Politicians do not hear pharmacy’s voice, PR adviser says
NHS contract holds pharmacy back - Howard Stoate
Government intends to re-engineer the pharmacy contract,
President says
Pharmacists oppose P sales of EHC
NPA/PSNC merger would increase pharmacy's influence
Pharmacy provides what the NHS needs - Unichem chairman
Facts and figures on sex and contraception
Smoking kills 320 people daily
We conclude our reporting of Unichem’s 2000 convention held in Puerto
Rico from September 24 to October 1
Politicians do not hear pharmacy's voice, PR adviser says
 |
| Simon Whale: one voice best |
Politicians do not listen to the pharmacy profession in the same way as they
listen to the medical and nursing professions because they see pharmacy as a
profitable retail business.
That, rather than poor performance by the profession’s representative bodies,
was at the heart of the profession’s inability to get its point across,
was a point made by Mr Simon Whale (director, Bell Pottinger Public Affairs).
Nevertheless, pharmacy’s influence would be greater if there was more unity
of approach and fewer voices, Mr Whale said.
Politicians and civil servants saw community pharmacies as retail businesses
which, large or small, were very profitable and had been for many years. This
meant that community pharmacy was not seen as a proper part of the National
Health Service. Rightly or wrongly, they expected people to work in the NHS
for the love of it and these views accounted for pharmacy’s small increases
in NHS remuneration. Policy-makers saw community pharmacy as principally a supply
function, which meant that the profession needed to work harder to promote the
value added elements of dispensing.
Hard-nosed treasury
The Treasury was particularly hard-nosed, Mr Whale went on. He believed that
it was not convinced that it got value for money from pharmacy. Supply was seen
as mechanistic and requiring little professional skill. So the question “Is
it worth £750m or more every year” arose.
Turning to the recently announced pharmacy plan, Mr Whale said that now, after
a long period of stability, community pharmacy faced new threats, challenges
and opportunities.
There was much to be enthusiastic about in the Government’s proposals.
It supported the concept of medicines management; it wanted repeat dispensing
schemes; it accepted that NHS Direct should refer people to community pharmacies;
it wanted stronger out-of-hours services; and it saw pharmacists as a key part
of the primary care team.
This was a degree of recognition that had never before been granted to pharmacy,
but there were grounds for caution for pharmacy owners and contractors. There
was ambiguity about whether new services would be provided by community pharmacies
or by pharmacists based elsewhere and there was ambiguity about additional funding.
The pharmacy plan proposed that medicines management and repeat dispensing should
be piloted under new local pharmaceutical services (LPS) contracts. This meant
that new services could be provided by pharmacists who were not existing contractors,
but that they would be paid from within the global sum.
One-stop primary care centres, many of which would contain pharmacies, would
be welcomed by the public, but possibly not by existing contractors They cast
doubt over future prescription volumes and the ability to offer new services.
The pharmacy plan also had implications for decision-making processes. At present,
many pharmacy-related decisions were taken nationally. That could change. Decision-making
could be devolved to primary care trusts and their powers could include authority
to determine the nature and extent of local pharmacy services, budgets and the
locations from which services were provided.
Now was the time to play up the strengths and attractions inherent to community
pharmacy. It was: national; accessible; popular; run by highly trained, experienced
professionals; a source of readily available expert advice; efficient and cost-effective;
an ideal tool for delivering health care objectives; and ambitious. These were
strong, persuasive messages and now was the time to communicate them aggressively.
To reap the benefits of the current situation, the profession needed to be flexible,
self-critical, willing to change, committed to the NHS and, perhaps, willing
to provide more services for relatively little immediate money. (Top)
NHS contract holds pharmacy back - Howard Stoate (Top)
 |
| Howard Stoate: bright future |
The future for pharmacy looks bright, but there are too many issues holding
the profession back, Dr Howard Stoate, MP (chairman, All-Party Pharmacy Group)
told the conference.
Community pharmacists were still working with National Health Service contracts
more suited to the 1950s than the 21st century and were severely constrained
in what they could do.
In particular, they did not have patient lists with which to work. They had
to respond to consumers who came to see them and to dispense what others prescribed.
They could not use their knowledge of therapeutics to influence drug use or
obtain best value for the NHS. Links with neighbouring general medical practices
were informal and there were no mechanisms for checking and dealing with compliance
issues. The service was demand led, and could not be tailored to the needs of
the local population. Dr Stoate said: “This is inefficient, unsatisfying
from a professional view, and does not serve patients well.”
