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‘I'm incandescent every time a pharmacy colleague is lost to COVID-19'

“Pharmacies are intimate environments necessitating close patient contact”

NHS England must provide community pharmacy teams with the personal protective equipment (PPE) they need or there will be more deaths, says Graham Phillips

The COVID-19 outbreak first hit the UK in early March. On NHS England advice, GPs locked their doors and practiced from the relative safety of telephone triages and online consultations.

Community pharmacies kept their doors open but have so far been more or less ignored by the NHS. NHS England held a primary care webinar on March 19, with subsequent webinars held on a weekly basis. Frustrated at the lack of information and support available to community pharmacy teams, I joined the webinar and asked some community pharmacy related questions – none of which were answered.

In frustration I tweeted NHS England director of primary care Dr Nikita Kanani to ask why community pharmacy had been ignored with none of our questions answered. The response was that it was a GP preparedness webinar and that a pharmacy webinar had already been held. Clearly the NHS thinks that primary care equates to general practice alone.

Nonplussed, I asked for the link to the pharmacy webinar but received no response. I couldn’t find evidence that a community pharmacy webinar had been held. Eventually, maybe out of embarrassment, NHS England eventually held its first community pharmacy preparedness webinar on March 25. This went over all of our questions but provided almost no answers. Keith Ridge, NHS England’s chief pharmaceutical officer, spent the first five minutes outlining a comprehensive raft of issues.

The rest of the webinar felt to me like a Kafkaesque exercise in obfuscation. I could not discern a satisfying answer to one of the questions that Mr Ridge had outlined at the start, with the conspicuous exception of the key issue of PPE. NHS England deputy director for pharmacy commissioning Jill Loader insisted that there was limited or no requirement for PPE in community pharmacies because teams can maintain two metres of social distance.

So far, so bad. On April 8, a second community pharmacy webinar was held which, in fairness, did provide some clarity. But once again, the advice to socially distance instead of wear PPE was repeated.

Ms Loader said that community pharmacies would have to pay for their masks. No explanation was given as to why pharmacy, uniquely within the NHS, has to source and pay for its PPE.

In the third webinar on April 22, the thorny subject of PPE was simply ignored.

Meanwhile, community pharmacists and their teams continue to put themselves at risk of exposure to the virus. It comes as no surprise that many end up with COVID-19 infections as a result. To date, at least five community pharmacy workers have died.

This is personal for me. One of my regular locums ended up in intensive care, on a ventilator, with a tracheotomy. They survived, just, but who knows whether they will return to full health?

I am so saddened by the tragic loss of life of my colleagues. Yet, with every life lost I become incandescent with rage that NHS England and Mr Ridge still continue to insist that community pharmacy teams don't need PPE if they can maintain social distancing in community pharmacy.

Anyone who has worked in a community pharmacy knows it is an intimate environment that necessitates close contact with patients as well as between members of the pharmacy team.

Are these people so divorced from the reality of community pharmacy practice they can't recognise this? Or are they simply not prepared to acknowledge this inconvenient truth for political reasons? One reason for their reaction could be that recognising the reality disturbs the narrative that community pharmacists simply "dole out" medicines, which is what NHS chief executive Simon Stevens told the Public Accounts Committee in 2016.

Mr Ridge, Ms Loader et al need to be challenged on what evidence supports their stance. Mr Ridge and various members of his team are General Pharmaceutical Council (GPhC) regulants. As a pharmacist myself, I would expect the GPhC to come knocking if I were to expose my teams and the public to this lethal infection in such a cavalier way.

In a final act of disdain, it came as a surprise to none of us that the Department of Health and Social Care (DH) initially excluded community pharmacists from NHS England’s £60,000 “death in service” compensation.

How many more community pharmacy lives will be scarified unless we speak truth to power?

Graham Phillips is director of the Manor Pharmacy group

8 Comments

R Jain, Community pharmacist

Mr Phillips' detailed timeline of the actions NHS England took with, limited, respect to community pharmacy is just, frank and the truth. 

I strongly believe that the UK public would have been looking at more severe outcomes compared to the tragic losses we observe today if community pharmacy had also closed its doors.

There have been systematic failings in future planning and thought processes for community pharmacy, its integration into the NHS and public health delivery, over the past ten years. Many local ideas for innovation and working for public health delivery fail to be recognised due lack of knowledge of what pharmacists are capable of undertaking and acheiving and to the supply nature of the pharmacy contract. The NHS 'Five Year Forward View' launched in 2014 has ended to not much benefit to the sector. 

Still, in 20 years, I cannot understand why individual contractors settle for a contract that is negotiated with no input. What do you pay your LPC fees for? LPC's - do you listen to your local contractors? 

