Jeff Gilbert
Keith Ridge is a busy man and The Pharmaceutical Journal is certainly testing his patience by being ten minutes late, owing to delays on the Northern line.
After dispensing with the niceties, we crack on with the job of covering the wide range of policy areas that England’s chief pharmaceutical officer is involved with. He was one of the architect of the ‘NHS Long Term Plan’, published in January 2019 — the five-year proposals that rely heavily on pharmacy delivering some of changes needed in primary care.
Ridge has also just written a section of the ‘Interim NHS People Plan’ for pharmacy, published in June 2019, which includes a promise to come up with a plan for foundation training for all pharmacists after their preregistration exam.
He is proving a popular troubleshooter for Matt Hancock, secretary of state for health and social care, who, in December 2018, tasked Ridge with leading a review of overprescribing and, in April 2019, a probe into the use of medical cannabis in the NHS. Ridge was also instrumental in pausing some proposed
cuts to NHS preregistration training, which were announced in February 2019.
After 13 years in the job, Ridge is not slowing down. If anything, he is gearing up for being in the driving seat during one of the most crucial times for pharmacy.
An awful lot has happened in pharmacy since our last interview, a year ago. It’s a historic time — would you agree?
Absolutely. This is the most fantastic time for pharmacy that there’s ever been, certainly in my working career. If you look now at the NHS Long Term Plan, pharmacy is central; having structured medication reviews and medication safety embedded in the GP contract; the deployment of thousands of clinical pharmacists across primary care and there’s an acceptance around the need to make sure education and training reflects that. These really are historic times.
Is there a slight risk of the NHS overpromising?
GP pharmacists are making a really big difference already
No, because we’re dealing with established issues around patient care. Take deprescribing: everyone is talking about it and the English Deprescribing Network is coming together to do something about the overuse of medication and looking at alternatives. We’re dealing with issues with quality of care, so I don’t think we can overpromise the public because these are important matters. I’m not going to say that the next two to three years are going to be without their challenges, but it will be worth it. Pharmacy needs to come together properly and make it work.
One prominent GP pharmacist we spoke to said he was worried that GP contract funding will not be enough to employ pharmacists with the right experience to make a real difference quickly.
I can see why people might say it is going to take some time but, in my experience, GP pharmacists are making a really big difference already.
So, it’s not keeping you up at night?
No… no, it’s not keeping me up at night.
I had one GP pharmacist approach me who is not eligible to work for the primary care network, as she isn’t on an NHS England scheme. What can we do about these very experienced pharmacists?
We’ve commissioned a survey to take stock … of where people are in terms of their training and development. In practice, these people will contribute to how the system works together. It would also be in her interest to make sure she’s at the right level of training. I’ve got no doubt she probably is, but identifying those gaps wouldn’t be a bad idea.
Can we discuss the role of community pharmacy in the ‘NHS Long Term Plan’ because there didn’t seem to be an awful lot to it.
It is over to local leaders and community pharmacists themselves to make sure they engage with the clinical directors of primary care networks and the infrastructure surrounding them
You’ll recognise we’re in negotiations at the moment and I’m not going to talk about that (the community pharmacy contract has since been published). As I’ve said previously, community pharmacy has got a major role in the implementation of the NHS’s long-term plan in two areas — one is around the treatment of minor illness. It’s about time that we moved towards scaling up, subject to negotiation, referral from NHS 111 and GP to community pharmacist referrals as well. If that pilot goes well, then that could take about 6% of all GP consultations, which is about 20 million per year.
Second, there is a clear role for pharmacists around prevention — the Quality Payment Scheme is a good infrastructure to build on and so I would expect to see more prevention-type activity in and around community pharmacy.
Should community pharmacy get involved in primary care networks now, or does it have to wait until the new pharmacy contract?
I don’t see why it has to wait. Since 1 July 2019, around 1,200 primary care networks (PCNs) have gone live and community pharmacy needs to get involved in the best way it can. Now it is over to local leaders and community pharmacists themselves to make sure they engage with the clinical directors of PCNs and the infrastructure surrounding them.
NHS England published an interim people plan on 3 June 2019, but there was no new funding behind it. How will it be implemented?
The ‘Interim NHS People Plan’ is a big step forward. Multiprofessional team working is at the heart of it. Indeed, the things we were talking about earlier in terms of minor illness or structured medicine reviews — they require a multiprofessional approach. We continue to make the case for pharmacy foundation training. There’s still a process to go through related to the spending review about how funding associated with that workforce plan will be distributed. There’s much more to do, however, and it is important that organisations such as the Royal Pharmaceutical Society help explain to relevant people why this is important.
