Stephen Thomas spent two years working in Vanuatu as its “equivalent of the RPSGB.” It placed a huge responsibility on young shoulders, as Rowlands Pharmacy’s superintendent pharmacist tells Neil Trainis…

One thing that strikes you about Stephen Thomas is he is one very busy man. So much so, it’s hard to imagine how he juggles all the roles he has. His CV reads like a register of momentous responsibilities; Rowlands Pharmacy superintendent pharmacist, Company Chemists’ Association member of the PSNC (due to be known as Community Pharmacy England) committee, board member of Community Pharmacy Wales (CPW), CCA representative at Cheshire and Wirral local pharmaceutical committee.

As we settle down to talk about the turbulence engulfing community pharmacy and ponder how pharmacists can possibly find time to focus on the health challenges in their localities as increasing overheads, cost-of-living pressures and poor funding threatens the existence of their businesses, it’s worth asking him how he finds the time to function as superintendent pharmacist.

“I have a fantastic team here. It has to be said, they are the best. They are really good people, they really know what they are doing. We spent a lot of time working together over a long period of time.

“They manage the day-to-day stuff, I come into the office as often as I possibly can. We spend time together, we have formal meetings, but every day, we’re talking to each other about something that’s happening.”

Stephen’s in-tray may be overflowing but he’s well versed in dealing with pressure and responsibility. He was a pharmacy manager at Boots by his mid-20s and pretty satisfied with life when he decided to stretch himself by plunging into the unknown. So off he went to Vanuatu in the South Pacific to work for a non-profit organisation as principal pharmacist.

It was some experience. He insists he was the “equivalent of the RPSGB for the country,” advising its minister “on all sorts of stuff, a real mix of things” such as “looking after the purchasing of medicines for the whole country, the distribution around the whole country.” He says his two years in Vanuatu gave him “a real broad understanding of how pharmacy operated.”

“I had a career in the UK and was quite happy but decided I needed to do something different and applied through Voluntary Services Overseas to do some volunteer work as a pharmacist. The long and short of it was I got accepted on to the programme, they gave me a list of countries that I could go and work in and I chose to work in Vanuatu which is between Australia and Fiji.

“It was fantastic. To be honest, it was probably the thing that made me the person I am now, gave me the career I have now, because I don’t think I would’ve got it had I stayed in the traditional routes. I was very much left to my own devices.”

Closures have hit everybody hard

Stephen chuckles when it’s put to him the role sounds like it was a great deal of pressure for such young shoulders. “It had its moments as you can imagine. I had somewhere in the region of two dollars 50 US per person per year to buy everything. It’s a developing country, so the funding was not there. That was an interesting challenge in itself. I was 25 when I arrived and then spent the next two years there.”

The experience, as demanding as it was, moulded him into the pharmacist he is and probably taught him to juggle all those responsibilities.

“I think it really underpins everything I’m doing now. We do quite a lot in external affairs now, so that stood me in good stead, I understand a little bit about how wholesale works and clearly, when you’re on your own, you have to be a self-starter. That sort of develops that side of your personality as well.”

It no doubt prepared him for life as a healthcare professional in the unforgiving 2020s, complete with pressure cooker working environments, financial instabilities and a lack of support from those in the corridors of power.

At Rowlands, he is responsible for professional standards, contractual matters and external relations. He might reasonably be described as a ‘CCA man’ given his career journey but he insists that as a CPW board member, which represents around 700 pharmacies in Wales, and PSNC committee member, he gives as much focus to the needs of small pharmacies as he does the large ones.

“I’m there in a CCA place, but when you get accepted on to PSNC or CPW, you actually are accepted on the understanding that you’re going to represent the interests of the whole sector and not just the bit that you’re associated with.

“Actually, in terms of PSNC and CPW, particularly in CPW, the division between multiples and independents is really minimal and there’s virtually nothing that we disagree on along those lines. There might be things we disagree on regarding other issues but between multiples and independents, there’s a lot of alignment.

