Tohidul Islam spent much of his childhood trying to steer clear of the Iran-Iraq conflict in the 1980s. So, he’s prepared for anything pharmacy throws at him, as Neil Trainis discovers…

“I grew up in a war zone, so I’m not really scared of a couple of baseball bats,” Tohidul Islam says calmly, letting off a little chuckle. It’s quite a line but it feels like more than a soundbite. It seems to be his way of reminding himself that no matter how tough things get in pharmacy, no matter how many times someone directs their ire at him, threatens him even, he can take some kind of comfort knowing he’s experienced something more dramatic.

Why the baseball bats, you might ask? We’ll come to that shortly, but you have to go back to the 1980s when Tohidul, an entrepreneurial locum pharmacist, was growing up in Iraq to get a sense of his back story.

His family moved there in the summer of 1981 from Bangladesh where he was born after his father, a diplomat, secured a post in the Bangladesh high commission in Baghdad. Their stay in Iraq coincided with one of the longest and bloodiest wars of the 20^th century, almost eight years of conflict between Iraq and Iran which ended with more than one million deaths, sparked by Saddam Hussein’s decision to launch a pre-emptive strike on what he believed was a disorganised and weakened Iranian military.

Tohidul says he and his family were not in the thick of the conflict but they were given constant, unsettling reminders that they were never too far from it either.

“We were bombed every other day. We were in Iraq until about mid-1987. I was seven when we left. Baghdad wasn’t really bombed as much, it was more the outskirts of Baghdad that got bombed quite a bit,” he recalls.

“Sometimes, you’d go to school and you’d see a big, massive crater. Once, I remember, at about two in the morning, all our windows just shattered. A bomb went off nearby. It was a scary time but the people were amazing.

“Apart from bombs going off here and there, you couldn’t tell you were living in a war zone. This was the Iraq-Iran war. The politics of it is quite complex but Iraq wanted part of the Shatt al-Arab which was a river that they wanted to claim and Iran wanted to claim it as well. But behind the politics, America wanted to bring down the Iranians and the Russians were supporting the Iranians to take on Iraq.”

Tohidul says he has “very good memories” of Baghdad and insists his childhood there was “fun” despite incoming mortar fire and bomb craters, mainly because the city had a large Bangladeshi community who helped him and his family settle. He has vivid memories.

“For us, there was a lot of Bangladeshis living there at the time. A lot of Bangladeshis were there on the rebuilding efforts. Everything needed to be rebuilt. There were a lot of workers from Bangladesh who were living across the Middle East as well and a large portion were living in Iraq.

“They were there on a diplomatic mission to make sure the Bangladeshis were safe. It was a pretty big community of Bangladeshis living in Iraq at the time. We had our own school. It was good fun… apart from getting bombed the odd time.”

I’m tempted to ask him if he saw any casualties as a result of the bombings. “A lot of that we saw on the TV on the Iranian side. We were living in a block of flats and one of our neighbours who lived upstairs, her son used to go off to the war for a few months at a time and then would come back. But living in Iraq, you didn’t really see much of that. Most of that happened on the border with Iran.”

His father’s work as a diplomat meant the family travelled quite a lot but by 1990, they had arrived in the UK where Tohidul continued his education. He thought about a career in medicine but reconsidered after seeing “some really scary stuff at hospitals.”

“I went to see my sister-in-law in her medical school in Bangladesh and I saw this kid come into the hospital with his leg stuck in a machine. His skin got torn off and it made me feel really sick.

“I went to my cousin’s medical school in another part of Bangladesh. He was a first-year student. Literally, there were boxes filled with dead bodies in formaldehyde to try and figure out how the patient died. I was like ‘I’m not doing this.’ It just made me feel sick, playing with dead bodies.

“You’ve got to respect doctors for what they do, it is really tough, cutting people open. It was my college days and I came back and said to my mum ‘I’m not doing this, I’m not doing medicine. It just makes me feel sick.’ So, my next choice was pharmacy which is very similar to medicine. Well, we deal with medicine. I got into De Montfort University. I really enjoyed it.”

His first two years there saw him hone his entrepreneurial skills and develop his business acumen. Alongside his brothers and sister, he ran a shop buying and selling second-hand computers.

“It got to the point where I was the tech support and I was building computers in eight minutes flat from scratch, putting everything together, Windows installed. That was my record,” he reflects, chuckling again.

