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Write the script if you want a fairytale ending

Ade Williams says community pharmacy in England needs a consistent proposition

By Ade Williams

American motivational speakers love a Churchillian saying. Back home, their resonance must cut through the dampness of nostalgia, but, to be fair, their ability to capture and insightfully describe timeless human experiences with uncanny insight is unique. 

Take this one: “Never let a good crisis go to waste”, which originally encapsulated Churchill’s hopes that the wartime alliance between himself, Stalin and Roosevelt would lead to a rules-based world order for peaceful co-existence – “to jaw-jaw is better than to war-war”, as the great man also said. 

Community pharmacy? Well, we know crisis. Real or perceived. 

My trainee year was a baptism. It was the fight against 100-hour pharmacy contracts. My introduction to petitions and photo-calls with the local MP (Theresa May). But as the years have rolled on, ‘existential threats’ mean a well-rehearsed playbook, deployed once the villains and heroes are cast. Incessantly unfurling the ‘fight is on’ banner leaves you tired – not least
when you notice the same adversaries time and again.  

An objective analysis of the plight of community pharmacy in England can validate our sense of injustice, even if it also confirms that it is not the complete narrative. Where, then, is our silver lining? Let’s not be deceived; staying in the fight is not it. 

Community pharmacy in England, often a wallflower in the broader NHS discussion, needs a fundamental shift of approach. This epiphany influenced me spending time on the board of our local Bedminster Business Improvement District (BID). Faced with a death spiral in our high streets, we had a pitch to invest in a vision of what could be created if resources were not limited. 

What carried the vote was the idea that no one but us could take on the renewal of our high street. It’s complicated: there are multiple stakeholders and different ownership structures of buildings and businesses. Historical and ideologically framed values differ widely. Yet we chose to make sure that every opportunity to access resources or influence investment decisions would be a step closer to our shared vision. We are stewards of our own destiny. 

Let me not kid you; there is no fairytale ending. As things got more challenging, personalities and opinions clashed. The immediacy of daily decision making, with local businesses in financial distress or at risk of closure, made it impossible to meet the vision-first ideal, although rather than undermining our values, it shaped them. We had to make more pragmatic decisions based in reality, and that meant discipline. We might have had a lighthouse to guide us through choppy waters, but we also had anchor points to help us take responsibility for our decisions. 

Community pharmacy has been limited and our vision tethered by commissioning and funding. Worse still, decisions made at Horse Guards Road seem to trump those at Wellington House, so our misgivings are directed to the wrong address.

When you look at some of the better emerging models of community pharmacy practice in the UK, you see an alignment of vision, policy and funding. Inertia in England may stem from insufficient effort articulating and projecting the vision, if it exists, and ensuring it remains a dynamic one, which is up-to-date. 

The false intellectual convergence that policy and funding produce a vision is a dereliction of responsibility. Yes, it’s challenging to share, and hard work keeping people focused on the prize, but if we are not answering these questions, we will continue to lag. 

It may be uncomfortable, but we need to know where we want to get to, the why, how and what for, and the logical path before we decide whether to accept. We may even start to say no. Vision drives agency and accountability. It is not as though there is a lack of innovation; independent pharmacy contractors continue to exemplify this in delivering patient care.  

We need a consistent proposition of what we can offer that is necessary, attainable and affordable. Where your vision is not easily distinguishable, you cannot demonstrate how you are working towards it. Your credibility is shot. You also never spot your silver lining. Worst of all, open, honest debates that shape and test ideas are replaced with woolly sound-bites, with hard choices and demanding work delayed. The public, who have taken us to heart, have many other just causes queuing to pitch for their turn. 

The real challenge for us, which cannot go unmet if we are to survive, is what we are doing to set ourselves up for success, before the Government turns up. It’s a sobering thought, but what happens if they never commit, or if their offer falls far short of the place we would like to be?

Ade Williams is superintendent pharmacist at Bedminster Pharmacy, Bristol

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