The National Pharmacy Association is undergoing “substantial change” as it tries to transform pharmacists’ fortunes, says Paul Rees. Its chief executive talks to Neil Trainis…

“It was probably about an eight,” Paul Rees says as he weighs up how good his knowledge of community pharmacy was out of 10 when he took up the post of National Pharmacy Association chief executive in late November. As powers of persuasion go, he would probably get a 10.

If pharmacists, or anyone else for that matter, had found the time to check his LinkedIn profile, they would have noticed an impressive career history replete with senior roles for large organisations where he spearheaded campaigns across a variety of sectors that, to varying degrees, brought about change.

That instantly struck me as I went down the list of positions he has held during a 25-year career spent in communications. His successes catch the eye and make you wonder what he might achieve for community pharmacy’s crusade.

“I feel very lucky and blessed to have had the career I’ve had. I ended up working on a number of campaigns that changed the law of the land or changed government policy,” he says.

His ability to win hearts and minds can be traced back to 1998 when he played a leading role at The Ramblers on its ‘right to roam’ campaign which led to the Countryside and Rights of Way Act 2000 that today gives people the right to walk on mountains, moors, heaths, downs and common land.

A whistle-stop tour of his career provides a flavour of the success Paul has had. From The Ramblers, he went to work for the animal charity Blue Cross as its head of communications, leading on its ‘Take Your Dog To Work Day’ campaign, before moving on again to work on the high profile Victoria Climbié public inquiry that led to the Children Act 2004 which addressed concerns about gaps in the child protection system.

By 2004, Paul was co-leading the Association of University Teachers’ (AUT) campaign of industrial action which saw lecturers boycott student exams. That led to a new pay deal with universities. Three years at the Home Office plunged him into a communications role for the public inquiry into the death of Zahid Mubarek, a British Pakistani teenager who was beaten to death by his racist cell mate in 2000. The inquiry found over 186 failings across the prison system and made 88 recommendations to “reduce the risk of something like this ever happening again.”

By 2007, Paul had pitched up at the National Housing Federation, which represents 1,300 non-profit housing associations, where he led a campaign to persuade the big energy suppliers to stop charging low-income households more for their gas and electricity through pre-payment meters. It was said to have saved poorer households more than £100 million a year.

Paul would go on to help the Charities Aid Foundation to get the government to drop plans to cap tax relief on charitable donations, then led the Royal College of General Practitioners’ campaign that prompted NHS England to give general practice an additional £2.4 billion of investment each year by 2020-21. That chimed with me given his current role at the NPA. Paul doesn’t have a background in pharmacy but getting NHSE or government to part with significant amounts of money is no mean feat. It’s something community pharmacy’s global sum could do with.

“I’ve always been passionate about healthcare,” he says matter-of-factly before pointing out he “led a transformation” at the Royal College of Psychiatrists as chief executive where he was awarded an MBE for services to mental health and equality, diversity and inclusion.

“By the time I left, we were winning awards left, right and centre. It was modern, cutting-edge and its membership had grown by 18 per cent and you reach a stage where you think there’s not much more you can do in a role.

“The Royal College of Psychiatrists was in a great position and (the NPA) role came up and having worked with GPs and psychiatrists, I really valued the opportunity to work with community pharmacists who are obviously very closely related to general practice.”

Paul presses home the point that the NPA position was not just another job. It offered him a challenge that he felt he was equipped to take on. Given the Conservatives’ stubborn refusal to increase community pharmacy’s global sum – although that stagnation might end after the general election – and the complexities pharmacies face around local commissioning, this might be the most difficult challenge of Paul’s career. He doesn’t lack enthusiasm or determination though.

“Community pharmacists are based in every community up and down the land and I wanted to see what I could do to help the independent community sector,” he says. “The role was a really interactive one and I could see the similarities between medical royal colleges and the NPA. Obviously, the NPA is a trade body, not a professional body, but it was a similar set-up to what I’d worked in before but working with different clinicians. I was really excited to have the opportunity and I’m really enjoying the job so far.”

Knowing how government departments work

The intriguing, some might say exciting, aspect of his career as far as pharmacy is concerned is Paul’s experience of government departments and primary care. He knows how each one functions and, importantly, where the pressure points are.

“Working with the Royal College of GPs, I got to understand how primary care works and I was always fascinated about the link between general practice and community pharmacy. I had done some work with the Royal Pharmaceutical Society at the Royal College of GPs, then working with the Royal College of Psychiatrists and that gave me greater understanding of how the NHS works.

“I also worked with the Academy of Medical Royal Colleges. I gave them some advice on one or two issues. So yes, I have quite a good understanding but there’s always more to learn and it’s been amazing.”

