Harry McQuillan achieved notable success as chief executive of Community Pharmacy Scotland but he was enticed by a new challenge. The Numark chairman talks to Neil Trainis…

Things might have turned out very differently for Harry McQuillan. If the fates had conspired in other ways, we may have been settling down to talk about his career as an elite athlete. Perhaps a shot-stopper in Scottish football, although Harry is playfully candid about his goalkeeping abilities as a young man. “If I’m being honest about it, I was one of these footballers that was really good one day, couldn’t catch a cold the next.”

He wasn’t bad though. “Before I went to do pharmacy, I was offered the chance to go and train with the junior team at Darvel,” he reminisces, reminding me their senior side, who play in the sixth tier of Scottish football, beat the might of Aberdeen in the fourth round of the Scottish Cup in January last year.

In another life, we might have been talking about Harry’s exploits as a professional volleyball player. “I was capped for Scottish universities at volleyball. I played in the British Championships. I was fairly sporty when I was younger. You would never see me with a body like that now,” he says with a chuckle.

Pretty quickly, you get a sense of why Harry, who was appointed chairman of Numark in January, had great success with the powers-that-be north of the border when he was chief executive of Community Pharmacy Scotland (CPS). Sure, he’s a very good communicator but he’s also charismatic, a quality that you might imagine came in handy during the 17 years he was at the helm.

He probably wouldn’t embrace the suggestion such is his humility, but it’s no exaggeration to suggest he was the driving force behind the transformation of community pharmacies in Scotland from solely suppliers of medicines to providers of clinical services. A minor ailment service, chronic medication service, public health service and Pharmacy First gained momentum on his watch.

Constructing a compelling argument comes naturally to Harry and pharmacy too seemed like a natural fit when he was thinking over his career options. “I have no medical background in terms of family connections or anything like that. When I was at school, I was probably good at a couple of things. Chemistry and maths. Both of those things seemed to fit within the pharmacy degree at that time, in the mid-80s.

“My dad was a joiner, my brother was a brickie, so I was from a manual trade background. And for whatever reason, I could just pass exams. It took me down that route of ‘hmmm, if you can do chemistry, if you can do maths, how do you combine the two of them?’ And pharmacy seemed to be a logical fit. I then applied to Heriot-Watt University in Edinburgh and did their pharmacy degree and took it from there.”

Scotland had nationalist government, so the NHS was important

He relished debating community pharmacy with people in positions of power and influence, although he says modestly that it wasn’t only he and CPS pushing on doors in the corridors of power that brought about progress. They had an advantage; the Scottish government already had a better understanding of community pharmacy and its ability to prevent ill-health and help people live healthier lives than its counterpart in England.

“In Scotland, we had a nationalist government in terms of the SNP, in terms of the whole majority, so the NHS was important, keeping people well at home was important, having access to a healthcare professional where people live, close to home, was important.

“So, again, you were pushing on doors. We were going into those meetings with a ‘and we would like to’ (position). We had a proposal saying we would like to do this, that we see the future as this…but not at all talking that supply isn’t important. In fact, it’s critical but it’s not enough. You’ve heard me say that in the past. It’s just not enough.

“It’s the care that goes around the supply that’s really important and how to deliver that experience. You build on the minor ailments service and you introduce Pharmacy First.”

The launch of Pharmacy First in Scotland in July 2020 is a good illustration of ministerial acceptance and co-operation without the rigmarole of painstaking tub-thumping which, in England, felt at times like it was going nowhere.

“Pharmacy First (in Scotland) was devised by Gail Caldwell and her team at NHS Forth Valley (who was appointed its first pharmacy director in 2008) years before we made it national,” Harry says.

“I think another thing we (at CPS) were willing to accept was ‘that’s a good idea. It’s not necessarily ours but that’s really good idea. That could work at scale, that could work nationally. Let’s start talking to the government about that.’

“Yes, we wanted to enhance it, we wanted to do something else but ‘wouldn’t this be great minister, if you could have 1,250 clinicians, clinical portals, at the heart of where people live, delivering this service? Wouldn’t that be great?’

“And when it was put to the minister at the time, Jeane Freeman, she went ‘oh absolutely. How do we do that?’ We came up with some novel ideas about how you use the money that’s already in the system to facilitate that.”

It helped Scotland had ChPO who understood community pharmacy

Harry played a key role in helping get Pharmacy First in Scotland off the ground but he does not take the credit for its launch. As he points out, the CPS board set out a strong vision for the service three years before it launched and, of course, it helped that the country had a chief pharmaceutical officer in Rose Marie Parr who understood community pharmacy.

“We had pharmacy owners deciding what they thought that model should be. My role then became ‘how do we get that,’ for lack of a better phrase, ‘socialised?’ Talked about? Put into the public domain?” Harry says.

