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Hemant Patel: Contractors and pharmacists must cooperate

“The relationship should be one of mutual reliance”

The relationship between these two professional groups needs to change, says Hemant Patel

When reading comments on the C+D website, it’s disappointing to pick up a discord between contractors and employee pharmacists. At first glance, it may look like an open war, but I am not sure it is an accurate reflection of tensions on the ground. It is clear, however, that something needs to change.

It is vital we improve relationships between pharmacists and contractors – their cooperation is essential to provide a high quality service for patients. The bitterness that is adversely affecting the profession and patient care can be resolved, but it requires a different way of thinking. The future model for pharmacy relies on knowledge-based services, trust and continuity of personal relationships. It will demand a different relationship between these two professional groups that work alongside each other.

Managing professional relationships is vital to business and success, with strong relationships leading to greater happiness and productivity. To reap these benefits on both sides, there is a need to change the dynamics.

The relationship should be one of mutual reliance. The contractor is relying upon the pharmacist to perform an agreed job, which is to keep the pharmacy running smoothly. The pharmacist is relying upon the contractor to earn a living. But in community pharmacy there is more to it. The contractor brings the necessary business expertise and financial investment and hence takes a risk in hope of a return. The pharmacist brings the expertise and hopes for a fair wage and fair treatment.

Just as with all professional relationships, this is one that must develop over time. However, there is little time before the new funding settlement comes into play in October. Contractors and pharmacists must promote the building of this relationship by being open with each other – sharing information about finances and their own lives. At the same time, the value of knowledge is increasing rapidly in the NHS and in society.

There is an urgent need to reconnect, recognise and reward pharmacists. The transformation of this important relationship is in the interests of the public, and indeed the profession, in order to ensure that patients benefit from the best their community pharmacy can offer.

Hemant Patel is the secretary for North East London LPC
 

What is the relationship between pharmacists and the contractor like in your pharmacy?

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30 Comments

Shaun Steren, Pharmaceutical Adviser

Hemant, I want the two things that are fundamentally absent from community pharmacy - honesty and evidence. What actually happens in a typical pharmacy (I have worked in well over a hundred) does not remotely resemble the descriptions given by corporate management, the RPS, the PSNC, the pharmacy minister or the pharmacy media. The descriptions are so incredibly inaccurate as to be knowingly disingenuous. 

1) The typical community pharmacy is badly designed, badly organised, physically dirty, understaffed and operated inefficiently. The majority of pharmacies I have worked in can be described as chaotic and dysfunctional. This chaos has become so normalised that is has become invisible. If anybody has worked in over fifty pharmacies in say the last ten years and they say this is not true, they are either a liar, of very low professional standards or so intellectually deficient as to be dangerous. 

2) The evidence base for the cost effectiveness of 'clinical services' is absent. I will happily debate anybody in exacting detail regarding the evidence base for the cost-effectiveness of NMS and MURs - you will lose very badly. Don't even go near the efficacy of OTC products and the long-term behaviour changing effects of 'healthy living advice'.

3) The culture of community pharmacy is one of box-ticking. Not only is there no evidence for what we do, what we actually do is not the same as that set out by the inordinate number of specifications. We pretend that MURs are carried out as detailed 30 minute reviews, we pretend that P medicine sales are carried out with detailed questioning and whilst under the supervision of the pharmacist, we pretend that SOPs are being followed and we pretend because what is specified is not physically possible and would not improve things if it were. 

Want to stop the negativity, the anger, the apathy? Suppress the corporate manager/politician bullsh*t speak and encourage brutally honest discourse based on the reality of the shop-floor and robust empirical evidence. 

Hemant, for what it is worth from an anonymous poster, I thank you for writing this piece and I can see that at this stage in your career, you have nothing else to gain by writing this other than to try and improve things for the profession. 

Hemant Patel, Community pharmacist

Shaun, clearly there is work to be done. At a number of levels.

1 Relationships between pharmacists and employers

2 Physical layouts which are fit for purpose

3 Purpose needs to be clarified and practice made evidence based.

Your recent experience is impressive and I am interested in hearing how we help move the mindset and the practice to a new reality defined by people with passion and energy like you and me.