Having started out as a journalist with the Watford Observer in 1993 before working for numerous national media outlets, he’s naturally comfortable talking to people face-to-face to find out what their hopes and fears are, although he offers a little smile when it’s put to him that he hasn’t been a journalist since 1998. Nonetheless, it’s no surprise to hear him say that one of the first things he did after joining the NPA was to get “out on the road” to talk to its members.

“It’s been one of the key things for me. I try and meet a member at least once a week and there’s nothing like meeting people, speaking to people, finding out how they’re feeling on the frontline. It’s ok to be in a head office and have certain thoughts and certain policy positions but the most important thing is getting out there and meeting members and I’ve got to say, the members I’ve met have been so friendly, so welcoming and although they’re really, really busy, they’ve been happy to share their knowledge and experience, which has been incredible.”

There isn’t enough time to talk in the hour or so we have on Teams about all the challenges independent pharmacies face but we ponder what options are open to them. Three years ago, then NPA chairman Andrew Lane told a national newspaper that some of its members were considering strike action over the government's refusal to write off £370 million in advanced funding as debts pushed pharmacies to the brink of closure.

But striking seems, as it did then, implausible. If pharmacists close their businesses for a day to strike, they lose out financially. Paul won’t be able to mobilise independent pharmacists in the way the AUT rallied teachers back in the early 2000s, so he is operating from a position of relative weakness. Paul insists industrial action is not always the answer.

“Interestingly, as you say, I did work for one trade union and industrial action was part of our campaign for the terms and conditions for the people we were serving. But other organisations I’ve worked for haven’t had the opportunity to strike,” he says.

“The Royal College of GPs and Royal College of Psychiatrists, they’re professional bodies, they’re not trade unions so they can’t call for strike or industrial action. The Ramblers Association, the National Housing Federation, the Charities Aid Foundation, they weren’t unions either and we achieved massive success in changing government policy and spending decisions, so you can bring about change without industrial action.

“And actually, I don’t think strike action is on the agenda for community pharmacies, so it requires the National Pharmacy Association, working with other organisations, to be that strong, clear voice to get across the key messages to decision-makers and the public about what community pharmacies need.”

Paul thinks the NPA has as much political clout as other healthcare bodies. For example, his former employer the RCGP held a parliamentary reception in January which was hosted by the Labour MP Rachael Maskell to enlighten other MPs and stakeholders about its general election manifesto. Paul says one of the things he has been struck by since joining the NPA “is the incredible access it has to government and decision-makers.”

“For example,” he adds, “Victoria Atkins, when she became health secretary, met with the NPA on her second day. Rishi Sunak, when he launched Pharmacy First, wanted to do it at an NPA-member pharmacy. We’ve been to number 10 Downing Street twice in the last three months and we meet politicians every week and we talk to the health teams of all the parties.”

Paul also suggests the NPA was “the only community pharmacy organisation to be represented at the Covid inquiry,” although if you glance down the list of Module 3 core participants, you will see the Royal Pharmaceutical Society just below the NPA. Nonetheless, he says the fact the NPA secured core participant status and some medical royal colleges did not demonstrates the “incredible clout” his organisation has.

“I know of one or two medical royal colleges that wanted to meet with the health secretary (when she took on the role) and they didn’t get a meeting for weeks or months. The NPA got their first meeting with Victoria Atkins after two days. So actually, the clout of the NPA is on a par with the biggest medical royal colleges.

“I think moving forward, what we want to do is explain that better through our new communications and marketing department to our members and other stakeholders the clout that we have.”

Sobering realism suggests that campaigns can be as boisterous and as coherent as they like but if those in power refuse to budge for whatever reason, that is the end of the story. A compelling campaign to stop the Tories’ pharmacy funding cuts, starting with an NPA petition that attracted two million signatures and was delivered to Downing Street in 2016 and culminating in a failed High Court case a year later, is a case in point. Paul is asked how a campaign to compel a probable Labour government to improve community pharmacy’s global sum should look.

“One of the key things is that you need very clear messaging. We’re calling for a new deal for community pharmacy and we think it’s very important community pharmacy gets 2.5 per cent of the NHS budget, that there’s a moratorium on clawbacks until there’s a new contract, that community pharmacists are no longer treated as second class citizens which they are undoubtedly compared to other clinicians.

“We need a new contract based on, not only dispensing, but also clinical services, prevention, de-prescribing, social prescribing and we need an end to closures and also year-on-year inflation increases. So, you need simple messaging that you can put down on a pledge card. You also need a strong media and communications presence to get the message across.”

