The first professional session of the Conference took place in the afternoon of September 13. Chaired by the President (Mrs Christine Glover), the session featured two speakers: Mr Peter Kielgast (of Denmark, and president of the International Pharmaceutical Federation), who gave the audience a world perspective on developments in pharmacy, and Ms Vanessa Bourne (chairman of the Patients' Association), who told the Conference what patients expected of pharmacistsThe first professional session of the Conference took place in the afternoon of September 13. Chaired by the President (Mrs Christine Glover), the session featured two speakers: Mr Peter Kielgast (of Denmark, and president of the International Pharmaceutical Federation), who gave the audience a world perspective on developments in pharmacy, and Ms Vanessa Bourne (chairman of the Patients' Association), who told the Conference what patients expected of pharmacists
Pharmacy in the 21st century has a challenging and bright future — if we take it. That was the message Mr Peter Kielgast (president, International Pharmaceutical Federation) delivered to pharmacists in his address on world developments in pharmacy. The more work pharmacists put into formulating strategic approaches to pharmacy practice in the next century, the more success they would have in realising the many possibilities open to them.
Mr Kielgast warned that pharmacotherapy would become increasingly complex, as patients would be prescribed still more sophisticated drugs while they routinely consumed non-prescription medicines, herbal remedies and dietary supplements. Patients would have easy access to unlimited information about drugs which they were not educated to judge.
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Peter Kielgast: profession will continue to succeed and grow |
Pharmaceutical products
What did the next century hold for pharmaceutical products? There would be many more products entering the market as a result of greater understanding of human DNA. Biotechnology was an expanding field that would drive drug discovery, drug delivery systems and drug manufacturing in the next 100 years.
Also, increasing competition from generics houses and limitations on patent protection would force the industry to continue to improve its efficiencies and its innovation. Mergers would continue, large and small; technology driven pharmaceutical firms would be taken up by larger, more asset-rich companies. This would result in consolidated research programmes to ensure that products were continuously introduced into the pipeline. Medicines nearing the end of their patient protection would be replaced with new products.
Mr Kielgast expected that there would be an increase in the rate of new products entering the market in the next century. But pharmacists might not be the only ones to claim expertise with these new medicines. "So, watch out colleagues," Mr Kielgast warned. "You might get competition from biologists, biochemists, virologists and nurses. You will need to update the knowledge with which you graduated."
Pharmaceutical services
Turning to pharmaceutical services, Mr Kielgast said that the pharmacy had changed from a place of drug manufacture to a place of drug storage and distribution. The move towards more patient-focused practice resulted from the realisation that pharmacists could do more than make sure that the right drug got to the right person. He added: "I think it is essential that pharmacists remain involved in the drug distribution process. However, I also feel that pharmacists talents are being wasted if that is the only function they perform."
The pharmacy was the most appropriate place for patient-centred services because pharmacists were higly knowledgable and skilled health care professionals. Also, pharmacies were well located in almost every developed country. And pharmacists still ranked first among the most highly trusted professionals. "This level of trust is a priceless asset that we must continue to maintain and indeed build upon," said Mr Kielgast.
Another reason was that many patients chose one pharmacy for all their prescription needs. "The advantage of this is that we have become the only health care profession with a full record of all the medicines that a patient has been prescribed by all of his or her physicians and specialists," he said.
Nowadays, the pharmacy was becoming more of a health centre as pharmacists changed the nature of their practices. However, in some countries, pharmacists still sold non-professional products, probably out of historical tradition and economic need — but Mr Kielgast believed that that was not where the future of the profession lay.
Another area of possible change in the future was expansion in clinical services. Mr Kielgast told the Conference that some pharmacists in the United States had been given limited prescribing authority. "I know," he said, "that you too are examining this following the publication of the Crown report. I hope you make the best use of this and I look forward to following your progress."
Also in the United States, pharmacists had started to give vaccine injections. This service made sense, Mr Kielgast believed, when the accessibility of pharmacies was considered together with the fact that pharmacists could be trained to deal with potential anaphylactic responses to vaccines. He added that this type of programme could easily expand to include weekly anti-allergy injections and other types of interventions that did not require the services of a physician.
"Many physicians may oppose this expansion of pharmacy services," Mr Kielgast said. "However, I feel that they will see that their talents can be better utilised in more technically challenging areas that exploit their expertise."
Patient factors
Turning to the subject of patients, Mr Kielgast said that they were becoming more and more educated about their health as a result of increased access to information and demand for better services for their money. "With direct patient advertising from manufacturers and endless amounts of information on the internet, our clients are beginning to ask more and more questions about their health care," he said.
As they entered the next century, the trend would be towards even greater information disclosure. The role of the pharmacist would, therefore, evolve to that of an information agent, guiding patients as to which information they had obtained in the media or on the internet was reliable.
"The pharmacist will no longer be the gatekeeper of information. Rather, he or she will help the patient discern good information from bad," Mr Kielgast suggested.
The changing demographics of the patient population would also affect how pharmacy was practised in the future. The population was ageing and becoming more wealthy. This made for a combination of informed patients with high disposable incomes and a large number of poor elderly people, all of whom would consume large amounts of health care resources. The pharmacist needed to be prepared to take advantage of this, Mr Kielgast said.
Governments and insurers
On the subject of governments and insurers, Mr Kielgast said that the population's demands for lower taxes and insurance premiums would affect the way in which health care was paid for in the 21st century. Governments and insurers would be looking at ways to rationalise health care costs while maintaining high standards of quality. Innovative health management schemes would force pharmacists to practise in more innovative ways.
