With the 70th anniversary of the NHS coming up our national health service is under more pressure than ever before – and when it comes to getting things done it seems that, more often than not, it’s down to pioneering individuals to drive change forward, rather than waiting for the powers that be to do it for us.
But having an idea is only the start. Say you are frustrated locally that something needs to happen – what do you do?
Vice chair of Kent LPC Sunil Kochhar is consultant pharmacist at Regent Pharmacies Ltd in Gravesend, Kent, and runs the pharmacytalk.co.uk initiative. He suggests the first thing to do is speak to your peers: “Over the last four years we’ve got a group of independent local contractors together who meet up once in a while to see what the issues are in our area and what we can do to address them. This is a great formula because when we all speak as one, this one voice gets heard.”
However, he admits this kind of collaboration comes with its own internal challenges: “Although we are working for the good of the profession we are, as independents, all in competition, so trying to get everyone to be open when it comes to benchmarking against one another isn’t always easy. And of course you also come up against trying to change the mindset of some who believe they are already doing things the right way.”
The way to break through this, he believes, is to start with a small issue that is common to the group, to get the collaborative ball rolling. “What you need is everyone to be on the same page and feel the same way about something in order to make change happen,” he says. And once you’ve got the wheels in motion, you can step up a gear. The group has been so successful that it is now trying to include multiples, too, but he says: “this is still a challenge as although the pharmacists themselves may want to change things, they have to convince their area managers who usually have their own reasoning behind decisions which might not fit a local agenda.”
Whatever change you are striving for, if you have made local progress it can still seem daunting to step this up to a national level.
Pharmacist Deborah Evans, managing director of Pharmacy Complete and a Fellow of the Royal Pharmaceutical Society, admits that, disrupting the status quo requires “vision, passion and persistence”.
What’s more, when you want to scale up, she stresses that “results matter when you want to be recognised as doing something different”. Her advice is that programme outcome metrics should be considered in the early stages of the project and be relevant to the needs you are trying to solve. “If you are offering a new service then measures of success might include how many people did you reach, including demographic mix, the health outcome measures, patient-related outcome measures and cost effectiveness.”
Another way to gain traction is by putting time and energy into self-publicity. “Award submissions, case studies in the trade press and social media can be used as channels to communicate what you are doing,” says Ms Evans, “plus consider inviting key local and national stakeholders to your pharmacy to see what you have achieved, to let them ‘see and feel’ what you are doing.”
A tireless promoter of community pharmacy, Lancashire LPC member Thorrun Govind is a pharmacist at Sykes Chemist in Bolton, and has just become the youngest ever elected member of the EPB at the Royal Pharmaceutical Society.
Her top tip for wider reach is to get in touch with your local MP. She says: “I invited all my local candidates to my pharmacy before the recent local elections and explained the situation that community pharmacy is in. I could have gone to their offices to explain, but it’s very different to get them in the pharmacy to see the real pressures we are under.”
This is all well and good if you are a practised orator or great at engaging an audience, but what if you are not an exuberant people person?
Ms Govind says: “People might find it strange that although professionally I’m an extrovert, I’m actually quite an introvert at home – but you can be both. Plus I think you need a thick skin, as you’ll get more knockbacks than successes, but that makes the successes sweeter.”
The ability to brush yourself off and keep going is not the only skill you need to develop to be a useful force for change. “Driving change requires courage, tenacity and a clear vision of what you want to achieve,” says Ms Evans.
“Leadership of change requires clear communication and an understanding of who it is you need to influence. Change also needs flexibility – good leaders work with others to build strong relationships built on trust and help others to see that there are many ways to work towards a common purpose.”
Mr Kochhar agrees: “Like anything, it’s teamwork. Gather your group and explain your vision, but be able to take feedback. Your vision may take a U-turn, and you need to be open to that. As a leader it’s also your job to find out who has the skills you need to achieve your end goal, so seek out those people and help them develop into those roles. It’s crucial to get your staff involved, and make sure they have the skills and training they need to sell that service to the community and commissioners. They are front of house and every contact counts, so you need the foundation to make it a success.”
Sometimes the barriers will be everywhere, so how do you persevere when everyone around you is saying ‘no’? “In my experience, this is about listening carefully to the resistance, asking more questions to understand more fully their objections and then addressing these. People are naturally resistant to change, frequently because they do not understand the need for change or the reason might be unclear. Be prepared to create the evidence that others need to help them with the change, but make sure you know what will influence them to change their mind and avoid making assumptions,” says Ms Evans.
GP pharmacist prescriber Siddiqur Rahman – managing director of PharmaSid Ltd, and a board member of The Pharmacist Cooperative – has done just that. He spotted a gap when it came to meeting the needs of diabetic patients in his community, and gathered enough evidence to convince his CCG to fund his training to provide a service.
He has been working as a GP pharmacist for the last two years, focusing on Type 2 diabetes, but is unable to initiate insulin or GLP-1 agonists and often has to refer patients that are uncontrolled on the maximum tolerated oral anti-diabetic agents to the severely overstretched community diabetes team.
“I saw an opportunity to improve diabetes care in my area and wanted to be accredited to confidently advise patients about correct insulin technique,” he says. “I also knew this would be in the CCG’s best interest as well, so I took it upon myself to find a highly-regarded and RCGP accredited diabetes course in the local area and persuaded my local CCG Medicine Management team to fund the £2,000 I needed for this course, so that I am fully competent and confident in initiating and managing patients on insulin.
“I have met my targets for the CCG in terms of prescribing cost-effective medications, and in the course of a year have now underspent the prescribing budget by £44,000. I have also undertaken CCG patient safety audits which the CQC were happy to commend me for, and so my local CCG were more than happy to fund my diabetes course, which will hopefully help both my practice patients and the secondary care team.”
Mr Rahman’s carefully planned persistence paid off – confirmation of Deborah Evans’s belief that “if you feel strongly enough about something you can make the change happen”. However, she stresses that for the process to be truly successful you need to leave your ego to one side and focus on the bigger reasons for change.
She says: “Check in with yourself to make sure the change is not about you but has a wider cause,” and Mr Kochhar agrees: “The mistake I made initially was trying to do everything myself, because I just wanted to get to my vision. What I’ve learned is that as long as we get to the end goal and what we do takes the profession forward it doesn’t matter who the driver is.”
Disrupting the status quo requires vision, passion and persistence