By Rob Darracott
The suggestion that “two-pharmacist” pharmacies might be a better way to run the sector – more time for face-to-face consultations with patients and members of the public – has been around for decades. But I wasn’t expecting North East London’s chief executive officer Shilpa Shah to suggest it as the answer to my question about what she’d have in a new vision for community pharmacy.
We were coming to the end of an intriguing conversation about the challenges currently facing the sector and the role local pharmaceutical committees (LPCs) are playing as integrated care systems come together to start their work in earnest. I’d asked her what community pharmacy should be looking for to get a better contract deal. There was a pause.
“This is my vision. For five years, the NHS should pay £60,000 to every pharmacy that dispenses over a certain number of items (pro rata for fewer) for a second pharmacist and to support the development of the skills of both pharmacists. It’s like the Additional Roles Reimbursement Scheme (ARRS) funding for general practice. That’s basically what I’m asking for,” she says.
“Could you imagine what we could do with that resource? Extra funding until we get everyone as independent prescribers. It would help community pharmacies and it would help the workforce pressures across the NHS. It would need to come with KPIs (key performance indicators) – you’d have to deliver to show you are making a difference to your community.”
She suggests you would link the KPIs to the things the NHS is concerned about – access to care, the availability of health professionals, health inequalities – and support community pharmacy provision as part of the urgent and emergency care system.
We develop the idea for a few minutes. Shilpa suggests such a programme could play to the strengths and interests of individual pharmacists and help manage a few current challenges along the way. Clinical development would become a fundamental part of life in a community pharmacy There would be better management of work to the skills and professional interests of the pharmacist, with peer support on tap to encourage innovation and practice excellence.
“It would improve job retention, reduce stress,” she says, but she is also thinking longer term. “It would open the door. For example, we haven't put a cap on the number of services, whether that’s GP-CPCS (the GP Community Pharmacist Consultation Service) or DMS (Discharge Medicines Service) or anything, eventually we may need to. I can imagine us having to say ‘can we slow things down, we’ve got a really tough time coming in the next few weeks? Can we pause referrals?’ That may happen.”
Capacity for services is front of mind, as Shilpa says the LPC is currently very service-focused. She took over as chief executive at North East London LPC in January this year, after almost two and a half years in a similar role at Kent LPC. “The big things are making sure we’re launching services that have been around for a while. For example, GP-CPCS started on the 1 November 2020. We only really got it off the ground in North East London in a clear, consistent way for both surgeries and pharmacy contractors on 1 March 2022. We’ve done 22,000 referrals so far, which is fantastic. DMS still isn't where it needs to be, but it’s getting there, we’re just waiting for the IT system to be implemented so again it’s clear and consistent.
“At Christmas my dad would deliver the Radio Times to elderly people who couldn't get out; when it was snowing, they'd phone up and ask him to drop their newspaper off and he’d ask if they needed bread or milk as well”
She says she is sure there will be a consultation that asks for views as the Pharmaceutical Services Negotiating Committee (PSNC) launches its work on a new strategy and vision for the sector. “But I’d just love to just have a chat because I think you get more from that, since you can understand what’s really happening on the ground.” She thinks more informal engagement with front line professionals would be beneficial. “I sit in the LPC. I don’t know what it’s really like on the ground.”
“We always start at the top and look down,” she adds. “We need to start by walking through the journey of someone who's got a short-term acute illness, someone who's got a long term illness and someone that's caring for somebody with an illness. And then look at what GPs and other stakeholders see when they look at community pharmacy.
“What you shouldn't see is five different journeys. How do we make it so that, regardless of who you are, where you're from, what you're there for, when you walk into that pharmacy, you get the care you need, and everyone understands what that looks like.
"The next step would be to socialise that vision, so everyone is clear what community pharmacy is for and what it can do, when they should go to one and when they shouldn't, and what they should expect when they get there.”
The return home
The move to North East London was very much a homecoming for Shilpa Shah. She grew up in Walthamstow, in the Borough of Waltham Forest. “Community is important to me,” she says. “My mum and dad had a had a newsagent in Walthamstow for 43 years; they were a big part of the community. People still stop me in the supermarket and ask how Cyril (Suresh) and Linda (Indu) are. They only retired because my sister and I made them because of Covid.
“I saw the impact my parents had in the community. At Christmas my dad would deliver the Radio Times to elderly people who couldn't get out; when it was snowing, they'd phone up and ask him to drop their newspaper off and he’d ask if they needed bread or milk as well. When the North East London LPC job came up, I thought I could get to do the amazing job I'm doing, but in the area I grew up in so that I could give back to my local community.”
