Unseen heroes

In January last year, on ITV’s This Morning, the topic of pharmacists came up – and the ensuing conversation caused an uproar among those in the profession.

Mocked by host Sam Delaney as ‘pretend doctors’ who ‘effectively [just] go and fetch the medicine’, rightfully indignant pharmacists took to social media after the show to highlight the massive role they play in virtually every aspect of the health service.

The controversy happened just weeks before the UK would be engulfed in a deadly pandemic — and little did pharmacists know then that their vital skills would become even more instrumental in the months to come as the NHS faced up to its biggest challenge in generations.

Sadly, misconceptions of the pharmacy profession have persisted throughout the Covid-19 pandemic, and despite having stepped up to the plate in a major way to save lives, they’ve received little recognition in the last year.

Behind the scenes work

Unite’s Guild of Healthcare Pharmacists (GHP) is now aiming to set the record straight. Unite caught up with GHP vice-president Ewan Maule, who works as head of medicines optimisation for Sunderland CCG.

He recounted how the pandemic response set in motion a vast operation within the health service which had pharmacists at its heart.

“As with other frontline healthcare workers, there was an immediate push to suspend some of the normal work and move towards the acute response,” he told UniteLive. “Every patient in hospital obviously has a lot of involvement with hospital pharmacists both clinical and otherwise, and our immediate aim was to work to get as many people out of hospital safely as possible to free up capacity.

“Then immediately after that we moved on to preparing the hospitals for the pandemic itself. An awful lot of the work of the pharmacists was very behind the scenes there,” Ewan explained. “For example one of the biggest demands for the pandemic was for oxygen. As a medicine, oxygen falls under the remit of pharmacy.

“We saw a lot of hospitals designating new areas to be intensive care units. One of the main requirements for this is that you have an adequate oxygen supply to those other areas, which many hospitals at the time didn’t have. Pharmacists took the lead on this to get that oxygen supply up and running and to make sure that it was safe.”

This was a particular challenge later on in the pandemic with the Nightingale Hospitals, which were built essentially from the ground up using conference centres.

“These new hospitals had all the same clinical requirements as those intensive care units but often in completely new-build facilities in conference buildings,” Ewan explained. “There was a huge amount of work done in preparing these new hospitals, not just with oxygen but the general logistics of safety and security and storage of medicines in facilities like that as well. All of that was completely led by pharmacists.”

Throughout the pandemic, many pharmacists were also seconded to work in intensive care units supporting doctors and nurses.

“The main aim of these pharmacists was to try and take as much of the non-direct patient care work from frontline services such as nursing and medical staff. One way they did this was within aseptic units in hospitals, where injectable medicines are prepared. They went into overdrive preparing these medicines so that they didn’t have to be made up on the wards.”

Another massive challenge for pharmacists especially in the first very strict lockdown was delivering medicines to patients – who would normally be in-patients coming in to hospital for elective procedures – whose care was now shifted to being delivered at home.

“Getting medicines out to those patients under the circumstances of lockdown was a huge logistical operation and again this was all led by pharmacists,” Ewan noted.

‘History in the making’

Even as recently as six months ago, there was a widespread sense that there may be no impending light at the end of the Covid tunnel, that perhaps we would simply have to accept living with, and dying from, the fatal virus for many more months or even years to come.

And then, in December, the world’s first successful vaccine was approved by regulators in the UK, and then the next, and the next. The creation, production and now massive dissemination of the various Covid-19 vaccines, and the speed with which all of this happened, is nothing short of a miracle. And again, pharmacists played an essential role from the very beginning.

“All of those vaccines that are now being rolled out were developed in clinical trials — and every clinical trial has a lead pharmacist attached to it,” Ewan explained. “Given the size and the scale of those clinical trials and the complexity of things like the Pfizer vaccine having to be stored at -80C degrees, this was another vital role that pharmacists played. As far back as April, very soon after the pandemic started we had staff focused on helping to support and develop those clinical trials.”

And now, pharmacists are yet again playing a huge role in the actual roll-out of the vaccines. GHP rep and primary care network (PCN) pharmacist Seema Varma is one of the legions of pharmacists who are taking part in this historic effort, and she couldn’t be prouder.

“It is a truly collective effort and a privilege to be part of the national vaccination programme,” she told UniteLive. “It is history in the making, coordinating and vaccinating the adult population under a strict timeline which has subsequent consequences for the economy.”

