Sadik Al-Hassan is a passionate advocate for pharmacy but says the profession needs to take a hard look at itself. The Labour MP and pharmacist talks to Neil Trainis…

When pharmacist Sadik Al-Hassan ended Liam Fox’s 32-year stay as North Somerset’s MP as the Conservatives suffered their worst ever general election defeat in the summer, a few eyebrows were raised.

For two reasons. Firstly, Fox was a renowned figure in politics, the defence secretary in David Cameron’s government, and Sadik a relative unknown. His victory probably took the general public by surprise, even though the Conservatives were going down in flames across the country.

During his victory speech, Sadik said he had overturned the odds to prove people who thought he “wouldn’t stand a chance” wrong. As we begin to chew the cud, it’s apparent there is more than residual satisfaction some months on.

“Yep, 32 years, eight elections, Tory grandee. GP as well,” Sadik says gleefully when asked if he’s still revelling in his defeat of Fox. That last observation was delivered with some gratification. Fox did indeed work as a GP and civilian army medical doctor before entering politics. But whatever the details, ‘pharmacist triumphs over Tory grandee’ has a nice ring to it.

The other reason is Sadik’s win intrigued community pharmacy’s fraternity, even those slaving away behind and in front of their dispensaries who had never heard of him.

Given community pharmacy’s unquenchable thirst to grab the attention of people who walk through the corridors of power, his election generated intense, perhaps misguided enthusiasm, judging by the reaction on social media. Some of those reactors said pharmacy might very soon enjoy a significant monetary increase.

“Great work. Now let’s get more funding for community pharmacy,” one pharmacist posted on X. “Hopefully this will lead to an improved position for community pharmacy,” another exclaimed. Amid the euphoria, it was easy to forget Sadik’s responsibilities as an MP would extend way beyond pharmacy.

“I knew, despite what some people thought, that there was a good chance to win this seat. It would’ve required a tremendous amount of effort and that is what I put in,” he says.

“We’re talking 80, 85-hour weeks. I worked full-time throughout the election campaign and the selection process. Don’t forget, I also had to fight to be selected. This was all while I was still holding my role as a superintendent pharmacist pretty much doing two jobs.”

Sadik, who is also vice-chair of the All-Party Pharmacy Group, is a full-time MP having stood down from his superintendent role at the online pharmacy PillTime.

“I firmly believed there was a 50-50 chance I could win. I briefed the (PillTime) board, I reported back to the CEO about what the outcome could be. I was preparing them for this scenario. They made it as easy as possible for me which, I have to say, after my years of service with them, made it gratifying.”

Sadik, though, is keen to emphasis that he has finished his revalidation and is still a pharmacist. “I actually had a meeting with the GPhC last week. It was unrelated to my revalidation thankfully,” he says playfully.

Politics moulded outlook on life from an early stage

He was no stranger to politics even before the general election, having served as Labour councillor then deputy mayor at Emersons Green Town Council.

“I spent about a decade as a Company Chemists’ Association rep too serving on LPCs, so I had quite a lot of committee experience. I was used to how you argue as a group of people.”

In fact, politics moulded his outlook on life from a very early stage. His father, who arrived in the UK from Iraq in the 1970s, was a civil servant – “I’m half Iraqi, half Irish by blood,” Sadik says – and father and son often spoke about his work in the service. At home, they would watch Yes Minister and Yes, Prime Minister.

“This was kind of the beginning of my political education. I learnt how to answer a question from Sir Humphrey Appleby. For me, there was always a strong Labour household. We had this aspirational middle class. My dad had a degree from the university of Aston.

“On my mum’s side of the family, there wasn’t degree education. I always had an interest in talking. As you may know from my career, I’ve always enjoyed the sound of my own voice.

“I led the debating society at school and I had an interest in helping people. I had a background with Amnesty International, organising campaigns, etc. That led me towards healthcare as a path because I was academically very strong at the sciences, maths.”

Stressing he has “experience working for CCA companies and experience working for independents,” Sadik says pharmacy and politics share an important characteristic; they involve talking to people about their concerns, fears and hopes.

“There’s a large overlap, which is crazy considering how few pharmacists are in parliament. I’m one of only two (the other being Taiwo Owatemi) and I’m the only community pharmacist in parliament. We spend all of our time learning how to talk to people, learning how to give them advice that they can trust and build rapport quickly.

“There are transferrable skills between pharmacy and politics, especially community pharmacy, where we spend all of our time engaging with our patients. For me, the backbone of my political skill comes from my pharmacy skill.”