“I did work for a regional multiple when I came back from Vanuatu who ultimately became an AIMp member. I was there for a couple of years when I came back. So, it’s not just that I’ve always been associated with CCA companies. I have worked elsewhere as well.”

Stephen continues the ‘pharmacy collective’ theme by insisting neither independents or multiples or any other sector has been hit more by staff shortages and closures.

“I think there’s a number of things at play. I think it hits all of us equally to be honest. But if you’re a sole trader-owner-pharmacist, then you’re going to be working every hour you possibly can to keep your business afloat. If you’re an employee contracted to work 40 hours a week, well that becomes a different conversation and that’s partly why – and it’s not just CCA multiples, it’s other multiples as well – I think we’ve seen some of the closures hit differently.”

He says his conversations with independents revealed some had taken out extra loans and “perhaps put money in from their pensions and remortgaged homes to keep their businesses afloat.” Some multiples, he suggests, “might take a bit more of a hard-nosed view on that by adopting the attitude ‘if that’s a loss-making pharmacy, then we perhaps need to think differently about that.’”

And although he unwaveringly insists “it’s hit everybody hard,” he is sympathetic to the plight of independents.

Rowlands’ vacancy rates are “coming down”

“In some cases, you might be an independent contractor who’s got an extra 10 years on your lease. What do you do about that? You might think you need to keep going for as long as you possibly can and perhaps be the last man standing, in which case, I’ll hoover up everything and it’ll all be fine.

“There’s lots of different elements that impact on decisions on whether pharmacies are sold or closed or consolidated. But I do genuinely think it’s hit all of us hard.”

There hasn’t always been a consensus within pharmacy, of course. There was recently a very public spat over whether a workforce crisis even exists at all, played out between the CCA and the Pharmacists’ Defence Association. Stephen knows there is a workforce crisis.

“I don’t believe there’s anybody in the sector who’s not had a problem at some point or another. Because I’m on CPW and PSNC, I get to talk to small multiple owners and I talk to independents. One of my colleagues on PSNC runs a small number of pharmacies in the east of England and has been suffering terribly with pharmacist vacancies and pharmacists moving to PCNs.”

Inevitably, Rowlands has suffered too but he insists vacancy rates for “both pharmacists and colleagues” at the multiple “is coming down, so that’s the good news.” He resolutely suggests his company has not “suffered anywhere near as badly as some of the other larger companies and indeed some of the smaller companies” simply because “we’ve been upfront with people.”

“We’ve been having a lot of problems but I think we did better than others,” he says. “Part of that was because we desperately tried to keep our pharmacists and pharmacy colleagues engaged. What were we doing? What was our vision for the future? And how can we support you and what are the things we can do to make your life easier and then try to act on that?”

Stephen is asked to elaborate on his claim that vacancy rates at Rowlands are dropping. “Our vacancy rate for pharmacists is down about 25 per cent, so that obviously is quite a significant number. That’s over the last 12 months. Things are starting to improve, there’s been a bit of an acceleration recently.

“Clearly, there’s a number of changes happening with the Lloyds pull-out of Sainsbury’s, there’s more pharmacists in the market and recruitment has accelerated more recently.

“We seem to be, I like to think anyway, other people may say different, but I think we are standing at the forefront of community pharmacy and being upfront and being open with our colleagues and keeping people engaged so they know what’s happening next.”

Last year, the CCA said “an alarming shortfall” of more than 3,000 community pharmacists had developed in England over the last five years and urged the government and NHSE “to plan for the future community pharmacy workforce or patients will face increased waiting times and even more pharmacy closures.” Has the government and NHSE planned sufficiently in the last year or so?

“Well, that’s an interesting question,” Stephen says. “Very recently, the CCA published some new data that suggested there are now 4,600 people who have been recruited through the ARRS programme and there’s nearly 8,000 people working in GP practices, so arguably, it’s not changed.”

