Charting a path for Northern Ireland’s pharmacies

In the midst of Northern Ireland’s political stalemate, Chief Pharmaceutical Officer Cathy Harrison is determined to deliver a clear roadmap for the sector’s future. By Arthur Walsh 

Anyone paying attention to the Northern Ireland political scene in recent years will be aware that citizens there have since late 2022 been living without representation in the Stormont assembly and executive due to a stalemate described by an Alliance Party assembly member as the “political equivalent of the seventh circle of hell”.

The result of a dispute over the Northern Ireland Protocol, which the Democratic Unionist Party regards as an existential threat to the unionist community and local economy, the collapse in power sharing has had a dismal impact on public services. This fact is perhaps best exemplified by reports this year of a badly neglected Lough Neagh – the treasured landmark that provides 40 per cent of all drinking water for Northern Ireland residents, and which now lies stagnant.

But despite the stalemate, some public servants have taken the view that inertia isn’t an option. In the absence of a functioning executive, chief pharmaceutical officer Cathy Harrison is determined to work with partners across the pharmacy sector to assemble a strategy designed to give patients and practitioners a clear roadmap for the years through to 2030 – with a clear focus on implementation. 

This strategy, which seeks to shape the role community pharmacy teams will play in the health sector in future, has involved close cooperation with negotiating body Community Pharmacy Northern Ireland, with which relations have been strained at times over the years amid long-running funding disputes.

Announcing the work in a speech at the Independent Pharmacy Awards in Westminster in September, Harrison noted the flurry of wide-reaching community pharmacy strategies England has had this year from organisations like the National Pharmacy Association and Community Pharmacy England. These ‘vision’ announcements are like buses, she said: “You wait ages for one, and then two, three or even four turn up at once."

Speaking to me after her speech, Harrison said: “For a number of reasons, we are approaching the development of a strategic vision differently in Northern Ireland. Our circumstances here are different to the rest of the UK at the moment. That means we don’t have politicians and therefore decision making is affected.

“To be honest, we haven’t got the luxury of spending time creating quite similar looking documents and then having to come together to find common ground.”

Derry girl

Harrison, who attended Thornhill College, the Derry school made famous by a worldwide smash Channel 4 show (“I’m still very much a Derry girl myself,” she says), went on from her A levels to an MPharm in Liverpool before spending the next decade working in community pharmacies in Britain.

A move back home with her young family saw her manage a Boots store in Coleraine, followed by a stint in the Department of Health working as a principal pharmaceutical officer. In this role, Harrison was responsible for community pharmacy service development and emerging areas of practice such as independent prescribing.

Then, in December 2018, she took on the role of chief pharmaceutical officer, initially on a temporary basis. Her position was made permanent just in time for the Covid-19 pandemic, giving her oversight of the profession in one of its most tumultuous periods. Harrison is responsible for policies concerning pharmacy practice and medicines supply, and oversees a team of 33 civil servants that includes five pharmacists. 

Defying tradition

Both Harrison and Alison Strath in Scotland (another ex-community pharmacist) have defied the English tradition of recruiting chief pharmaceutical officers from the ranks of hospital pharmacy. What has her previous experience meant to her in this job? “It’s been very helpful,” she says.

“My whole time in the department has been very focused on that, and leaning on that experience. In a lot of the policy areas I became exposed to, I was always seeing the opportunity for community pharmacy.”

“I always thought we could do more and contribute more if we were included earlier [in planning],” she continues, adding that, regrettably, professional development in Northern Ireland has at times lagged behind other parts of the UK. 

She is clear that it’s not only the pharmacist’s role she has in mind, but those of the entire team – as demonstrated by the current push to bring pharmacy technicians up to professionally registered status. The need to address these gaps has been a key motivator for the work towards a 2030 strategy – which, Harrison says, weaves together existing commitments rather than proposing new policies that politicians would need to consult and vote on.

“This is the pulling together of the existing policies around workforce digital investment and services and bringing them together into a coherent plan that we could actually implement over the next number of years,” she says. 

It can then be presented to political leaders as a fait accompli. Of course, there will be a need to win support for the proposed direction of travel, both in terms of gaining buy-in from the sector and securing funding – no easy task while there is continued uncertainty over when power sharing will resume.

Battle rhythm 

“We need to have a very clear understanding of what community pharmacy can bring to the challenges that our health system is facing,” Harrison says. “They’re all the same challenges you would see anywhere else in the UK.”

She describes the work as “very well thought through”. It sets a “battle rhythm” for achieving the outputs Northern Ireland (NI) needs in terms of role development, new services and the legislation changes that will be required. Workforce issues have been singled out as an urgent priority for implementation, with undergraduate training places for pharmacists in NI universities having already doubled since 2020.

Harrison says workforce objectives are “really coming together; there are a lot of challenges, but you’ve got to start somewhere, as we’ve all learned.”

Getting pharmacist headcount right has been as big a challenge in NI as in the other home nations, she says, and the strains have been felt across all pharmacy sectors. She says: “We need to pay attention to how we attract, recruit and retain people,” a big component of which will involve setting out the emerging practice opportunities for early years pharmacists and those wishing to progress their careers. 