”It was good fun but the third year of pharmacy came and I had to move away from all of that and focus on pharmacy. After that, fast-forward to my pre-reg year, the first day, I absolutely hated it. I did my pre-reg training at a multiple. The experience of the branch wasn’t brilliant. It was the whole atmosphere in the branch, everybody backbiting.”

Leaving reviews anonymously

It would become clear to Tohidul that employee pharmacists had few mediums to voice their concerns or let off steam. Locums didn’t have a forum to talk about rates or whistleblow if bad things were happening at a company.

So, he set up The Pharmacist Cooperative (TPC) which provides online discussion groups and connects locums to employers, among other things. It proved to be quite popular. He also set up Syrkle, which began life as a WhatsApp group in 2016 giving locums the chance to network, whistleblow and share knowledge and is now an online platform that allows pharmacists to leave reviews anonymously and avoid being blacklisted if their review is less than flattering. Pharmacists can post reviews about employers, locum agencies, pretty much anything, although Tohidul suggests Syrkle is “still at the beta stage. We’re testing a lot of the features.”

The moment that might have triggered his interest in online discussion groups may be traced back to the mid-2010s when he feared the market for locums was changing for the worse. His anxiety was fuelled by a dip in his own earnings.

“Up until 2014, 2015, I wasn’t really on social network much apart from the odd Facebook. I didn’t really care too much about any of that stuff. But I could see my salary literally halved within the space of a year or two and I couldn’t figure out what was going on. The numbers just didn’t add up in terms of what was on the register and the way the market was suddenly changing for locums.

“So, I reached out to a good friend of mine who told me to try some WhatsApp groups. I didn’t know they existed at the time. I joined one WhatsApp group, I joined two, then I joined a few more and saw jobs getting posted. I could see locums would ask to negotiate a rate that was posted by employers.

“First of all, employers wouldn’t post any rates and when they did, it was very basic, like £17, £18, £19, £20 (an hour). But when locums tried to negotiate, they’d get shot down. They’d get told to accept the offer or they can leave the group, that kind of attitude.”

Tohidul says he saw much of the same on other online forums, so he decided to set up his own group which would be managed by a locum and underpinned by “a few basic rules.”

“Everyone was welcome to join. I didn’t want to see arguments every day about rates. I wanted to create an environment where we wouldn’t be constantly arguing over rates but talk about how we can improve things. That was a way to stop the arguments and just move on.”

He reveals there was opposition to his group from some contractors and locum agencies who wanted to use his group to publish their rates. He says “it almost came to the point where the agencies were becoming too powerful.”

“I had one agency say to me ‘look, we want to post whatever rate we want.’ I said ‘you can do. There’s many other groups out there. Go and post it.’ I was also getting complaints about some companies.

“So, I thought we need to start creating reviews for companies. If you start posting reviews, surely the ones that are good will float to the top. The same with employers. Once you start giving reviews of which one is good to work for, companies will want to achieve the type of respect that the one everyone wants to work for has.”

Giving people the ability to post reviews turbo-boosted interest. One of his WhatsApp groups had 256 users. “At one point, we were outgrowing the groups every two to three days, so we just kept making new groups.” However, allowing locums to post a review on the “safe space of a network that was being run by locums for locums” started losing its appeal. Tohidul soon realised that ‘safe space’ was not safe at all because locums, he claims, were being blacklisted for posting reviews. So, he considered another option; anonymity.

“My friend said ‘move on to Telegram’ where he said you get much bigger groups, up to a thousand on them and people can be anonymous.” Anonymity has protected people who use Tohidul’s platforms but it has not shielded him from the animosity of individuals who feel his platforms have unfairly singled them out. And this is where we get to baseball bats and threats of violence. One company owner told Tohidul he would come to his house with a baseball bat because one of his sites had shared some bad reviews about his business.

“I said ‘yeah, come down, I’ll have a cup of tea ready for you. You know where I live,’” Tohidul says, revealing he’s been threatened with legal action by a multiple and incurred the anger of independents who have told him bad reviews make it harder for them to hire staff. Some independents think he’s helped to bump up the cost of locums.

“(Independents) don’t like the attitude some locums have and they think it’s all my fault which I don’t really understand because we’re not encouraging bad behaviour, we’re encouraging locums to be more entrepreneurial, to see themselves as a business,” he says.

