Graham Clews is News and Views Editor at Jizak.
Pharmacy director for Boots UK Richard Bradley on union representation, technology and dealing with negative press.
Boots UK has almost 2,500 stores and it boasts that more than 90% of the UK population lives within a ten-minute radius of a Boots store.
Its history and its familiarity to so many British people means that almost anything Boots does is considered newsworthy by the mainstream press, in a way that the actions of no other pharmacy, or chain of pharmacies, would be.
But Boots has hit the headlines more than ever in 2018 and not all of the stories have been favourable. Patient safety, overcharging the NHS for specials and an exclusive deal with Pfizer to sell over-the-counter Viagra all received press attention.
Meanwhile, in June 2018, Boots' own pharmacists voted to derecognise the Boots Pharmacists' Association.
As pharmacy director for Boots UK, Richard Bradley occupies one of the hottest seats in pharmacy. His decisions affect almost 7,000 pharmacists employed by Boots, the millions of patients who are treated by the company's pharmacies each year and the pharmacy profession as a whole, which is inevitably affected by what Boots does.
Do you feel responsibility for the pharmacy profession?
I feel responsibility and privilege in this job. As a young pharmacist aged 21–22 years, I was on the LPC [local pharmaceutical committee] in Doncaster and now it's just on a bigger scale. I have that responsibility to our people, our patients and the profession. Over 169 years, Boots has always worked well as part of the pharmacy sector and the success of community pharmacy and Boots are interlinked. Working alongside the CCA [Company Chemists' Association] and the PSNC [Pharmaceutical Services Negotiating Committee], I do feel a responsibility to create a sustainable future for the sector.
How do you react to negative press stories about Boots?
I get to see the amazing work that pharmacy and our teams do across 2,500 stores, dispensing around 220 million prescriptions and a lot more over-the-counter visits. I get to see all the good stuff. We are the largest public-facing pharmacy and we are bound to be in the spotlight and occasionally we do get things wrong. These things are difficult to see and lead through — and lead our teams through — but it is so important that we learn from them. We are accountable to our patients, to the NHS and to the public for everything we do and it is important that when challenged we do take any learnings we can from it.
Making pharmacy safer is important but so is making medicines safer. We have a great part to play in patient safety in the medicines after they have left the pharmacy. We have traditionally tended to see patient safety as dispensing what was on the prescription accurately but we are in a world where that is getting very accurate and technology will only ever improve that. So the next step is to look at what happens to those medicines once they leave our pharmacy.
Why did Boots pharmacists vote to derecognise the Boots Pharmacists' Association?
Pharmacists, like all healthcare professionals, want to understand what their future looks like and what the future of the profession looks like, and I think we have to do a good job in both creating and communicating that. We also need to demonstrate the career pathways and roles for pharmacists that they want to do over the coming years that will give them the professional satisfaction and fulfilment they need. This is partly pharmacists saying we want things to be a bit different from how they are today and that is something we definitely accept and we definitely lean into.
What are the opportunities for community pharmacy over the next few years?
Our fundamental role is to see how we can play a greater role in the health outcomes of the general public. There are lots of different areas that this covers in my head: medicines management, prevention, self-care, urgent care, antimicrobial resistance. These are all areas that are important to the NHS, important to patients, and they're important to the future health of the nation. In some places, you can clearly see how community pharmacy has a really good role in these at the moment, and we have to look at how it can do even more so in the future.
Pharmaceutical care is at the heart of what we do and will continue to be so. We've all seen the statistics about the number of people who don't take their medicines correctly, about the number of people on more than eight medications. We're already playing an important role in that with the services we provide — the new medicines service and medicines use reviews — but we have to evolve those into a greater and more consistent role and, importantly for me, integrate them more into primary care than is currently the case today.
Health and social care secretary Matt Hancock's green paper on prevention is a great opportunity for community pharmacy too. We're the only healthcare profession that sees people when they're well. Something like 800 million people walk through our doors each year and we represent about a fifth of community pharmacy. As the available healthcare profession on the high street, the role we can play in prevention is something we should significantly look to involve ourselves in.
What would you like to see in a new community pharmacy contract?
We need to encourage both the NHS and pharmacy to invest in the right areas that can increase the value we can offer to the NHS where they have priorities: polypharmacy, shifting care into the community, prevention and urgent care. But that needs to be in a sustainable way.
We need a road map for integration further into primary care. We want to work with GP colleagues but digitally we have to enable the right flow of data, be able to update the patient care record when we have done a medicines review or a flu vaccine, and have read/write access. I accept that comes with a deal to be struck on both sides and the NHS will say "you have the summary care record, so we need to see pharmacy use it consistently", and I think that is something we need to listen to as a profession.
There is a constant debate between national and local commissioning of pharmacy services. Where we do one thing as a profession consistently across the country, the profession can get behind it. Flu vaccines are a good example: one national service delivered really well — the patients understand it and you can tell people about it in a consistent way. Recognising that the NHS will still want to do most things on a local level, I would like to see a move towards a framework of services with common specifications, legal contracts, training and so on — almost a menu for local areas to be able to commission from.
One example of where this could work is emergency contraception. The available treatment is very different by postcode and age. As a patient, understanding how to access emergency contraception in community pharmacy is hard and it is difficult for us to communicate a consistent message to patients. Smoking cessation services present another similar challenge.
What role will technology play in the future of community pharmacy?
I've spent 20-odd years as a pharmacist, the first few of which were in front of patients all day every day, and I'm a big believer in the fact that pharmacy is about people and face-to-face interactions. Virtually all of the positive conversations I have with store colleagues and patients, as well as the letters I get every week from customers about the difference we have made to their health, are about the value that is delivered by our people and the value that is delivered in the community. The role of face-to-face conversations is where the added value of pharmacy is and will be for a long time to come.
At Boots we spend a lot of time on our customer research and they want virtually the same as they have always wanted: they want to control their own health, but it needs to be easy for them, they want it to be convenient and they want great people there when they need them. The digital age gives pharmacies different ways of meeting those needs.
Is there likely to be a decline in the number of high street pharmacies?
Even to carry out the role of pharmacy that we can play today and provide the services our patients have today, we have to release some capacity from the system. Some of the omnichannel [mix of online and bricks and mortar pharmacy] world enables that capacity and there are other things that enable that capacity: how the roles of our pharmacy technicians and our pharmacy teams evolve; and automation, whether in store or centralised.
If we want to evolve and play a greater role in healthcare, we are going to have to look to release that capacity even more than we are doing today.