Anatomy of a speech: David Webb

microphone speech.jpg
microphone speech.jpg

Anatomy of a speech: David Webb

England’s new chief pharmaceutical officer, David Webb, used his speech to the Clinical Pharmacy Congress on 13 May to set out, as he put it, the future direction of the profession and his personal priorities for the next few years as the new head of the pharmacy professions. Rob Darracott deciphers the key paragraphs

David Webb: “There’s a lot going on in pharmacy and in the NHS at the moment. Most of it is really exciting and positive. Some of it is challenging. We’re on the verge of a new era of clinical pharmacy. Delivery of the future is in everybody’s hands.

“I [intend] to be a chief pharmaceutical officer [CPhO] for all members of our two professions, and for all parts of the NHS. To be approachable and inclusive, and to appreciate your contributions as we move forward through the next few years working together to improve patient care.”

Rob Darracott: A strong start. Community pharmacists were once told that England’s previous CPhO was irrelevant to the community pharmacy contract. Later on, he was the architect of everything bad that happened in it. Of course it’s not that simple. The responsibilities of the CPhO across government and the NHS are considerable; some impact directly on what community pharmacists do, others relate more to the roles of all pharmacists across the system, or cover activities that keep patients safe when accessing and using medicines. 

DW: ”The pandemic years have been incredibly tough for everyone. And there are now immense pressures across the system that I recognise. I want to sincerely thank you all, and your colleagues and teams for the work you have been doing for the last two years. Life has been extremely difficult. It has also been transformative for the role of pharmacy in the NHS. 

"At the core of this will be the most fundamental change to our profession in decades"

“I’ve always been really proud of the pharmacy teams I’ve worked in. Some of the practice those teams have delivered has been at the leading edge and sometimes beyond the leading edge. But I’ve been particularly struck on the visits I’ve made so far by the integrity, professionalism and commitment of the teams [I’ve met].”

RD: David Webb’s first external visit as chief pharmaceutical officer was to a community pharmacy – Jignesh Patel’s Rohpharm in Plaistow, East London (see also here). There is no harm in giving him options to visit more, especially where integrated working is in preparation or a reality. 

DW: “Pharmacy professionals everywhere have emphatically shown that they are delivering the NHS Long Term Plan priorities, supporting the NHS to deliver through incredibly difficult times and now supporting the recovery. We’ve demonstrated, collectively, we can deliver as teams across the system. This has given us a huge amount of credibility as we further integrate pharmacy into the NHS and pathways of care. 

“Over the next four years, we’re going to see a great deal more change as a result. We will all need to be ready to harness the possibilities as they arise, so that we can work together to ensure that patients get the very best possible care from us as an integrated team, wherever we are in the system.”

RD: Significant. The NHS Long Term Plan is still the driving strategy across the NHS in England. And it’s the first mention (there were many) of integration, integrated teams and integrated care systems (ICSs). If community pharmacy needs a signal that it must think, nationally and locally, about integrated working with others for its place in Futuretown, this is it. Integrated care and systems thinking was a key subject in Mr Webb’s presentation to the recent closed-door LPC conference. If you’ve recently been told (again) that the national contract is the only game in town, then think again or risk being left out when the real debate about how community pharmacy fits into integrated primary care (where the money is going) starts. 

DW: ”At the core of this will be the most fundamental change to our profession in decades. Every pharmacist will be a prescriber on registration from September 2026. This totally transforms the professional landscape and we need to frame everything we’re doing with this in mind.”

RD: He’s not wrong (see below).

DW: ”The NHS Long Term Plan ambitions, including the move to ICSs, have been driving changes in our professional practice and providing strategic impetus to everything we’re doing across pharmacy and medicines… Integrated care boards and integrated care partnerships will be statutory entities from 1 July. 

“These new organisations, and the committees that come with them, change our whole healthcare landscape. They give us the potential to form partnerships to deliver integrated services across a large population, using population health management approaches and much more besides. I encourage you, as pharmacy professionals, to step into these spaces and to demonstrate your leadership. You have so much to offer.”

RD: The CPhO knows that community pharmacy has some very good local leaders, who have seen all this coming and started preparing years ago. But he also knows this is not true everywhere. The new system leadership posts – 42 community pharmacy clinical leads in integrated care boards and the senior pharmacy integration regional leads (Mr Webb would mention them later) – are part of the solution. Community pharmacy needs to plug into them from day one.  

DW: ”New ways of working, new relationships and a fresh look at how services are organised and provided at a local level will provide a myriad of opportunities to use the skills of pharmacy professionals more, and that includes independent prescribing. 

“I can envisage a time when it will be common for pharmacists to manage many long-term conditions within ICS pathways of care. Nationally, we can set the conditions for all that to happen, but it needs to be system led and locally delivered if it is going to come together and work for the benefit of patients.” 

RD: While the management of long-term conditions catches the eye, the second paragraph is key. Again, it signals the need for local action, in terms of both leadership and delivery. It could be a very good thing that the proposals on representation in England recognise the importance of revisiting structure and functions often. That might be needed immediately.