Shilpa studied at King’s College in London. Hers was the final cohort to complete the three-year degree at the Manresa Road Chelsea site. She says she got a good pay bump following registration because of the fallow year immediately behind hers. “Boots were really worried there’d be a workforce shortage.
“I thought I might have to change my behaviour, but actually, in the role you just need to be yourself”
She spent the first 16 years of her career with Boots. Her first pharmacist store management position was a non-dispensing site, so she “got to learn more of the business side.” Progress through Boots eventually led her to a large store manager role in one of the company’s top 300 stores, which was when a pharmacy student “Saturday healthcare advisor” said to her “Sixteen years with one company?” which made her start thinking about what else was out there.
In her next role as area manager for Lloydspharmacy, again in North East London, she got an opportunity to speak at a round table event at the House of Commons, due to a last minute drop out for a company representative. “It felt really glam and different to do something like that,” she recalls, “but these were the people talking about change and it felt as though they could make a difference.”
When the Kent LPC job came up, it felt like a natural progression to apply, even though her LPC experience was limited to spells as a Company Chemists’ Association representation on North East London, and then Enfield, Barnet and Haringey LPCs. “But I thought: this will give me an opportunity to change the things that we constantly moan about’. Spurred on by colleagues at Lloyds, Shilpa applied for and got the job.
“As an area manager, your pharmacies have to deliver the KPIs you've set them. As an LPC chief officer, you want a service to be successful, but delivery is down to the pharmacy. You influence from the sidelines.
“I say it like it is, so I thought I might have to change my behaviour, but actually, in the role you just need to be yourself, be personable, talk to people, help them to understand why this is important to you or to community pharmacy, and the rest will come with it. You need to speak professionally about other health care professionals. For example, I would not say ‘GPs have shut their doors’ but would say ‘We know GPs are working in a different way; but this is an issue we're having locally…’ because we don’t know the details and struggles their surgery is facing It’s the same with flu. You don't tar every GP with the same brush when it’s just a few that put up posters or send out messages telling people not to have their jab at the pharmacy.
“Moving to this area, I knew what the job involved. I knew the remit of the LPC and what was a bit extra. Having said that I always go above and beyond. So, if I've got a contractor phoning me about training, even though training is not really part of an LPC’s remit, I’ll help them because it helps them it helps community pharmacy, it helps local residents.
Early funding success
It’s clear right now that she’s enjoying the job. Eight months in, she feels she’s built the right relationships with the key stakeholders. It helps to have an early success to prove your mettle. “Week six, into the role I had a big breakthrough with the CCG (now ICB),” Shilpa says.
“Richard Brown from Avon LPC, my predecessor, who did two days a week here during the transition, had negotiated £55,000 to employ somebody to support GP-CPCS. I went to a meeting with the primary care transformation manager. We were having a conversation about the £9m Winter Fund for primary care. We were talking about CPCS, DMS, all the new services coming out, primary care network (PCN) leads. Community pharmacy on the front line of primary care.
“I managed to negotiate that £55,000 into £566,000 – £100,000 for GP-CPCS, £300,000 for PCN lead development, including days out so they can actually do the job (PQS doesn’t pay enough). And £166,000 for the hypertension service and anything else coming down.
“That funding really helps our contractors. I've got a very small team. There's me, services pharmacist Dalveer and Rebecca, our office manager. All full time. A committee of 13. I've aligned everything with NHS pay banding and saved money for contractors. We’ve reduced the levy – not massively as we don’t know what the implications of the Review Steering Group proposals will be on the LPC – and we closed our office in favour of home working.
As for those RSG proposals, she says the LPC is already in a good place. “We’ve made a lot of moves already, pre me joining NEL” she says. At the end of the day, contractors have voted and it's important we try wherever possible to implement what they voted for. Until we get the toolkit, we don't really know how it's going to affect us. Timing is a challenge; we’d like to get it done in six months, by the end of March.”
“It’s a really good team. We work well together and we’re focused. For me, work hard in your work hours and I won't disturb you outside of that; just get the job done. Do what you need to do, but do it in the right way. If you need to take an hour off take out, that's no problem. Just make it up later in the week.”
The support for PCN leads is due to kick off in October with a leadership workshop day, covering the new NHS landscape, the role of the Integrated Care Board and so on. “From then on, we've got about ten hours a month for each lead to visit GP surgeries and all the pharmacies in the PCN. We are going to support them and structure it so they talk consistently. October/November might be the Pharmacy Quality Scheme, for example. The PCNs don’t involve community pharmacy too much at the moment, but they are looking to change that, so as we transition and start using the funding we have been given, that might work really well,” Shilpa says.