We need cohesion within our leaders now. Where leadership has been publicly shown by Chief Medical Officers, there has been silence from the Chief Pharmaceutical Officer. The guidance that has been delivered has been without detailed thought of our physical and mental working environments. I only trust he has been working hard in the background in a proactive manner to look after all aspects of the profession. A reactive response (death in service announcement) looked weak. A full statement explaining the delay would have allayed the concerns that all community pharmacy staff have during this period. 

A strong leader is only as good as his comrades that they look after. The comrades need to be fair to each other - I know this does not happen with the presence of the large multiples alongside individual independants... Just for once, any localised politics at professional body director levels need to pushed to one side for the greater good of the sector. Show leadership and management, please. 

https://publichealthmatters.blog.gov.uk/2019/06/28/pharmacy-playing-a-pivotal-role-in-prevention-and-public-health/

N O, Pharmaceutical Adviser

""Still, in 20 years, I cannot understand why individual contractors settle for a contract that is negotiated with no input. What do you pay your LPC fees for? LPC's - do you listen to your local contractors? ""

Unfortunately, the independents have no choice. They can't even take strike action or sue a wholesaler for not giving any discounts on Branded Items (reduced wholer discount items)

Do you have any viable idea?

mark straughton, Pharmaceutical Adviser

The systematic failing and lack of forward thinking in the community pharmacy sector is true and correct. But for those community pharmacists the outlook is a lot worse. Dispensing remuneration is nose diving and remuneration for professional services are not enough to cover the average pharmacist wage so are not viable. There's the threat of remote supervision, a massive supply of pharmacists filtering through and the corporate drive with multiples. What is the way out?

We're well past respect/cohesion/protection/leadership from any NHS bodies or politicians. We're really not in the main picture and we sit on the periphery despite us being the 3rd largest healthcare workforce in numbers.

The lack of knowledge of what pharmacist can do is all down to the ultimate conunderum that pharmacists can't check voulmes of prescriptions and embrace services at the same time; but its not viable for businesses to employ 2 pharmacists at the same time (unless theres a reduction in pharmacist wage).

This problem has been around in my head for years and if anyone has a realistic way around it then I welcome your views.

Lucky Ex-Locum, Superintendent Pharmacist

Just to be pedantic, I think you mean 'sacrificed' not 'scarified' because moss certainly never grows on us!

Kevin Western, Community pharmacist

The problem, Graham is, that there is NO ONE who has the access to "power" who will talk to them as you have just written. its all far too friendly. Every other sector has been out there in the media lambasting the DoH and Ministers for their failings but the culture of "dont rock the boat" ingrained in Pharmacy is stopping that happening, consequently the DoH , with no publicity to worry about are happy to continue trampling Pharmacy into the mud. 

Who cares, its only Pharmacists.... they are only shopkeepers arent they? 

Lucky Ex-Locum, Superintendent Pharmacist

Pharmacy is not, has never been and never will be 'part of the NHS'. We are not directly funded by the NHS as the other sectors are and are only considered as part of the 'in' crowd when something is wanted of us. Other than that we are firmly put in our place on the outside looking in.

I'm surprised it's as few as five deaths tbh. Given that we are coughed on more than anyone, the wonder is we don't all have it, and for Ridge to say we don't need PPE because we can maintain social distancing just shows his total lack of knowledge of how pharmacy actually works. Maybe in the sort of swanky establishments he goes to there is space, but if he was to go to some of the smaller, vital high street pharmacies in town and city centres he would quickly realise the impossibility. I have worked in many dispensaries where, to be two metres away from everyone else, you would need to be the other side of the wall. In my opinion though, PPE is a bit of a waste of time, given the hours we work.

mark straughton, Pharmaceutical Adviser

What a calamity! Sad to hear about the locum here. The only confidence that I have is that the statistics in terms of mortality rates are entirely in our favour and incidents are few and far between.

Forgive my ignorance, but wasn't there a system which enabled pharmacy team to purchase any PPE they need and construct any safety barriers in a pharmacy then get it reimbursed? It's not an excuse or a let off for govt mind, I just hope if so pharmacy teams were all aware of this.

Lucky Ex-Locum, Superintendent Pharmacist

Safety barriers are pointless because patients just lean around them to talk to you, masks only help to stop you infecting someone else, not vice versa (and the vast majority of customers aren't wearing them), plastic aprons are so thin and wafty they probably make the situation worse, gloves make your skin peel and also make you feel artificially protected (a glove can pass the infection to the face just as easily as a hand) so as things are, PPE isn't worth the effort. Just keep washing and gelling until your hands bleed and hope for the best. I'm relying on the assumption that my immune system is always in a state of high alert to jump onto any infection quickly - I've not had a cold for two years, never had the flu, so something must work.

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