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