The National Pharmacy Association chair Nick Kaye talks to Neil Trainis about the people who had the biggest influence on him during his formative years and an exciting opportunity that has opened up for him on the Isle of Man…

“I realised today that I’m 48 and my mum died at 47. So, I’m older than my mum ever was,” Nick Kaye says, his mind drifting into deep thought. It’s a poignant but intriguing moment.

Poignant because his mother Elizabeth, who was a primary school teacher, died from cancer when he was 22. “She passed away in 1998, 1999. I can never remember the date. It’s really weird. I’m quite good with dates. I know it was July but I couldn’t tell you the date,” he says.

Nick’s father and grandfather were community pharmacists and it was unlikely he was ever going to be anything other than a pharmacist, although he insists he wasn’t cajoled into pharmacy and, growing up, considered a career as a lecturer. But as he talks about his mother – and this is where it becomes intriguing – I get a sense of how she helped shape his approach, not only to his vocation, but to life. As he recounts her brave battle with cancer, he also reveals how “quite brutal” the health service could be.  

“We had the diagnosis when I was 15. She died of breast cancer, secondary complications. I’ve never forgotten the way she was told which was quite brutal. They just said ‘oh, you’ve got cancer.’ Back in the day, I suppose that was the way it was just delivered.

“You wouldn’t have known she was poorly. Chemotherapy, all that kind of stuff, it was always the British stiff-upper lipped-type stuff. I don’t know if that’s made me quite bad at articulating my own feelings in life.”

That admission comes as a surprise because as a community pharmacist, chair of the National Pharmacy Association, board member of Cornwall and Isles of Scilly integrated care system and chief officer of Community Pharmacy Cornwall, speaking eloquently should come naturally to him. Yet it seems Elizabeth was his biggest influence, impressing upon him that life experience, having the courage to take a chance when an opportunity comes up, was as important as sitting exams.

“Some people see clinicians as all powerful and keeping a human being at the centre of it all…you can get quite process-driven in both medicine and pharmacy,” Nick says. “It was something somebody told me that I’d said during an induction when I was back in the pharmacy. I was going round saying to everyone ‘look, this isn’t a green bit of paper, this could be your mum, your son, your daughter, your grandmother.’ There are a couple of things it did to me.

“One, it made me say ‘yes’ to lots of things because I thought life was short, which probably reflects in my career. I say ‘yes’ to stuff and then work it out after because life’s short. So, I very rarely say ‘no’ to stuff. The other thing is…the only argument I remember my mum and dad having was about whether or not I was going to go to private school. My dad said ‘you’re going to private school’ and my mum said ‘no, he’s going to a comprehensive.’ She said ‘education isn’t about passing exams, it’s also experiencing life. He needs to be sellotaped to a table, he needs to be beaten up. He needs to be able to talk to somebody in the rowing club as well as somebody in Number 10.’ And if she’s left me with anything, I hope I’ve got a small amount of that ability in me.”

The resilient way his mother dealt with her illness has stayed with him. “She was ‘you know, we carry on, it is what it is’ and she was really keen to carry on with normality. She was poorly, she went through treatment, then we were told she was well, then we were told she was poorly and she had a mastectomy, then we were told she was well, then we were told she was poorly and she had to have radiotherapy and it had gone into her eye.

“She opened the car door and the car door hit her eye and she thought she had blurry vision but they said ‘no, you’ve got it in your eye.’ She had a Phantom of the Opera mask for her eye and then she was well again and then they said she’s poorly.

“I still remember the last chat with my mum. I was living just outside Newquay and I saw her every day, then I hadn’t seen her for probably two days. I went round to see her and she was yellow and she’d sunk in. I said ‘are you alright mum?’ And she’d always said yes but she turned round to me and for the first time ever, the only thing she said to me was ‘I’m really tired.’ And she died three hours later.

“My mum’s maiden name was Perfect. Can you believe that? She always used to say she was perfect until she married my dad and he couldn’t argue.”

