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‘Blame the bureaucrats for pharmacy going from hero to zero’

“In my opinion, Keith Ridge has serially undermined the community sector of our profession”

NHS England’s chief pharmaceutical officer has let community pharmacists down, according to Graham Phillips

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.”

26 Comments

Sri Kanaparthy, Community pharmacist

Has Keith Ridge even worked in a community pharmacy? May be he should work for at least a week before he makes decisions on community pharmacy and its future direction. 

Graham Phillips, Superintendent Pharmacist

I must respond to Keith's disingenuous reply below:

 

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.”

 

Its interesting that he doesn't deny any of my accusations.. he can't because they are all the documented truth.  But as for his damascene conversation to independent prescribing in community pharmacy (which is, of course, fast becoming a norm in Scotland). Keith did everything in his power to prevent it. I was at the CPhO annual meeting where your correspondent Hitesh Patel asked Keith that very question only to be swatted like a fly. More here: 

 

https://www.chemistanddruggist.co.uk/opinion/englands-chief-pharmaceutical-officer-has-lost-his-way

 

This man's utter hypocrisy makes Donald Trump look like a man of virtue by comparison! 

sunil maini, Community pharmacist

Mr Ridge. Please read the comments posted,and the "likes"  endorsing the comments.Have some dignity please and act on it.....

Caroline Jones, Locum pharmacist

Well done Graham, accurate evaluation. Have you considered standing for the Ridge role when that severely out of touch 'pharmacist' with his Judas views on pharmacy finally slithers off with his pockets full of NHS remmunerations??? With inexperienced or non-pharmacy leadership at the heads of the RPS, GPhC and CPO what hope has pharmacy for a fair future. We need experienced pharmacists in all these roles not blow-hard nonentities who could not find the front line let alone stand the post.in the crisis we have faced and will continue to face for many months to come. Keith Ridge is a total disgrace in the eyes of the vast majority of front line pharmacists and politicians ARE to blame for appointing such a person to the role he holds without continuing to check on the current state of his practical experience and standing within the profession he seeks to judge. I for one cannot wait for the day he goes; not with a bang but a whimper and a greasy stain. DIng dong the witch is......

H.N. BURDESS, Community pharmacist

Caroline,

Well said. Too much attention is paid to the over-inflated c.v..The rule is do not employ someone with a ph.d. because it sounds good.Common sense, experience, less reliance on acronyms and  the ability to communicate in plain English are much more important.The candidates should fill in application form in their own hand-writing which would be subject intense graphological analysis.

You are right to say the RPS and GPhC are run by non-pharmacists. I think the first task of the next CPO is to set up a pharmacy under the auspices of the said bodies. This would be a model pharmacy that achieves perfection in all aspects. We can all visit it to see how a pharmacy should be run.

 

 

 

O J, Community pharmacist

Graham has echoed my frustration which I have been highlighting for over a year.
This man has caused an uncalculated damage to the sector and the most surprising of all is his sheer arrogance. To sum it up crudely, he doesn't give a flying toss.

Chris Locum, Locum pharmacist

There was clearly a major change in policy. The government had secret talks with Amazon in the belief it could shake up the drug pricing in the UK in a significant way.

Leon The Apothecary, Student

"Secret."

Amazon looking to get into the UK Pharmacy market is very clear, in my opinion. The way companies like P2U and Rowlands are aligning themselves with aspects of Amazon for potential buyouts give a strong indication of what they are aiming to achieve.   

R A, Community pharmacist

Community Pharmacy was doomed the day when contractors started to gobble up independent chemists to build up small chain of pharmacies. This consolidation dehumanised the sector and made it easier to commoditise the sector. This benefited the few at the cost of the long term sustainability of the sector. 

In Europe its more normal to have owner operator pharmacies then large chains. This acted as a incentive for pharmacists to protect the trade of OTC in pharmacies exclusively. Therefore allowed a good source of income and safe use of medication. The fragmented nature of the sector in Europe also prevents the dominance of wholesalers like Alliance Healthcare and AAH which have a monopoly on supply of medication in UK. Or price fixing by drug manufacturers also in UK. 

If previous pharmacists and RPSGB prevented the rise of small chains leading to big chains we wouldn't be so vulnerable. Unfortunately its my generation of pharmacists who carry the toll robbed of an opportunity to build a career in community pharmacy because financial security in this sector no longer exists. 

Leon The Apothecary, Student

What would your opinion be on the socialisation of pharmacy? Run purely by government or the NHS?

R A, Community pharmacist

Whats wrong with an owner-operator model like in Continental Europe?

I can see so many advantages over socialisation of pharmacy:

1. The owner takes the capital risk therefore has an incentive to identify where a service is required. This saves the tax payer money, which is likely to be wasted. 

2. A pharmacist being responsible for the operation of specific pharmacy also allows the regulators to ACTUALLY do their job. As they can regulate individuals for failure of standards. Any chain base pharmacy creates a buffer between the operating director calling the shots and responsible for how service is carried out and the pharmacist executing these actions. Naturally the regulator holds the pharmacist responsible who are merely 'soldiers' following a chain of command from the upper tier. This is an issue that also plagues the NHS hospital so no I don't agree with socialisation of pharmacy it creates less transparency and accountability.

 

Benie I, Locum pharmacist

Ultimately pure greed which continues unabated by liars peddling lies about patient care. If you've ever been privy to meetings of these so called pioneers you'd know patient care is not even mentioned.

