadn’t been in pharmacy long but had already been hit by a sense of helplessness. Their discussion still resonates with Ade.

“I remember having this exit interview with him and he said ‘nobody recognises us and I don’t think we can do much from the independent pharmacy.’ So, I thought ‘oh, I need to tell people what we do.’ Also, I was surrounded by people in our team…Shirley who used to do our deliveries and she would then do social prescribing, and Beata (a pharmacy technician at Bedminster Pharmacy) and I thought ‘there is a story here that people don’t know and it’s not about the pharmacy or the pharmacist, it’s about the team of people who are the face of the NHS and who are in the community.’”

He is more than happy to blend into the background so his team get recognition for their work but he is frustrated that some people may still not know what community pharmacies do despite years of campaigning by pharmacy bodies. It’s worth bearing in mind, though, that the community pharmacy narrative still needs to be told because the profession is evolving. The public, for example, may not know they will soon be able to get support through the New Medicine Service if they have been prescribed antidepressants. They may not know pharmacists and pharmacy technicians perform blood pressure checks as part of the hypertension case-finding service and it may be news to them that pharmacists prescribe.

Pharmacy and its potential has excited Ade since he was 16 when he came to Hove from Nigeria in 1997 to live with his aunt. He walked into a pharmacy in the seaside resort as a teenager wondering what to do with his life and hasn’t looked back. But his formative years, including a pharmacy placement exchange in Richmond, Virginia, and time spent in Canada learning his trade, fuelled his frustration as much as his hunger and left him with the impression community pharmacy should be further down the road than it is because he knows only too well the scope of that potential.

“I’m coming at this from a sense of real failure. We’re not a new profession. The NHS is 75 years old, pharmacy has been part of the NHS from the beginning, more so than general practice which turned up later. Seventy-five years later, why am I still telling people ‘this is what your NHS looks like and community pharmacy is part of it?’

“But I also acknowledge I’m part of the problem because what do we move on from? What are accolades on the mantlepiece if in five years’ time, we’re back to the same questions again? All through my professional career, I’ve only been able to do about 20 per cent of the things I imagined were possible when I walked into that pharmacy in Hove. And most of the time, I’m fighting to keep the doors open. And that’s not a good place to be.”

Personal tragedy helped shape Ade

It feels like Ade has come a long way. He and his three siblings were raised in Nigeria by their single mother who he describes as “a central figure” in his life which, by his own admission, is influenced by her idioms.

“My mum came to the UK to train as a nurse but she didn’t complete that programme for various reasons. One of the things she always used to say was ‘many people who tell you ‘well done for what you are doing, raising three, four kids,’ don’t dismiss them because you’re raising four kids. She said those are the people who have great value.

“The second thing was she always had a sense of ‘to be part of the community, you must contribute to it.’ And those things have always shaped how I see my role as a pharmacist. Don’t tell people it’s a shame where you are, the question is ‘what can I do to change it?’

“For me, community pharmacy opens its doors to people but you’ve got to open you heart to people. But more importantly, you need to bring the community to the heart of what you are doing. Because then, you don’t spend time thinking ‘is there more?’ You see it. You touch it. Yes, it’s strenuous, yes, it’s not romantic, yes, it puts the pressure on you, yes, you will constantly be aware you’re not doing enough. But you’ll never get to the point where you think ‘I’m not enjoying this anymore.’

“You can get to the point where you say ‘actually, I’m not making a difference anymore’ and then you check out. But you are there to serve a purpose and that helps to put the focus less on how I feel.”

Personal tragedy also helped Ade become not only the pharmacist but the human being he is. His father died when he was eight. It made him “very conscious of how vulnerable” he had become and “now really empathetic to people who haven’t got many choices.”

“All of a sudden, I was one parent away from destitution. Hopes are encapsulated in one interaction or one person. And it happens all the time, people come to you, they’re very desperate and I feel that.

