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Exclusive: PAGB’s new president, Mike Knowland, tells Arthur Walsh why the consumer healthcare association won’t stop talking about the importance of self-care in its bid to shift care closer to patients and community pharmacy

“I’ve got a live example of how Pharmacy First can really work,” Mike Knowland tells me eagerly when I speak to him in February. He recounts how over the Christmas break – a time when NHS services are traditionally under great strain – his daughter was suffering from tonsillitis and the family struggled in vain to get a doctor’s appointment before being referred to a nearby Tesco pharmacy.

“It was brilliant. We were sent straight there and she got seen, got prescribed antibiotics and at the end of the course her tonsillitis was better. That will have taken a significant amount of pressure off a GP,” he says. 

This is a defining message for PAGB: that shifting care closer to patients and putting pharmacies in a more central role will benefit the country, the health service and – more on this later – the economy.

And while in the case of his daughter a prescription was needed, he argues that the potential for self-empowerment is much wider and includes over-the-counter (OTC) medicines as well as newer tools: “People are still seeking GP appointments or attending Accident & Emergency for conditions they could easily treat themselves.”

The general manager for Bayer’s Northern Europe division was appointed PAGB president in January after previously holding the vice-president position, inheriting the top role from Bas Vorsteveld. As he tells it, his principal goal will be to consolidate the association’s efforts to put self-care on the national agenda and ensure warm words from Labour translate into action.

“It’s evolution, not revolution. The reality is self-care is here to stay, it’s becoming more prevalent and more important,” he says. 

“The PAGB has been talking about the self-care agenda for decades – it isn’t new for us. For me it’s about what we do as an organisation to help the NHS reduce the burden and educate the public.” 

And with the NHS buckling under the weight of record demand, he says the message is more important than ever: “Our job is to really empower individuals so they can embrace the opportunities presented by self-care.” 

He argues there is a “huge opportunity” for over the counter medicines and to be a part in this journey, and says he wants to be ensure that policymakers take this seriously.

“We’re very much encouraging the government to look at the community pharmacy funding model so they can actually support the direction of travel to pharmacy being the first port of call. And how do we put community pharmacy at the heart of everything without just shifting the pressure from GPs to community pharmacy? We want to make sure we support pharmacies.” 

Economic angle

He talks me through some of the sums underpinning PAGB’s claims. “What I can talk about is the cost to the NHS – £6.4bn on prescriptions and appointment savings – £2.7bn in prescription savings, and on top of that £3.7bn in appointment savings.” 

“There’s a huge opportunity here, you ultimately get people healthier for longer and they spend less time away from work. If you add all of that up, when the government talks about its agenda for growth – one of the challenges here in the UK is that productivity is lower than it needs to be. Part of that is because working-age people are not in work long enough because they’re ill.”

He claims self-care has a direct impact because people “fundamentally spend less time off work”. “You drive productivity and you drive growth,”he says. Presumably, a higher consumer spend on OTC medicines will also benefit PAGB member companies too.

Putting a number on productivity benefit claims he acknowledges is “quite difficult” although he claims: “We do know that by doing this we can get people back into work an additional five days a year. That does have a significant impact.” 

What specific levers are needed to make this happen? Educating the public is key, he says, and so is launching more reclassified medicines – “a super big priority”. 

“We estimate that if reclassification were to reduce NHS prescribing spend by five per cent that could save the NHS a further billion in prescription and appointment costs. That’s made up of roughly £600m of prescription costs and £770m of GP appointments. It widens access to medicines for the public rather than having to go through GPs.”

Shortly after we speak, the government published its wish-list of health conditions –like oral health, sleep problems, pain and urinary tract infections (UTIs) – for which it is inviting applications from manufacturers to switch drugs from prescription only to P or GSL.

Some of the wish list conditions may present clearer opportunities than others – it’s hard to imagine a switched GSL sleep medicine anytime soon – but it is surely useful as a roadmap for the industry.

At the time we spoke, he wasn’t able to comment on the outcome of the government’s work behind the scenes, but did speak about the input his organisation had along with the other bodies making up the ‘reclassification alliance’: “We’re clear as PAGB, who represent the industry, on saying these are the things we’d be interested in. I’m not privy to those because obviously some are confidential for my competitors. They’ll be asking for things I don’t know about and vice versa.”

He emphasises: “Reclassification has to be done in a safe way; patient safety is absolutely at the heart of everything we do.”

He’s reluctant to comment too much on whether the MHRA’s current pathways are fit for purpose, but will say there is “definitely room for improvement” and that the PAGB has fed back to the regulator on “how it can be made easier and less cumbersome”.

Are switches good for pharmacy? “One of the questions is whether it’s negative for pharmacy. But in some instances when we switch, the ultimate reason is driving self-care, which brings more people to pharmacy.

