In her first interview since becoming chair of the General Pharmaceutical Council, Gisela Abbam tells Neil Trainis that having worked alongside governments, the United Nations and World Health Organisation, she found pharmacy never had a voice…

A glance at Gisela Abbam’s CV gives you the impression she has seen it all before. She once chaired the British Science Association where she helped make science more accessible for people who had been underrepresented in the field and underserved by it because of their ethnic background.

In her three years as chair, made all the more challenging by the pandemic, she rejuvenated efforts to tackle equality, diversity and inclusion issues that had beset science. And as she pointedly said just before leaving the Association, “science is important, certainly, but science engagement is just as valuable.”

Gisela has spent much of her career trying to give people on the periphery of society opportunities they never had. She worked alongside governments, the United Nations, the World Health Organisation and the World Bank to improve health outcomes for communities all over the world and has written over 45 white papers on various public policy issues for governments.

As head of government affairs for GE Healthcare, a subsidiary of America’s multinational General Electric, she worked with several charities to create a campaign to improve early diagnosis of diseases in the UK. She was inspired to do that after a distressing personal experience when she fell ill, turned to private healthcare to find out what was wrong and had to have one of her kidneys removed because of the late diagnosis of severe endometriosis.

She is resilient and her latest appointment feels like a coup for the General Pharmaceutical Council.

“It’s really interesting. Over the past decade where I’ve been involved in health and on working committees with the WHO, the UN and governments across the board, pharmacy never had a voice,” she says during an interview on Teams when asked why she decided to take up the GPhC’s offer.

“Pharmacy never had a voice on any committee that I’ve worked on and because of ill-health that I had, and even looking at the pandemic, I realised the importance of the role of community pharmacists in particular and the role they played supporting the healthcare system.

“I thought that actually, it would be great to be in a role working with the regulator but, even though it’s from the patient standpoint in terms of patient safety, the work and the status of what the GPhC does and helping attract more people into the profession, that’s why I joined.

“It’s a shame, it’s a missed opportunity and working with governments, I don’t know any government that has really consulted with the pharmacy profession generally in their policies across the world. They may do on an ad hoc basis but it’s not something they do all the time.”

Independent prescribing is "really exciting"

Gisela, who was recently appointed a member of the UK Commission on Pharmacy Professional Leadership, only started as GPhC chair in March. She is asked where she thinks pharmacy regulation is at this time and whether she has had enough time to reflect on that properly.

“Yes indeed. One of the big things for me is the independent prescribing. I think that’s really exciting. It’s a great opportunity to increase the role of pharmacist through the clinical services they provide because there’s a gap in the provision of healthcare everywhere.

“Around the UK, the demand is more than the supply, so that’s great but at the same time, there’s a challenge as well because obviously, there’s a lot that needs to be worked out in terms of the broader healthcare system, what should pharmacists be doing in the clinical areas, which areas should they focus on?

“For example, mental health is an area where there’s a huge gap in terms of service provision. I know that we have some work around mental health pharmacist being carried out, so for me, that’s a great area.

“The other part links to education and training. What can we do from our standpoint as regulators to attract more people into the profession to maintain the high quality and standards that are required for patient safety?”

Independent prescribing has been trending on social media and been at the forefront of pharmacy chatter for quite some time.

The GPhC’s director of inspection and fitness-to-practise Claire Bryce-Smith told this year’s Clinical Pharmacy Congress that it found “clinically inexperienced independent prescribers operating online” as well as increasing numbers of online pharmacies failing to meet standards.

Her remarks left a question mark over the wisdom of the GPhC’s decision to scrap the requirement for pharmacists to have at least two years’ experience before enrolling on an accredited independent prescribing course. Gisela does not think a question mark exists.

“It’s not about the length of time of clinical training, it’s the fact that people feel they can do a lot of things online and are not following the process properly, whether they’ve been trained for 10 years or 15 years, some of those issues wouldn’t change. So it’s not about that.

“And we want to attract high calibre people into the profession as well, so putting a time limit … some people, two years would be enough, some people would need longer, some would need shorter. So, if we said two years and the person is not ready, then it means we’re pushing the person to do it rather than having a system that actually gives the assurance that way.

“If two years is not enough, then the person would obviously have to train a bit longer. If there’s a shorter time they can get into it, then that opportunity is there.”

We have got to grips with online pharmacy

More and more people are going online for medicines and medical advice which deepens the importance of ensuring online pharmacies are operating safely. Given increasing numbers of online pharmacies are failing to meet standards, it seems the GPhC has failed to get to grips with the online pharmacy problem. Gisela is not impressed with that assessment.

“It is a bit harsh because it is a growing thing. With the shutdown of a lot of services due of Covid, online pharmacy increased over that period over the last two years and is why there have been so many people … some are compliant, some are not.

“We are going out and picking up what the issues are and that is why we are looking at how we can respond to it as well. I think we’ve got a grip on it. That is exactly why we are sharing what the issues are broadly so that people are aware of it and we are checking and making sure compliance improves.”

Naturally, the GPhC has its hands full trying to ensure bricks-and-mortar pharmacies operate safely and effectively. We could be here for days talking about those challenges but we settle on one issue that has reportedly been a problem for pharmacists working in primary care networks; namely that some GPs are not giving them enough time – as little as 10 minutes by some accounts – to complete a structured medication review because PCNs have been offered thousands of pounds to deliver more reviews to patients.

