David Webb: ‘It is time to step away from historic rivalries and focus on patients’

It must be difficult to start a job when the previous incumbent was in role for more than 16 years and made such a powerful impact. And yet, David Webb, chief pharmaceutical officer for England, has made his mark since taking over from Keith Ridge in February 2022.

In his short time in the role, Webb has announced a review into the professional leadership of pharmacy, created 42 new community pharmacy clinical lead posts for all integrated healthcare systems (ICSs) across England and, in this interview, he announced a new ‘pathfinder’ programme to supercharge pharmacist-led independent prescribing services.

In addition to these big changes, Webb has also travelled around the country, talking to pharmacy teams and gauging what is going well and what is not. This thoughtful and personal approach is very much in character for Webb, who was previously chief pharmacist and clinical director for pharmacy and medicines optimisation at Guy’s and St Thomas’ NHS Foundation Trust. In that role, he oversaw the COVID-19 vaccine rollout and put in place a ‘system-wide’ palliative care medicines scheme.

In his first pharmacy press interview as chief pharmaceutical officer, carried out before the appointment of Thérèse Coffey as health secretary, The Pharmaceutical Journal sought to get an insight into what Webb has in store for the profession.

Why did you want to become chief pharmaceutical officer?

You cut your teeth locally, you see that you can make things happen, but then you begin to realise that there are some things that require a national focus to move things forward.

The [COVID-19] pandemic experience, being around the table with so many different parts of the profession, and seeing the fundamental professionalism and drive and desire to do things, made me realise that a collaborative approach can be fostered at a much bigger scale. There’s this part of me that’s driven by bringing people together in an integrated way to celebrate what we achieve collectively as opposed to what we achieve individually.

I think encouraging people to step away from historic rivalries or celebrating one part of pharmacy over another — I think those are for the past now and it’s about focusing on what our collective endeavour is for patients, so I am really driven by that.

Applications have recently opened for 3,000 funded independent prescriber training places. What are your hopes for that programme?

That we start making tangible progress in relation to being able to complete episodes of care for patients. Prescribing is the tool that will get us very close to that way of working. At the moment, we’re able to do really amazing things and support other professionals, but the ability to prescribe and bring that sort of expertise that pharmacists bring around medicines, will make them excellent prescribers.

It will inform how best we set things up when, in 2026, everybody emerges as a prescriber, which is the most fundamental change in our professional life in decades. And we are going to launch a ‘pathfinder’ programme in terms of pharmacist prescribing. The ambition is to have one pathfinder in each region at ICS level. A ‘systems’ approach that does some things at scale and is ready for the big change that’s coming.

Will that include community pharmacy?

Yes. We have ambitions around introducing pharmacist prescribing in the contraception service, so that’s already part of programme planning. But these pathfinders are going to be a significant step for us.

We’ll probably learn three things from it: what process and governance we need, and what safe systems look like in that environment. How we resource it will also be a really important question; it will probably set the tone and the strategic approach for the next round of the community pharmacy contractual framework, which will be a couple of years hence.

The other part of the equation is that everybody else has to be on the top of their game too. The work we do around pharmacy technicians and how ‘hub-and-spoke’ arrangements might play out to support teams to be able to devote the time they need to clinical service are important. Everything has to stack up to make this happen and that’s a really exciting possibility.

Are you alluding to changes in supervision regulations there?

It’s part of the equation. We need to be thoughtful about how we arrange all the blocks to make it possible for people to do this. In community pharmacy, how are we making sure that the facilities are available so that people have capacity to do all of this work, as well as capability? There is some deep thinking that needs to go on about this, but I think that the pathfinder pilot will be crucial in terms of the learning.

When do you plan to start the pilots and how many will there be?

At the beginning of 2023. Our ambition is probably an ICS per region as a testbed for these ideas.

The new health secretary, and the previous health secretary, have both talked about a Pharmacy First service for England. How far along are plans for this?

We are committed, in the long-term plan and contractual framework, to making the best use of skills and abilities, particularly in community pharmacy teams. But it’s not just about movement of effort, it’s also about doing things well. The Community Pharmacist Consultation Service (CPCS) and the NHS blood pressure check show the possibilities of a population health-based approach, particularly in the context of health inequality, both have built confidence with patients and systems in the offer from pharmacy. So, momentum has been building over some time.

I get the sense that Pharmacy First won’t happen before winter 2022?

There are extensions around the CPCS, but we also have to recognise that self-care and signposting is already an essential service within the contractual framework. So, what I’m trying to do is draw a distinction between the two different elements.

The health select committee said there needed to be a workforce plan for pharmacy — are you looking into that?

NHS England and Health Education England are developing a workforce plan for the health service over the next five to ten years, and we would expect to be involved in that as well, so yes. I think there is also something really important at the ICS or system level, about looking at pressures in systems and relative balance of workforce, and about the skills, experience and technology that would allow you to move between different places. We’ve generated some guidance on shared employment models, which will start to give a steer about how it’s possible to be, for example, a community pharmacist and a primary care network (PCN) pharmacist. How people want to work is becoming a really important consideration.