DW: ”I hear your messages on workforce pressures from secondary care through to community pharmacy especially and acknowledge that this is the case for many professions within the health and social care system… At a national level, NHS England and Improvement is working closely with ICSs, employers and colleagues in Health Education England on workforce planning for the whole pharmacy workforce and the wider NHS workforce and applying this across each of the 42 ICSs in England. But it’s equally important for all employers to make sure they are training enough pharmacists, pharmacy technicians and support staff to meet their needs.”

RD: The last sentence reads like a direct challenge to employers. It wouldn’t be the last.  

DW: ”Developing the role of pharmacy technicians is crucial, including the ability to operate under patient group directions. This will enable pharmacists to move to a mainstream independent prescribing role and help us meet some of our workforce challenges. Developments in the use of skill mix and hub and spoke will underpin the increasing clinical role for more pharmacy professionals and enable that clinical future we are all seeking. 

“We are starting to see the enabling legislation come through – for instance, extending the dispensing errors defence to hospital pharmacists and the regulations to allow the GPhC to set out the responsibilities of superintendent and responsible pharmacists… There will be more to follow.” 

RD: Long-standing elements of reform have not been abandoned and are vital to creating space for pharmacists to deliver a more clinical role. Beefing up the powers of the regulator to support pharmacists in their clinical roles – by holding employers to account – has been a role earmarked for the GPhC for a decade. Note, too, that ‘clinical role’ does not just apply to pharmacists. 

DW: ”Because of this exciting future, we’ll need strong professional leadership to guide, support and enable the transformational change I’m describing. That’s why the four UK CPhOs are establishing a commission to produce a blueprint for the purpose and functions for professional leadership in pharmacy for the future. This is to ensure we have the right support in place for the profession, for patients, for the NHS, to work with the regulator and the government.” 

RD: Recent developments at the Royal Pharmaceutical Society – not mentioned by name – have disappointed (at best) the four UK CPhOs. The new RPS emerged from a period of introspection following the removal of its regulatory functions designed (or destined) to fulfil similar functions to the medical royal colleges, committed to professional excellence in the public and patient interest. Whether we like it or not, professional organisations sometimes have to change at the behest of those that support their continued existence and status.

”Community pharmacy colleagues are a key part of the overall direction of clinical pharmacy practice in the future. They are an essential part of the ICS vision"

DW: ”Medicines optimisation to benefit patients and communities is the prize and the ultimate goal of all this work. If pharmacists routinely prescribe, they can run specialised clinics as well as do routine prescribing and, importantly, deprescribing in a way that may help address issues before they become problems… Medicines optimisation, as a part of population health management and as an approach in integrated care, will deliver on all of these priorities: polypharmacy, medicines safety, value, sustainability, mental health and parity.”

RD: Continuity with his predecessor, Keith Ridge. The CPhO’s connections to senior NHS leaders – he reports to NHS England national medical director Steve Powis – mean these priorities are NHS priorities too. They encapsulate all aspects of the use of medicines, the good, the propensity for harm, the value and the costs, incidentally useful criteria for assessing the merits of any new service opportunity or proposal.  

DW: ”The next stage of the aseptic and NHS manufacturing medicines transformation work is an example of what we’re aiming to achieve. Our ambition is to move from the production of 4 million doses per annum to 40m ready to use doses that can be taken out of the hospital and closer to home, and free clinical time at ward level. The aim of the hubs is to make high volume standardised products, creating capacity in the hospital spoke sites for more bespoke, complex and innovative medicines that require aseptic preparation.”

RD: Neat. Hub and spoke is a way of working, not a technology.

DW: ”Community pharmacy colleagues are a key part of the overall direction of clinical pharmacy practice in the future. They are an essential part of the ICS vision. 

“It’s hugely positive to see the growing confidence everyone has in community pharmacy, with more pharmacy integration programme pilots already on the way and several more in the pipeline. These are just the tip of an iceberg in terms of opportunity once independent prescribing becomes mainstream…

“We are already actively working on developing opportunities to use prescribing in community pharmacy. We’re offering 3,000 funded places for independent prescribing this year and this will provide us with valuable experience on how best to expand independent prescribing among existing pharmacists in community pharmacy. Working with employers and all our partners, we are aiming to deliver fulfilling roles across all sectors for new and existing registrants.” 

RD: England may be a little behind Scotland and Wales on this, but it may be no bad thing that those nations are already exploring where community pharmacist independent prescribers go next; England is a vast estate in comparison, and more complex for that reason among many others.

DW: “Final messages: The next few years are pivotal to us as a profession, to all professionals in pharmacy and to our patients. Therefore, it is essential that all of us get the right working relationships in place nationally, at system level, and locally to enable us to achieve our ambitions. I’ll be doing this on your behalf and hope you will join me and contribute your support and energy for the road ahead.”

RD: There it is again, right at the end. Local is going to be very important for the future of community pharmacy practice. 

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