Sadik suggests he is “not your typical pharmacist” because of his interest in the PR aspect of pharmacy, although there are other pharmacists who elucidate just as effectively.

“A lot of pharmacists do an amazing job but don’t shout about it. There are things pharmacists do that make a difference for patients that go unnoticed, apart from by the patient. When I worked for Well, there wasn’t a role for a pharmacist like me who had an interest in public relations.

“I always remember what the head of HR said on a visit to my pharmacy. He said to me ‘it’s really interesting what you’ve done Sadik.’ And I said ‘oh, which bit of the pharmacy are you talking about?’ And he said ‘there isn’t a role at our organisation for a pharmacist to be a public relations spokesperson and you’ve created one for yourself.’ I ended up doing a lot of PR work for Well Pharmacy.”

Pharmacy has not been great at capturing data to illustrate how it changes, sometimes saves, people’s lives. For instance, has pharmacy ever produced a study with patient testimonies highlighting how poor funding has impacted their health?

You would think strong auditing and compelling evidence would lead to better funding. Perhaps it’s not that surprising Labour has made pharmacy wait for contractual talks on 2024-25 and beyond to start.

Unrealistic request of government from some groups about money

“The bit I know is community pharmacy is already meeting with Stephen Kinnock, the pharmacy minister, as that sits under his portfolio. I know they’ve already had conversations and the discussion is ongoing,” Sadik says. Ultimately however, health secretary Wes Streeting is the main man.

Sadik, however, gives the strong impression community pharmacy is its own worst enemy because “there’s different elements in pharmacy that want different things.”

It’s a deflating but not surprising assessment and intriguingly, he says there are “some groups out there with a quite unrealistic request of government about how much money they should get.”

I press him on that. “I’m not going to mention specific groups. But there needs to be from the sector the idea that every element of it understands we are not going to get a five-year backdated inflationary increase to the pharmacy contract because there are savings we’ve already done baked in.

“That would be, in my mind, somebody saying ‘I want a 28 per cent increase.’ That’s probably not going to happen. We need to think about what we do to stabilise the contract now. In the early days when I started at Boots, pharmacy was still quite a profitable concern. We’re talking 20 years ago nearly. Pharmacy managers used to get 40 per cent bonuses.

“We have to take our criticisms there from how we as an organisation, especially community pharmacy, used to extract money from the public purse in those situations. I think the balance has gone too far the other way now.”

It's even more dispiriting to hear Sadik say “there are still fundamental arguments in the sector about what a pharmacy should be.” But he has a point.

“There are elements in our group that say ‘actually, a pharmacy can exist without a pharmacist.’ In my world, if you don’t have a pharmacist in a pharmacy, then it’s a shop. And we will lose if we go toe-to-toe with Tesco, as we have done.

“We’re at a crossroads now to answer this fundamental question ‘what is a pharmacist and does a pharmacist do?’ If I asked 40 pharmacists right now, I don’t think we’d come up with the same answer.

“If I asked a pharmacist in a GP surgery, a pharmacist in a supermarket, a pharmacist for Boots, a pharmacist for an independent, I would get different answers to that fundamental question. At the end of the day, we are experts in prescriptions and prescribing. And GPs are experts in diagnosis.”

He paints a clear picture of what a pharmacist should be and it’s not particularly good news for general practice pharmacy. “A pharmacist is an expert in medicines. A pharmacist is not a cheap GP. A pharmacist is an accessible healthcare professional. A pharmacist is not someone who can fill appointment slots in a GP surgery.

“We need to make sure our profession is distinct, that we play to our strengths, and we look at what the future could be where we meet our potential, which so often as a profession we have not.”

What does good prescribing in independent pharmacy look like?

Another of community pharmacy’s fallibilities, he says, lies with independent prescribing. In short, the sector has allowed “other people to control its destiny.”

“I was at university a long time ago and I was told when I Ieave, I will probably be a prescriber and if not, I’ll be a prescriber a year later. And that has been going on for over 20 years.

“The reality now is when pharmacists come out of university, they are going to be qualified independent prescribers and yet we do not have a system that used them. Community pharmacy, our biggest employment chunk, doesn’t use that system well.

“In pharmacy, time and time again, we have been done to. We have never gone on the front foot and said ‘right, we are going to use prescribing to do..’ or ‘we are going to incorporate this system here’ or ‘we are going to build this network, we are going to push forward.’

“The Royal Pharmaceutical Society does some great stuff talking about the professional competence behind this, some of the ideas about how you prescribe effectively but what does that look like in practice?

