Consider the following headlines from May 2016: “Junior doctors’ strike: All-out stoppage a bleak day”, “The junior doctors’ dispute is over – but the battle against the government to save the NHS is just beginning” and “Jeremy Hunt admits junior doctors’ strike has killed his career”.
It’s clear that the British Medical Association’s (BMA) well-publicised opposition to the imposition of a new contract on junior doctors hogged the media’s attention this spring. In fact, it often overshadowed the fight against another controversial government proposal about the health service – the planned cut to community pharmacy funding in England. While at times the two struggles ran in parallel, the latter made fewer headlines and rarely garnered national TV coverage.
But with both groups continuing to face increasing workloads, financial pressures and ongoing political battles, can pharmacists do more to replicate the medical profession’s public relations strategy, in order to get the sector’s voice heard?
Strength in numbers
The Pharmacists’ Defence Association (PDA) was one organisation which did make it onto the front pages this year, after its workplace survey featured heavily in the Guardian’s investigation into alleged target pressures at Boots.
According to the PDA, it has 25,000 members, yet it is still engaged in a long-running dispute for recognition from Boots. The bone of contention is the multiple’s claim that pharmacists at its 2,500 stores are already catered for by its own union, the Boots Pharmacists’ Association (BPA).
Contrast this fractured landscape with the medical profession, where the BMA is the undisputed trade union for UK doctors – representing 168,000 members in negotiations over pay, contracts and workplace conditions.
The BMA was able to flex its muscles recently when it spearheaded the industrial action against the controversial junior doctors’ contract. But if you were hoping for the BMA to reveal its secrets, prepare to be disappointed – the doctors’ union told C+D that it is still “too sensitive” a time to share any insights from its battles with health secretary Jeremy Hunt.
Doctors and pharmacists may be going it alone for now, but that does not mean their experiences are unique.
Brian Fisher, a GP and vice chair of NHS Alliance – which represents healthcare professionals across primary care – says the government has been “making life difficult” for both professions, so both sectors are “in the same boat”. He feels the pharmacy cuts campaign would have had even more resonance if it had received similar union backing to that enjoyed by junior doctors.
“I don’t think pharmacists have the same unionised workforce as we do. That’s a real problem,” Dr Fisher says. “National representative groups need to fight for pharmacy, to fight for recognition, and to think about what opportunities there are for [the sector].”
This, he says, will in turn strengthen “how pharmacists fight against the cuts, and the [other] threats that are raised against them”.
This lack of coherent unionisation is not just a strategic problem – it can affect how community pharmacists feel about their professional standing. One respondent to the C+D Salary Survey 2016 was so disillusioned by the perceived lack of union representation that it left them unable to advocate pharmacy as a career choice.
“If pharmacists had backing similar to that of junior doctors I would perhaps recommend [this career],” they wrote. “But there is nobody fighting on our behalf.”
Success without union support
Yet without inside knowledge of the BMA’s tactics or union backing, pharmacy has still been able to replicate some of its success in its own fight against the planned funding cuts in England.
The National Pharmacy Association’s (NPA) Save Our Pharmacy campaign resulted in pharmacists from all walks of life joining forces to oppose the planned £170 million cut to the global sum. The NPA amassed a total of 2.2 million signatures from patients and the public and it claimed the resulting healthcare petition was the largest ever delivered to 10 Downing Street. The organisation even announced last week that one member of parliament in every three has since been been contacted through its ‘Email Your MP’ tool.
A key factor in these early successes seems to have been the NPA’s ability – also demonstrated by the BMA – to bring different groups together as a single voice.
“The effectiveness of the campaign so far has been partly due to the unity of purpose across the sector,” Stephen Fishwick, head of communications at the NPA, says. “This has underpinned the coordination and campaign discipline that is necessary for success.”
The differences between how doctors and pharmacists promote themselves, and how successful they are in bringing their agendas to the attention of the government, could stem from the different aims of their two biggest representative organisations.
For doctors, the BMA plays the role of both trade union and professional association. But individual community pharmacists’ professional representation body, the Royal Pharmaceutical Society (RPS), has no union role.
Community pharmacist Gerry Diamond suggests the fact that the RPS exists to support and develop its members, rather than champion their employment rights, risks leaving pharmacy “waiting on the starting blocks”. Meanwhile other health professions – such as nursing, for which the Royal College of Nursing negotiates on employment and pay – have “steamed ahead with advanced roles”, he argues.