With six boroughs covered by NEL LPC, Shilpa has the lion’s share in North East London ICS. Yogendra Parmar is her opposite number who looks after the other two, in City & Hackney LPC. “We have a really good working relationship – we pick up every couple of weeks. We trust each other to do what's right. if one of us is at a meeting that the other can’t attend”
“With the new ICB, it’s tough – everybody is having a place-based meeting about different things, so we're having to attend a lot of meetings just to get to know the people we’re working with,” Shilpa says. “They’re really involved in community pharmacy – I took the chief medical officer to three pharmacies last week. He’s really focused on wanting to know what's happening out there and what influence he can have in his role with the CEO and the chief pharmacist as well.”
“They invite you to everything – I’ve been invited to meetings about housing in Barking, for example. It’s a good sign that community pharmacy is important enough to invite; whether we choose to go or not is a different thing.
“What is emerging is a recognition, particularly following the Fuller Stocktake, that community pharmacy has a huge role to play, and has probably been underutilised. For example, in Havering we've not had a smoking cessation service for years. The question now is, ‘how soon can you get it running.’ We need a service spec, but we could be running in two weeks if you get a spec over.”
Shilpa says the GP view of community pharmacy has changed considerably from her time on the LPC as a CCA member. With regards to the GP-CPCS “there were a couple of surgeries who wanted to know why they couldn’t just send people to a pharmacy, or who suggested their pharmacy didn’t know what they were doing, but the majority were just click, click. Referrals are going through and it’s been a smooth transition.”
Shilpa says she’s now brokering arrangements in one borough for more community pharmacy Covid vaccination sites, as the NHS preps for the next round of boosters starting on September 12. “They’re looking to community pharmacy a lot more because they can see that during Covid we really stepped up,” Shilpa says. This year, regular commitment is as important as the numbers, even for 100 jabs a week. “Are you doing flu vaccines this year? Yes? Okay. You can co-administer.
“I talked to a pharmacy this morning. Shut on a Saturday and Sunday. Get a pharmacist in on the Saturday. Run a clinic, that’s your 100 jabs done. Pay the pharmacist £400. Get a member of staff in to do the paperwork and everything that goes with it. Give them £150 for the day. You’re still quids in and you’re doing your bit for your patients.
“They can't think out of the box due to the pressure everyone is under. You’ve got to carve out time for the new and innovative”
“Area managers are geeing up the multiples, but independents don’t have that. You just need someone to say you can do it. Think differently. Think big. And you never know what you uncover. A contractor this morning said he’d volunteered in a mosque where he lives to do vaccines. That’s outreach as well, which is what we need in London to reduce inequalities. If 20 pharmacies do their bit, you’re not relying on one pharmacy to do a lot.”
“The contractors I’ve spoken to in the area where sites were needed have all said they are interested, so I’ve put their names forward.
What I love about my job is the innovative ideas and knowing that I’m making a difference to peoples’ lives. It’s nice when someone says that's a really good idea, we're going to pay Community Pharmacy to do that.”
Shilpa says her upbringing has given her a clear view of inequality; she thinks pharmacy can provide solutions. “It's all I talk about,” she says. “My mum and dad came here with nothing. They worked hard to get everything they have. I was lucky enough to go to university at a time when you didn't pay for your degree. I get my healthcare for free. I see so many areas of deprivation and I see pharmacy as a solution for that.”
Two years in Boots, Stamford Hill, in the centre of an orthodox Jewish community, provided early lessons. Staff, who helped her understand the community customs, are usually local and they’re important for that, she says. Visit a pharmacy in Tower Hamlets today and you find a lot of the staff are Bengali speakers. “People trust them and tell them things they may not tell another health professional. That’s what got me talking to the local authority about the vaccine hesitancy service we've just launched. I came up with the idea in Kent, with the support of Cavita Chapman, regional head of equality, NHS SE, but it didn't get funded there.
“To a certain extent, everybody is stuck doing things the way they’ve always done. They can't think out of the box due to the pressure everyone is under. You’ve got to carve out time for the new and innovative. Pharmacies that have taken up the service think it’s brilliant. It will be even better when we start up the Covid vaccine sites again. At the moment, you’re having a conversation, but it’s not easy to have a vaccine.”
Shilpa says she does her best thinking outside of working hours. She might work on a Sunday morning, before spending time with family and friends. Or opportunities will occur to her while she’s volunteering. “I’m on a suicide prevention group in Waltham Forest. At my first meeting the PH team were all interested in what community pharmacists could do to help. I was there for Samaritans, talking about community pharmacy.”