R A, Community pharmacist

Hi Benie, 

I agree the sector was distroyed by its own greed and the sheer incompetence of the regulators. Articles like this fails to acknolwdge this and blame the politicians, which is not the case. 

Other failures which sits on the head of the profession and the regulators is the failure to control the proliferation of pharmacy schools. The idea of training more pharmacist to create a more competitive workforce is short sighted and wrong decision. This leds to a reduction in the quality of pharmacists qualifying and devalues the profession. Unfortunately no one in the sphere of pharmacy raised concerns about this?

In contrast I found it admirable how the GMC and BMA challenged the governments idea of a 3 year med course for pharmacists/paramedics because of the impact it will have on the traditional medicine degree which are between 4 to 6 years.

The pharmacy sector lacked the collective voice to protect the sector instead it adopted a 'every man for himself' attitude which is leading to its demise. 

Benie I, Locum pharmacist

Yes, very well put. I didn't even mention the 'regulators' if you want to call them that. As soon as the big money started to roll In they jumped in bed with the corporates. Effective Regulation essentially ceased at this point and the results are what you see today; where in the middle of an unprecedented pandemic the most pressing issue for Rudkin of the GPhC was that Locums we're making too much money. Absolutely laughable. 

Invictus Maneo, Student

I have dubbed what you describe as part of the "over-corporatisation" of Pharmacy.

And let us not place the blame squarely at the feet of politicians. They vacillate with the times. Some of us bought into the short-sighted business-jargon-laden gambit of "cost-savings and efficiencies" and gift-wrapped the sector in the name of modernising it.

As CS Lewis once described:
"indeed the safest road to hell is the gradual one; the gentle slope, soft underfoot, no sudden turns, no sign-posts".

Consider the baffling idea of the "mystery shopper" in Pharmacy -- it was one step down the metaphorical safe road mentioned above. The erosion and usurpation of the Pharmacist's/RP's
real oversight capacity was gradual.

Ebers Papyrus, Pharmaceutical Adviser

Ridge should promptly be asked to explain his leadership decisions, the blunt tool of attrition was never a responsible act. Furthermore this has come from the figurehead of the profession. Funding cuts are directly proportional to reducing patient care. He has misinterpreted or better still ignored the sector’s worth through both prejudice, perceived superiority and a complete lack of engagement which persists today.

Alaistair Burt MP a co-signatory to the infamous open letter detailing the cuts has admirably accepted he was wrong. Ridge already a long-standing CPO at the time advised Burt and DH. 

The resilience and professionalism of the sector continues to show its worth and Ridge’s circle of influence is shrinking rapidly.

Invictus Maneo, Student

Two contributory factors to Graham's case for the seeming "fall" of the community sector:

1. A complete devaluation of the significance of the RP role.

2. The self-aggrandizing attitudes of some of our own colleagues who look down on being a "mere" Pharmacist and rather see a company-car-driving inflated role as more superior. But then, who would blame them given the current risk-reward ratio?

The fight is not lost yet however!

Invictus Maneo, Student

The entire concept of "clinical pharmacy" is odd and curious.

A Pharmacist is educated in the areas of Pharmaceutics, Pharmacology & Pharmacokinetics, including the fundamentals of therapeutics and drug safety.

And for added measure, in the community sector, there is the bonus of Responding to Symptoms.

Just because these apply differently in different settings does not diminish or elevate one's standing. Any arrogance thereof is wholly unwarranted.

I won't leave out Pharmacy Law & Ethics either as it particularly relates to the community sector.

Jay Doshi, Superintendent Pharmacist

Excellent summary Graham. Agree with you Uma. Perhaps Mr Keith Ridge can come and ask our patients or even our local GPs or MP or Mayor when he (Mr Ridge) has spare time.

Dave Downham, Manager

"That framework is likely to mean a combination of credentialing an existing portfolio of training and experience, necessary agreeing a personal development plan to get everyone up to the same level including independent prescribing.”

I've read the above 3 times and still don't know what it means. Is it even English? The issue is that the man is unaccountable and so go on his merry way with initiatives, frameworks and grudges against the sector and wave down at us from his ivory tower.

C A, Community pharmacist

The framework will require you to produce paperwork to justify your current experience and competence, and require you to study in areas you haven't covered to bring pharmacists up to standard. Then do it all again if you want to be an IP. 

Silly question, is Keith Ridge an IP? 

Uma Patel, Community pharmacist

We have gone from zero to hero to zero with Keith Ridge. Good riddance when he retires soon

Benie I, Locum pharmacist

Irrelevant as the damage done is terminal.

Invictus Maneo, Student

Actually, I believe it's reversible.
The GPhC will have to assign real and specific authorities to the RP.

Indeed, by statute, the company, owner and their Pharmacy conform to the RP's discretion.

Such is how far removed from first principles the profession has strayed.

Benie I, Locum pharmacist

Not sure how that will happen when the multiples seemingly direct the GPhC. 

Kevin Western, Community pharmacist

well said Graham. the man is a waste of space and resources. He is disingenuous, self promoting and completely inimicable to us. the reply to your blog is illustrative- if thats all he can think of as a positive for his entire tenure in the job, and that, an apparent wish, not an accomplishment, then wtf has he been doing?

why are we still struggling to be paid? why wasnt he arguing for more services, not less pharmacies? Not welcome in community Pharmacies? I'd love him to walk in here!

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