Bryce-Smith said the GPhC had adopted an “anticipatory” approach to regulation – “getting ahead of the curve before things become a problem” – so how is it applying that modus operandi to this particular problem?

“We have had meetings with the General Medical Council about it,” Gisela says. “One thing we are doing is Duncan (Rudkin) and the other chief executives come together across all the regulatory bodies and one of my key priorities is stakeholder engagement, for us to work with other regulatory and other healthcare professionals, to come together and look at the issues and how we can resolve them. That’s something we’re looking at.”

It feels like a pivotal moment for independents. Contractors have until June 17 to have their say on proposals to reform the PSNC and LPCs and a government consultation on hub and spoke, which community pharmacists have been told has the potential to transform their businesses, recently closed.

Gisela does not want to talk about hub and spoke because the GPhC is still in talks with the government but she mulls over the potential risks of technological innovations in general.

“One of the things I’m concerned about is access to patient records. With new innovations and technologies, it’s important pharmacists in particular are able to have access to patient records.

“I know that for online pharmacy, because I did a shadow inspection of an online pharmacy, they said the challenge they actually had … they had to stop prescribing in one particular area which was to do with UTIs and they struggled to get the GP records to make sure what they were prescribing, the antibiotics, they weren’t overprescribing and because they weren’t able to get that, they had to stop giving out online prescriptions for it.

“So for me, that is an area we really need to work on with the broader healthcare system. Pharmacists need to ensure they have the right information to make the right decision in terms of prescribing and diagnosis. They need to understand the patient background properly to be able to do that. I’ll be advocating for a more integrated system that can help achieve that.”

She insists community pharmacists across the country having read-write access to patient records is “a must” as independent prescribing increasingly comes to the fore and says the GPhC is speaking to the GMC on the issue.

Pressure is on the GPhC to improve

Nobody in pharmacy is immune from scrutiny. The pressure is on the GPhC to improve its processes and although there has been progress, there is still work to do. In recent years, the Professional Standards Authority has flagged up concerns about the GPhC’s performance, notably around fitness-to-practise. It has failed to meet all the PSA’s standards in this area in the last three years and this year, the PSA said it met just two of its five standards, failing on customer service, transparency and clarity around certain FtP processes and the timeliness with which work is completed which the PSA said had “significantly declined.” Gisela is asked why the GPhC has consistently struggled with this.

“First of all, we’re not a regulator that has the same issues flagged up. Part of the reason is that if we’re doing a review, sometimes it involves another organisation, for example, the police who might be involved in it, or another organisation.

“Because of that, it’s more about time limits, so if you pass it on or you’re waiting for information from another organisation which is out of our control, unfortunately, the process still continues as far as the PSA and the people who are involved are concerned. That is why the process is a bit delayed in some instances.

“The PSA wrote to me when I started and said they can see that GPhC is really making progress to achieve the fitness-to-practise, so they do understand the complexities of it even though, obviously, we haven’t met the standards.”

Last year, the GPhC said it was trying to improve its understanding of why disproportionately high numbers of fitness-to-practise concerns had been raised about black, Asian and minority ethnic pharmacy professionals. Of the 1,322 concerns it received against pharmacists between April 1, 2019 and March 31, 2020, nearly two-thirds were against BAME pharmacy professionals. It seems the GPhC has more to do to understand why this has been happening.

“It's people complaining, that’s the problem. The challenge is that you can’t stop people complaining. It needs a more systemic-wide engagement,” Gisela says.

“I contributed to the government’s racial commission. Unfortunately, the findings from that didn’t acknowledge there was systemic racism, so that’s been part of the challenge as well. From my standpoint, we get information and as the complaints come in, we make sure the complaint is looked at objectively and researched and those who chair panels are really thorough in making sure there’s objectivity in it. But unfortunately, it’s out of our hands.”

I've suffered racism many times

Racism, and what has been termed unconscious bias, continues to be a problem for the wider health system. A study of ethnic inequalities in healthcare published in February by the NHS Health and Race Observatory found widespread inconsistencies in the ability of people from different racial backgrounds to access services and the way staff are treated across the workforce.

Gisela says matter-of-factly that pharmacy has “a large proportion of pharmacists who are from ethnic minorities, especially in community pharmacy” but insists “the health system struggles to promote people from ethnic minorities in particular.” The burning question is why is this so?

“I don’t know. I think it could be a combination of things, unconscious bias, but it’s systemic. I don’t think it’s about pharmacy in particular, it’s a systemic issue,” Gisela says.

“The fact people are raising it will help to tackle it. The GPhC has developed a really comprehensive EDI strategy which is helping us internally and externally as well. It’s a workforce issue but from a community pharmacy and independent pharmacy perspective, I think there’s a great proportion of ethnic minorities.”

She is asked if she has ever suffered racism during her career.

“Oh yes. So many times unfortunately. But the reason why I continued was that if you look at it and say ‘okay, I’m not going to continue,’ then it means (racism) will continue.

“Some people have to stand up and say ‘despite all that I’m seeing, all that I’m suffering, I will still continue pushing because the more ethnic minorities move up, the better it becomes.’ Actually, we’re all the same. People with a different perspective or diversity of thought, it doesn’t mean they are different from me.

“They actually bring some new ideas that will enrich that particular organisation.”