"If governments are looking to decrease expenditures on pharmaceuticals and pharmacists' fees, it will become increasingly more important for pharmacists to demonstrate the value of their services," said Mr Kielgast. "Can we really show the people who pay our bills the value of having prescriptions filled by pharmacists instead of by technicians with bar code readers? What would be the danger of removing pharmacists from the dispensary? Do people die because of this? These questions are important for us to be able to answer."
It was imperative, Mr Kielgast warned, that pharmacists begin to document the value of their services and gather evidence to hinder or fight off external threats to their existence.
Governments and insurers would pay for health care services. They just needed to be reassured that what they were paying for yielded the most effective and efficient results. So pharmacists needed to demonstrate that their knowledge could be used in ways to optimise health care spending. Indeed, the money that was paid out for their services could prevent outlays of money for more expensive services.
Technology
A major advance in technology had been the internet and, since January, 1999, all US-based major online pharmacies had launched websites. PlanetRx and Drugstore.com were the largest and most influential. A key question was what impact would online trade in medicines have on the traditional bricks-and-mortar pharmacy. Mr Kielgast predicted that there would be a "brutal battle" and that heavy demands would be put on the leaders of the pharmaceutical profession to steer through this battlefield.
"The cyber-drugstore is in its infancy and it will probably not become a freestanding alternative to the traditional pharmacy but, rather, part of a larger health care network. The internet will, however, present a great challenge to the pharmaceutical profession at the start of the new millennium," Mr Kielgast warned.
Cyber-pharmacy would, to a certain, extent, be an attractice alternative to the present bricks-and-mortar retail store, particularly if pharmacists continued to add too little value to the drugs they dispensed. "But we have a lot of competitive edge if we, in an innovative way, can put a price tag on our competence, and this is one of the key issues for pharmaceutical organisations in times to come," he said.
Pharmacists could either wait until advances in technology forced them to change or they could make change happen as a result of new technology. They could choose to be "innovators" or "laggards". "It's up to you in which category you stand," said Mr Kielgast.
But what if none of this happened? One of the main barriers to success in the future of pharmacy would not be any of the factors that Mr Kielgast had so far discussed. An important factor would be the state of the populations in the developing world. The high rates of HIV and malarial infection in Africa made the future dim for many people.
Pharmacy in developing countries would be limited in future by its ability to demonstrate that it could participate in the development of modern health care systems that were effective and efficient.
The more developed world could help by gathering data to demonstrate the value of pharmacy services that pharmacists in under-resourced countries could use to develop sound programmes. The International Pharmaceutical Federation was trying to help pharmacist in developing countries face the 21st century by giving them access to share a worldwide network of colleagues.
"With more exposure on the international scene, pharmacists from developing countries can share in the collective expertise of pharmacists in more fortunate situations," Mr Kielgast said.
He concluded by saying that he was confident that the pharmaceutical profession would continue to succeed and grow into the next century and beyond. "But don't fight for a position and role that no one will pay for," he warned.
Britain already has a network of walk-in health centres in most high streets. They are called pharmacies, Ms Vanessa Bourne (chairman, Patients' Association) told the Conference.
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Vanessa Bourne: patients counting on you |
But patients had yet to grasp the full potential of seeking advice from pharmacies and pharmacists. "I am sure pharmacists could do more to publicise their expertise in this regard," said Ms Bourne.
She went on to say that the move to expand the services on offer by opening dental and optical facilities in larger pharmacies was in its infancy, but if it was to succeed it needed to be a fuller service than patients currently found. There was no doubt that "one-stop shops" were what patients wanted from the NHS.
The pharmacy world had much to do to educate patients on new drugs and the way in which these drugs would reshape the NHS of the future. "Just as the discovery of antibiotics changed the need for the isolation hospital and the sanatorium in the past, or the discovery of new drugs for the mentally ill reduced the need for enormous mental hospitals, so the drugs of the future will require a reshaping of the service of the future," Ms Bourne said.
She believed that one of the most exciting innovations in the health service was the advent of NHS Direct. As a new addition to the health care armoury it held the potential to relieve the 24-hour burden on primary care, and might in the longer term aid the recruitment of general practitioners who did not wish to adhere to the traditional "open all hours" work pattern. If NHS Direct was to do that, however, it was vital that its advent was linked to changing requirements throughout the NHS.
Ms Bourne explained that patients did not always see the whole picture of the NHS. But that was not their responsibility. Without the facts, how could they make a judgment? How many patients knew the value of NHS resources allocated to one person? How many patients knew the cost of a hip replacement, or cardiac care? "And yet, when these costs are spelt out, patients are not fools," Ms Bourne said. "So long as the NHS keeps these figures to itself, there will be constant conflict over proposed change."
She urged that pharmacists would do well to encourage the dissemination of such information.
Any organisation offering the latest technology in healing and saving lives had to change constantly to stay efficient and effective. "If we are to continue to offer patients the service they think they are getting and paying for, then those with the knowledge and experience to bring that service about must play their part and speak out," she said.
Ms Bourne told the Conference that pharmacy and its highly trained and experenced practitioners were without doubt at the epicentre of changes in health care. She hoped that the BPC would make a lasting contribution to the way the NHS could be in the future.
"Your patients are counting on it," she concluded.