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Dilip Joshi was named as Advocate of the Year in the Independent Pharmacy Awards 2013. He is a pharmacist who has equipped himself for practice in the modern age and who is trying to promote the conditions for practitioners to fulfil their potential. Douglas Simpson went to Dilip's pharmacy in South London to find out about the man and his mission

Dilip describes himself as a bit of a late developer, when it comes to pharmacy. He decided on the profession after careers advice at school and did not really know what the pharmacy course involved until he was on it at Leicester school of pharmacy. He enjoyed his time at Leicester, he says, and graduated in 1981.

Preregistration was with a small independent €“ Elmfield Drugs in Canning Town in East London.

€It was a very busy pharmacy and I have memories of whole seas of faces €“ of people waiting for their prescriptions to be dispensed. It could be quite daunting.€

He learnt, he says, to adopt a neutral approach when giving the results of such things as pregnancy tests. €Some people are happy to receive the news; others not.€ This was an early lesson in diplomacy.

Dilip carried on working for the same company (in a branch in Forest Gate) after registering.

He was, he says, able to manage the pharmacy as if it were his own. He had a say in buying for the shop and was often able, he claims, to get better deals for his one shop than the company could achieve for the rest.

He had thus honed his diplomacy skills further €“ this time with pharmaceutical company reps.

But Dilip did not see a long-term future in managing other people's pharmacies and bought his own business after 18 months. It was in Sydenham, South East London. This was eventually relocated into a nearby Sainsbury's Savacentre where Dilip practised for five years until 2000, when Sainsbury's decided to run their own operation.

In the meantime, Dilip had acquired a couple of other pharmacies in Brixton and Clapham, South West London, one of which he moved to its current location eight years ago. The other he sold.

His current business, Boss Pharmacy, is in Bedford Rd, Clapham. It is in a housing area between two doctors' surgeries. There are no nearby shops. Dilip says he has an excellent working relationship with both surgeries.

The pharmacy's inventory is all health-related and the focus is entirely on health care. There is a consulting room, a small office, and a consultation point where discreet conversations can be held, as well as the dispensary and shop area.

_{STAFF AT BOSS PHARMACY (Left to right) Swapnika Kamarapu (counter assistant), Geri Banahene (Health Champion), Narges Shahrbaf (pharmacist on duty), Manish Deshpande (dispensary technician) and Joshna Sachania (dispensary assistant)}

Dilip's aspiration is that his pharmacy should be a centre of excellence. It is accredited to provide all the services commissioned by the local clinical commissioning group (and, before that, the primary care trust) €“ emergency hormonal contraception, smoking cessation, NHS health checks and the like. It is also a Healthy Living Pharmacy.

Boss pharmacy was involved with a local surgery in a cancer detection project that attracted official attention and was mentioned in a government White Paper. This saw the handing out of specially devised leaflets to people buying medicines for such symptoms as persistent cough, unresolved stomach complaints and rectal bleeding, advising them to seek screening tests.

Advocacy role

Dilip got into pharmacy advocacy by being elected to Lambeth, Southwark and Lewisham local pharmaceutical committee 25 years ago. In the early days, he says, the LPC was just a talking shop. But over the years it has evolved €“ as have other LPCs €“ into something totally different. He is now chairman.

€We changed the LPC so that it was engaging with commissioners a lot better. We started meeting in Lower Marsh, Waterloo, where the PCT and its forerunner the family health services authority (FHSA) had offices. This helped us build up relationships. We kind of grew up together.€

Dilip developed his advocacy role further when he was elected to the Pharmaceutical Services Negotiating Committee in 1998.

His decision to stand for the PSNC marked a step change in the development of his personal career. At the time, he owned three pharmacies and the issue was whether he was going to expand and own more or seek fulfilment in some other direction. He decided on the latter course and stood for the PSNC.

He was on the committee for 12 years and was its vice-chairman for three. He served for a time on the negotiating team that met the Department of Health on contract issues.

Dilip's representative role expanded further when he was elected to the board of the National Pharmacy Association in 2004, serving as chairman in 2007.

During the course of his representative duties, Dilip has hosted two royal visits €“ the Duke of Kent to a Surrey pharmacy and the Duke of Edinburgh to his pharmacy in Clapham.

The Clapham pharmacy also made an appearance in the Michael Moore film Sicko, which contrasted healthcare in the United States with that in the UK and Europe.

During his time on the NPA board the organisation changed course to refocus its efforts on independent pharmacy rather than seeking to represent community pharmacy in general, which had been policy in recent years.

