Keith Ridge, NHS England’s chief pharmaceutical officer, praised community pharmacy teams for their response to the COVID-19 crisis during a local pharmaceutical committee (LPC) conference last month. He said: “Your response…has been of the highest order…It’s been incredibly difficult…for community pharmacies but you have demonstrated your essential clinical role in the NHS.”
So, how impressed should we be by Dr Ridge’s five-star community pharmacy review?
Well, let’s consider a little bit of history here. I worked closely with Dr Ridge around a decade ago.
Let’s not forget that in 2013, C+D reported Dr Ridge had claimed there were “too many pharmacies”, and that there was a “need to think carefully about a transition to getting the right number of pharmacies, through the pharmaceutical needs assessment”. He said that a “survival of the fittest” scenario could be healthy for pharmacy.
By contrast, a year later in 2014, the environment had changed. NHS England’s community pharmacy Call to Action consultation on the role of the sector seemed incredibly positive. The original consultation document noted that pharmacies are well-used and that the sector’s ease of access is a key strength.
With the beefing up of medicines use reviews, pharmacy looked set to take centre stage in primary care. There was even growing patient dissatisfaction with access to GPs due to their increased workload.
There was an equally positive series of patient stories illustrating how community pharmacists were unsung heroes who were busily preventing life-threatening catastrophes with fantastic clinical interventions.
Then, in December 2015, the Sword of Damocles was dangled over community pharmacy. The sector went from being a pivotal clinical public health resource to – as the NHS chief executive Simon Stevens told MPs – an inefficient service that “costs something like £2.8 billion to dole out £8bn pounds worth of medicines”.
So, why did we go from hero to zero? We’ll never know, but the about-turn is notable in its extremity. And the rest, as they say is history. In my opinion, Dr Ridge has serially undermined the community sector of our profession at almost every conceivable opportunity ever since.
We were left out of policy making and denied NHS support to train as independent prescribers – unlike the merry band of “clinical” pharmacists. In 2016, Dr Ridge misled MPs at the all-party pharmacy group (APPG) by exaggerating the extent to which hub-and-spoke dispensing could reduce error rates.
He was eventually forced to issue a ‘sorry-not-sorry’ retraction. As C+D reported: “Dr Ridge apologised for being ‘inadvertently misleading’ when he used an APPG event…to compare the 3% dispensing error rate in England with a ‘0.00001%’ error rate at “large scale automated dispensing facilities in Sweden”. It was “not appropriate to draw a direct comparison” between the two countries, because of the way their error rates are recorded, he admitted.
When I established my own award-winning pharmacy back in 2010, Dr Ridge was an early VIP visitor. He was full of praise for our business and, it now seems, feigned enthusiasm when I laid out a vision for the future. Eight years later, Dr Ridge did at least acknowledge that he was not sure he was a welcome guest in community pharmacies any longer.
But for me, Dr Ridge’s ultimate betrayal of community pharmacy is in the NHS response to supporting our sector throughout the COVID-19 crisis. This was perhaps best illustrated in that webinar in March when Jill Loader, NHS England & NHS Improvement deputy director for pharmacy commissioning, insisted pharmacists should “maintain distance rather than wearing personal protective equipment (PPE) all the time”, which was Public Health England guidance at the time. Where was Dr Ridge when we really needed him?
I’ll leave the final word to the current chair of the all-party pharmacy group, Jacqueline Doyle-Price, the Conservative MP for Thurrock, Essex and a former health minister. She wrote in the Mirror last month:
“Today I am calling on the government to back the Mirror’s campaign to save family chemists…The faceless bureaucrats that run the NHS do not see the value in local pharmacies. They think there are too many of them and that some should close…Well they are wrong. Our pharmacies are at the heart of our NHS. And it is our pharmacies that have kept the NHS standing during this pandemic.”
“Faceless bureaucrats?” Who could she possibly have meant?
Graham Phillips is director of the Manor Pharmacy group
In response to this blog, NHS England drew attention to a statement from Keith Ridge delivered in a video released on September 16. He said: “I’m currently working with colleagues to develop an educational framework that will enable those existing pharmacists who want to, to accelerate their development to the same level of clinical competence. That framework is likely to mean a combination of credentialing an existing portfolio of training and experience, agreeing a personal development plan to get everyone up to the same level including independent prescribing.”