Describing their work at vaccine clinics as ‘a well-oiled machine’, Seema and her pharmacist colleagues are the first in the door early in the morning to prepare the vaccines.

“We follow science-based procedures to prepare and dilute the vials to a state that’s suitable for vaccination,” she explained. “It’s important to be organised from the start of the session otherwise it can slow down the whole clinic. Especially with the Pfizer vaccine, we work to strict timelines because these have to be used within days of being taken out of its storage temperature of -80C.

“I’m proud to say we haven’t wasted any doses,” she added. “Stock control and waste prevention is a key component of what pharmacists are doing in the vaccination programme. Every dose is accounted for against the patients in attendance.

“We prepare the required quantity of vials based on patient appointments, and at the end of the day, we reassess doses against patient numbers, and so then prepare one vial at a time.  It is a  meticulous process so no doses are wasted –  every single dose is precious.”

‘It’s lovely getting to see patients’

Contributing to the vaccination effort has also allowed Seema, who’s worked in various roles in pharmacy over the last twenty years but only just recently started her current role as a PCN pharmacist in August, to meet her colleagues and speak to patients face-to-face for the first time.

“It’s lovely getting to see patients, most of whom are very grateful,” she said. “A few weeks ago I was vaccinating patients on immunosuppressant medication and many of them hadn’t left their homes in over ten months because they were shielding. They were so pleased to have a day out to see us.”

While Seema finds her work personally rewarding, the going hasn’t always been easy – when she and her colleagues first began their vaccine work, they were regularly working twelve hour shifts. Seema said she also found it challenging under lockdown not being able to meet with patients in her normal work as a PCN pharmacist, where she works with GP practices and patients in the community.

“Ordinarily I would be doing medication reviews face-to-face, getting patients to bring in their medications and talk about them,” she explained. “It’s a very different experience having to do it over the phone, as is not being able to meet fellow colleagues within your area.”

Despite the challenges, Seema wouldn’t have it any other way – the earnestness with which she speaks of helping patients is an all-too familiar sentiment expressed by all NHS workers, no matter what role they play. But that total commitment to caring for others is now being exploited by a government which has yet again betrayed these workers who’ve saved so many lives.

‘Slap in the face’

Commenting on the government’s recent announcement that it would recommend a mere one per cent pay rise – a real terms pay cut – for NHS staff this year, Seema said she had only one word – ‘disbelief’.

“NHS staff have gone into work day in and day out caring for sick patients at great personal risk to themselves,” she said. “Many have sadly passed away, while others have experienced their first  mental health episode as a result of the stress of the pandemic.  Additionally, they’ve had to deal with the stress of potentially bringing Covid home to their families, or job losses within the family. But they go into work every day — because they care about their patients and colleagues. The pay rise announcement was a slap in the face.”

Ewan agreed and slammed the government’s excuses about affordability.

“The government can afford what it wants to afford — we’ve seen a lots of waste in other areas of government spending, so I don’t think that there can be any doubt that this is a political decision rather than an economic one,” he noted.

Ewan said he fears for the future of the pharmacy profession if the government continues to go down the same road of failing to value NHS staff.

“Only recently pharmacists were added to the occupational shortage list, so we already know that there are not enough pharmacists in the country to be able to fulfill the vacancies that we have at the moment,” he explained.

“Given the massively important and specialist roles that pharmacists have undertaken throughout the pandemic, there’s a real risk that if we don’t have good approaches to recruitment and retention,  if another pandemic were to hit in ten years’ time, we may not be able to manage it as we have done now.”

For Seema, she hopes that proper pay rise for all NHS staff will also one day be matched with greater recognition that pharmacists – unseen heroes – deserve.

“I don’t think the efforts of pharmacists are really acknowledged or appreciated by the media or by the government and it’s a shame,” she said. “We contribute in many different ways towards healthcare; be it in research, clinical trials, education and training, optimising medication in hospitals and GP practices and in more patient-accessible services like community pharmacies, or as working as Independent Prescribers. However, there is a lack of awareness of what this profession is capable of and actually does – it is more than counting tablets.”

As pharmacists across the UK continue to do their vital work in so many different areas of the healthcare system, Guild of Healthcare Pharmacists (GHP) president Roisin O’Hare has a special message for members and the public. Watch in the clip below:

You can find out more about Unite’s Guild of Healthcare Pharmacists here.

By Hajera Blagg