Interviews
Jay Patel: A brush with death and a new lease of life
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Jay Patel, executive director at Day Lewis, tells Arthur Walsh how a brush with death sharpened his clarity on the things that matter in this exclusive interview
It was a blustery day in November 2023 and Jay Patel was feeling up against it. He had driven two hours from his home in Surrey to a branch of Day Lewis and then seen a succession of patients on a busy shop floor. Jay, an executive director at Day Lewis along with siblings Sam and Rupa, had wanted to get back to working as a pharmacist at the coal face alongside experienced manager George in an East London branch.
Thinking to familiarise him with how the newer pharmacy services work from the patient’s perspective, the team there suggested he try a blood pressure check. The reading was “slightly high,” he says. He wasn’t too concerned, chalking it up to the demanding day he’d had. But George – “an assertive guy in a good way” – was adamant, telling Jay this warranted further investigation.
That opportune checkup, and the team’s proactiveness in urging Jay to follow up the results, set into train a life-changing series of events. In January 2024, a cardiologist assessed Jay and found “aggressive narrowing” of the coronary arteries, likely genetic in nature (his father, Day Lewis co-founder Kirit Patel, died from a heart attack in 2016). A few months later, he underwent “brutal surgery” as surgeons opened up his chest and carried out a bypass.
The recovery wasn’t easy, and for some time after the operation he was unable to lift his young children. But thanks to being in relatively good shape before it all kicked off, he was back on his feet within a couple of months. He thanks his family for their unwavering support, as well as the pharmacy team whose proactivity saved his life. “It was a two for one really: the proactivity of the team in offering it and the service itself,” he maintains.
The support from pharmacy didn’t end with the initial hypertension check. Post discharge, after completing a New Medicines Service consultation it emerged that he was intolerant to statins, forcing a change to his prescription. “From diagnosis to coming back out and managing myself better –it’s the wraparound service,” he says.
Now he’s taking a back to basics approach: “It’s eat better, sleep better, move more. If anything’s too extreme it’s not worth doing.”
Back to work
The experience has left him with a renewed clarity about what is important both in his family life and in his career,. “Perspectives change when you get a critical moment like that,” he smiles.
Having returned to work in August, when we meet in December 2024 he is keen to talk shop. Top of mind is a recently launched co-ownership scheme allowing pharmacist managers to buy half the value of the Day Lewis branch they run.
“Independent pharmacy owners are fabulous,” says Jay. “We’re looking to try and build a pharmacy model that has both agility and scale. We’re offering pharmacist managers the option to buy up to 49 per cent of the value they run.
“It’s not just Day Lewis pharmacists – it’s open to experienced pharmacists who have an ambition to own their own pharmacy. It allows for a vested interest in both the teams and the patients and encourages a greater commitment to patient care.
“We’re hoping to get motivated pharmacists in there. We’re able to support them so they are providing patient facing activity all the time, and anything that’s not patient facing we will be supportive – things like procurement, HR advice, marketing, legals, finance and accounting has all been handled by us essentially, so these guys are then able to spend their times with their patients and their teams.”
There is significant interest, he claims, adding that around 88 co-owners have taken up the offer as of early December. "It’s going to be the best of both worlds: an independent owner with the support of a large organisation.”
Services are another core pillar in the company’s mission to satisfy what he describes as the four key demands of patients: prevention, diagnosis, acute treatment and ongoing management. A number of private services have got up and running in the past few years, and at some point in 2025 there are plans for a soft launch of a pharmacogenomics offering, something first floated by Day Lewis head of pharmacy Tim Rendell in the spring of 2022.
Fourteen employee pharmacists have been trained so far, says Jay. “There’s a lot of research into it and how it could help to identify the one in 10 patient who might need their medication switched based on their genetic makeup. “However, the challenge is always converting that into a GP changing a prescription.” And supply is complicated too. “The service isn’t as easy as people think but we’re playing with it and will see what happens.”
Branch review
Day Lewis’ latest annual accounts showed that although the company is still decidedly profitable, something in the system isn’t computing. While turnover rose by 5.9 per cent, profits were down £1.8m on the previous year. If more business no longer equates to more money at the end of the day, is it a sign dispensing just doesn’t pay?