NPA has big-hitting comms expertise

Paul reveals the NPA is undergoing a process of internal improvement, appointing Ben Russell, who spent eight years at The Independent as its political correspondent, as a director. Like Paul, Ben has extensive experience in communications, building powerful campaigns for a variety of charities. He, like Paul, has knowledge of the inner workings of government, not only central but local, having been a senior media consultant for the Local Government Association. It feels like the NPA has some big-hitting comms expertise.

“As an organisation, we have created a new marketing and communications department,” Paul says. “You also need to have really good engagement with politicians because you’ve to get the message across, not just through the media but in private meetings with MPs. We’ve been to 10 Downing Street twice in the last three months, we’ve met Wes Streeting, we meet leading politicians all the time, so that’s really key.

“And you’ve got to build support amongst the public, ensure the public are right behind you, want to see your campaign succeed. That was really important in the ‘Put patients first by general practice’ campaign. If you talk to people on the streets, they really are keen for community pharmacy to be properly supported. Since the pandemic, people have seen the value of community pharmacy because they really value the opportunity to see a clinician without having to make a phone call and wait two or three weeks to see someone.”

Paul insists it’s important “the various organisations within community pharmacy work together” and although he points to the NPA, Community Pharmacy England, RPS and Company Chemists’ Association’s recent joint #VotePharmacy manifesto as a sign of progress, it is hard not to think of the four separate pharmacy visions that were launched last year by four different organisations.

“It’s about building a big tent approach, if you like, and getting the message across to the public, to politicians, and building up that sense of momentum and that’s what we hope to achieve at the NPA,” he says.

It is interesting to think how Paul might use his knowledge of government departments to bring about a change in governmental attitude towards community pharmacy. Unless, of course, we can take Labour, providing they win the election, at their word that they will support pharmacy. I recall during an event at the House of Commons in 2017, the then shadow health secretary Jonathan Ashworth promised Labour would “reverse” the cuts if they got into power.

“I worked at the Home Office, the heart of government, I advised ministers, I saw how they made decisions, I worked closely with the Department of Health when I was at the Victoria Climbé inquiry, I worked on another public inquiry, the Zahid Mubarek inquiry to work closely with the Home Office,” Paul recalls.

“I was actually part of the team that helped set up the Ministry of Justice when I was at the Home Office, so I’ve worked very much at the heart of government and I’ve seen how decisions are taken and it’s using that knowledge that has helped me achieve success for a whole range of campaigns.

“You have to understand how the government works internally to be able to run influence in campaigns that then influence decisions by ministers, by decision-makers, and I think that gives us an added string to our bow, my having that knowledge.”

He believes “all politicians are starting to see how important community pharmacy is” no matter what party they belong to. “They want it to be at the centre of primary care and the front door of healthcare. The key thing is to enable that ambition to be followed through with more money and a better contract. I’m hopeful that because of the conversations we are having, all politicians are now clearer about that.”

Given the likelihood of a Labour election victory, Streeting, as shadow health secretary, should be the focal point for community pharmacy’s campaigning endeavours, although Paul is aware that reshuffles can quickly change things. Nevertheless, he says when the NPA spoke to Streeting, he “was very keen for community pharmacy to be properly supported and sees it as being a key part of the prevention agenda.” However, Paul stresses the NPA is “apolitical.”

Mental health support for pharmacists

In January 2022, when he was at the Royal College of Psychiatrists, he was awarded an MBE for services to mental health and equality, diversity and inclusion. GPs have provision in their contract for mental health support. In 2017, the government launched the GP Health Service, a £20 million scheme that enabled GPs to seek counselling or medication from mental health nurses and psychiatrists if they were battling anxiety, depression and feelings of hopelessness.

Paul recognises the pressures pharmacy teams are under and says “we definitely want support for community pharmacists” but he stops short of saying he will campaign for the pharmacy contract to contain provision for mental health support.

“We’d need to look at the vehicle for that but they are treated as second class citizens on so many levels. If you’re trying to run a health hub and you know that thousands of equivalents have closed in the last 10 years…community pharmacists have dispensed so much time trying to source medicines, trying to look at the drug tariff, then they secure the medicines and then the money might be clawed back. That is a recipe for huge anxiety across the whole sector and something must be done to support community pharmacists and their mental wellbeing.”

Of course, progress on a range of issues largely hinges on whether Paul is able to work easily with the NPA Board which has contained some strong personalities down the years.

“I’ve worked with the board closely already and I have a great working relationship with the chair Nick Kaye. I’ve attended three board meetings and the board have been incredibly supportive since I’ve been with the organisation,” he insists.

“I think the board wants to see the organisation modernise, renew, grow, and that’s the agenda I have. We’re working through a whole host of changes that we’re rolling out as we speak.”

It's a hugely challenging time for independent pharmacy teams and a very interesting time to be working at the NPA.