The year ends as it began: waiting for an announcement from the Government on a new strategy for community pharmacy. The strategy is being developed from round-table talks initiated by Frank Dobson when he was Secretary of State for Health. Participants in those talks - who included representatives from the profession, government, the National Health Service, medicine, nursing and patients - agreed that the NHS should make better use of community pharmacists (PJ, September 26, 1998, p474). But we have yet to see what the Government has in mind.
The speculation is that the strategy will have something to do with prescribing, which was the subject of a second report from the team led by Dr June Crown. Crown II urged the recognition of two types of prescriber: independent and dependent. Independent prescribers were those who were responsible for the assessment of patients with undiagnosed conditions and for decisions about clinical management; dependent prescribers were those who were responsible for the continuing care of patients who had been clinically assessed by an independent prescriber (PJ, March 13, p347). We should not have long to wait before finding out whether or not Crown is reflected in the strategy.
Prescribing issues generally have featured strongly during the year. The National Institute for Clinical Excellence - set up by the Government to give guidance to the National Health Service in England and Wales on the clinical- and cost-effectiveness of new and existing clinical interventions - began work on a programme established by the Department of Health (PJ, August 17, p223). It was soon embroiled in controversy over one of the items on the list, namely, zanamivir, an anti-influenza treatment marketed by Glaxo Wellcome as Relenza (PJ, September 11, p374). Although the spin put on the launch of the NICE was that it was to facilitate the introduction of effective new treatments its first action was to decide that there was not yet sufficient evidence of clinical efficacy in practice to allow Relenza to be used on the NHS (PJ, October 9, p561). Glaxo Wellcome called for the NICE to be overhauled (PJ, October 16, p622).
For the profession generally, a feature of the year has been severe problems in the supply of generics. In community pharmacy, shortages are dealt with by adding affected drugs to category D of the Drug Tariff, which allows pharmacists to substitute branded products where a generic is unobtainable. This leads to increases in the drugs bill and local prescribing budgets have been badly affected. There is no clear consensus on why the generics industry is in difficulty. Supply problems have been caused by the suspension of the manufacturing licence of Regent Laboratories (now to be restored - see p970). But that alone cannot explain everything. Other factors that have been suggested include changes in manufacturing arrangements and failure of the Department to support the patient pack initiative. This list is not exhaustive. The Department of Health has responded by reducing the threshold for schedule D entry from four weeks' stock in the supply chain to two. It may have other plans up its sleeve. Meanwhile the report of the House of Commons health select committee on the issue is awaited with interest (PJ, November 13, p773), as is a report by OXERA, which has been contracted by the Department of Health to undertake a fundamental review of the field (PJ, December 11, p933).
Another notable development during the year was an attempt by Superdrug to reopen the limitation of dispensing contract issue (PJ, September 11, p370). A pamphlet was published by the company and meetings were addressed by its staff, but there is no evidence that it has gained any support. Self-interest on the part of the company was a shade too obvious.
Resale price maintenance on medicines remained in place for a further year. However, the Director General of Fair Trading was given leave to take the matter to a full hearing before the Restrictive Practices Court (PJ, March 20, p384). The case is not expected to be heard before the third quarter of next year, so the end of RPM on medicines, if it comes at all, is still some time off.
The loss of RPM would be a severe blow to community pharmacy. So would be a further reduction in the margin on National Health Service dispensing. But to make such an assertion does not mean that they will not come about. Steps are needed now to prepare the profession for such developments. There is now a growing belief that this would be facilitated by changing the practice model. This is exemplified by developments in Scotland, where the Clinical Resource and Audit Group is promoting the principles of classic pharmaceutical care as a means of introducing clinical pharmacy for pharmacists in primary care (PJ, April 10, p527 and 531). At the year end, the Scottish Health Department announced that it would be funding pharmaceutical care projects to the tune of £0.5m next year.
New practice models need new remuneration models. However, there is precious little sign that the main negotiating bodies have made any progress on this or even that they believe it to be necessary. The Royal Pharmaceutical Society clearly recognises that the way professionals are paid has a profound effect on the way that they practise and has put forward proposals for debate (PJ, January 16, p65). That debate has yet to begin in earnest.