Shaun Steren, Pharmaceutical Adviser

Scotland’s chief pharmacist Bill Scott took the stage to explain his vision for healthcare. “The model we have got now is not fit for the 21st century,” professor Scott warned, arguing that the current remuneration model – in which pharmacy owners are paid for contracted services – was a rate-limiting step to pharmacy’s success. Professor Scott said he had been considering how to contract for the future given the fundamental shifts in pharmacy practice toward service delivery. His solution was to split the current contract into two pathways.

 

The first would see payments continue as normal, with the NHS contracting pharmacy owners for premises, stock equipment and support staff. But the second pathway would see an NHS contract with individual pharmacists directly to provide professional clinical services. Pharmacists would have a patient register, with remuneration based on the number of patients on their list.The proposal, professor Scott argued, would create a win-win situation for pharmacy owners, pharmacists and patients. It would still reward pharmacy owners who invested in their pharmacies and staff, but would remove the “perverse” performance indicators driven by turnover, professor Scott said. For pharmacists, it would facilitate professionalism and independence, as well as supporting the continuity of patient care, he claimed. The model could also encompass locums, as there was no reason they could not be contracted for clinical services, and larger multiples could form ‘group practices’, allowing pharmacists at a store to share lists, professor Scott explained.

 

The proposal would also allow the sector to be seen equally by other healthcare professionals, he suggested. “Not only do GPs insult you by calling you shopkeepers, but also they say the only thing you’re interested in is money. You wonder why we have an uphill struggle – I say it’s part of the current model.”But to achieve the end result, some pharmacies needed to modernise and begin to offer services, Mr Scott added. “There are some pharmacies that if a martian were to land he couldn’t tell the difference between a  pharmacy and a pig sty. We must get rid of them.” 

 

 

See more at: http://www.chemistanddruggist.co.uk/news/individual-pharmacist-contracts

Shaun Steren, Pharmaceutical Adviser

That was written in 2010. Devoid of corporate management/politician bullsh*t speak, speaks of the reality of the shopfloor and indentifies the perverse target driven profiteering culture of community pharmacy. Every pharmacist on the shopfloor knows exactly what needs to be done to truly help the patient/tax payer, there is no mystery, just vested interests focussed on profit and self-promotion. 

Harry Tolly, Pharmacist

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Chemical Mistry, Information Technology

Give him credit for saying it, but like all before too little to late !

Hemant Patel, Community pharmacist

Kevin, it is too late for those who are retired or about to retire but I am sure that it would give them joy to see that the next generation does not have to go through the nonsense that we have had to go through. My back and knees are gone, doing things is a bit more difficult, soon I would be left to pasture but it would be a great feeling to know that I played a part on establishing a new platform for intra-professional dialogue. What will it take to have the likes of you onboard?

Angela Channing, Community pharmacist

You and all the others at the RPSGB had your chance, H, and you all blew it! Too late now! Sorry. 

Hemant Patel, Community pharmacist

Angela, I have blown a lot of things in life and probably continue to do so. But, I am keen to ackowledge my mistakes made innocently or otherwise and more critically learn new things. That new thing is keep an open mind and work with those who have created space in their lives to keep moving forward and engage with all those who are ready to create an alliance for change. I ask you too, what change do you want to see? And, what are you prepared to do to achieve it. Harry engages and I will be publishing a radical idea which I hope the contractors would agree to. But, I will not live in 'yesteryear' and with anger and bitterness. Still Passionate about pharmacy and forgiving of those who may have wronged me. You and I have an opportunity to be radical at this time as we are unconstrained by the forces of pressure at the core of politics. So, let us be creative and inspiring. I hope you will not blow the chance as mant have done in the past.

London Locum, Locum pharmacist

That Credit is limited when he is speaking out is only for his own self serving needs. What's the urgency now? Why wasn't this mentioned a few years ago when his fellow professionals really needed it? I think we know the answer....

Hemant Patel, Community pharmacist

I seek no credit and accept blame for the part I might have played in creating the current culture. I am not a pharmacy owner so do not get the point about self-serving and I do not make anonymous comments. The urgency was not created by me but by the comments on this platform which saddened me. Whatever the position, in UK we have fair-minded people who will work for fairness. You ahve a simple choice: be a sceptic forever or join hands with those who want to more than just blurt out the frustration. Innuendo at the end of the msg does not help anyone. Specify what it would take for the contractors and employees to work with a common purpose in a fair society. I would not did not respect those who abused the situation and reduced locum rates or treat them badly. Would you suport a pharmacy contract stipulating a minimum hourly rate which is seen to be fair by both parties? Write to DH now.

