We start with funding, to get the inside track on the delay from the corridors of power. The explanation is appropriately lengthy.
“We did great work getting MPs on side, then we threw some of that goodwill away,” he says.
“If you look at the NPA’s campaign, a lot of people here felt a little bit attacked. We weren’t responsible for the last 14 years, we weren’t responsible for the five-year funding settlement. And this felt like a little bit of an attack when we’re actually trying to engage and sort things out.”
The National Pharmacy Association (NPA) would likely argue it’s also trying to engage and sort things out, but in reality it’s just one of many trying, which is seen by some as a bigger problem.
It’s the “fractured nature of pharmacy politics,” he says.
“Multiple membership organizations all are vying for the same people, that was really the reason behind it, as opposed to having anything to do with winning a better settlement from government.
“When you’re having good conversations, then suddenly you attack, it’s not really going to make anything any better. Shouting never solves a problem.”
Confusion
The “problem”, he says, is that “people in pharmacy groups want different things, even within the same memberships. And that’s very confusing for government. It’s hard to explain to the minister the difference between the NPA, the CCA, the IPA, CPE, the PDA… at the end of the day, there isn’t a unified pharmacy voice.
“The other interesting bit is, where does workforce fit into this? The CPE is a negotiating body, and some of the other very successful negotiating bodies feature a large element of workforce.
“Personally, I think Janet Morrison does an amazing job trying to bring the schizophrenic voice of pharmacy together into a coherent vision”
He says pharmacy always seems push for the pharmacy, not the pharmacist. “Not the pharmacy technician, not the dispenser, not the team that makes up the process. There needs to be the voice of the people who work in it, not just the employers or the owners.”
The PDA has been angling to join CPE at the negotiating table to do just that. Does he think they should?
“I think it should be looked at, to see who sits appropriately. The PDA is a strong voice for the professional element of pharmacy, you also need to think about the USDAW element of it as well. But bring workforce in there, it’s really important we represent the people who do the work on the ground.”
Otherwise, he says, “where’s the voice? If you look at successful negotiations in healthcare over the last 20 years, all of them feature worker representation.
As unsuccessful as 2024 negotiations have been, at least he says they have started. “I’m an optimist. I think we’re going to get a funding settlement for last year, which is going to be tight-ish, because we’ve already done most of the work.”
What sort of percentage uplift would be ‘tight-ish’?
“I do not speak for the Treasury, and I don’t speak for the Department of Health, but for last year, somewhere between three and 7% would be great. The idea we’re going to get a 28% increase is ludicrous. For this year, another increase of around three to 7%, plus the cost of national insurance across pharmacy. I don’t know if the National Living Wage is going to go in there, if it’s realistic or not.”
Schizophrenic
How about a back payment of sorts?
He says it’s “hard to prove the argument for that when we’re this far along. If I was sitting in the Treasury, that’s money I don’t want to pay. It’s not because the Treasury doesn’t appreciate what pharmacy does, it’s because the Treasury’s job is to give good value for money with the taxpayer, and we’ve already done the work.
“Don’t forget, the Treasury is there to provide value for money for the taxpayer. That’s their job. It’s not about restricting department funding, it’s about making sure we’re not overpaying for things.”
He says a departmental spending review is going on, taking a “fundamental look at the value for money departments offer, what they’re proposing for the taxpayer. It’s a massive exercise, it means looking at every line of the detail.”
“Effective messaging is always going to be united. If you have a disparate message you’re going to get a disparate impact”
And ultimately, the DH could impose a deal that pharmacy has to take.
“It’s definitely happened before in my time in pharmacy, we don’t really agree to the contract, we just get it.
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“There’s this discussion about the negotiating body not doing what it needs to do. And I disagree with that, because the negotiating body has to contend with the fact that there are five different voices within pharmacy that all want different things, and they speak directly to ministers as well. It undermines the argument.”
He says effective messaging is always going to be united, that a disparate message will deliver a disparate impact, and he hopes the voices from the pharmacies sectors consolidate into one.
“There’s things you can argue about publicly and there’s things you can argue about privately, right? And we have spent too long airing our dirty laundry in public. It doesn’t help us at the negotiating table. Personally, I think Janet Morrison does an amazing job trying to bring the schizophrenic voice of pharmacy together into a coherent vision.”
Debate
As for what that vision should be, he says a “really interesting question I don’t think pharmacy has ever answered is, what does pharmacy want? We need to decide what we want from the future, because if we don’t, we will continue being done to.
“I don’t see a singular view of what pharmacies should be, and that’s because we have these multiple voices and a multiple understanding of what it is to be a pharmacist. Somebody who talks to patients when they buy paracetamol is a pharmacist. Somebody who does Pharmacy First is a pharmacist.
“Somebody who checks the accuracy of a prescription is a pharmacist. Somebody who checks the clinical validity of a prescription is a pharmacist. We are the experts at various ranges, with various expertise, and yet we don’t have a decision in, say prescribing, because prescribing sits with GPS.
“I think pharmacy is an expert in medicines, so there is an element of treatment choice there. If the GP diagnosed and the pharmacist picked or prescribed, that feels like a natural kind of boundary line, because that’s what we’re experts in. We’re experts in medicines.
“We know, appropriately, what’s best for a 65-year-old of Afro Caribbean descent, we know which is the best drug choice in that situation. It doesn’t diminish a GPs role, that has always been about diagnosis and recommending management of it.”