For hospital pharmacy, the year was dominated by a worsening recruitment crisis (PJ, January 3, p99). It has also become apparent that the current grading structure is out of date. Calls have been made for it to be reviewed (PJ, November 6, p732). For the future, hospital pharmacists are to be brought within the pay review body system (PJ, November 20, p806). This is welcome news, since staff covered by review bodies do better in remuneration terms than those who are not.
The recruitment difficulties and also the aspirations of hospital pharmacists in relation to clinical practice have led to greater emphasis on the role of technicians and a number of calls for some form of registration and regulation for this key category of staff. Pressure for developments in this area is growing, although there is opposition.
A further focus on the role of technicians arose when the Society decided that all dispensary staff should be trained to particular standards (PJ, February 13, p216, and March 13, p351). The National Pharmaceutical Association, representing proprietor pharmacists, had major concerns about the cost and general implications of the proposals (PJ, May 8, p645), but problems were in the process of being resolved by the year end (PJ, October 16, p631).
Recruitment problems are not, of course, confined to hospital pharmacy. They affect other areas of the profession, too, and continued to be a problem during the year. Fresh light was thrown on the matter by a workforce survey in the West Midlands (PJ, December 4, p912). The survey also indicated a further shift towards employee status for pharmacists in community pharmacy.
A major development in the pharmacovigilance field was the general extension of the yellow card adverse reaction reporting scheme to all community pharmacies (PJ, November 13, p769). Not before time.
For the industry, a new price regulation scheme was agreed (PJ, July 10, p47). It included a price cut of an average of 4.5 per cent from October 1 for branded prescription medicines (PJ, July 17, p80). The Pharmaceutical Services Negotiating Committee sought compensation for loss in contractors' stock value (PJ, July 24, p109).
National Health Service issues were prominent during the year. As well as the NICE coming on stream, there were announcements for walk-in centres in high street locations staffed by nurses and general medical practitioners (PJ, April 17, p528) and major developments in NHS Direct, the Government's telephone health advice service. At the year end, steps were being taken to test the use of pharmacies within the service as a "fourth disposition", that is, places where callers could be sent (see this week, p983).
In October, Alan Milburn replaced Frank Dobson as Health Secretary (PJ, October 16, p623).
On the parliamentary front, the year end saw the welcome launch of an all-party Parliamentary group for Westminster (PJ, December 11, p931) and the election of one pharmacist to the Welsh Assembly and another to the Scottish Parliament (PJ, May 15, p681). But we still have not got a chief pharmacist at the Department of Health. Bryan Hartley retired from the post during the year, but an attempt to find a replacement came to nothing (PJ, May 22, p728). Nothing has been heard since. It is about time that the Department took steps to fill this glaring gap in its top personnel.
For the Royal Pharmaceutical Society, there were a number of key developments. Among them were a consultation document on a new Code of Ethics (PJ, September 18, p416), and the appointment of a Cardiff-based secretary for Wales (PJ, January 9, p49). A new edition of Martindale was published (PJ, April 24, p591). Towards the end of the year, the Society published a framework for clinical governance in pharmacy (PJ, September 25, p479). A particularly pleasing development was the announcement that the Council had approved the formation of an Academy of Pharmaceutical Scientists, comprising the Society's Pharmaceutical Sciences Group and the UK Association of Pharmaceutical Scientists (PJ, December 11, p939). A rift that has lasted almost a decade is to be healed.
It was a year of progress for The Pharmaceutical Journal, too. PJ Online, the journal's website, was launched (PJ, September 18, p414). Tomorrow's Pharmacist, an annual for students and preregistration trainees was published for the first time (PJ, October 30, p707) and a quarterly for primary care pharmacists was successfully piloted (PJ, October 2, p518). Both were produced within the PJ editorial department.
On the education front, Liverpool school of pharmacy celebrated its sesquicentenary (PJ, July 3, p6).
At the year end, Britain saw what was claimed to be its first "internet pharmacy" (PJ, November 27, p843), which led to a decision by the Society's Council to take urgent steps to establish ethical rules for such operations (PJ, December 4, p895). A sign of the times!