Despite the RPS not having this dual function, it has still managed to engage in the national conversation. Its statistics show that during 2015 “the RPS and its spokespeople appeared in national and regional media on average once a day” and featured in more than “400 media clips throughout the year”. This achieved a media reach (the number of people or homes who were exposed to the organisation) of four million.
By comparison, the BMA earned 7,500 mentions in the national media in 2015, not to mention 800 mentions in parliamentary debates. But it took the first all-out doctors’ strike in the history of the NHS for the BMA to achieve its current level of media attention – a unique situation, unlikely to be replicated by community pharmacists any time soon.
The RPS insists that its own campaigning efforts have led to significant progress for the sector – and lists “gaining access to care records for community pharmacists, [and] increasing recognition of community pharmacists through delivery of services such as flu jabs” among its recent successes.
A spokesperson for the society adds: “We work with unions, trade bodies and specialist groups to ensure pharmacy has a strong professional voice, whilst respecting the different roles of these organisations.”
In an interview with C+D last month, the new RPS president, community pharmacist Martin Astbury, also pledged to continue to “make sure that all opportunities are taken” to promote the role of community pharmacy.
The NPA, which specifically supports independent community pharmacists, did not find that a lack of union backing caused unsolvable problems during its campaigning, says Mr Fishwick. Instead, he suggests that doctors’ success may be explained by their status in society, rather than more sophisticated or militant lobbying strategies.
So perhaps with a shared vision there’s still a lot that can be done, he says, adding: “The pharmacy sector has certainly shown that it is capable of organising itself into an effective lobby.”
Follow the money
Mr Fishwick may have a point about doctors’ elevated status in society. It is one thing to have “media reach”, but this counts for little unless that profile is leveraged to drive the profession forward. GPs, for example, have been able to gain control of local commissioning budgets, which Dr Fisher says has given them a political and public prominence that pharmacy is still yet to achieve.
“General practice feels itself to be part of a network now, that has responsibility for commissioning, health and wellbeing,” he says. “I would hope that pharmacy would travel in that direction.”
You can hardly blame community pharmacists for feeling left out of this network. This sentiment was reinforced in April when NHS England published its General Practice Forward View – a 60-page strategy document that, while containing occasional references to pharmacists, still served to highlight the commissioning body’s glaring lack of a similar grand vision for the profession.
NHS England’s plans for general practice will be funded with an injection of £2.4 billion a year by 2020-21 – a 14% increase in funding, a 1% rise in GPs’ pay contract for 2016-17, and a £2.16 rise in their immunisation payments. At the time, Pharmaceutical Services Negotiating Committee (PSNC) chief executive Sue Sharpe highlighted that this pay uplift was in “stark contrast” to the government’s decision to slash pharmacy’s funding.
Influencing the government
In response, NHS Alliance has called for NHS England to give community pharmacy the same financial support and profile it has shown to general practice – by developing a forward view for the sector. Until then, it will remain “the most underutilised healthcare profession in the NHS”, the organisation warns.
Earlier this year, it also called on NHS England to “pay specific attention to commissioning a community pharmacy-led new model of care, looking to fully utilise the pharmacist’s expertise within the heart of communities”.
Dr Fisher says there are good reasons why pharmacists should be given a bigger commissioning role: “There are huge opportunities for pharmacists to be part of planning [health services]. They are closer to our populations than any other professional, and they have enormous opportunities for understanding what local communities want. They could have a really significant impact on people’s health and on minor illnesses.”
The patient voice
They may not have the commissioning clout of GPs, but the proximity to patients Dr Fisher mentions may hold the secret to any success pharmacists can hope for in the face of the funding cuts.
As Mr Fishwick says, community pharmacy is a respected, trusted group that is valued by patients. It is not clear if other professions – such as time-pressed GPs – would have been able to to personally mobilise their patients to the degree seen during the cuts campaign.
“We shouldn’t underestimate the importance of patient advocacy,” Mr Fishwick adds. “Patients have the most to lose from the Department of Health’s [funding] proposals, and the bond of trust that exists between pharmacists and patients provides a base level of public support that is crucial to this, and any future influencing campaign.”
If positive change comes out of the campaign, it will be partly due to the concerted efforts of community pharmacists, who are making the case for protecting their profession. The hope is that the public outcry and tireless campaigning from pharmacists will ultimately result in the sector being put on a similar footing – in terms of funding and how they are perceived – to their medical colleagues.
With parliament in recess until September, we will have to wait and see if the new pharmacy minister, David Mowat, decides to opt for cuts or a change of course. Only then will we know if pharmacists’ voices are truly being heard.