“As a kid, if my mum was late coming home for any reason, I’d be conscious of ‘I hope she’s ok, I hope she hasn’t had an accident.’ Life can flip on you very quickly and you know you haven’t got those safety nets.

“My dad always had really bad respiratory problems for a non-smoker. He used to work in the construction industry in the days when there wasn’t particularly good standards in health and safety. A lot of that really aggravated those conditions and unfortunately, in the days when men were not known for turning up at GP surgeries, he had that from aggravations from cardiovascular problems.

“It was a series of things and for someone who was relatively young, he passed away unexpectedly in a sense. But it was an insight into education and making a difference but also how the decisions people make and how they lead their lives.”

Ambitions as a pharmacist “never been fulfilled”

Ade’s mother, he insists, is also his “biggest critic.” She “doesn’t suffer fools gladly” and is “not particularly impressed with people who have roles, particularly men, who do not change things for the better.” One wonders what she would’ve made of Ade looking out across Piccadilly Circus from that giant screen.

“She’s not very sympathetic as a previous civil servant. She doesn’t have room for excuses and I don’t have room for excuses. I’ve been telling her ‘oh, it’s all bad’ and she just looks at me and says ‘what are you doing about it?’ And then she reminds me ‘you’ve been doing this for a long time. But you’ve become part of the problem.’

“And even worse, she’ll say ‘look, you’ve got a profile now, you’ve benefitted from the problem.’ When she reads the things I say, and the flowery language I sometimes use, she’ll say ‘so basically, you’re ok but your patients are having a tough time.’ Or ‘you want your patients to help you out but you’re in a better place than they are, so how does that work?’”

In one sense, Ade’s youth engineered him to make great demands of himself. He comes across as hard to please, not because he’s unappreciative, but because he has high standards. He always wants to do more, hence his suggestion that his ambitions as a pharmacist have “never been fulfilled.” But his childhood also taught him to understand vulnerability which has allowed him to improve the lives of people who call on him and his team at Bedminster.

“You’re conscious that you’ll always need people to show you kindness. You’ll always need people to be there. You’ll always need people to be mindful of you and your circumstances and you’re grateful for those people that are.”

He also got an early experience of leadership when his mother sent him to military school in Nigeria. The experience stayed with him. “The military tried to replicate in the academic system some of the influences they had that helped them to do leadership roles. Many of them had gone to Sandhurst and war colleges in America and they would provide secondary school education fully aligned to military standards.

“You were in school but you were getting the drills and you were being taught about strategy and strategic thinking. To an extent, it wasn’t to militarise you but to explain to you some of the fundamentals. One of the core ones was leadership.

“For me, when I was there, this was a pain. I had to get up early in the morning and do runs and as you progress, you get higher. You become a student officer and you get to the point where you’re higher than your teachers and lecturers and you have more authority than they do.

“But there was always the sense of your responsibility to organisations, to people. And nobody had time for your excuses. I think I struggled with that because I’m empathetic to the problem but I am now less willing to understand when I see what we have are excuses because, with collective will and proper delegation, can we not do better than where we are? And shouldn’t we have done so by now?”

He suggests “politically,” community pharmacy “has been let down,” although you wouldn’t think any amount of political meddling or neglect would hinder his pharmacy team, whether it’s raising money and awareness of meningitis or prostate cancer, tackling vaccine hesitancy, providing blood pressure checks in the local pub and much more despite the challenge of recruiting staff.

“It’s been difficult, particularly finding locum cover,” Ade says. “The reality is because of the funding pressures and the whole cost of running a community pharmacy has come under so much strain, you’re then having to take on more and more and trying to protect your team.

“One of the things I’m conscious of is our team give out a lot, and even with all the awards in the world, we’ve been blessed by them and the community sees that. And we need to protect them and our community has always recognised the value of our team even more than I or the NHS will do. Most of our team are known on a first name basis by people and they understand their roles.”