Is a five-year pharmacy degree a good idea?
I have history here. After the 2008 pharmacy white paper, we discussed the integrated five-year degree. I’ve always believed that it is required and I was disappointed we didn’t get it over the line. If I had been successful, then we would now be delivering the types of pharmacists that we all now need.
An integrated degree with workplace-based training is critical for the types of clinical practitioners we want to see
The consultation from the General Pharmaceutical Council (GPhC) [in January 2019] on initial education and training standards is fundamentally important. An integrated degree with workplace-based training is critical for the types of clinical practitioners we want to see. There are ways of delivering that which can be done efficiently, but I think it will require a different funding approach to undergraduate education for pharmacy. Those are the types of discussions we had before; we’re going to have to have them again to deliver this. The case is even stronger now because of what pharmacists are being asked to do by the public, patients and the NHS. Whether it’s five years’ duration — that’s another matter altogether. At the moment, it is governed by an EU directive and there might be an opportunity to think again if it’s possible to get all the learning done in a shorter amount of time. If we leave the EU, we will have to see what happens.
Are degree-level pharmacy apprenticeships a good idea?
I’m glad that it is being put on hold for a while, but I don’t think we should just dismiss the idea out of hand. We should be exploring it in a robust way, working with others, because this might be part of the answer. It must be aligned to the GPhC standards, of course, but a different funding flow might help. We haven’t explored it enough yet and I think we need to get beyond the word of ‘apprenticeship’ and just think about whether, strategically, it could help or not.
A lot of chief pharmacists were really shocked when the cuts to preregistration training were announced at the start of 2019. Do you think these should happen?
There is a need to look carefully at as to whether dosette boxes are working as effectively as they can be
I did take a interest and advised Health Education England that it wasn’t the time to go live on this. They took my advice and I’ve worked with the All England Chief Pharmacist Group and others to slow it down a bit, so that there’s more consultation [that can take place]. We need to think about it in terms of a broader workforce plan around pharmacy. The funding was going to be invested back into pharmacy, but I think being able to explain to people properly how this all fits together is important.
Looking at medicine safety, do you think the use of multicomponent compliance aids should be reviewed?
They have a role, particularly in care homes, around helping nurses and residents organise medicines. But when I think of my mum, who has several conditions, she seems to manage the four or five medicines she takes without a dosette box. There is a need to look carefully at as to whether dosette boxes are working as effectively as they can be. There are probably people that can cope without them and there does need to be more consideration in terms of their use.
Are you worried about
antibiotics being handed out under the NHS Urgent Medicine Supply Advanced Service scheme?
I don’t want to see anybody stockpiling — I think I’ve made my view very clear about that — it will cause more problems than it’s worth
Antibiotics represent 2% of all NHS Urgent Medicine Supply Advanced Service scheme supplies and around a third of the requests are knocked back straight away. Some are for liquid medication where a parent has spilt it and others are for long-term antibiotic use that’s required clinically. I have asked for there to be an audit; there’s been one already, but I’ve asked for a further one. I need to make sure that it does fit with the National Action Plan for Antimicrobial Resistance and that the appropriate safeguards and processes are in place. Am I worried about it? No. Am I looking at it? Yes.
No-deal Brexit — is pharmacy ready?
I have to say this is probably the most detailed project I’ve ever been involved with, with line-by-line assessment of individual medicines supply checks and things, and I have to say thank you to front line pharmacists, the pharmaceutical industry and others in terms of coming together to get ready for this. On 31 March 2019, we had a very good state of readiness and we’re looking to continue that state of readiness to 31 October 2019. I don’t want to see anybody stockpiling — I think I’ve made my view very clear about that — it will cause more problems than it’s worth. I think the system is as ready as it can be.
Pharmacists are going to be central to coping with a no-deal Brexit, aren’t they?
Pharmacists are going to be right at the front line — that comes with the territory. I’m grateful to them for being prepared to do that; to be the interface with the public. Is pharmacy ready? I think the answer is, by and large, yes. I can’t guarantee that there are not going to be any shortages, that there are not going to be any problems, but I’m confident that mitigations are in place.
- This article was amended on 31 July 2019 to clarify that a prominent GP pharmacist said he was worried that GP contract funding will not be enough to employ pharmacists with the right experience