How much of an impact is recruitment into PCNs having on workforce shortages?

Colleagues have said to me that there are some real challenges, and I acknowledge that. But I think we need to sort of understand more about why people might be moving employer, and I don’t think it’s solely community pharmacy to PCN, it can be from hospital as well. Some of it might well be to do with the ability to have a clinical career.

We shouldn’t inhibit the workforce from moving from one place to another, I don’t think that is the solution, but the things we’re trying to do around clinical services in community pharmacy, for example, could create the possibility of having that clinical career in a different setting.

There’s been a lot of talk about temporary closures of community pharmacies, in Scotland predominantly, but also in England. How worried are you about them?

From the information we have, closures are still relatively infrequent relative to the majority of the service offering. But I don’t think we should take that for granted. I think we need to understand what the drivers are. There are opportunities to intervene if some of those closures do not appear to be for appropriate reasons. And the [local NHS England] teams take those seriously. I would think the majority of closures are just for a matter of hours, as opposed to complete closures. I know it’s played out in a sort of lens that relates to pharmacist availability. Again, it’s about the whole team, isn’t it? It’s about having a skilled team able to support you and an effective operation.

Medicine shortages are becoming more frequent and serious in their impact on patients. What more needs to be done to tackle this problem?

Shortages are very important issues, although much of the work around medicines availability sits with the Department of Health and Social Care and I’m conscious that the teams there work very hard to minimise the impact. I have wondered if we should be reaching out more to patients and explaining.

As a more general point, it’s not really in relation to shortages, as a society we’ve become used to seeing things as commodity, and we expect them to be delivered very quickly and at the time we want them — that is not an unreasonable expectation, but this is a problem in relation to medicines. We perhaps need to educate the public a bit more that it is not instantaneous, because people are putting in their professional judgement and making sure systems are safe and that further supplies can be arranged.

In Scotland, they are looking at a proactive pharmacogenomic testing system to test people before they take medicines. Would you like to see that approach in England and what role should pharmacy play in it?

It’s a fascinating area. Our national efforts have really been about DPYD testing and avoiding adverse effects from certain types of cancer chemotherapy and genetic diagnostic tests, which tell us about our success in using medicines in monogenic diabetes and conditions like that. I think what we’re trying to do at the moment is understand the utility of all the testing. What we need to be asking ourselves is how would that affect our decision making? There’s a balance point between what’s technically possible and what’s actually meaningful.

There is good evidence for drugs, such as clopidogrel and opioids, for example, that you could make interventions on the basis of a genetic test. Would you like to see that type of testing in the NHS?

Yes, I think so. Medicines optimisation is something that the world of pharmacy can make the major contribution to. And when you can see pharmacogenomics as another tool for people to apply, who are already adept at medicines optimisation, then I think it makes a whole lot of sense, because you’re bringing new skills and new understanding, but it is within a framework of practice, where we’re already oriented to what’s the best outcome for this individual. A big workforce question is: what skills and knowledge do we need to fully exploit the potential of the genomic medicines approach? That’s a really interesting area.

What are the aims of the review into professional leadership within pharmacy? For instance, do you think the Royal Pharmaceutical Society should become a royal college?

The aim of the review is to look to the future and ask what it is we need in terms of professional leadership in the modern era. What are the forms? What are the functions? The reasons for doing that are positive, not negative. It’s a UK-based commission; the purpose is to report to the four chief pharmaceutical officers. I’m very interested in what the commission is going to say about the shape of the future. In my own mind, I am trying not to prejudge an outcome or reflect on the Royal Pharmaceutical Society or Association of Pharmacy Technicians UK, and where they are at the moment.

So, if royal college fits the function, then that might be the vehicle, but it’s not the only thing?

Yes.

I saw that you opened a health hub at Neasden Temple recently. How was that?

That was fantastic. I’ve been really lucky coming into this post because people have been very warm and generous in spending time with me. By the end of September 2022, I will have visited at least each region to see a different facet of pharmacy practice. We went to community pharmacy in Honley in Yorkshire and looked at the way they’ve been part of the community mobilisation, particularly in terms of COVID-19 vaccination. I was really struck by what a central part of the community the pharmacy was and the role that the team played in terms of anchoring and supporting that community, it was really quite compelling. Then to go to a different setting, at the temple, and see healthcare professionals, through this voluntary offer, making a difference to people’s lives. There was a whole range of things going on: resuscitation techniques through to healthy eating advice. And they had built a kitchen to give demonstrations on how to cook food with less fat. Really compelling and pharmacy was a key part of that endeavour. It makes you feel very proud of what your colleagues do, and to know it makes a difference as well.