“We did that in September and this was genuinely quite serendipitous. In October 2017, Rose Marie published Prescription for Excellence. Low and behold, the two (visions) were almost identical.

“So, you were into a position where the pharmacy owners wanted to do something, government wanted to do something policy-wise, although there was no money attached to it at the time. And you suddenly went ‘wow, a shared ambition.’ You had a group of civil servants who were willing to lobby, fight for funding, the network who said ‘we want to do it and we want to be paid for it’ and you actually had this mutual agreement of ‘this is the way ahead guys.’

“The board of Community Pharmacy Scotland deserve some credit for that. The board and the chair were good at explaining what they wanted and just seemed to have a knack at being able to get things delivered.”

Harry does not subscribe to the view his appointment at Numark means he no longer has access to any of the influential people who were an email or phone call away when he was at CPS. But by the same token, he is clear his arrival has not seen Numark suddenly become primarily a lobbying group.

“No, no, no. I really think my role is to focus Numark on how the community pharmacy network delivers care to the populations. How we would then go about that might be this or it might be that and we might need to speak to people but I don’t think the function of Numark specifically is to lobby. We will need to do part of that, absolutely, but it won’t be its core purpose.”

Nevertheless, it is tantalising to hear Harry say “some of the relationships I managed to establish during my 17 years at CPS still exist.” It is tempting to think those contacts will give Numark extra political punch.

“It’s how do you add value to those relationships and, I’ll be honest with you, not trying to do other people’s roles. I don’t want to do (new CPS chief executive) Matt Barclay’s job. That’s not my job anymore. But I have an insight into how it’s done and, therefore, how does Numark support other entities and organisations to deliver their role? This is not about the Numark chairman trying to do someone else’s job but if I can make it easier for them by doing and assisting in information, insight, absolutely. I’m more than happy to participate in that. But equally, not abusing the relationships we’ve got.

“(The Numark role) is a change. My expertise is in Scotland. That’s based on where I live, where I’ve worked, my accent, everything else that goes with it. But knowledge can be acquired for Wales, England and Northern Ireland.”

Harry reveals in the few months since joining Numark, he has met Northern Ireland’s chief pharmaceutical officer Cathy Harrison and has meetings coming up with David Webb and Andrew Evans in England and Wales respectively. Harry also says he recently spoke to Alison Strath in Scotland “about where we are going with the future” of community pharmacy.

“What does this model begin to look like? Someone else will talk about the money. I know it’s important. Funding, a stable network…in fact it’s critical. And I have a view on that but it’s not my job to deliver that. Where I can assist it and advise, absolutely, because it’s what I’ve done,” he says.

He insists he can help Numark in its lobbying efforts, even gain access to influential people it did not have access to before his arrival, without putting too much emphasis on the point.

“MPs, yeah, and probably civil servants actually (in terms of) how that’s briefed, what that might look like, what’s your thinking, what’s your policy, intent? Then, what does that mean for Numark? How do we support that delivery? Ultimately, what we want to be doing, let’s be honest about it, is actually getting in before the strategy is produced and the policy, so we can go ‘well, how did that work, have you thought about it,’ rather than the reaction.

“If I had any form of success, if I could define it for Numark, we’d be able to influence the thinking to have it included in a strategy that’s then deliverable on the front-line.”

Approaching “twilight” of career but Numark offer was irresistible

Harry turns 60 next year and, by his own admission, is approaching the “twilight” of his career. But he doesn’t agree with the suggestion that he stepped down at CPS because he had taken the job as far as he could. “I always think you can do more. But it was probably the right time for the changing of the guard.”

He had other offers but the Numark one proved irresistible. “I had a couple to look at going back into community pharmacy frontline and a bit more from other wholesalers, shall we say. None of them had the unique bit between Phoenix and Numark about having the support end to end and being able to see that almost from manufacture to basic citizen interaction.

“No-one else, that I can see, is able to influence that as much, so that became the attraction to come to Numark. Also, I had just left an organisation that deals with membership and you’re coming into a bigger-number organisation.”

Shortly after Harry’s appointment, Phoenix UK’s group managing director Steve Anderson said he “will be a key figure developing our Numark propositions going forward.” Harry tries to expand on those “propositions.”

“It’s about me being able to advise about the future. Let’s take independent prescribing. What’s that going to look like in a community pharmacy environment? And as it comes in the next five, 10 years, how do you support that?

“One of the propositions is ‘how do you support that and make it deliverable within a community pharmacy setting? What types of things would need to go along with that from a Numark perspective?’

“Have I got the answer to that today? No. We’re going to have to look at it and certainly develop that. I always like to think about this role, the chairman’s role, and I always talk about ‘deliver tomorrow and help with today.’ But we need to be smart in our head with our proposition and ‘deliver today, help with tomorrow.’”