Left a deep impression

If pharmacy is not, to use an overused phrase, in his blood, then it is certainly embedded in his family history. His father and grandad had pharmacies in Leeds but they sold those in 1972 and bought a pharmacy in Newquay where his maternal grandfather was the pharmacist. His aunt and uncle were pharmacists, Nick’s son is in pharmacy school in Swansea and his brother is a pharmacist too.

“It was really bizarre. My mum met my dad at work because, although she was a teacher, she was also doing counter stuff (in the pharmacy). And my brother ended up being the chief pharmacist of Southmead, Bristol.”

Another person who left a deep impression on Nick was Jonathan Silcock, an associate professor at the University of Bradford, who Nick insists “inspired” him “in the way he looked at stuff.”

“He was the first pharmacist I met who wasn’t properly risk-averse. He was more pragmatic about the real world. I really valued that level of teaching,” Nick says.

“I said to my dad I was going to do my pre-reg in Boots because I’d been stacking shelves in a pharmacy since I was 12 and I was thinking I was going to get a 2:1 or a first. And I remember my personal tutor saying to me ‘you won’t get in.’ I said ‘what are you on about?’ She said ‘well, you’ve got free thought and they don’t like free thought’ which I thought was a really interesting comment.”

That ‘free thought’ has not just allowed Nick to see the bigger picture in pharmacy but in business too. He is an entrepreneurial healthcare professional. He says he was never tempted by a career in general practice but he is a partner at Veor Surgery in Cornwall and his bio on the NPA website says he was “prescribing advisory for Newquay doctors’ group.”

“Yeah, that was back in the day,” he muses. “Probably 15, 20 years ago, there were two independents in Newquay and we used to, like two families, try and outdo each other all the time which was great for the people of Newquay.

“We were doing things between us. For example, Merck sponsored a project whereby we used to go to Newquay Hospital on alternate weeks and review all the drug charts. That was community pharmacy reviewing all the drug charts. I did alright at that. It was pre-PCN and they advised ‘what do you want to do? What do you want to prescribe? What could pharmacists do?’ And that led to a walk-in emergency supply service in Cornwall. We do about 15,000 supplies a year.”

Awful hotel fire, a proper tragedy

Nick reveals that service came about in tragic circumstances when a fire at Penhallow Hotel in August 2007 killed three people and he and his father did the best they could to help those who were caught up in the blaze. Nick's memories of the tragedy are vivid and raw.

“There was an awful hotel fire, proper tragedy, and my dad and I got a phone call and at two o’clock in the morning, we were using emergency supply legislation and giving out medicine, insulin, inhalers, antiepileptics.

“And the lead consultant at A&E, because it was classed as a major incident, went ‘well, where are all my meds queries?’ He said ‘all I saw were ill people. I don’t understand where all my meds queries were.’ And he was told ‘they went to two pharmacies that opened.’ And he went ‘well, why don’t we just do that as a thing?’ So, that scheme literally started from that hotel fire.

“The hotel was a five or six-minute walk from pharmacy. We literally opened the pharmacy up, water out, cups out, they used us if anyone needed any medicines.”

Nick’s time as a partner in general practice fascinated him to begin with but he soon got “quite bored of it.” It was the “buzz of a community pharmacy” that really intrigued him.

“I was a partner in general practice for five years. We used to joke that doctors can be quite challenging but we had a lot of really good colleagues. We didn’t have many doctors in the practice, we had loads of multi-disciplinary people. I worked with fantastic pharmacists, paramedics, all sorts of people. It was just good to see how that side of the world works.

“I never stopped doing community pharmacy, I never stopped being a shareholder in community pharmacy. I always used to do two days a week in a pharmacy, then three days a week in general practice. I never just did general practice.”

Maybe pharmacy is in Nick’s blood after all. He is a shareholder in Hendra’s Pharmacy in Penryn where he used to be superintendent pharmacist and still works one day a week. He was superintendent at Nick Kaye’s Pharmacy in Newquay until 2017 and is a director and superintendent pharmacist of a company in the tax haven of the Isle of Man called Kingsley Muti. It’s an interesting, ambitious venture.