London Locum, Locum pharmacist

See above.

London Locum, Locum pharmacist

See above.

Harry Tolly, Pharmacist

Mr Patel, its great that you have come back to engage on this matter. BUT the issue is not really merely about pay. No Sir. Its really about the alienation and powerlessness that employees or locums feel. Joe Bloggs pharmacist feels totally unrepresented. Let me give you a stark example. In 2009, with great fanfare and huge writeups, the RPS convened a workplace pressures symposium. The great and good all said something needed to be done. Then, quietly and without debate, it was dropped with a passing of the buck to the PSNC. I ask you, the PSNC ? Will turkeys vote for Christmas ? To date NOT ONE issue from that symposium has been addressed. NOT ONE SINGLE ISSUE. This is just one example of many, and this is why there is such widespread disillusionment within the profession. ............................................................................................................................................................

http://www.rpharms.com/current-campaigns-pdfs/workplacepressures.pdf

Hemant Patel, Community pharmacist

Fulfillment in life is imprtant. I cannot change everything in pharmacy but I am trying locally. Just ask employees in NE London. We have three employees on our LPC in their own right. Despite Locum Locum's comment's I'm going to continue as I feel strongly for the cause of contractor/employee (in my view employees should be associates like in law firms and surgeries) relationship. Without a relationship based on new 'rules' and 'perceptions' both the sides will lose to others. That is not a thinkable legacy.

I firmly believe that any man's finest hour, the greatest fulfillment of all that he holds dear, is that moment when he has worked his heart out in a good cause and lies exhausted on the field of battle - victorious. Vince Lombardi

London Locum, Locum pharmacist

Great post Harry. Nothing was done as it was not in the interest of multiples and contractors.   But as soon as a cut is announced about their bottom line the petitions are dawn up, people are up in arms. Even a hilarious suggestion is made about striking. Who are called to back these actions? Oh yes those employees/locums from the workplace pressure symposium. Give me a break....

Shaun Steren, Pharmaceutical Adviser

I applaud Mr Patel for writing this piece. Employee/locum pharmacists  are the largest group of pharmacists within community pharmacy. However, you would think they didn't exist when you consider the complete absence of their perspective in the pharmacy media and corridors of power . Mr Patel refers to the comments section, indeed he would have to, nowhere else is the shop floor reality of employees/locums being discussed. 

 

 

 

 

Hemant Patel, Community pharmacist

Shaun, i would like to think that we are in a transition. A deeper recognition that knowledge and product needs together to produce an outcome is taking place. So, it makes sense to re-align the partnership based on trust, respect, and fairness. If these three things were important to you what would the world under your control look like?

David Lewis, Community pharmacist

Oh for an ideal world.  Why do I read comments like this and always get that feeling that the people at the top of the totem pole (who are suposed to represent us all) are so out of touch with reality they should be on TV - in a reality show!!  'Divide and conquer' has been the mantra for ages, 'corporate bullying' is massive but our 'leaders' seem to have missed it all. 

Hemant Patel, Community pharmacist

David, broad generalisations give a picture. I get your point and am speaking as an employee. When Catholics and Protestants in NI, Blacks and Whites in SA, Greeks and Turks can sit down together and build a future, why can't we when the opportunities are greater. Help me replace anger with handshake of conciliation leading to a more secure future for both. What would it take to get your support?

London Locum, Locum pharmacist

They need you now David to help them maintain their profits so all is forgotten. UNITY is the name of the game. You terrible cynic you. 