Conscious he hasn’t provided a specific answer, he insists “it’s more about ‘where do we need to be?’ And what’s that support function going to be when it comes around?”

He may be at Numark to advise and help it improve its offering to members but the CPS chief executive still resides within him. In March, he urged the governments in England, Wales and Northern Ireland to create remuneration and reimbursement mechanisms that allow community pharmacies “to look forward and develop” as they can in Scotland. The “reimbursement approach” in England, Wales and Northern Ireland, he said, should have “a tripartite role” to allow pharmacies to deliver their government’s health priorities, provide health systems “with high quality medicines at a value-added price” and ensure pharmacy networks have “the confidence to fully deliver NHS services and invest in its estate.”

It seems natural to ask the man who headed up pharmacy’s negotiator in Scotland how he assesses Community Pharmacy England’s progress, fresh from reforms that were billed as seminal.

“Scotland, at one point, was following the same road as England. We adopted Category M a year later and we got into this ‘boom and bust,’” Harry says. “We started looking back, the cashflow for contractors wasn’t great at all, so we convinced the government that we needed to break away from this. We always had one tariff anyway but this is causing this type of behaviour in the network that isn’t suiting anybody. Do I think CPE England understand that? Based on my experience, yes, I think they do.

“Getting government and civil servants to accept the same thing is another debate. Just because you ask for it, doesn’t mean it’s automatically going to happen. I well know that.”

Finances being removed drives a behaviour of caution 

When you see statistics like 10 pharmacies on average are closing each week and hear reports that pharmacies are having to scale back their services and reduce their opening hours, not to mention 93 per cent of people working in community pharmacy are at high risk of burnout, it feels like an understatement to say things have been tough for community pharmacies under the Conservatives.

Harry recently said “over a period of time, I can fully understand how the continual spectre of finances being removed from the system drives a behaviour of caution and concern from pharmacy owners.” Things might improve if a different government is in power after July 4 but it’s hard to know what Labour would do for the sector, whether their vocal support for pharmacy has substance or is nothing more than shallow platitudes.

It may be a waiting game but many pharmacists may not have the time to wait. Harry is asked how he might persuade Numark members to put money into developing and improving their pharmacies when many pharmacists are dipping into pensions or selling their cars just to keep their businesses afloat.

“How does – now I’m going to say the Numark family looking right across Phoenix and the wholesale and whatever else because that was part of the uniqueness of it – how does that assist in making the supply of medicines as absolutely efficient as it can be?” Harry says.

“Some of the stuff we do in community pharmacy, if you looked at how other industries or sectors deal with that type of stuff, they wouldn’t do what we do. They would look at making that efficient.

“You’ve probably heard me in the past taking about separating out accuracy of supply from safety of supply and I think a lot of the activity at the moment in community, rightly because of where the model has been, was on accuracy of supply.

“We are moving into a field of safety of supply. I am absolutely convinced of that. The network needs to see that and I think it’s got a bit confused with safety. It’s in there but you need to be accurate. But I could be 100 per cent accurate and zero per cent safe if I’ve given you the wrong thing.

“So, there’s a period coming where we’re going to have to deal with the accuracy really, really well and really efficiently to release the people, the pharmacists and the clinicians, to deal with the safety.”

Harry hasn’t been at Numark long but already he has a sense that some of its members are struggling with a workforce shortage. Although there is hope.

“I think part of that is pharmacists and that’ll be for a wee while but that’ll stabilise again because roles will be filled and then there’ll be people who move on and move across to other sectors, so that will stabilise again. It’s what we do with technicians and support team members for pharmacy and technology. All of that is in there, that we get that optimum way of operating that will allow care to be delivered.

“But it’s not just Numark members. I just think it’s the pharmacy sector. And medics are struggling with workforce, nursing is struggling with workforce. Primary care professions are struggling with that. It’s not unique to pharmacy. And if we say ‘are some Numark members experiencing that,’ yes, they will. It would be naïve to say they’re not.”

NHS England should shoulder some, but not all, of the blame. General practice has been able to employ pharmacists through the additional roles reimbursement scheme although, from community pharmacy’s perspective, there have been encouraging reports that pharmacists are returning to community because they are tired of being deprived of the chance to see patients often enough.

The cynical view is that since it was established as a special health authority of the NHS in 2011, NHSE, which has been frequently criticised, has never understood community pharmacy. The previous ChPO was a civil servant, the current one has a background in hospital pharmacy. Community pharmacy needs a community pharmacist ChPO, although a counter argument might be the sector, to put it bluntly, simply hasn’t been able to produce one good enough to take the role.

Harry is asked if NHSE really does get community pharmacy. “You might want to come back and ask me that once I’ve visited them. I’m not sure what the answer to that question would be.

“I’m going to go and find out though. And if there’s an opportunity to advise them on how that works, I will do so.”

I didn’t expect anything less from Harry.