Ash Soni: ‘You get fed up with people throwing rocks at your head’

Ash Soni has announced his decision not to stand for re-election as president of the Royal Pharmaceutical Society (RPS) when his current term comes to an end on 18 July 2019. He has held the role twice: first between 2014 and 2016, and again from 2017 until now.

Soni spoke to The Pharmaceutical Journal about his reasons for not seeking re-election for a third term, and his plans for the future.

You’ve come to the end of your term as president of the RPS: why have you decided not to stand for re-election?

I believe in fixed terms. If you have a break — even if you think about coming back at some point — you can go and find out some of the things that you may not be seeing. And you can have some constraints in this type of role: you’ve got a number of different hats, but at the same time, the one of the presidency is the primary one. It always takes priority.

For me, the benefit has always been being able to take the RPS, as president, into rooms that it didn’t always get into. For example, I am the Local Professional Network pharmacy chair for London and I’m on the executive and council of the National Association of Primary Care (NAPC).

As for my plans: I chair the digital minor illness referral group for London, and the NHS Urgent Medicine Supply Advanced Service. And the NAPC has asked me, potentially, to take on responsibility for leading, on behalf of pharmacy, within the primary care home model: looking at how pharmacy can be better integrated and creating more exemplars within primary care networks. Having the capacity to do that is one of the challenges I face — because in a role like this, having the time to go and do that [kind of work] is really quite hard.

It’s been great doing this role: it’s been really valuable and interesting to get into places and do some of the things I’ve done

I’m also doing some work in Bangalore, India. With an organisation called Stepcare, a team of us are building two primary care centres from scratch. Our team includes GPs, dentists, myself as pharmacy lead, and others. We are building the primary care centre of the future. It’s digitally led, digital first, technology driven and supported by clinicians, but in a way that is very much designed for patients and the public to take greater control of their health.

We’re changing the way primary care operates in India. We’re due to open a pilot with 10,000 patients in 2020. Then in 2021 we’re opening two sites, each of which will accommodate 50,000 patients.

It’s been great doing this role: it’s been really valuable and interesting to get into places and do some of the things I’ve done. But now it’s time for the next step — how do I work with some of these other organisations to take our plans from theory to implementation? I need to give myself some capacity to do it. You can’t do this job [of president] two days per week. You’re constantly talking to people, meeting people and advocating on behalf of the profession.

I don’t think the consequence of releasing time is going to mean I’ll be sitting on my hands.

You are in discussions with NHS England around the operation of your Stansted pharmacy — does this have any bearing on your decision to step down now?

No, it doesn’t. I get fed up with the amount of flak you get thrown at you; people throwing rocks at your head. But no, not at all. I am currently waiting for a letter from NHS England saying the investigation is closed. I just don’t have a formal letter. But as far as they’re concerned, it has been [closed] for months.

One of the things we’re looking at is whether we can work with the primary care network in that area, so we may be looking again at service delivery, which is outside the process of dispensing.

And one of the challenges is how we move from the situation in which we operate — in which we have a supply contract with service attached — to a service contract with supply attached, so that it becomes much more about the care you provide to the patient and, consequently, you get your medicines to deliver high quality outcomes.

The other challenge, for me, is that we’re seeing the multiples moving towards building hubs, remodelling connection points, using Amazon-style boxes — a lot of that takes the care part out of the process

We’ve got to ask: what is the care provision that we are able to provide? We’ve got to create capacity in pharmacy. It’s got to be funded, but we’ve got to create capacity for pharmacists to be able to take on that role. That’s not going to happen if you’re standing there having to dispense every script.

The other challenge, for me, is that we’re seeing the multiples moving towards building hubs, remodelling connection points, using Amazon-style boxes — a lot of that takes the care part out of the process. We need to think about how to put the care process back. How do we enable independent pharmacies to compete in this market? We know, from surveys that have been done, that the public who use independent pharmacies appreciate what they get to a much greater extent. When they want care, they tend to go and find a pharmacist they know. It’s about people, and you can’t replace that.

You previously said that you were keen to see the legal defence against inadvertent dispensing errors expanded across the whole sector — where are we with that?

The frustration is that all of the matters going on around Brexit have delayed a lot of the things that are enablers from a pharmacy perspective. Seeing the inadvertent dispensing errors legislation and the enhancement of the roles of the superintendent and the responsible pharmacist developed … it’s very frustrating to still be waiting for them to be implemented. Particularly given the fact that they have gone through the entire process in England, it is literally a question of getting the legislation through parliament.

Even though I may not be in this role, I will continue to press government to say: you need to sort this — you need to deliver the things that you have promised. Inadvertent dispensing errors legislation must be seen as equitable across the entire profession.

Supervision in community pharmacies was probably the most controversial topic during your time as president.

At some point that discussion will reopen. Who knows where it will go and what will happen. We have to think very hard about what supervision is and what we do to ensure patient safety, while enabling pharmacists to have the time to do the things that pharmacists need to do.

We need to do that in a safe, effective way, with overarching governance that demonstrates that, at all times, a pharmacist is able to provide a clinical check, clinical care and oversight of the process. Even though there may be others delegated to deliver it, it still has to have the control and oversight of a pharmacist.

This is because that’s the part that we know provides a level of patient safety and acts as a safety net for prescribers. We are part of a protection mechanism for the public. If you take some of that away, just by making it a process, you take away that safety net. It’s really important that we maintain that.

How have you coped with the constant feedback on social media?

You get used to it. The problem with social media, to a great extent, is that bad news is more interesting than good news. People tend to miss the stuff that is good and tend to reflect on the stuff that is bad. That’s just the way these things are.

The problem with social media, to a great extent, is that bad news is more interesting that good news

With lots of social media — Twitter is a perfect example — you only have so many characters [to use], and trying to respond in a coherent way can be difficult.

So I find social media challenging on occasions. But at the same time, from a personal point of view, it’s a good place for some of the positive messages you get as well. And you have to reflect on some of the negatives — ask yourself, what’s triggering this? Is it something that you need to deal with and address? It’s not always a question of saying “No, no, no!” — sometimes it’s a case of saying, “Oh, yes: that’s something we didn’t see.”

What are you most proud of from your time as president of the RPS and, in retrospect, is there anything that you’d have done differently?

From a pride perspective, two things strike me. One is getting inadvertent dispensing errors legislation through and seeing it hit the statute book, and seeing the protection and removal of the threat of criminal sanctions against pharmacists in a community setting.

The other thing is the move towards population health-based care. It’s really important to show how, from a pharmacist’s perspective, we are central to ensuring improved patient outcomes.

My one regret, probably, is that I never got a prime minister to talk about “pharmacists, doctors and nurses” — it never happened!

My one regret, probably, is that I never got a prime minister to talk about “pharmacists, doctors and nurses”. It never happened! We talk a lot more about pharmacists across the system — the whole system — and that’s fantastic. But we’re just not yet seen as that first sentence. That, I would say, is one thing that we really want to see.

There’s a real recognition that, with all the settings that pharmacists are operating in and the changes that are going on, people value the role that pharmacists play. That will continue to grow and that is a demonstration of what we can achieve.

And we need to be more inclusive. We haven’t got to seeing inclusivity at a level where we really want to be at. Work is still ongoing in how we are seen as a Royal College for pharmacy and medicines and, as that continues to evolve and develop, we will become more attractive to all of those who have a relationship with care that involves medicines.

The opportunities there for us as a Royal College, and as an organisation, just get greater and greater.