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Exclusive: PM Questions –Ash Soni

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Exclusive: PM Questions –Ash Soni

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Ash Soni FRPharmS, OBE, qualified as a pharmacist in 1984 and is the clinical network lead for Lambeth CCG. He is an independent prescriber and in 2011 was appointed to the Government’s NHS Future Forum. He has been chair of the NPA and is the current RPS president.

President of the Royal Pharmaceutical Society Ash Soni has strong views on many of the issues affecting pharmacy today and is robust in his defence of the profession’s leadership body. Interview by Richard Thomas.

Ash Soni is approaching the end of his second year as president of the Royal Pharmaceutical Society after succeeding Martin Astbury in July 2014. Despite a frenetic schedule that sees him represent the RPS all over the world, he still retains the energy and passion that has long marked him out as one of pharmacy’s leading lights.

Soni, who owns Copes Pharmacy in Streatham, south London, and is also clinical network lead at Lambeth Clinical Commissioning Group, says it has been “an immense privilege” to lead the profession at a time of enormous change and upheaval. It seems pharmacy – and the RPS – has never had such a high profile or been under greater scrutiny.

“A crucial part of my role is to promote the whole profession to policy-makers and other health professionals so they better understand the essential role pharmacists play in improving patient outcomes,” he says. “I believe the Society has had a great deal of success here and it is something I enjoy doing.”

Critics might argue that the RPS, along with the other pharmacy bodies, has actually had a vanishingly small impact in terms of influencing Government policy in England if the controversial pharmacy funding cuts and drive for efficiencies are any measure. What was his reaction to the now infamous December 17 letter from the Department of Health and NHS England?

“One of absolute shock,” he says. A contractor himself, Soni understood instinctively that a 6 per cent cut in income could wipe as much as £15,000 off his bottom line. “That, in theory at least, is a member of staff. Like all pharmacy owners I have to somehow create the space to make up the shortfall through additional activity. It won’t be easy.”

Then there are the concerns about how the cuts will be distributed and whether there will be a further round in 2017/18. So is the Society talking to the Department of Health about trying to reverse the decision? “We are in constant dialogue with the DH about various things but the 6 per cent figure is not negotiable as it has come down from the Treasury. If ministers aren’t prepared to give in to the junior doctors, the chances of giving pharmacy what it wants are pretty remote.”

Unintended consequences

He has serious concerns about the negative impact on patient care and access to pharmacy services that could occur as a result of the Government’s direction of travel.

“I worry a lot about the unintended consequences. A pharmacy forced to close as a result of financial pressures may be one in an area of greatest need. Likewise, a pharmacy in a cluster that may become unviable could be offering high quality services rather than one that is providing only a basic level of care.”

In other words, a reduced funding allocation across the board is the bluntest of instruments to reduce pharmacy numbers, if this is indeed the real intention of a Government in pursuit of “efficiencies”, stated or otherwise.

The imposed funding decrease may be a “done deal” and Soni has significant misgivings about the speed of events – “the time allowed for the consultation was much too short to think properly and plan” – but he says the sector should now seize the opportunity to look seriously at service redesign. Although details are still sparse, the proposed pharmacy access and integration funds are key to this.

However, pharmacists themselves must also be prepared to change and adapt, and they must be given the tools so they can take proper clinical responsibility for patients’ medicines. And that, Soni believes, can only mean having access to the full patient record.

“Pharmacist access to the summary care record is an important breakthrough but it is just the start. If we are to embrace medicines optimisation, we have to have access to – and be able to feed into – the same information as other clinicians and have enduring consent from patients to enable us to do this all the time.”

But are the structures in place to enable community pharmacists to fulfil their potential? Soni came in for strong criticism last year – not least from PSNC and Pharmacy Voice – when he likened the “top-down” national pharmacy contract in England to a “straightjacket” that held back local innovation and failed to promote integrated working with GPs.

His comments came in the wake of proposals from the RPS and the National Association of Primary Care for a new contractual framework to incentivise GPs, community pharmacists and others to collaborate on care. Does he stand by what he said today?

“Yes, absolutely,” he says. “We need a framework that allows services to be designed around the needs of local populations, rather than the providers, but clearly we mustn’t throw the baby out with the bathwater. Better alignment of the incentives within the GP and pharmacy contracts is the way forward. And pharmacists must engage locally and come up with solutions – or someone else will.

“I never said we should abolish central contracts,” he emphasises. “And it is really important that community pharmacy does not lose the supply function as it is this that provides the footfall for services provision. However, GPs are paid for their intellectual capability and so are highly valued. Pharmacists should be seen in the same way.”

The 6 per cent cut is not negotiable as it has come down from the Treasury

Fears unfounded

The president also found himself under almost personal attack from certain quarters over the Society’s enthusiastic support for pharmacists in GP practices. (Indeed this was one of the reasons he gave this interview – to put the record straight.) There are concerns that this could lead to services – and funding – switching out of community pharmacy and into general practice. He says these fears are unfounded.

“Utilising the skills of pharmacists in a general practice environment has to be a good thing for patients to get the best out of their medicines. If anything, it will lead to more opportunities for collaboration between community pharmacies and GP practices because there will be better lines of communication with pharmacist being able to talk to pharmacist.”

Soni knows what he’s on about here. He first started working with his local GPs on a sessional basis back in 1990. “And there’s nothing to stop community pharmacists having a conversation with their general practice anyway, and saying ‘what are your challenges? How can I help?’.”

He accepts that the Society’s stance has caused tensions and maybe some of the language used could have been chosen more carefully. But he is adamant on one thing: “This is about using pharmacists to create better continuity of care. It is not about undermining community pharmacy.”

Ash Soni’s vision for the RPS and the profession

  • Royal College status in five years
  • Two-thirds of pharmacists in RPS membership (currently around 55 per cent)
  • Full pharmacist read-write access to patient records
  • All pharmacists to practise as prescribers
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