“What does that look like in a Boots? What does that look like in Well? What does that look like in an independent pharmacy and how do they use it to answer some of the problems in the healthcare system?”

Pharmacy, Sadik insists, has “been in crisis probably for the last eight years, severe crisis for the last four, existential crisis throughout my entire profession.”

“I still have not seen, despite white papers, APPG reports, King’s Fund investigations, a stable vision for how pharmacy is going to look in the next decade that works for everybody.”

Given Sadik’s frank views of pharmacy, this interview might be regarded as an hour or so of self-flagellation rather than an appraisal of pharmacy’s predicament but it’s hard to argue with his observations. His next line, though, takes me by surprise.

“It is hard to fundamentally change the processes in GP surgeries, hospitals, to incorporate what pharmacy can do because, actually we’re unreliable when it comes to service delivery.”

He doesn’t stop there. “We’re unreliable when it comes to advice. We’re unreliable when it comes to opening times. We’re unreliable when it comes to patient continuity of care. And this is only the worst of us that people see.

“We are very easily tarred with what we’ve done over the last two decades; closing pharmacies, not answering phones, not integrating with the rest of the health system. We spent a decade trying to liaise with GP surgeries and had people who would never answer the phone to them.

“I’ve worked in a community pharmacy and have rung my neighbouring pharmacies and have not been able to get through. And I have a direct line to them.”

In Sadik’s eyes, quite a lot of rotten apples are giving everyone a bad name. “Portishead is a really good example. This is because of the disparity of service offering in an area. We have an independent pharmacy and two Jhoots branches, so three pharmacies serving a population of about 50,000.

“You have one-and-half to two pharmacies operating in that area because the quality-of-service provision in, say…I’m going to specifically call them out…Jhoots Pharmacy in that area, is low.

“I’ve had conversations with GP surgeries about ‘how can we possibly work with this pharmacy when they don’t answer the phone?’ They’re not operating in a safe and effective way. We’re seeing more medicines incidents coming out of there. And there’s so many pharmacies that tar us with that kind of thing.”

Labour may look at wholesalers in great detail

One thing pharmacies, generally, cannot be blamed for are medicines supply problems. Sadik says there are “always fundamental elements about how supply works” but the government needs “to look at what’s actually happening.”

“If you look at the overall pricing of medicines, perhaps the price we are setting is a little too cheap and we’re actually getting a false economy there,” he suggests.

“A lower medicines bill is actually costing us more in productivity and, because of concessionary prices, overall charge. If you look at a medicine that goes into shortage and then goes on to a concession price, you’ll find that its price stabilises after the concession price is withdrawn at a much higher level than it was previously.”

The government might want to look at whether the Medicines and Healthcare products Regulatory Agency, who issue wholesale distribution licences, is regulating wholesalers effectively. Some have been accused of hoarding medicines (the Healthcare Distribution Association says its members are not doing this).

Is the MHRA actively investigating concerns by, say, making a surprise visit to a wholesaler’s warehouse? In short, can we expect more from the MHRA under a Labour government?

“I don’t know because money is not a printable commodity. A lot of regulators for a lot of environments have had a very hard two decades. We need to look at what their function and what their role is and how they do it.”

A few years back, Community Pharmacy England regional representative David Broome claimed pharmacies were being denied supplies by some wholesalers with whom they were not 'first-line' customers.

In 2018, a National Audit Office report identified an “unexpected growth in wholesalers' margins” as they investigated an “unexpected increase” in generics prices. “I believe profiteering comes to mind,” Sadik says.

“I think the current pharmacy model and current payment model does seem to lean towards unusual behaviour, especially around shortages and concession prices which, if looked into in detail, would cause some manufacturers and wholesalers problems.

“I’m all for a smooth supply chain and I hope wholesale really does smooth out over the coming 12 months otherwise, it might be an element we will look at in great detail.” Sadik insists “more and stronger regulation of wholesalers can’t be anything but a good thing.”

It would be negligent not to talk about trust in politics, so I mention that in 2017, then shadow health secretary Jonathan Ashworth promised Labour would reverse the Tories’ pharmacy funding cuts if they got into power. A video of his speech during a parliamentary meeting is on YouTube.

Memories are long. Labour risks irreparably damaging the trust of pharmacists for future general elections if it fails to fulfil Ashworth’s promise.

“If you look at the establishment of trust with a Labour government,” Sadik says, “we’ve had nine years of pharmacy cuts and the first talk of a ballot by (the National Pharmacy Association) was when a Labour government comes in. Where was that five years ago, four years ago, three years ago, two years ago or last year?”

Now that is an awkward question for pharmacy.