Pre-lockdown Britain seems as distant now as the coronavirus threat did then. The virus began making headlines in January, but throughout February life in Britain carried on more or less as normal.
It wasn't until early March that it became clear the UK was facing something very serious – and that community pharmacies were going to be on the frontline like never before. Hand sanitiser, normally a low volume line, started flying off shelves. Paracetamol - of all things - was hit by shortages and price hikes.
An instruction to GPs to limit their face-to-face consultations delivered an influx of worried patients to pharmacies. Many sought to stockpile medicines ahead of a potential lockdown, while others wanted to know how they and their families could stay safe. Some were presenting at pharmacies with possible symptoms of Covid-19.
Towards the end of the second week in March, Sutton contractor Reena Barai said to herself: “Next week is going to be different.” It was clear the spike in her team’s workload was not a passing phenomenon and that they urgently needed to protect themselves. She drew up a checklist of Covid-19 safety precautions for pharmacies that quickly went viral.
Antrim pharmacist Eoghan O’Brien describes “two really intense, mad weeks” beginning in the middle of March, with panicked patients “stocking up”. OTC sales were almost triple what he would usually see at that time of year and “more than any Christmas week”; scripts were up 30 per cent.
When Pharmacy Magazine spoke to O’Brien in April none of his staff had so far needed to self-isolate – a relief when at one point a third of pharmacy staff across Northern Ireland were kept at home by infection concerns. But the team had been working at the absolute peak of its capacity. ‘This is unsustainable,” he found himself thinking during the busiest period.
A mid-March survey carried out by Pharmacy Magazine revealed the extent of pharmacists’ fears. They felt they and their teams had been left defenceless against a virus that can cause serious illness and is fatal for a small minority (33-year-old hospital pharmacist Pooja Sharma became the first UK pharmacist to die of Covid-19 on March 26).
“Nobody cares about us - we are guinea pigs for Government,” PM was told.
Staff felt increasingly exposed as more and more patients turned up. NHS consignments of PPE were often inadequate and in some cases failed to materialise. True, there were PPE shortages even in hospitals besieged by confirmed Covid-19 cases, but no primary care service was getting more footfall than community pharmacy. Many felt forgotten by policy makers. “We are a constant afterthought,” says Reena Barai.
Less than a fifth of pharmacists responding to a Pharmacy Magazine survey were confident they had enough PPE to keep staff safe throughout April. Many spoke of having to use their own resources to protect their teams.
PDA national director Paul Day told PM in April that the sector was “on the cusp of convincing politicians and the public of the need for PPE”. Many pharmacies were now receiving surgical masks and protective screens, though there were still “logistical problems”. “Going from having nothing to having something is an improvement,” said Day.
With some employee pharmacists saying their companies’ stance on PPE left them feeling unsafe, Day had a warning for business owners: “The person tasked with the safe running of a pharmacy is the responsible pharmacist – it is not an edict from head office. If they as a healthcare professional think they and their team need PPE, then they need PPE.”
During the first weeks of lockdown pharmacists in England felt badly let down by the system. They may have been seeing more patients than anyone outside of hospitals, but many felt that in Government’s eyes they were at the back of the NHS queue.
One particularly unhelpful illustration of this was communities secretary Robert Jenrick’s announcement of a community pharmacy medicines delivery service for vulnerable ‘shielded’ patients in a televised briefing.
The public was told of the service weeks before it could be launched, creating confusion and ramping up pressure as patients not in the shielded group demanded deliveries. One pharmacist described it as “the single most irresponsible statement from a minister, ever”.
Cashflow became a big worry towards the end of March, with PSNC chief Simon Dukes warning pharmacies were on a “cliff edge”. In all four nations relief first came in the form of an advance on global sum money, exasperating many. “It’s not new money, it’s our own money,” says Reena Barai. Eoghan O’Brien worries that what is in effect a loan could create a false sense of security.
Scottish and Welsh pharmacists appeared to enjoy greater support and recognition than colleagues in England, with ministers seemingly more engaged and less fixated on purse strings. Even Northern Ireland - where contractors were on the brink of industrial action before the pandemic hit the UK - had a tranche of ‘new’ funding to cover staff and social distancing costs before England.
It wasn’t for want of trying, says Simon Dukes. PSNC “put forward many arguments, backed up with detailed evidence” on the need for funding over and above the global sum, but the initial cash injection of £300m was “the maximum that the Government was prepared to give” in the first instance.
“We hope it will be enough to help many contractors with their bills over the next two months, but a loan is not enough,” says Dukes. Talks on additional funding were ongoing when he spoke to Pharmacy Magazine.
No account of pharmacy’s Covid-19 response could be complete without acknowledging the heroic efforts of teams throughout the UK. Dukes says PSNC has heard “so many amazing stories over the past month about community pharmacy teams all over the country stepping up to help their patients and local communities through this crisis”.
But perhaps more impressive than individual acts of innovation is the simple fact that pharmacy teams throughout the country have done what they always do – ensured the safe supply of medicines and offer support to worried patients – in the most difficult circumstances imaginable.
Reena Barai is proud of what she and her team have achieved: “We have stepped up in terms of our level of service – everything from answering the phone to serving patients and delivering medications.
“I’ve not taken on anybody new, we’ve put in extra hours and I think all our staff have done incredibly well.”
There is an unfortunate irony in the fact that the pharmacy workforce in its entirety has been so crucial despite Government officials having long maintained there are too many pharmacies on our high streets. This is perhaps true in England and Northern Ireland in particular.
Is there any hope these efforts could bring about lasting change? Says Reena Barai, “I’d love to say yes but I don’t know. Local politicians and GPs have really understood how we’ve stepped up, but I think there is a layer in the powers-that-be who are possibly not recognising this.
“If they truly understood that we are the frontline, we wouldn’t have to fight for the things we’ve had to fight for, such as PPE, key worker status and testing for our staff.”
Eoghan O’Brien describes himself as an optimist. He says there have been “lovely messages of support” from Northern Ireland’s chief pharmaceutical officer, and thinks the crisis effort could lead to “proper negotiations, where both sides are equal”.
But he thinks the pandemic will be followed by a serious recession, and worries old attitudes could reappear: “You’ve done a brilliant job, you deserve more but we don’t have the money.”
Says Simon Dukes: “The efforts and achievements of pharmacies have been hugely impressive and we will continue to use examples of this to highlight their value and as an evidence base for future discussions with Government.”
At the moment it is impossible to predict what the next week will bring, let alone how things will look when new contracts are being agreed. Dukes says his immediate priority is to negotiate additional funding for the sector. “This is urgently needed, he says, adding: “We also know how worried many in pharmacy are about PPE and we will continue to apply pressure on this.”
For now, Barai’s biggest priority is protecting her staff by maintaining social distancing. Then comes her patients, “making sure I can supply their medication and continue to offer a delivery service to those who are shielding or isolating at home, if we are still able.”
Her third priority is keeping her business afloat and dealing with the “massive financial impact” Covid-19 has had on her pharmacy. “That’s always at the back of my mind. It should probably be at the front of my mind but my priority is my staff and patients.