Wild West
Such a change would spark intense debate, but debate is everywhere in pharmacy. One example is the introduction of Hub & Spoke.
“The only way you can have good dispensing revenue at this point is through economies of scale,” he says. “That’s what this allows. It’s not about taking large amounts of revenue from pharmacy, it’s trying to use economies of scale to be able to make money from the volume.”
“Model two cuts the pharmacy out, which I think is where the risk is. Why wouldn’t the person just directly go to the hub to get their stuff?”
Still, doubts remain among some.
“There’s always going to be a reluctance towards change. People feel wedded to this idea that we dispense medicines to make money, and clearly they haven’t been paying attention to what’s happened in the last decade, let alone the last five years.
“I don’t think there is a strong future revenue from dispensing, and that’s why model one is really useful, versus model two. Model one keeps the pharmacy wedded to the patient, model two cuts the pharmacy out, which I think is where the risk is. Why wouldn’t the person just directly go to the hub to get their stuff?”
Read more: Government set to ‘introduce’ hub-and-spoke legislation in 2025
Why not indeed. Sales at online pharmacies are soaring, though not necessarily in an altogether good way.
“The online prescribing pharmacies, that is one of the Wild Wests of pharmacy at the moment,” he says. “Some do amazing work with some absolutely fantastic algorithms to help with choices, really good controls in place to prevent abuse and harm. Some people are doing it really cleverly. And some people are not.”
To combat the ‘nots’, tougher online regulations were introduced, then pushed back on by online outfits and the CCA.
“The regulator isn’t there to do nice things for pharmacy, the regulator is there to protect patients,” he says. “It isn’t the job of the regulator to shout about how good pharmacy is, the regulator is there to keep patients who use pharmacy services safe. The standard of some of the superintendents has meant that they aren’t meeting the requirements.
Read more: Target-focused ‘transactional’ online pharmacist suspended
“I’d say to any pharmacist who’s newly qualified, spend a bit of time practicing before you become a superintendent, before you take on that responsibility.
“Because you have to be able to challenge cost decisions that are unsafe. You have to be able to say that things won’t work, and actually be able to say no. If you don’t feel like you’re able to say no when something’s unsafe for your patients, then you’re not up to the role of superintendent. I’ve known some fantastic superintendents over the years who have been champions of patient safety and care, and that’s the role.”
Amazing
As an MP with constituents, but also an indelible connection with pharmacists calling out for political help, does he ever feel conflicted with who he champions now?
“My number one priority is always going to be my constituents, and within that, solving pharmacy as a problem. I’m always going to be a friend of pharmacy. I’ll always care, it means a lot to me.
“I’m still a registered pharmacist now. I care a lot about getting healthcare right, because it’s great for the profession, but it’s also great for my constituents. If they can go to a pharmacy, and their medicine is in, and it’s open when it’s meant to be, that’s great.”
Read more: General election: The pharmacist vs the Tory GP grandee
Great yes, but it also feels like the minimum. Perhaps this is where UK pharmacy is at – struggling to provide what patients have come to expect while the government fails to support its efforts. So what would his ideal world for pharmacy be?
“Taking ownership of the medicine side of things. I see a world where pharmacists can work in a fulfilling role, with technicians providing services underneath, freeing up a pharmacists time so they can manage patients, treatments, liaise with GPs on electronic systems, all integrated so that we know the diagnosis right the way through the process, so we can make the right treatment decisions for the patient there and then, connected with a digital system that allows people to interact with the NHS in a new more convenient way, all supported by better technology, integrated care and predictive medicine, using big data from the NHS combined with pharmacogenomic data so that we can actually get ahead of disease states, confirming the diagnosis, and have someone coming into the pharmacy for their preventative treatment.”
It’s a long sentence, and he pauses for breath. “I think our future in healthcare in 10 years could be amazing. If we can find our place within it.”
Get to know Sadik...
Age: 40
Status: Married with two kids
Best advice you've ever had: I used to be even more cocky than I am now. Someone said to me, if you spend more time listening and less time talking and proving that you're smart, then you'll get more out of the people around you. And that was quite interesting.
What about the worst advice: ‘It's not your turn’. I was asking why I didn't get a role I applied for, and that put me on a bit of a spiral, the idea that you have to wait, it doesn't matter who's best. That's a completely wrong style of management, always. In my career I always promote the best person, I always hire the best person.
Favourite book: Terry Pratchett, Guards! Guards!
Current Netflix show: Lucifer.
Favourite drug: I've always quite liked the sound of Bendroflumethiazide. Pain in the bum for dispensing errors with a 2 ½ and a 5mg, but it always made me feel smart.
Least favourite drug: Probably Omeprazole, purely because of the amount of people who don’t like the colour of certain brands, some would get side effects because of the colouring. People would often specify one particular brand, I spent a lot of time hunting down brands because someone didn’t like a certain colour.
Death Row meal: Nando's, or a steak.
Advice for a superintendent: The job of superintendent is about protecting patients, you need to look through every decision. Does this improve the safety and quality of care for my patients? Does this mean that they'll get their question answered quicker? Does this mean they'll get their medicines quicker? Will this mean that they are less likely to get a dispensing error? Everything you do should be looked through that lens of the patient, and as long as you do that, you'll always make the right call.
