Talk of strike action in a national newspaper was a carefully crafted way of getting the attention of the government...and it worked, says Andrew Lane. The National Pharmacy Association chairman talks to Neil Trainis...

When the going gets unbearable, people start to consider all manner of options no matter how drastic. National Pharmacy Association chairman Andrew Lane tried to impress upon us something along those lines when he told The Guardian in February that some of his members were thinking of striking because of the “desperate situation” they found themselves in.

Community pharmacists across England have spent the last year or so braving a deadly virus to serve their local populations whilst wrestling with significant debts and contending with almost no support from a government that expects them to deliver Covid vaccinations.

As we settle down for a Teams interview, it is only natural to ask Andrew if patients can expect pharmacists to go on strike in the near future as the government stubbornly digs its heels in over the £370 million in advanced funding pharmacy wants written off and reimbursement of £400 million in Covid costs laid out by the sector during the pandemic.

“This is an interesting one because I think lots of people picked this up and I suppose there was a month's worth of co-ordinated effort that went into that piece and we certainly didn't say anything about striking,” he insists.

“It's interesting what the press pick up of course. Ultimately, it's desperate for many of our members, so it's not surprising that you do hear people talking about some form of protest. Nobody wants to let their patients down, so strike action is the last thing pharmacies would want to do but instead we just need to make the evidence-based case and appeal to the government to do the right thing for the nation's heroes who are out there.

“I think one thing, and it's no fault of the observer who just sees that headline, perhaps misunderstand maybe. I don't know if that's the right word. We weren't advocating (striking) at all. The journalists got all over that and escalated it to 'pharmacies are going to go on strike.'”

To be fair to The Guardian, it did not attempt to sensationalise Andrew's comments. Their headline 'pharmacists in England considering strike action over Covid debts' was an accurate reflection of what he had said even though he firmly makes the point that the NPA does not support such action.

“If you speak to some independents out there, some of them are actually saying (they are considering striking). As a leadership body, we would not go into print and say that's what we want them to do. To us, that's just the strength of feeling that is demonstrating what the government need to hear.

“You may be aware of this but we use an extremely respectable lobbying agent and these guys work in the shadows, behind the scenes, and we don't overpromote that because it's the ace up the NPA's sleeve in a way that we can have these co-ordinated approaches to communications through various media channels in a way that actually works really well.”

The notion of any pharmacist striking, particularly during a deadly pandemic, is enough to make one shudder given the ramifications it would have for patients. Andrew is asked if any NPA member has told him personally that they are thinking of striking.

“Not me personally but Stephen (Fishwick) who heads up our comms team gets discussions with various members of ours and the strength of feeling that we've had at some of the forums, that's something that's been on their lips, it's not something we've made up just to stir it in the press. Obviously, there are people out there with that strength of feeling.”

How many people have that strength of feeling? What proportion of the NPA membership were, or perhaps are still, thinking of striking?

“I know you want to get to the bottom of this but it really was something that we used as an anvil to get the government to listen. There's many, many leaders who give me a call. I talk all the time to various people, leaders of pharmacy London, Greater Manchester, some of the LPC operators out there and many of our members are in that duel role and when that Guardian piece landed, many of them said 'thank god the NPA have said that. Thank god we've got actually the balls to go out there and stand up to the government.'

“I'm not saying that was the desired approach we had long-term. Our advisors are saying to us 'well, these are carefully crafted words that we wanted landing on the front page of The Guardian' and we got that.

“In fact, if you look at the way we've operated in the last year in this dreadful pandemic, there's been a concerted campaign through our Covid group of board members and what we do in that Covid group is we agree copy that will go out to any of the press and effectively, like I said, it was a carefully crafted way of getting this to the attention of the government and it kind of worked.

“To your question about how many, we don't have the actual number of how many phoned the NPA because we haven't polled them but certainly in the feedback that we've had through various large groups, whether that be pharmacy London or others, they've said 'thank god the NPA have gone out and delivered that message' because that is reflective of many of our members. Not all members of course.

“The people who have seen it in the negative have missed the subtlety of that fact this has been a worked up approach by various bodies in the sector and at the end of the day you want a response.”

Andrew suggests his “carefully crafted words” in The Guardian on the morning of February 10 had the desired effect later that day during the Downing Street briefing when Boris Johnson said community pharmacies should be reimbursed for their Covid costs “as soon as possible.”

“We all want a response about the money at the moment and make sure the loan is turned into a grant and that has been PSNC's foremost struggle,” Andrew says.

“We still don't know why that hasn't happened but we managed to get, through that message, Boris to respond. We still got the dithering, we still got it being batted between the Treasury and NHS England but we've also got another campaign coming. This is all part of a cleverly crafted comms plan drafted by our comms group at the NPA but clearly supported by the very clever team at the lobby group we employ.”