Shaun Steren, Pharmaceutical Adviser

LL, I agree, many contractors have never given a toss about employee/locum pharmacists, whether that be their working conditions, wages or professional prospects. In fact many considered it a zero sum relationship: as wages dropped their costs fell and as jobs became more scarce they were emboldened to bully more aggressively. Of course they dressed up this 'competition' as the 'cream rising to the top'. With extreme hypocrisy they now renounce this sort of competition for themselves and with extreme audacity ask us to now support them. Mr Patel, for reasons he can explain, suggests that the comments pages are not representative of the relationships between contractors and employees. I agree, such is the hostility, the majority of employees would have their comments removed if they were to present their honest opinion. I have attended many 'managers meetings' over the years and on every single occasion when the managers were left on their own, extreme animosity and anger was expressed (with profanity) towards their corporate employers. This estrangement within the profession is irreversible and the arrogant comments made on here by contractors further seal this disconnect. How should employees/locum relate to contractors - through aggressive trade unionism. Employee/locum pharmacists ought to unify and fight back. We should fight them aggressively on every single issue relating to individual workloads. We should fight them aggressively on every single issue relating to staffing levels. We should fight them aggressively on every single case of profiteering through targets. We should whistle blow to the NHS fraud unit on every single example of fraud we encounter. We should whistle blow to the national newspapers about the dangerous working conditions that put patient safety at risk. We should whistle blow to all media about the real cost to the taxpayer for those two minute MUR/NMS chats and the complete absence of evidence for these pseudo-clinical services. Employee/locum pharmacists should be energised by the power of social media. Did you remember how that single Facebook message by a mother discussing 'free paracetamol' via her local minor ailments service led to an explosion of requests across the country? Why not whistle blow through social media and explain how every time somebody has one of those  brief little chats - £28 is lifted from thier pocket without their knowledge. I suggest this would also go viral. When you think about the contractor-employee/locum relationship in this context, you can very much understand why they want us silenced and subjugated, we can be very dangerous. 

 

 

 

London Locum, Locum pharmacist

Haha. Oh is it Important now? Nothing to do with the fact pharmacists' support is required by contractors for petitions etc.... Was it not important before when workplace conditions and pay were(and are still being) eroded ?

Hemant Patel, Community pharmacist

We cannot build a future whilst looking back and being sarcastic. If change does not begin with you then who should it begin with? If not now then when? I wrote because I care about the profession not the division. So, what is your proposal to bring two important interests together?

London Locum, Locum pharmacist

Professional respect and autonomy in the workplace. I think that is a good foundation. Something which is lacking in many pharmacies. No more bullying from non-pharmacists regarding ridiculous targets(MURs and NMS). How does a non-pharmacy manger know if a review is clinically necessary? Adequate staffing to cope with the increasing workload. No future is possible whilst the above and more go unaddressed. So do not be surprised by any apathy of disdain exhibited by employees/locums.

Chris ., Community pharmacist

Over to you Sami.....

Harry Tolly, Pharmacist

The contractor brings the necessary business expertise and financial investment and hence takes a risk in hope of a return. The pharmacist brings the expertise and hopes for a fair wage and fair treatment.

 

Well, the multiple contractors are NOT treating pharmacists fairly or well or professionally. Bullying is endemic. And with the droves coming out from the Universities the employee pharmacists have little choice but to put up with all the rubbish thrown at them.

 

AND you forgot the biggest problem :  SMART intelligent young pharmacists are being prevented from bringing their knowledge, expertise and willingness to be innovative as self employed contractors .... by virtue of the CONTROL OF ENTRY regulations that is now proposing gifting local area monopolies to contractors.

 

You well know the Kings Fund report from a decade ago which showed that Independents were more innovative and more likely to be receptive to and delivering new services (that report seems to have been buried). Noted that Boots is now a donor to the Kings Fund.

 

Let all pharmacists compete on a level playing field IN THE PUBLIC INTEREST. What are exsting contractors so scared of ?

Harry Tolly, Pharmacist

PS . Mr Patel, I am grateful that you have brought this topic up.

 

We need a series of articles to put into perspective WHY there is such disillusionment and  DISCONNECT between employees and contractors (and by contractors I mean essentially the multiples).

 

Lets have an open and honest dialogue.

Hemant Patel, Community pharmacist

Happy to oblige. Whilst there is some disillusionment on both sides, is it not a good time to shape future by a constructive dialogue. NEL LPC has had three (3) Employee reps on the LPC and they make a good contribution to development of local services.

V K P, Community pharmacist

to have an open dialogue mr Harry, the questioning technique has to change from using WHY to HOW. 

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