Building the future - part one
Seven community pharmacists tell us what they’re working on, and what they’d like to do next. First up, Sobha Sharma from Neem Tree Pharmacy in Abbeywood, London and Vikki Furneaux from Monkbar Pharmacy in York
Sobha Sharma is owner and superintendent at Neem Tree Pharmacy, Abbeywood, London, as well as co-owner of Woolwich Late Night Pharmacy and Plumstead Pharmacy. She gained her MPharm from UCL in 2004 and worked in Boots for a couple of years after completing her prereg. She and her husband bought Abbeywood Pharmacy in 2009 and added the other two businesses in 2013 and 2018. A mother to four children aged nine to 14, Sobha also completed her MSc, including an IP qualification, in 2018.
As a 100-hour pharmacy in a health centre under a GP surgery, Woolwich Late Night Pharmacy has been busy doing Astra Zeneca and now Pfizer vaccinations. Sobha says it has been “a real privilege” to work in the vaccination programme. “As frontline healthcare workers, my staff and I had the chance to be vaccinated in December at Guys, but we waited to open our own clinic to lead by example. We have a duty of care to the people we work amongst, and we felt it would be hypocritical if we were giving it but not getting it here ourselves.”
I am optimistic that maybe this was what was needed to showcase what we do.
As well as being able to show her community what the vaccination process involved, Sobha could also talk to those who were hesitant about getting the jab about the risks and consequences of catching Covid. She and her family all had it in March 2020.
“I’m pretty sure I caught it from customers coming into the pharmacy in the early days of the pandemic, as we had people showing up with cough and fever,” says Sobha. “It was a slow build up. I had a heavy chest for a week or two, and felt very tired, but I didn’t have any of the classic symptoms of fever and cough and GI upset like my husband and my mum did. Luckily, my symptoms were mild to moderate. I did feel really tired for a couple of months afterwards, but now I feel fine.”
Aside from having to self-isolate and find locum cover, Sobha says the early days of the pandemic were definitely tough. “No one helped us at all for the first couple of weeks,” she recalls. “We were all working tirelessly to make the pharmacy safe for customers and staff, not least of which meant sourcing and paying for all our own PPE.”
On the plus side, Sobha says running a Covid vaccination clinic has raised her pharmacy’s profile in the community, both with patients and commissioners. “My priority is to expand our clinical services to include private blood tests and allergy tests,” she says, “and the CCG has been in touch to talk about others. We have done phlebotomy training and were about to launch this when Covid hit. Next on the cards for us is Fit to Fly PCR testing, and we are also in talks to do Randox day-2 and day-8 Covid tests as well, which is enough to keep us busy for the time being.”
Despite her proactive attitude, Sobha says if she could change one thing about the way community pharmacy works with the NHS, it would definitely be to be more integrated. “Community pharmacists are good problem solvers and managers,” she says, “but we do need support from the NHS. We do so much, but it seems like we are just getting pats on the back for it and that’s not enough. I’d like to see us being paid for our consultations because we are giving advice all the time – and that’s without CPCS 111 and the GP CPCS having got off the ground.
“Matt Hancock says he wants to drive money from the NHS into pharmacy, but if we have to repay the Covid support grant, there will be some pharmacies that are simply not going to be financially viable. We’ve been the ones who have risen to the challenge to see patients during the pandemic. Even at surgeries that were open, it proved too hard for many to get appointments or even speak to someone on the phone.”
Sobha has plenty of examples of how her pharmacies’ open doors have helped people in need of healthcare advice and interventions. “We have a big Nepalese population. I speak Nepalese and Hindi, which has helped me work with the Gurkha population, who did not understand how to access Covid vaccinations,” she says. “We gave a woman with dementia her first Covid jab, and when she came back for her second at the appointed time, we could tell from her records that her GP had given her a second vaccination only five days after she saw us for her first. She’d forgotten she’d had it. We highlighted the problem with her GP, but can you imagine how it would have played out if it had been the other way round?”
Sobha says being able to demonstrate that pharmacy is the face of the NHS frontline during the pandemic has left her optimistic about what’s to come for the profession. “Our profile has gone up and people see the value of community pharmacy, so I’m hoping that will change our future. I love my profession and I love my job and I am optimistic that maybe this was what was needed to showcase what we do. Community pharmacy has so many skills in-house that we are perfectly placed to work with other healthcare professionals in ways that would benefit the NHS.”
As if she hasn’t got enough going on, Sobha has now started a part-time PhD in pharmacy practice. “It’s not money that motivates pharmacists,” she explains. “We just want to make a difference to our communities.”