Exciting pharmacy and wholesale operation

Kingsley Muti recently won planning permission to use a warehouse on the Balthane Industrial Estate as a pharmacy with three consultation rooms and a collection point for private prescriptions and prescriptions for Manx Care, the Isle of Man's health and social care provider. Nick hopes to have a team of prescribing pharmacists, nurses and GPs on the site.

And Kingsley Muti will not only operate a pharmacy from the warehouse but a wholesale operation too, selling prescriptions to any pharmacy on the island and distributing medicines to patients’ homes or allowing patients to pick them at the warehouse. I read somewhere that the site will have a robot that can deliver 100,000 prescriptions a month.

“It’s a warehouse. The front part has been re-fitted, there is no shop, it’s just a waiting-in room. There’s then final assembly of prescriptions, there’s a Meditech robot. One of our directors walked in and said ‘well, I could’ve bought a Ferrari but I think this was money well spent.’ It’s three metres high and nine metres tall.

“And we’ve got one full size treatment room and three consultation rooms. And we’ve got the island’s only wholesale distributor authorisation, so we’ve got a full wholesaler dealer’s licence, and we’re working on how that could look like, could we keep extra stock? So, we’ve got two separate businesses on one site in effect.

“When the boats don’t go, what could you keep? And could you use the Isle of Man for import and export because it’s not the same as Jersey because it’s not import/export because VAT rates are the same. People have sort of said to us they are looking at patent release.

“At the minute, all the patent release is kept in Malta and brought across and there’s a rush to get it to the wholesalers in the mainland by midnight. People are asking ‘well actually, could you keep it on the Isle of Man? It’s a much shorter hop across.’”

Nick says the dual pharmacy-wholesale structure of the business could “add to medicines resilience” on the Isle of Man where the supply of medicines to patients has been “terrible.” However, he describes the Isle of Man itself as “a really interesting jurisdiction.”

In fact, he makes it sound almost like an alien planet compared to the UK, although he suggests it’s “a fascinating little microcosm, a bit from Scotland, a bit from Wales, a bit from England, a really fascinating place to practice.” Nick says 26 pharmacies serve a population of over 84,000.

“The GPhC doesn’t exist, the MHRA doesn’t exist, CQC doesn’t exist. They regulate themselves but they offer a framework back and, actually, the thing about the Isle of Man which is really fascinating is we’ve had some challenges since we’ve gone through it. But Maria Bell, who’s the chief pharmacist of Manx Care, has been looking at clinical delivery of care, hubs of care.

“They’ve raised the single activation fee to £1.80, they pay £28 a month for blister pack patients. Their model of care is really different. The prescription charge £3.85. Maria’s really interesting in her vision. No EPS. EPS is going live this year. It’s absolutely fascinating.”

Project in tax haven probably won’t make me a millionaire

The Balthane business could be very lucrative, so the cynical journalist in me is curious to know if Nick and Kingsley Muti’s three other directors pursued the project so they could make a quick financial killing in the tax haven. Nick is not offended by the question.

“There are four directors. Two of those are investors. Everyone else is an Isle of Man resident. I’m not an Isle of Man resident. They’ve made money in property and in Microgaming (a privately held gambling software company based in the Isle of Man). Actually, one of the guys involved with it started Aspen Pharmaceuticals in South Africa, then went into Microgaming and has come full circle.

“But let me be really clear; they want it to make some money but actually, they know the island needs something like this. They’re not being altruistic but they’ve got enough money. Actually, what they’re looking at is ‘if we wanted to make it look really different, what would it look like? And healthcare seems like a good place to put in some money.’”

Nick insists there were two factors that attracted him to the Isle of Man. One, was the difference in the single activation fee which he says “makes it an easy way to break even quite quickly.” Two, was “the potential to use models of care differently.” He is not ashamed to say that “making money is an important part of the sustainability of it” and why should he be? Profit, as far as pharmacists who are doing the best for their patients are concerned, should never be a dirty word. Nonetheless, Nick is circumspect.

