Pharmacy In Practice
The accidental contractor with designs on your future
“I fell into being a contractor,” says Aneet Kapoor. “I did my pre-reg for Boots and after qualifying in July, got my own store by September. I turned that store around in nine months on a starting pharmacist’s salary.
“Then my dad fell ill and he had to be rushed back from India. My brother Maneet who is a pharmacist had one pharmacy at the time, and he said ‘I need you. Dad needs looking after.’ I said OK, handed my notice in at Boots and ran my brother’s shop for about six months. My dad got better, and my brother was ‘Right. What are we doing? I’ve seen a couple of shops’. I said, ‘alright then’.” It was 2006.
Aneet and his brother set up a company together, bought a pharmacy in Liverpool and very quickly another one in Chorlton, then they took his brother’s original Rochdale pharmacy into the business too.
“The new contract came in 2005 and everyone was still getting to grips with how it operated, especially the clinical governance side, ensuring everyone had written policies and procedures, not just in their heads. I’d come from Boots where everything was policy and procedure, so I brought that in.”
The first foray into community pharmacy representation was equally unplanned, and again Aneet gives his brother a starring role, which followed their attendance at an LPC contract event. “I was always quite outspoken, and Paul Benson [Manchester LPC veteran and former chair] came over to our table at the end of the night, pointed at me and my brother, and said ‘we’d really like to get you guys involved in the LPC’,” Aneet says. “My brother went along to the first meeting, and he came back and said ‘we’ve joined as contractors, but you’re the named person. You’ve got to go to this meeting’.”
The outspoken Aneet - his engagingly frank assessment of the new contractual framework and call to action at the Pharmacy Show can be found here - was soon in demand, and was co-opted onto Bury & Rochdale LPC in 2007/8 as well, although that didn’t last long. “The chair had already made his intentions clear that he wasn’t going to stick around for much longer, so I became the chair of Manchester in 2009, and I gave up Bury & Rochdale in 2011 because I couldn’t do both. Like anything I do, if I’m going to do it, I’m going to do it properly. I don’t do things by halves.”
It’s a philosophy he applies in business too. “We’d bought four pharmacies by 2009, then we sold the Liverpool one because it taught us about ourselves, that we are very much hands on people. Yes, we’re businessmen, but we’re not going to run it from afar.”
I remind Aneet that when I asked him on the Sunday of the Pharmacy Show what he was doing the following week, he told me he was spending Monday in the LPC offices, Tuesday in his own office, then Wednesday through to Saturday in the pharmacy – he works most of the time in the business’s pharmacy in Whalley Range. “I’m a responsible pharmacist basically,” he says. “I like to be part of what’s going on. I enjoy the variety.
“It’s the way we run our businesses; no job is too big or too small. It’s really key for staff to see that we’re a team and we’re in it together. Friday night I picked up the hoover. It’s about making sure everyone understands we can muck in together to get what needs to be done, done.
“The LPC element keeps me ticking over in the pharmacy. I spend a lot of time thinking about it while I’m there, what we can do differently, but without both experiences I couldn’t do either well. I can only drive what I’m doing at the LPC because experience the coal face every day.”
Innovation comes naturally
He cites the Community Pharmacist Consultation Service and says how important it is to get it right and support contractors, as pharmacy can ill afford to lose patients from poor experiences in the early days of the service, but he’s also concerned about pharmacists’ dented confidence from a poor early experience. “We want to make sure contractors understand this is not a big monster, it is what you are doing every single day. It’s within a framework now, and you’re getting paid for it.”
Tackling something new and then looking for the next thing appears to come naturally to Aneet. “Any role I’ve taken in LPCs has always been around expanding the role, first of the pharmacist, and now the technician as well. For example, there is no reason why technicians cannot deliver an inhaler technique service – it’s not a clinical service, we’re not adjusting treatment.
“I was one of the first pharmacies to do flu vaccines, in 2007, maybe 2008, as a pilot. “I didn’t do medicine or dentistry becuase of a phobia of needles. I inject about 800 people a year now.”
“I signed up for every service. You learn that not every one of them works for each demographic, but it was the opportunity to do more. I did a prescribers course to be able to add something to the role.”
Like anything I do, if I'm going to do it, I'm going to do it properly. I don't do things by halves
Aneet has been an LPC chair for 10 years, the last three of them leading the combined Greater Manchester LPC, formed by the merger of six LPCs across the region – it grates on him that they missed out on seven (Bolton LPC) by 0.8 of a vote (one contractor). “One of my friends didn’t put his paper in, he hold me afterwards. He thought it was a given.”
The GM merger was not only bold, it was achieved relatively quickly. “It was a result of the Health & Social Care Act that the penny started to drop,” Aneet says. “PCTs were dissolving and they were going to form the NHS Greater Manchester team. That was when we started thinking about aligning ourselves. Myself and Peter Marks [Aneet’s opposite number at Stockport LPC] looked at how we could work. We formed a working group (Community Pharmacy Greater Manchester [CPGM]) – we called it a confederation – of the seven LPCs. We tested different models of operation, we employed somebody – everyone put money in – and that one co-ordinator became a full time employed role by 2014.”