"Secondly, I’ve seen many instances with switches where there are still bigger packs or slightly different formats that still need to be P lines. When you switch you can still ensure there’s something for pharmacy.”

A major switch like Pfizer’s Viagra Connect is a “classic example” of how reclassifications can benefit both pharmacies and patients, he says.

When I ask him what barriers there might be to some of the PAGB’s ambitions, he replies: “Industry alone can’t achieve this. We need collaboration with the NHS, community pharmacy and the MHRA. It needs a joined-up approach; it’s all very well sitting as an industry saying let’s have more self-care, but we do need the support of those other bodies.”

What’s the response from government? Are the benefits as set out by PAGB self-evident, or do politicians need a little more persuading? He replies: “We’ve got a commitment from the government to continue to progress and develop national self-care policies, which is encouraging.”

He tells me that PAGB chief executive Michelle Riddalls has had meetings with health secretary Wes Streeting who “really likes what PAGB is doing and the fact we’re coming in with solutions – we’re not just saying here’s a load of problems, you need to sort this out.”

And on top of briefings with pharmacist MP and chief whip Taiwo Owatemi – who is “really supportive of self-care and in particular reclassification” – PAGB lobbies across the political spectrum and attends party conferences.

He’s feeling positive: “Standing here today, I think we’ve got decent buy-in. We’ve got the secretary of state saying, ‘I get it’. Time will tell, right? 

PAGB’s policy proposals don’t all revolve around OTC products, he says. Encouraging the use of digital tools to facilitate education, diagnosis and self-treatment is another key ambition.

“The other thing we want to talk about is allowing pharmacies to regularly populate medical records, which at the moment is difficult to do. That would ensure the patient pathway is consistent and seamless – wherever you go, people know who you are.”

Health education is a perennial campaigning point for the trade body. “One of the key areas for us is how do you drive education to the population. We’re talking to government, we want to get education in self-care in schools as part of the curriculum.”

Some of this can be done through manufacturers’ own initiatives, with Mike citing a Bayer digital education programme on women’s intimate health that has gone out to schools. “It’s all about widening access to information.”

That was all funded by Bayer. But presumably if PAGB is looking for government buy-in that will involve putting resource into it in the form of public spending? “Absolutely right – that’s one of the things we want, to make sure self-care is integrated into the RHSE curriculum.”

Work with pharmacy

It’s a time of significant change for UK pharmacies as funding and workload pressures mount at the same time as initiatives like Pharmacy First signal new opportunities. Which of these developments are key focus areas for PAGB?

“It’s not about one over the other, but Pharmacy First is certainly up there as being super important. It will bring customers back to pharmacy, which is one of the challenges for pharmacies at the moment.

"Having said all that, all services pharmacies provide are promising for both the sector and us in industry: they do flu and travel vaccinations, blood pressure checks and many other things. Pharmacy First brings seven conditions where they can prescribe. But don’t forget all the other things they can do including smoking cessation.

“For me the challenge is how do we continuously highlight what pharmacies can do and the role they play in that self-care journey, which we know doesn’t happen without having a really strong pharmacy sector.”

Mike says one of PAGB’s tasks is to support a better funding settlement “so that pharmacies can actually make it work”. 

“Without that funding, the danger is that you shift the pressure from GPs to community pharmacies, and that doesn’t solve the issue. One of the biggest challenges they talk about is the outdated funding model: when you’re predominantly a dispenser, that’s how you make your money, that’s challenging, right?”

“Where we need to support them as an industry is to help them use products in the stores,” which he says partly comes down to educating pharmacy teams on the role they can play in preventative health and how to engage with customers.

He speaks of a “definite alignment” between industry’s goals and the pharmacy sector, adding: “We recognise that we have to give the information and education to pharmacists to allow them to feel comfortable in driving self-care”

Some pharmacies – particularly independents – say they struggle to make OTC into a substantial revenue stream. What practical advice can he offer? He comes back to the need for education: “It’s incumbent on the industry to ensure they provide the right information on what products do and how pharmacies can support their customers and patients; detailing is super important. That’s the biggest role we can play.” 

When asked what recent wins PAGB is proud of, he says the previous government’s primary care recovery plan in May 2023 was a “major step forward,” incorporating “seven of the nine recommendations made by the self-care strategy group in our blueprint”.

“They recognised the impact self-care can have for the public, the economy and the NHS. We’re now committed to supporting successful implementation of that policy.”

PAGB launched its five-year strategy in January and Mike says the team is ready to attack its goals: “We’re not sat on our laurels – there’s still a lot of work to do. At the end of these five years we want to be able to look back and say we took a chunk out of those GP appointments and played a fundamental role in driving costs out of the NHS.

“We won’t stop talking about this because we know the importance in terms of the amount it saves in costs and also the opportunity it brings in terms of productivity and growth.”