Jay says the NHS needs to realise what a good deal it has. “As contractors, we all need to fight for fair remuneration for the dispensing service. The return that the NHS gets from dispensing is incredible and the risks to the NHS of community pharmacy not doing it are huge.
“There’s no alternative to community pharmacy. Government believes it might want to do it itself, but it’s demonstrated time and time again that procurement is not something it can handle particularly well. Look at the personal protective equipment fiasco – they can’t buy one product. How are they going to handle the complexities of pharmaceutical procurement?”
The latest accounts, which cover the 12 months up to April 2024, tell of a branch review that has seen the chain merge several pharmacies and dispose of some others with “particularly low footfall”. How big is the estate currently? “It’s circa 250 pharmacies at the moment,” he replies, adding that despite a degree of churn in the estate “our patient numbers are growing weekly”.
Selling branches is “always a difficult decision,” he says, opining that it is especially hard for them compared to a big corporate who can “very much just close their doors overnight” as happened with the LloydsPharmacy Sainsbury’s branches. He says a fully independent contractor would never countenance a move like that.
“For 50 years we’ve reviewed our pharmacy portfolios. That’s nothing new. We tend to seek out higher than average dispensing pharmacies because it helps with the conversion of patients to services.”
He claims Day Lewis is now the “joint-third largest contractor in the country” based on item numbers, principally driven by “huge divestment” of larger groups: “It’s Boots, then Well, then Tesco and Day Lewis are around neck and neck.”
He clearly sees Day Lewis as being able to leverage both scale and ability. Is there an ideal maximum number of branches beyond which its operations might become too unwieldy? He’s reluctant to put a figure on it but replies: “Our goal has always been to be as large and successful as we can be, while maintaining our core values and adhering to our core purpose as an organisation.”
We’re independent
We get into a conversation about the meaning of the term ‘independent pharmacy’. Perhaps the accepted view is that ‘independent’ covers one to 10 stores, possibly up to 20 – Community Pharmacy England (CPE) uses 10 as its cutoff. Any higher and you’re in different territory, one that in its previous incarnation the Independent Pharmacies Association (IPA) spoke for.
But Jay says putting a number on it is always going to be arbitrary, arguing that there are two main categories: corporate chains and independently run businesses. He has no doubts where he falls in this schema. “I cast myself as an independent. We are all incredibly good operators – operationally secure, balanced around risk, looking at opportunity, safety and governance.”
“We’re often misunderstood,” he says, developing his point. “Take the top eight IPA contractors in terms of size of pharmacies. We have a combined total of 400 years of ownership within the same family ownership structure. That’s within the same family, often multi-generational family businesses as well.
“Unfortunately, what’s happened is we get divided up crudely along size: you’re independent or you’re multiple. We should be divided up on the lines of the type of owners we are. If I was to compare myself to some of the larger corporations – I might be positioned that way because of the size of the organisation – but the differences come down to relationships.
“My relationship with my colleagues, our relationships as owners with our colleagues and suppliers and extended stakeholders is better. We see that as a core part of doing business – we don’t have a brand. We believe our brand is how we act and how we conduct ourselves.”
Jay, who does store visits every other week, feels he and the rest of the Day Lewis management team have more skin in the game as a result. “There isn’t this conflict you might have with a large PLC going, ‘well I don’t care what’s happening in pharmacy. I need to get my money out today, where’s the share price at?’ We are pure-play pharmacy and we’re making long-term decisions.”
“My constitution says I have to remain independent. We’re making long-term decisions – in that sense we’re different from the corporates. Sustainability and security are important to us.”
And he thinks CPE needs to act faster to increase representation of IPA member companies on its negotiating board. “I think there’s a misalignment. There’s a significant amount of representation for supermarkets, health and beauty retailers and online pharmacy on the negotiating board,” but in his view the independent chains don’t have enough of a say.
There has been some progress, with two individuals recently granted non-voting ‘observer’ seats on the board but Jay says: “We saw this coming a mile away and people are digging their heels in.”