Big issues for contractors
With lots going on, Shilpa says she still has to be mindful that those she represents are coping with some big challenges. While the majority of her contractors are independents, and there are locums to be found in East London, she says workforce is a big issue, particularly for staff. “When I first started at Boots in Barking, Brenda and Lillian started work there just after they left school and were there until they retired. They’re still friends to this day and I keep in touch with both of them. That doesn’t happen anymore, not many people stay in the same job for a long period of time.
“How do we get our contractors, into the mindset that most people want different experiences? They might work with you for two, three years and then they’ll go and work somewhere else; they might try a whole different field.
“IT is an issue too,” she says. “We have few providers who can provide a total solution. If you have a single provider of a solution, where’s the incentive to be better? In London, we have one system for NHS flu, a different system for London flu, it’s too much for pharmacists. Then, a patient will say ‘the doctor sent me here’. Are you looking for a prescription or a referral? If your company uses online doctors/services, you might need to look at another system. We need to make language more patient-friendly. You don’t expect a patient to say, ‘my doctor has referred me for a GP-CPCS meeting with you’.
“Stock availability and price is affecting our contractors massively. We’ve always said there’s some winners and some losers with price concessions but it feels as though everyone's a loser at the moment.” National contract matters don’t take up a lot of her time – a committee members’ WhatsApp group is proving useful in highlighting issues that can be escalated to PSNC.
Shilpa says that, given the capacity constraints within national organisations, it’s partly the responsibility of people like her to feed good ideas in – she has recently submitted the service specification for the vaccine hesitancy work in Tower Hamlets into PSNC. Last year, she circulated the results of a major Healthwatch survey.
“I love my local area. I love North East London, but I love community pharmacy, so I try and share where I can, because I want all areas of community pharmacy to do better. It’s no good if we’re thriving, when pharmacies across the country are shutting down. That’s not going to help anyone."
Quick fire questions
Optimist or pessimist?
Optimist, I think, although if you ask me if the glass is half full or half empty, I’ll says it doesn’t matter. Have another drink afterwards.
What gets you up in the morning?
I love my life. I love my job, although those that know me well, know that I'm not an early bird. I like knowing that everything I do is making a difference to someone's life and making it a bit better.
What have been your most professionally rewarding moments?
I got to meet Prince Charles at the recent NPA pharmacy event. The Independent Community Pharmacist Award we won as Kent LPC in 2021 was brilliant. I was a Macmillan trained pharmacist in Boots, and as the store manager I had Macmillan trained No7 counter assistants.
I arranged to go into the local hospital to show people suffering from cancer how to do their makeup with the No7 girls and to talk to them about their medication, side effects and so on. It became a bit of a movement; we got Marks & Spencer involved to talk about bras after mastectomy, for example. The charity work while I was at Boots is a highlight. I got an award for ‘best of the best’ charity champion.
Who's inspired you in your career to date?
I'm really lucky. I've had a lot of great leaders (some not so great), so while I couldn't name one particular person, I've had people who have been real advocates, including some male figures who pushed me to be the best female leader I could be, sometimes by having challenging, difficult conversations with me, but I always respected that, they were trying to support me to be the best that I could be.
The not so great leaders taught me about the type of leader I never wanted to be. I look at my mum and dad and what they've done for their local community and the impact that they've had which is so inspirational. That’s what’s kept my heart and soul in retail and in community pharmacy.
How did your volunteering start?
I was a ‘gamesmaker’ at the 2012 Olympics. I got an email afterwards asking if I wanted to be a volunteer. I chose the Samaritans – it was the first on the list with an information evening the following week. If I do something, I tend to want to do it straight away. I've been there seven years; three years ago I was voted in as branch director. My tenure finishes at the end of September, but I’m looking at other roles that I could do within Samaritans
I love it – it’s not always easy listening to what people are going through, but it keeps you grounded and makes you realise how lucky you are. I’ve also recently trained as a listening friend for Pharmacist Support and I am a pharmacist at Crisis at Christmas every year – I don’t have time to locum, so that's me doing my few days of pharmacy every year.
I started as a volunteer pharmacist, 9 years ago then they asked me to be a team leader and now I'm one of the deputy healthcare managers. This year one of the things we're implementing, fingers crossed, is using independent prescribers, so we can take prescriptions to local pharmacies within London that are open on Christmas Day. It’s great to be able to use my day job to change a process to make things better for people in another area.