He says he believes the NPA has contacted pharmacists who have said they are considering striking to reassure them and make it clear that would not be the right course of action.

“There's been quite a bit of press around that comment and we've come out quite strongly with the piece we've said that this wasn't a call to strike but it was identifying that so many of our members are in a desperate situation.

“This is where we can work very closely with press like yourself to make sure we do get that message out. We aren't calling for our members to strike and maybe you can give the clarity perhaps that this was a co-ordinated approach to get Boris to the table over the money.”

As the vaccination rollout continues at pace across the UK, countries in the European Union have dithered. Worse, their unfounded scepticisms about the AstraZeneca vaccine may have damaged concerted attempts to get people to get vaccinated.

In the meantime, pharmacies in the UK have pressed on uninhibited even if setting up a vaccination clinic or helping to run one has been immensely challenging. Lindsey Fairbrother, who runs Good Life Pharmacy in Derbyshire and was named Independent Pharmacist of the Year, said it was the hardest thing she has ever done in her life.

There is an expectation on community pharmacies to get involved in the vaccination programme, yet one question lingers; is it fair for the government to expect pharmacies to deliver Covid vaccines when it is cutting the sector's funding, refusing to write off the £370 million in advanced funding and reimburse them for their costs during the pandemic?

“It's all about how the negotiator positions itself going forward. The NPA aren't at the table for those negotiations,” Andrew says.

“We've had a number of our members who wanted desperately to get involved in vaccination and clearly we had the ability to support them through that. I was calling for pharmacy to be involved in vaccination right from the very beginning, before we learned that they weren't going to pay us back the money straight away, despite the promises that Matt Hancock made at our conference last year that no pharmacy would be out of pocket I think were his words.

“We've continued with that pressure to make sure they are true to their word despite the fact it's batted backwards and forwards. But to answer your question about the vaccines. It landed in a series of ways. You had that initial desire from many of our members to want to vaccinate, and at the time many of us thought, including myself, that it would end up being a flu-type planning scenario.

“We were used to the flu and my rhetoric in the press was 'we're here, we're trained and we will deliver' and I was relentless on those particular messages and on the back of the fact that many of the so-called experts were saying 'no, you don't really want to get pharmacy involved, they won't be delivering the at-scale numbers the government want,' we had an awful lot of push-back. It's one of our successes that we managed to get vaccination through our auspices.”

Andrew strikes a similar tone to Pharmacists' Defence Association chairman Mark Koziol who said the Covid vaccination programme is crucial if community pharmacists are to finally convince the government they are an integral - and clinical - part of the NHS.

“I think we've been been in the press about 800 times over the last year and a lot of those consistent messages have landed and landed well,” Andrew says.

“Where we've got to with vaccines, it's a bit of a challenge and that we're still batting around the money piece is always going to be a challenge but it's more a challenge for PSNC to land the credibility of what we're doing on the front-line as a clinical service.

“We've always been talked down as non-clinical and the challenge we've got in community pharmacy is just to convince the government we are a clinical service on a high street, accessible, you don't need to keep these big vaccination centres going and it will become more like the flu as we get different variants coming through and everyone's had their initial jab.

“We got the fact that NHS England wanted to roll out their own plans even though we were pushing back against the big vaccination centres.”

He is proud that some NPA members “are running those large vaccination centres” and insists with some gratification that his organisation's persistent pestering of the government led it to lower the minimum number of Covid vaccines pharmacy-led sites had to deliver each week from 1,000 to 400 to allow more pharmacies to take part.

“There's 200-plus pharmacies involved in that many of those are our members but we kept plugging away because the first vaccine out was the Pfizer vaccine and there was limitation on storage which we recognised.

“But when the Oxford vaccine came out, we said 'you've got to relax this thousand and we kept pressuring ministers on that and finally, we got NHS England to take that down to 400 but again, NHS England were very much in the driving seat. We were badgering in the background.

“When we had conversation with Kemi Badenoch, the equalities minister, she was quite keen on us promoting issues around anti-vaccination in BAME communities and some of the social media stuff that was going around and on the back of that, we said to NHS England that community pharmacies are massively placed in these communities so use us for the reach.

“We had one-to-ones with the vaccines minister Nadhim Zahawi and he got that and he's been championing the role of community pharmacy. In a year, we've come from from barely getting a mention in the flu season because GPs were not happy we were doing it and we had what I would call 'the vaccine wars' with GPs in the background and there's still quite a lot of that around.

“I think we've landed this at a level that we've now become an accepted face of the vaccination programme which is absolutely brilliant.”