Counter culture

My guest this month is a woman who has spent the past 42 years moving with the times in community pharmacy, helping thousands of patients and generally flying the flag for our intrepid pharmacists. Now that the kettle has reached optimum temperature and the biscuit tin has been prized open, it’s time for me to say a big hello to Rekha.

It’s vaccination season! How are things going?
Every year I see that our targets increase nationally and in London and our uptake keeps getting higher and that’s really good to see. Getting media coverage about the associated benefits for the population has also helped to spread knowledge about the flu jab. In the last couple of years, we have seen a much larger year on year increase in people taking it, mainly due to the pandemic. Greater general awareness of vaccinations and people paying much more attention to messages emerging from the Department of Health has also made a huge impact.

Does that help to boost levels of trust in the community?
Familiarity breeds trust and return rates have definitely increased. People are more likely to come back to the same pharmacy or the pharmacy service in general next year and the year after. They are also more likely to recommend it to friends and family, following their own experiences. Consequently, flu vaccine uptake in pharmacy – as a proportion of the national uptake – has increased from less than 10%, when we first started out on the national programme, to 30% this year.

That equates to 600,000 pharmacy-administered vaccinations across London. It informs the public that pharmacists are these highly trained healthcare professionals with exceptional abilities. That knowledge of exactly what a pharmacist is will only continue to increase in the next few years.

How has COVID-19 hastened change in pharmacies?
The last couple of years has included front end services, such as pharmacy consultations and providing advice to patients who have common conditions. These can often be efficiently and quickly managed by the pharmacist.

Crucially, it’s the right help, in the right place, at the right time. I have seen public confidence grow very quickly during this period and we should be able to get to a point where patients self-refer themselves to a pharmacist. In certain circumstances that pharmacist would then be able to prescribe for a range of conditions or provide signposting to more appropriate care if needed. This would immediately release the burden on other aspects of primary care.

How important is it for the pharmacist to be widely demystified?
It would be great if universal messages about the capacity of the pharmacist to embrace extra responsibilities got through and into the public consciousness. Ultimately, this is what community pharmacists want because we’re always hearing about the pressure on GPs and emergency services in the NHS, but with the vast network of community pharmacies across the country, in many ways the solution to healthcare service pressure is already there – it’s just about making the pieces of the puzzle fit together.

What must happen in order to introduce the truly modern, all-encompassing community pharmacy?
This involves looking at the whole infrastructure of pharmacies and how we can perhaps use those buildings differently; allowing the pharmacists and wider pharmacy team to release their full potential, with all the facilities they need to run vaccination programmes, testing & monitoring, long-term condition management and consultations.

This will link pharmacies to the NHS in a much more structured way. But that connectivity between institutions relies on a much better shared system when it comes to patients because, at present, it is so fragmented. If you have a central database containing information, such as vaccination status, prescriptions or blood pressure, the service becomes much more consistent.

I see no reason why this can’t happen. It opens up a host of possibilities and can only be for the benefit of the NHS, patients and healthcare professionals.

Do you think that the pandemic has showcased what can be done?
If there’s a will to do it the systemic problems can be solved. Unfortunately, it often takes a catastrophic event to prove it. In terms of the COVID-19 vaccine – as with seasonal flu – pharmacies have been a pivotal factor in solving the problem and enabling other areas of the health service to operate as usual. Additional workload was taken on during these times and no other areas were allowed to suffer.

I have witnessed community pharmacies absorbing this pressure and, once again, they are very much the unsung heroes.

How vital is that continued link between pharmacies and their communities?
Community pharmacists really have a special bond with the neighbourhoods in which they carry out their duties and it takes a particular type of character to operate effectively in this environment. There is, however, a major workforce issue in community pharmacy – I have never known the situation to be so difficult in terms of pharmacists and staff availability. It is also incredibly busy and this is the case throughout primary and secondary care.

To continue under the current circumstances is only going to be possible if pharmacists can adopt more of a professional clinical role, which is less administrative, reduces the existing bureaucratic burden and increases responsibility towards patients.

Only this shift will reduce the amount of patient-facing time for GPs. There needs to be much greater recognition of the profession within the wider NHS ecosystem. I’m seeing better signs now, but bigger and more widespread changes still need to happen.

What are your own reflections on the start of your incredible career and the future of pharmacies?
When I qualified in 1980, everything was dispensed manually and labels for prescriptions were carefully handwritten. It was only later on when computers and the printers came along to replace pens and ink pots.

What has been consistently amazing to witness during my four decades is how much people trust community pharmacists and are prepared, on a whim, to share their entire life and health stories!

I want pharmacies involved in every single vaccination programme where they can contribute greatly to increasing uptake. I’d want a situation where absolutely everybody felt that community pharmacies are where you went for public health advice and consultation – within fully integrated modern premises.

Finally, Rekha. Which pop record would you choose for the soundtrack of your life?
‘My Way’ by Frank Sinatra. I have certainly done it my way, had some very open conversations and have no regrets about my career.