Vikki Furneaux had spent most of her career in hospital pharmacy, including commissioning and then running a £10 million aseptic suite and radiopharmacy unit, before she joined her husband and his business partner at 100-hour contract Monkbar Pharmacy in the centre of York three years ago.
“The majority of the running of it is down to me,” says Vikki, who works a nominal 23 hours a week, balancing this so she can spend time with her three young children. “I helped set the pharmacy up in 2012 and tried to maintain my career in hospital pharmacy, but quit in 2017 and integrated myself as full-time as I can.”
“Since I joined the pharmacy, there have been some major changes,” she says, adding that she wanted to bring skills developed in setting up a training programme for band seven pharmacists, working on call and as directorate pharmacist in rheumatology, into community pharmacy.
“I’ve tried to be innovative,” says Vikki. “In hospital, pharmacists are well respected and really integrated into the multidisciplinary team. We worked together to get the best outcome for the patient. Community pharmacies don’t even work with each other, let alone with the wider healthcare team.
“I immediately set about trying to change that in our area. There were already some good links with GPs; I worked to formalise them. I got in touch with other pharmacies so we could all support each other. Over the last three years, I’ve got us integrated in various different networks.
“I’m the pharmacist lead for our PCN and the clinical director also asked me to sit on the York Healthcare Collaborative, a group she co-chairs comprising lots of different health leaders in York. There’s primary care, mental health, the voluntary services, drug and alcohol services, the hospice, PCN clinical directors from across the city, public health from the council. Twenty or so people trying to get better health outcomes and reduce health inequalities. The LPC is on there, but I represent the coalface.
“I think I’ve managed to raise the profile of what we’re capable of. There’s a huge appetite in that group for community pharmacy to do more – we’re trying to break down the operational and financial barriers. The public want us to do more, primary care want us to do more, so we’re trying to make that happen. GP practices are behind on last year’s work. They’re struggling to catch up while dealing with a mental health crisis and a huge vaccine rollout on top. They are sinking. The public are losing confidence in them. Community pharmacy can help.
I make up for that with enthusiasm and determination. If something’s a good idea, it’s a good idea
“We need to be able to administer the Covid vaccine, especially if a booster is required, alongside the national flu vaccine programme. We need access to medical records so we can do health check readings, compliance reviews, minor ailments services like they have in Scotland. We need dedicated training time too, like the rest of primary care.
“In the last two or three weeks, I’ve had suicidal people come in, people who are self-harming, a gentleman with a huge, horribly infected very deep gash on his elbow, frustrated he couldn’t get in to see his GP. He needed to go straight to A&E. Someone in hypertensive crisis – with a history, feeling dizzy, nauseous – was actually referred to us by the GP team. We sent them to hospital in an ambulance. None came in through the CPCS.
“We only get paid for the minor ailments consultations that are formally referred to us. There are huge campaigns telling people to go to pharmacies first, but that simply isn’t funded. Over the counter sales don’t cover the cost. The vast majority of consultations end in low cost or no sale at all.”
Vikki says that while the PCN is keen on the CPCS, it is under so much pressure it is outsourcing appointments to an online doctor service. “We could deal with a great many of those appointments now. With funding and training, we could do many more. We could deal with them in person, which patients like, and it would help with antimicrobial stewardship too. We’ve got an otoscope. We’ve already got private PGD services for UTIs, otitis externa, strep throat, impetigo. You need people that are fresh in from other sectors and don’t just accept where we are.”
A £25,000 refit at Monkbar pharmacy last year made things Covid-safe, and retail space was sacrificed for a second Covid-safe consultation room to deliver more services. “If we can get the data to show how many people we can help, that might break down the funding barriers,” Vikki says. “We’re introducing more PGDs. Next week, I’m giving a talk on travel health to practice nurses to build up our reputation. We’ve got a brand new website.
“To be honest, they were the priorities for 2020 as we realised that although it is our biggest customer, the NHS is not going to pay for us to stay open. As a 100-hour city centre pharmacy, we must stay open because people rely on us so much – in the evenings and at weekends particularly.
“We were already on 20 per cent private services before the pandemic; most pharmacies average 10 per cent. Our aim for last year was to increase to 30 per cent, but, obviously, we went backwards. We need to claw back those private services again just in order to be able to keep our doors open.”
Vikki says networking with other pharmacists can be a source of ideas as well as mutual support. “One thing I do lack is experience,” she admits. “But I make up for that with enthusiasm and determination. If something’s a good idea, it’s a good idea.”
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