“Do I think it’s going to make me a multi-millionaire? Probably not. Do I think it’s going to be a really interesting way to practice, look at change, and maybe a few pennies? Hopefully.”

Sandwiched between England and Ireland in the Irish Sea, the Isle of Man appears on a map rather isolated and vulnerable, particularly with the supply of medicines in mind. Nick insists patients there have struggled to get hold of medicines.

“There’s three main wholesalers, there’s no short-liners. The three mainline wholesalers use one shipping company because it’s an island. They do their best. If the boat doesn’t go, there is no resilience, so the amount of extra stock you might have to keep is huge. So, from a pharmacy point of view, if we can get some stockholding on the island, if we can make that cost-effective… and the Isle of Man is really interesting in contract numbers. Most of them were Lloyds.

“Lloyds have gone, they’ve been bought by Clear Pharmacy (a chain based in Northern Ireland). There’s a couple of independents. So, we don’t think there’s a massive market for people wanting to hold extra stock but what we want to do is have that medicines resilience for key lines.”

Nick provides a flavour of what the Isle of Man is like for those who have never been to it. “It has a really interesting demographic. So, it’s an elderly skew, a bit like Cornwall but a slightly older skew with it. There’s quite a lot invested in private healthcare.

“There’s a really interesting statistic where 84 per cent of the population have private healthcare but they can’t use it on the Isle of Man, so they fly up to Liverpool or Manchester or London. There are bits (of the Isle of Man) that are deprived but there are some really wealthy people, so it’s a really interesting microcosm of stuff.”

Power to instruct other health professionals

His role at Cornwall and Isles of Scilly ICS also sounds interesting. The ICS website says he’s chair of the ICB’s personal experience, equity and prevention committee and a member of the ICB’s quality and integrated care area committees. That all sounds like a bit of a mouthful but the intrigue is in the detail. In short, Nick has the power to tell a health professional to go and work in another healthcare setting.

“I chair the system one that overlooks the top. The committee is really bizarre. I think it’s the first in the country whereby in Cornwall, you’ve got the integrated care board, we’ve got Royal Cornwall Hospital Trust and we’ve got Cornwall Foundation Trust.

“And within that board, the three chief executives all have the right of veto. Each organisation has its own system group and I can exclude the chairs of the other organisations. They had a chat and said ‘look, you’re the only person without baggage, we think you can chair stuff quite well.’ It's more of an assurance thing.

“For example, if you have something around quality whereby the outcome is the geriatrician should be working in the community, the three CEOs can all have a veto but in theory as chair, I can write to any geriatrician or consultant and tell them they’ve got to go and work in a GP surgery or a pharmacy. It’s an unbelievable privilege. It’s never been done before.”

He describes himself as the “quality chair for the system,” a role that has prevention and social care wrapped up in one large healthcare package.

“For example,” he says, “if Cornwall had more diabetic amputations than other parts of the system, what’s the ‘quality’ (aspect) of that? Royal Cornwall Hospital Trust can say ‘are we doing the operation safely? Is there an excess infection risk?’

“Cornwall Foundation Trust go ‘actually, we’re in charge of some of the care for nurses. Are we giving the right care? That’s our quality bit.’ The integrated care board can go ‘are we commissioning those people to do things in the right way?’ But the system group can go ‘well, why are the legs being chopped off? What’s the prescribing like? What’s the prevention like?’ And if the cause is ‘we’re not prescribing enough,’ you can direct primary care to prescribe more.”

Nick’s role, although not exactly social prescribing, certainly has shades of it. “If our kids are too fat, we need to do something with food boxes, so one of the things I’ve done is get out to see community workers who, like the Brazilian model, make contact with families and teach them how to cook.

“Is that what we should do? Should we bring back the patient activation project which we did in Cornwall 10 years ago about people understanding diabetes more? It’s unbelievably cool if it works.”