Tohidul sees himself as a cultivator of constructive communication, not a mischief-maker, but when asked if he’s worried he could be subjected to physical harm by someone who feels aggrieved by his endeavours, he is philosophical. “No, to be honest, it’s not something I lose sleep over. It doesn’t concern me. If anyone’s got a problem, I’m happy to speak to them. I’ve had a lot of angry pharmacy owners on the phone but when you speak to them and say ‘calm down, let’s have a proper conversation’ and pick apart their argument, they realise it’s not me who’s at fault.”

He makes it clear his sites publish good reviews too. “We’ve had some really cracking reviews for Boots and Lloyds, saying ‘the team is amazing, it was a really good day, the branch was well staffed.’ They’re all on there. I’ve not removed any of the reviews.”

Yet he often takes to Twitter to publish what he alleges is evidence of wrongdoing at some companies, including screenshots of messages between employer and employees. That ‘evidence’, which Tohidul insists he scrutinises before publication, comes from people who contact him on Telegram, WhatsApp and Twitter.

“There’s one that came through the other day where someone tried to book a shift and had been emailing the company for days and no response. And then in the morning, she said ‘I’m still available if you need that shift covering.’ No response until 1pm when they called up and said ‘do you still want to cover this branch?’

“So, having messaged them for days and got no response, all of a sudden, halfway through the day, they wanted her to cover the shift. She said ‘sorry, I’m booked up somewhere else.’ She showed me the whole message thread.”

A powerful whistleblowing tool

Telegram seems to be a powerful whistle-blowing tool for Tohidul. “I think we’ve got over 10,000 pharmacists on there at the moment. In a week, I’ll probably get 10, 15, 20 messages with evidence.”

He says he also runs a “branch-closure reporting system” following allegations, denied by the Company Chemists’ Association, that some multiples have closed branches because they have been unwilling to pay locums agreed rates. The CCA says a workforce crisis is causing closures.

“Anywhere in the country, I guarantee I will find you a locum and I won’t charge you a penny for it,” he insists. “No agency fee, nothing. I will find you a locum who can go to that branch on that date. The rate, you’ll have to negotiate between yourselves. But I’m so confident there isn’t a shortage that I’ll find you a pharmacist within the hour.”

It sounds like Tohidul is the go-to person for whistleblowing in pharmacy and although it seems he’s not quite ready to accept that characterisation, he insists he and TPC, which has a team of 20 “admins” who support the network, will continue protecting users’ identities and “take the bullet,” so long as they are “brave enough to stand up and report things.”

“We’re going to do a freedom of information request to the NHS to find out how many closures have been reported, then compare that to the reports we’ve had as well,” he says. “From the preliminary results I’m seeing, the average rate for the last 12 months has been around £40 an hour. And on average, at least 20 per cent of locums have been sat at home for more than 10 days a month.”

However, a recent survey by Locate a Locum gave the impression that locums are becoming increasingly important to pharmacies and are not being unfairly treated. It claimed its research, based on 160,000 shifts on its platform between April 1, 2022 and March 31, 2023, showed 40 per cent of locums in the UK earn over £40 an hour and eight per cent are paid over £50.

Comparing the rates with those recorded during the previous financial year, the agency said average rates across the country increased by almost a fifth to nearly £39 an hour. Tohidul jumps in.

“Eight per cent are over £50. Let’s break down that figure. Forty per cent are paid over £40 an hour. So, in line with inflation from when I qualified in 2005, it's not a pay rise, it’s the same rate. When I qualified, I was on £25 to £30 an hour. In 2023, if someone’s on £40 an hour, they’re on the same rate I was on in 2005. So, it hasn’t gone up.”

Naturally, there are two sides to every coin. In September last year, Amish Patel at Hodgson Pharmacy said a minority of locums were guilty of “unprofessional blackmail behaviour” by delaying their application for a shift until a week or so before the start date when they would contact that pharmacy with offers to work for increased rates, knowing the pharmacy wouldn’t be able to open without a locum. Patel said he was abused on Twitter and Instagram by a group of locums after speaking out about his concerns.

“I’m not denying there are people who are unprofessional. There’s a few bad locums who give everyone a bad name,” Tohidul says. “It’s like a bell curve. You’re going to get some bad actors, you’re going to get some really good ones and you’re going to get the average.”

As Tohidul knows all too well, it’s important to keep things in perspective.