Webb is aware of community pharmacy’s challenges

He says NHSE has “a bit of a disconnect to the situation.” It’s hard to grasp that notion because of the presence of the chief pharmaceutical officer. Surely David Webb should be impressing upon NHSE executives the importance of community pharmacy and its needs.

“Yes, he is there, you’re right. It’s not his sole responsibility of course, he’s responsible for pharmacy in hospitals, prisons and all sorts of places,” Stephen says. “But yes, he should be aware of, and I’m sure he is, some of the challenges faced by community pharmacy. I’m sure he’s not immune to that.”

Part of the problem, he suggests, is the time NHSE takes to get things done. “The NHS is a bit like an oil tanker; it takes a long time to turn round. I don’t know what he might be doing behind the scenes to try and rectify that. I haven’t spoken to David for a long time actually but it can’t be easy having to change a policy that has been long in place.

“And giving him the benefit of the doubt, he’s not been there that long. I’m sure he is aware but I’m not quite sure how easy it is to change.”

Perhaps pharmacy’s tub-thumping, largely encapsulated by the ‘Save Our Pharmacies’ campaign, is starting to pay off after all. Stephen believes the recent injection of £645 million is “a huge vote of confidence in what pharmacy can deliver.” In the grand scheme of things, it’s not enough. But he says he’ll take it.

“It’s a huge amount of money. It of course involves us doing extra work to get access to that. It doesn’t cover some of the core funding challenges that we’ve got. The sector has been talking about a 30 per cent shortfall in funding for quite a while now, depending on whether you take it from £2.8 billion or £2.592 billion, whether you take it before or after the cut, that equates to about £780 million to £840 million, so on the face of it, £645 million is not enough. But are we pleased that £645 million is coming our way? Absolutely.”

The present is challenging but the future is compelling. Pharmacist prescribing is set to open all sorts of new doors, although that comes with the caveat that without “an NHS strategy, robust planning and thoughtful implementation,” as Keith Ridge put it in a recent article for the King’s Fund, the benefits could be lost. Stephen says the number of pharmacist prescribers at Rowlands “almost varies week by week.”

“We’ve got, I think, 20 in Wales, we’ve got another 10 going through the training on that. We’ve got about 15, 20 in Scotland. From a proportionality point of view, we’ve got 58 pharmacies in Wales, we’ve got 41 in Scotland, so the numbers might not sound great but it’s quite a substantial proportion that have been put through training.”

An ACPT in every pharmacy

As independent prescribing is increasingly embedded into pharmacy practice, so the responsibility on pharmacy technicians grows. He insists Rowlands has “invested heavily in training people on technician training courses.”

“We have an ambition to have at least one accuracy checking pharmacy technician in every pharmacy that we have. Obviously, it takes time to get there, not least because the technician course is a two-year course to start with. But we are investing heavily in technicians and ACPTs and are utilising far more than we might otherwise do.

“We have a clear mandate to our pharmacists that where they’ve got an ACPT, make sure you’re comfortable using their skills but, for goodness sake, use them and relieve some pressure on yourself. We already have ACPTs in Wales under the smoking cessation service because that’s where the service specification allows it.

“We invested in technicians doing flu vaccinations this year and Covid vaccinations if they were in a pharmacy that was permitted to do that.” An interesting question, he says, is “who backfills the technician?”

Stephen reveals Rowlands is ensuring all its medicines counter assistants “have got a dispensary qualification as well so they can operate either in the dispensary or the medicines counter area.”

“And everybody who works purely in the dispensary has also got a medicines counter qualification, so we’ve created a much more flexible workforce in each of our pharmacies,” he adds.

“We’ve also had success by saying to the pharmacist ‘if you want, we will allow somebody else to take on management responsibility for the pharmacy and you can be a true, community pharmacist. You don’t have to worry about booking people’s holidays, you don’t have to worry about price changes.”

A thought occurs: if only life was that simple for independents.