In the latest in a series of interviews with inspiring members of the Royal Pharmaceutical Society, Dipesh Raghwani discusses how pharmacy can provide an inclusive service to the lesbian, gay, bisexual and transgender (LGBT) community.
What’s your background?
I’m an independent community pharmacist; I qualified in 2010 and I opened my pharmacy in 2012. I’m also the deputy lead for the Royal Pharmaceutical Society Greater Manchester local practice forum; I’ve been with the group for four years now.
Why did you want to work with Pride in Practice?
We’d always been interested in making sure that we’re an accessible pharmacy, meeting the needs of the local community. We work in quite a diverse area. At first, we contacted Pride in Practice, which supports primary care services to offer equity of care to LGBT patients, just to get some information about how we could better support the community. We had a training session and we found that we were already doing a lot of the things that Pride in Practice encourage. So it wasn’t something new for us, in terms of the language we use and the way that we try to create a safe environment for those patients.
We had a discussion with Pride in Practice about their accreditation framework. At the time, it only focused on GP surgeries, but they said they were looking for a pharmacy framework and asked if we’d mind being assessed.
The main difference here between pharmacies and a GP surgeries were that we don’t have a registered patient list. When someone comes in, whether opportunistically for over-the-counter treatment or as a regular patient of ours, we use a non-discriminatory process. For example, we use generic language: rather than say ‘husband’ or ‘wife’, we always use the word ‘partner’. Pride in Practice recognised that as something really positive.
We use generic language: rather than say ‘husband’ or ‘wife’, we always use the word ‘partner’
The training and accreditation also raised awareness in our team of issues within the LGBT community, such as hormones for trans people and health inequalities in the community — for example, regarding mental health and smoking. We recognised some opportunities that we could use within the pharmacy, that we may not have thought of before.
What did the training and accreditation process involve?
When we had the training in store, one of the Pride in Practice managers came in to train the team. It was quite eye-opening. For example, my team were surprised that electric conversion therapy used to be available on the NHS. It was interesting for them to see how the mindset has changed over time, but also the way our role has changed over time too. Pharmacy is not just a supply function anymore: people see us as a health hub where they can come for advice — not just for treatment of ailments but also health promotion and prevention, and all of the clinical services that we deliver as well.
Regarding the accreditation: basically, we had a framework that we worked to. It looked at things such as how our pharmacy is laid out: does it feel like an all-inclusive environment? We put posters up on our equality policy; we have our chaperone policy on display; we have the LGBT Foundation poster on display as well, which says that you can call them if you are lesbian, gay, bisexual or trans and have any questions — their number is displayed prominently.
The accreditation also considered our human resources (HR) processes: it asked whether we specifically include matters around sexuality or the LGBT community within our HR procedures.
Has the whole pharmacy team been trained?
Yes. We had some training recently, and one of the case study questions was, “What would you do if someone had an issue with you displaying the LGBT Foundation poster?”
It was really humbling for me to see my whole team respond, to say: “That poster is there to support people. If you don’t need that support, that’s great. But there are others that do, so this is for them”.
We have a no-blame culture, because people are sometimes raised with those perceptions or stereotypes
Have you encountered people who did have an issue?
Well, not necessarily people with an issue, but people have made remarks. That’s their own prejudice. We have a no-blame culture, because people are sometimes raised with those perceptions or stereotypes. And some people who are an LGBT community member feel those stereotypes in their own household, which may make them think it’s not safe to come out.
What do you do differently since becoming accredited?
I think for us it’s more an awareness of some of the issues facing LGBT people: things that, as a team, we really weren’t aware of. Take health inequalities as an example: 25% of street homeless people are LGBT. A shocking statistic like that was eye-opening in terms of making us look at things differently.
We want to develop our service so that it is all-inclusive. We recognise, for example, that trans men may come in for emergency hormonal contraception. It’s important not to ask questions that may embarrass them, or to say that “this is only for a woman; why do you have this prescription?” If we have a prescription query, where something looks a bit different — say, a higher than normal dose — how do we find out why, without making the patient feel obliged to come out or to explain their situation?
Things like that can make a big difference to that person. If a patient has a bad experience at one point of healthcare, that might tarnish their view of healthcare professionals generally.
Most pharmacists will already be all-inclusive, but sometimes little things like considering terminology helps. There’s a lot of terms that people might not understand, such as bisexual, pansexual or genderfluid.
Have you noticed an increase in LGBT people using your pharmacy since you became accredited?
I think so, yes. But also, now people are more open about discussing issues they may be facing. It’s not that we have all the answers for them, but we can signpost them to people who are specialists in that area for support. That’s the most important message: it’s not about having all the knowledge. It’s about having the skills to make sure that if somebody comes in, they don’t feel like they have to be closed. We create an environment where people can speak openly, should they need to. But also, if they need further support, we can signpost them to experts who can assess their needs and give them that support.
What advice would you give pharmacists who want to get involved, but are not in an area where the Pride in Practice team currently operate?
Contact the LGBT Foundation anyway. They will have material that they can share with you. They may not be able to come out for face-to-face training, but there is a lot of material available already.
It’s about thinking about how to remove barriers, in the same way you would with any community. If 50% of your patients spoke another language, you’d want to know how to communicate with them to provide the best service. In the same way, this is around making sure that the service we are offering caters to the needs of the LGBT community.
Pharmacists who would like to find out more about Pride in Practice can contact Claire Marshall at pip@lgbt.foundation.