Community pharmacy has several representative groups who are at times in vocal competition with one another over which of them best serves the sector’s interests. This sometimes feeds into a perception of a divided sector, something politicians could use to stall difficult conversations if they wished to.
What’s Jay’s take on all this? “There is a perception that it is disjointed. I don’t think that’s necessarily reality. We have more in common than there are differences. As I said, effectively three-quarters of us are pure play pharmacy.”
That said, he doesn’t hold back when it comes to his views on some of the big corporate chains. “We don’t bring people in so we can sell them products. I think some of the corporations involved in pharmacy – not to be inflammatory – but there are some organisations in pharmacy that stand to earn more money from people being unhealthy rather than healthy.”
What does Jay mean by that? “If you look at the processed food supply in supermarkets – that’s a big risk. I don’t sell cigarettes in the same premises as I’m selling healthcare from, I don’t benefit from people being unwell. No disrespect to other organisations, but you might see some conflicts with their pharmacy offering.”
Faulty reward mechanism
Recent policy announcements underline his argument, he says. “I’ll give you a scenario about what really separates us. Rachel Reeves made an announcement against independently owned businesses: the inheritance tax law changes. Suddenly, whether it’s a Day Lewis or a sole trader, we are all now liable to stump up inheritance tax. Where do you find 20 per cent from the value of your business? How can you fund that? That’s not a Boots issue, or a Tesco, Asda or Rowlands issue.”
He is agnostic about the current administration noting that while Labour is generally willing to pump more resource into health the party “is also demonstrating that it isn’t as pro-business as we had assumed”.
On the national insurance hike, which is expected to cost the sector tens of millions, he says: “We’re just waiting to see if that’s been factored into the funding. Hopefully the government will understand that as pharmacies we don’t have the privilege of increasing prices overnight like other retail sectors.”
“We’ve had no pay rise for 10 years, so we are in a deficit. It can’t be any worse than that. I’m just having to wait it out, unfortunately. I can’t predict what politicians are going to do. No one can at the moment.”
Everyone is avoiding long-term plans until the next contract is announced, he says. In the meantime, he is focusing on upskilling employees. “We’re trying to get our team as match-fit as we can and waiting for the rules of the competition to be announced – and the reward mechanism.”
He believes that the mechanism is out of whack. “We are being funded for one activity – services – and expected to perform something else – dispensing – at a loss. It can’t be either/or, they’ve both got to be sustainable because they both add value.”
Pharmacy has been dealt a tough hand but needs to marshal its strength and focus on two things: “First of all fight for better reimbursement. Second, focus on money: saving it and making it.”
By savings he largely means running dispensing operations as efficiently as possible: “Make sure you’re claiming for everything and reducing losses. Look at the people you’re using in the dispensing process and make sure they’re operating to their qualifications.”
Streamlining the separation of clinical checks and pharmacy checks is key and “that’s really down to using technology”. There are new PMR systems coming onto the market that are going to be a complete game changer, he believes.
He bemoans the fact that there is a lot of bureaucracy in the dispensing process: “EPS was supposed to make life efficient but it doesn’t. It makes the claiming process much better for the government but it adds huge amounts of bureaucracy for pharmacy.”
Making money means “increasing the value from the patient’s point of view”. Pharmacies should take opportunities to meet the patient’s needs wherever they can: “Is there anything else the patient needs a diagnosis for, like blood pressure testing? Are there any other preventative measures I can offer?”
Having a motivated team is crucial. “The two drivers are intention and capability. They have the intention to do something because you’ve coached the team to believe their purpose is to help their community stay healthy and feel better. Do they have the capability of doing that? It’s important to train your staff so they are capable to perform across those four domains.
“I’m a case in point,” he says. “It was the hypertension case-finding service that really picked it up for me – that and the fact the team was so proactive about me following it up. When I got the result, I shrugged it off; I reckon I would probably have just said forget it and left it for another year or so, until symptoms presented.
“If my team didn’t focus on the blood pressure testing, I wouldn’t be alive. I can absolutely guarantee that.”