This, he believes, will enhance the value of the NPA as a resource for the independent sector.

On the issue of representing community pharmacy generally, Dilip feels that unity is key.

€What external stakeholders like the Department of Health need is one strong voice coming from pharmacy. So we need to be careful what is put out in our name. It is no good a variety of bodies putting out a variety of views. Now is the time to work together.

€When I was chair of the NPA, we hosted a meeting of the chairs and the chief executives of the principal pharmacy organisations. This kind of event can be used to co-ordinate responses on key issues. If one body has particular expertise in a particular area it can be chosen to lead on it on behalf of all.€

Achievements

Is there anything he is particularly proud of in his advocacy role?

€Raising the profile of pharmacy within the Lambeth, Southwark and Lewisham area in particular. GPs largely shape policy and they are starting to listen much more than they used to. I am also pleased with the development of local pharmacy forums, which we started in North Lambeth, as an accredited training medium for pharmacists. We got people from the commissioning side to attend as guests at sessions on mental health and diabetes, important areas for commissioners. They saw the high quality of the training. We were saying to commissioners: 'Here is a skilled workforce, use us'. Getting that message across to those stakeholders was one of the biggest things that we did.€

That kind of initiative is ongoing, with forum meetings still taking place on a regular basis. Other LPCs have adopted the idea as well, Dilip says.

Another area where the LPC has taken the lead is in Lambeth, becoming the only London borough to acquire HLP status.

€This has helped to ensure that no services have been decommissioned in Lambeth, Southwark and Lewisham. In fact, the opposite has been the case.€

Any big successes on the PSNC or NPA front?

€I was there when the new contract was shaped; though I don't know whether some colleagues regard that as a success! We were in a difficult place at the time because the DoH wanted to look at the supply chain very closely and the feeling was that pharmacists were making un-covenanted profits. The DoH wanted to deal with that in isolation. One of the big successes was to link fair remuneration for pharmacists, based on the cost of providing the service, with the supply chain issue.€

Any disappointments?

€Having to give up the prescription thresholds that protected small contractors. This created great difficulties for small contractors, many of whom were providing an excellent service.€

Another disappointment was the so-called 'balanced package of measures' that changed the control of entry rules. €This led to the fiasco of 100-hour pharmacies.€

Is he pursuing any campaigns at the present time?

€Yes, a couple. Pharmacies are very often the first port of call for common conditions but, in deprived areas in particular, people will go to their GP because paying for medicines is a significant barrier. We have a local scheme where patients, normally exempt from prescription charges, are able to access a range of medicines through pharmacy without payment. We have been campaigning for the scheme to be extended with a wider formulary of products.

€We are also lobbying for pharmacy to become truly integrated into care pathways rather than being used on an ad hoc basis for specific elements of services.€

Personal development

Dilip has an MBA. Why did he embark on this course?

€I wanted to enrich my experience, which also applies to the diploma in marketing that I did after the MBA. I had no illusions about being headhunted in the city or anything like that, but it has enabled me to gain a better understanding of business issues, which has helped me in my advocacy role as well as in my business.€

Dilip is also an independent prescriber.

€We want to develop the role of the community pharmacist. And this is one way of doing it.€

A project resulting from that had Dilip in his consultation room in his Clapham pharmacy with a direct link to a nearby surgery reviewing asthma patients in depth, including performing spirometry. €For us this was groundbreaking as, using British Thoracic Society (BTS) guidelines, I could change prescriptions. We were offering real value. We were picking up possible cases of COPD which had been diagnosed as asthma. We referred them back for further investigation.€

Even though the project was a success, and was written up as such in Health Service Journal, it has not been repeated.

€This is frustrating. Funding is always an issue. We have to find some way of making these things, when they are proved to be of value, sustainable.€

Dilip is not able to use his prescribing skills at present because there is no prescribing budget for pharmacy to tap into.

Sustainability is an issue that Dilip feels very strongly about. It is all very well having such projects as his asthma review project and such things as 'Ask Your Pharmacist' week. But they are of little value, he believes, if they do not inform what happens day in and day out. The future of pharmacy lies in practice change feeding into the patient care pathway rather than a series of ad hoc projects, occasional tests and PR weeks, Dilip states.

He declares: €Pharmacists should be used in a much more imaginative way. Some secondary care procedures could be diverted into GP surgeries and capacity in those surgeries could be freed up by diverting some activities to pharmacies. People like easily accessible services, so patients could be expected to welcome such developments.€

Dilip is hoping that the advent of the health and wellbeing boards will foster such changes.