But Aneet says that while it was increasingly obvious what needed to be done next, it was a conversation with a new CCA (Company Chemists' Association) and Lloydspharmacy representative on Manchester LPC that proved the catalyst. “I hadn’t met Phil Maslin at the time, but he phoned me. He said ‘I’d like to talk to you quite frankly. Why are we all working separately?’ I said: ‘Go on.’ His next line was ‘we should just be one’. We spent an hour and a half on the phone.
“We were already working on a provider company for Greater Manchester which had been nudged by DevoManc [shorthand for the devolution of health and social care budgets for the region] who told us ‘you need to get on a GM footprint otherwise you ain’t going to be at the table’, so that tied in nicely. Selling the vision wasn’t the difficult bit, because we’d been co-operating for a number of years as CPGM, but the problem was when you weren’t the statutory body it became a barrier. Contractors were in full support of the proposal, and it wasn’t a matter of let’s do it one by one, it was let’s do it all in one go.”
Decision made, and historic vote taken, the six LPCs of Ashton, Leigh & Wigan, Bury & Rochdale, Oldham, Tameside & Glossop, Manchester, Salford & Trafford and Stockport formally joined on 1 October 2016, with a combined team brought together with all the HR and legal processes necessary. Chief officer Adam Irvine arrived at the same time.
The transformation of Greater Manchester
Pharmacy is now involved in clear structures within the regional devolution settlement. We are talking the same day as a meeting of the Community Pharmacy Provider Board, which comprises GM and Bolton LPCs - “we’re in agreement with them that what we’re doing is right for pharmacy, we have a good working relationship” - provider company CHL (CPGM Healthcare Ltd), a practising pharmacist representative and the Greater Manchester Health & Social Care Partnership (GM HSP). That feeds into the Primary Care Board, which includes GPs, optometrists and dentists, which in turn feeds up directly to GM HSP Executive.
Now GM LPC is undergoing a further transformation, as it looks to continue its work across Greater Manchester while meeting its obligations in supporting contractors to delivering on the new contractual framework (you can read Aneet’s description below). “Adam leaving in December [to Cheshire & Wirral LPC] gave us an opportunity to pause and reflect,” Aneet says. “We’ve done a great job over the two years, but I think the networking task naturally came to an end. There was talk of what a new contractual framework would look like and the Long Term Plan gave us that perfect platform – we were already working in neighbourhoods, so while the mapping had changed, the principle of population-based healthcare hadn’t.”
A major organisational redesign three years after the merger of six organisations into one is probably the right thing to do, but I ask Aneet where the prompt to tackle something like that comes from.
“It’s obvious,” he says. “We were struggling to balance managing the team internally, and keep up appearances externally. One side was getting the focus, the other wasn’t. We’d got loads of admin support, but no direction for them. An example: tendering, VAT and services need specific financial skills that we don’t have. Data analysis is another.”
It’s a team effort. Aneet singles out vice-chair Ifti Khan (Well Pharmacy and the CCA) specifically. “I’m really lucky. He thinks laterally, and does detail. I’m very much a blue sky thinker, where we need to be. Ifti will come back with five or six questions. We answer the questions and, guess what, we’ve got a framework for how we deliver.”
With a provider company and training academy, contractors in Greater Manchester seem to have all the building blocks in place. Now Aneet wants more. “Yes, we have the contracts, but the provider company needs to pave the way contractually for what community pharmacy can do. I want the provider company to go in with a tested model, saying ‘we’ve delivered this, you’ve got this area of deprivation here, we can do this for you’. The academy works closely with CPPE, with RPS, Health Education England, any training provider that wants to come and talk to us about fulfilling the needs we’ve identified.”
As for the future? “The 67 primary care networks are our big focus, ensuring we’re not reliant on the employed team and the board for PCNs. We cannot deliver the contractual framework (CPCF) going forward, unless community pharmacy on the ground steps up. Engagement with PCNs is not just a tick box exercise for the Pharmacy Quality Scheme; we are fully committed; we have a two-year support programme outlined and budgeted. We will support them, hand hold them.” Further leadership will be provided by the locality lead pharmacy members of the provider company, who will support PCN leads in their area.
Aneet says: “The leadership stuff is really important, but we can’t do it without the guys at the coal face. It’s OK me going out doing presentations, but the ones that need to hear what I’m saying don’t set foot in the room. It’s how we get to them that’s going to be our big challenge. And I’d love to get Bolton on board at some point,” he adds.
I ask how he does it all. “I’ve got a very supportive wife,” he says. “It gets tiring. This weekend I was flat out; it was my first Sunday at home for a while. I was just spending time with the kids [aged eight and seven]. We had a great day. This year was my first family holiday abroad in four years. It does take its toll, but if I’m going to do something I’m going to do it properly. I like to keep on top of things. Once the kids are in bed, it’s half an hour, an hour. The worst thing is to spend a Saturday cleaning up the inbox or reading stuff you should have read in the week.”
But that work ethic must come from somewhere? “My dad,” he replies immediately. “Dad was a market trader. I was working at the age of six on a Saturday. Originally it was out of excitement because I got to go to work with him, by the time I was 10 it was ‘please leave me at home.’ I did that from six to 18. Mondays we had off, Tuesdays straight after school, get picked up go to the market, pack the stall up. Wednesday, load the van ready for Thursday. Thursday, after school same again. Friday, load the van ready for Saturday. Sunday off.
“That’s where it comes from. Graft.”