“The most significant thing is going to be our increased numbers because we have been through quite a sustained period of shortage,” says Harrison. And there are “unique pressures” that come from having a land border with the Republic of Ireland. “They have a very vibrant economy, and there’s a lot of attraction for the pharmacist,” she says. “But Northern Ireland is still a fantastic place to train and build your career and is a much more affordable place to live.

“Students really enjoy studying in Northern Ireland and we’re looking forward to having the practice there for them to enjoy working there.” Harrison is also excited about the opportunities opening up for pharmacy technicians as they professionalise, taking on additional roles such as the use of patient group directions (PGDs). She describes this as a “great incentive” for pharmacy technicians in all sectors, “especially in community pharmacy”.

“Our whole workforce development ambition around pharmacy is very much about keeping in mind that they will be a cross sector workforce and contributing to pharmaceutical care and delivering better outcomes from medicines supply,” she says.

When it lands – no date had been confirmed as P3pharmacy went to press – will the strategy look like what has been launched in other parts of the UK in recent years? “The general strategic direction will be very closely aligned to what we’re seeing from the rest of the UK,” Harrison confirms, singling out the NPA’s Making Changes, Meeting Needs vision document as sharing many of the aspirations held by Northern Irish pharmacists.

Short-term actions

When it comes to clinical services, there will be a particular focus on the short-term actions needed to secure investment in training for the additional skills needed to bolster existing service models like Pharmacy First, which is offered to the public every winter. The introduction of prescribing and PGDs “will set it in a different direction in terms of the opportunity and the mechanics of it”, Harrison says.

Workforce and service development objectives are being set for implementation over the next three years, while longer term goals include overhauling working practices through modern digital infrastructure. “We still use paper prescriptions,” says Harrison, adding that “incremental steps” are being taken to digitise services and achieve electronic patient record access.

While it is to be expected that a country’s health administration will maintain close links with a pharmacy sector negotiator, the level of cooperation required for this approach seems unusual. It is not unheard of for CPNI and the Department to publicly brief against one another over a funding spat. Has the work on this strategy required a shift in mindset from both parties?

Harrison replies: “We have some experience of working collaboratively from the pandemic”. She goes on to say that this approach “served us extremely well”, allowing quick decisions to be made and investment channelled towards “where it was needed”. There was a “high level of trust at that time as well”, which is “actually quite difficult to sustain outside of an emergency, so we are now trying to get back into that space”.

And she adds: “No doubt there will be issues that we won’t agree on, and there will also be the realities of difficulties around securing resource. But it’s vital that we can agree this overall strategic direction and priorities.” 

Harrison talks about the importance of “leaning towards the interests” of pharmacy owners and their teams. “It’s very much about those people who will be delivering this, who are either already building their career in community pharmacy or are just starting out,” she says. “It’s important that they can see some of the ambition there.”

Cutting edge

Harrison has mentioned that in certain aspects of practice, progress has been slower in Northern Ireland than elsewhere in the UK. But that’s not the whole picture by any means, she says. Many pharmacies in Northern Ireland are hugely forward thinking and proactive within their communities, and NI students’ registration exam results are typically at or near the top of UK university rankings. 

“I’ve worked across the UK, and, without a doubt, we have some of the best community pharmacies here in Northern Ireland,” she says. “There are quite a number of pharmacies who really want to be at the cutting edge of practice, and they’re always coming forward for those innovative services that make a meaningful difference to patients’ health.”

While it is necessary to help pharmacies develop new business models around emerging services, Harrison recognises that medicines supply is the beating heart of the sector and this is unlikely to change any time soon. 

I’m curious about her department’s approach to medicines shortages, which are felt keenly across the UK and in Europe, but are perhaps an even more sensitive talking point in Northern Ireland in the wake of the NI Protocol and the Windsor Framework.

“Medicines shortages are a real challenge for all community pharmacies across the UK – it’s an issue for all pharmacies, ” Harrison agrees. “We do hear about the difficulties in both global supply chain issues and the availability of medicines in general.”

The Department has recognised this and is trying to build it into its winter preparedness planning, including public messaging explaining why shortages happen “because so often it is a pharmacist who has to tell the member of the public that they haven’t got the medicine, and there’s not an understanding that often this is outside of their control”.

“Shortages are part of life unfortunately, but we remain open to trying to improve this,” says Harrison. “Northern Ireland is part of the UK supply chain, so we do work very closely with Department of Health and Social Care, which has a high level of surveillance over supply chains. We’re also very alert to any issues that may be specific to Northern Ireland.”

During the pandemic, she forged close relationships with her home nation counterparts “and that has continued – we learn a lot from one another”. “We’re all dealing with the same challenges and approaching them in slightly different ways,” she continues. “In the devolved administrations, we do like to have our own accent, and that reflects the differences in our health systems and how we as individuals operate and get the job done. But there is a lot of commonality in the vision for pharmacy across the UK at the moment."

Having recently spoken at a clinical pharmacy conference in Warsaw, Harrison tells me: “Whenever you speak about practice in Northern Ireland and in the UK, you realise that we really are at the forefront in the whole world in our thinking around pharmacy practice. 

“In our busy days, it can feel at times that things are almost impossible and we’ll never see the change we need. We have to realise we have come a huge way, and a lot of other countries across the world are looking to us; it’s important to remember that.”