He clings to the idea that things can always be better, that there is no perfection but suggests the things that “could make things better have been very slow.” Patient group directions for pharmacy technicians, for example.

“What does that say about us? We seem to be unable to do something where there’s a universal acknowledgement that this is the right thing to do. But we’re still not able to do it. That sums us up really. Let’s just get on and do these things because that would release the potential. We are not able to think about progressive approaches to practice and development.”

No clarity of commitment from Labour

He is, however, confident that pharmacies can make decent money from locally commissioned services as they hold out hope that national funding might just increase. And one project Bedminster is involved in thrills him.

“One of the things we are very excited about is we are part of a research group looking at PSA (prostate-specific antigen) testing in community pharmacy. This is particularly for Afro-Caribbean men who have a higher proportion of prostate cancer. We are looking at how can we break the testing barrier and what role can community pharmacy play?

“It's going through but it’s still very early days. We’ve got consultants involved in this and general practitioners and they’re thinking ‘yeah, community pharmacy is the best place.’ Now, if you are struggling to understand how pharmacies can do blood pressure checks properly, how can they do that?

“For those people who have those roles, what are we expecting of them to be able to do it correctly? How much time are you spending, how are you stretching yourself? Because your leadership should also be motivational. You should be the person telling community pharmacy ‘you can see yourself doing this at the moment’ but too many times, it’s community pharmacy telling those people what they can do and those people saying ‘are you sure?’”

The Conservatives stubbornly refuse to properly fund community pharmacy despite their protestations of support and understanding of the sector. Ade is not convinced Labour is as attractive a proposition as they were a few years ago.

“When Jonathan Ashworth was shadow health secretary, he visited Bedminster Pharmacy and I spoke with him. We had the local press and were doing a question and answer session. I remember asking him and he could tell me exactly what community pharmacy needed and that he was signed up to it. And I thought ‘wow.’ He knew the brief.

“Now, I’ve heard Wes Streeting speak about community pharmacy on a few occasions and my anxiety is I don’t hear a clarity of commitment. I don’t hear them saying ‘we are going to fix this, we are going to sort that out.’”

But, inevitably, Ade says community pharmacy cannot point the finger of blame at others if it hasn’t got its own house in order. Why, he asks, has his profession failed to push for protected rest time for all pharmacies in the last 10 years as report after report emerged highlighting pressures and low morale?

“It’s almost like saying ‘recruiting medical professionals to come to Australia is the problem.’ Medical professionals would say it’s the NHS and the environment that’s the problem. Australia is simply offering you a way out.”

He suggests community pharmacy hasn’t been helped by NHS England because it “still hasn’t been able to provide the vision” or any “enablers.” However, he says pharmacy did little to pre-empt this.

“I feel we let them because I never heard us shouting enough to say ‘where is the vision? Where is the clinical direction? How is it going to happen?’ And that’s the problem. We, as a profession, did not fight for our profession.

“We must be very clear what we want. My anxiety is we will go through another round looking for political saviours while actually, we need to do some serious work.

“The leadership structure changes we’re looking at in pharmacy is part of that but that must come with an acknowledgement of ‘how have we ended up here?’ And ‘what needs to change?’ We could be looking at it again in 2033 and saying ‘how?’”

Ade is trying to take his pharmacy’s destiny into its own hands by rolling out some private services, although he concedes “it will drive health inequalities because pharmacy’s strength is we can provide universal access.”

“We do private travel clinics predominantly. Because the NHS has been slow to catch up with even funded services, if you’re already doing a private blood pressure check service and the NHS lands it but it’s very rigid, very difficult to unpack, difficult to set up, you can imagine thinking ‘I’ve got something here that works.’

“Also, while we’re still sorting out how pharmacists will prescribe in community pharmacy, we have a whole new generation of pharmacists who are trained and clinically assured and able to take on prescribing roles.

“They’re not going to wait any more. There will be innovation and this is where the contract has not really worked.”