Pharmacists were able to do, and wanted to do, more, he went on. They wanted
to be involved in changes in delivery of patient care and not simply to respond
to changes.
“I want you to be part of the process of formulating change, firstly because
you are in the best position to understand how the changes will affect patients,
but also because they affect the way you work and are remunerated,” Dr
Stoate said. “If you want to be part of the formation of policy, rather
than having to respond to the agenda set by others, there has never been a better
opportunity.” (Top)
Government intends to re-engineer the pharmacy contract, President says (Top)
 |
| Christine Glover: Government wants value for money |
The Royal Pharmaceutical Society’s Council received clear messages from
the Secretary of State’s policy adviser before the announcement of the
pharmacy plan at this year’s British Pharmaceutical Conference (PJ, September
16, pp384 and
397) that the Government
was wedded to a “quality and value-for-spend” agenda and that it intended
to re-engineer the pharmacy contract to achieve its aims.
Another clear signal was that the control of entry arrangements for community
pharmacy could be changed if they were seen to block the development of better
services. This was a big lever with which to move changes and make things happen.
The President said that although change was necessary, the Government’s
plans brought considerable challenges, difficulties and even pain. She said
that she had told the Minister that many pharmacists had invested their entire
professional lives and their capital to make the community pharmacy network
what it was today. They had done their best by the National Health Service by
investing in it to create a comprehensive, quality medicines supply network.
He should build on those benefits and not lose them.
Turning to the issue of professional regulation, Mrs Glover said that the Government’s
plans for a pan-regulatory body were aimed at achieving commonality among regulatory
systems within the health service. However, she added: “They do not actually
want to regulate us all, although this was mooted during the modernisation discussions,
but they want to be able to lean on us. They want more lay representation and
comparable penalties, and this is reasonable with more multiprofessional working.”
She added that the Society’s 30-year-old disciplinary procedures would
be overhauled. Initially this would be confined to introducing the ability to
suspend someone who was unfit to practise through ill health or substance misuse.
By next summer, the whole system would be overhauled.
So far as continuing professional development was concerned, the President said
that lifelong learning and continuing professional development were core responsibilities
for any professional. She said: “I have no doubt that it will only be a
short time before we shall have to have revalidation to stay on the register.
The doctors are already doing it; the nurses are setting up for it. Council
has yet to debate this issue, but there is no doubt that outside pressures appear
to be taking us down this path.” (Top)
Pharmacists oppose P sales of EHC (Top)
A majority of pharmacists at the convention preferred products for emergency
hormonal contraception to be supplied under patient group directions (PGDs),
rather than become pharmacy medicines.
During a discussion after presentations on current attitudes to sex in Britain
and on contraception (see next page), 86 per cent of pharmacists present said
that they would be prepared to supply emergency contraception. Of those, 69
per cent said that supply should be by PGDs, not by pharmacy sale.
The PRESIDENT of the Royal Pharmaceutical Society (Mrs Christine Glover) said
that the Society’s view was that EHC should be available to women who needed
it. PGDs were probably preferable, but pharmacy sale could not be ruled out.
Women who could not afford to buy it should be able to get it free of charge.
Mr PETER MARSHALL (deputy chairman, Numark) warned that the Consumers’
Association would expect about 10 minutes of counselling before EHC was sold
or supplied and would criticise pharmacists harshly if this was not done. Pharmacists
would have to ask what price would make this worthwhile. He could not see many
people paying £15 to cover the pharmacist’s time. PGDs offered a
better route.
Mr PETER CATTEE (a Unichem regional chairman) said that women should be charged
for EHC wherever possible. Price would not be a barrier. The success of treatments
for thrush and smoking cessation products showed that people were prepared to
pay for what they wanted.
Other findings of the debate were that a small majority of pharmacists (58 per
cent) believed that EHC should not be supplied before it was needed. The views
of male and female pharmacists differed here, with 58 per cent of women pharmacists
and 42 per cent of male pharmacists believing that supply for future use should
be allowed (68 per cent of pharmacists at the convention were men). Sales to
men were opposed by 75 per cent of men and 78 per cent of women. Dr NICOLA GRAY
(a member of the Society’s Council) said that the Manchester EHC scheme
had identified a problem with pimps trying to obtain EHC for use by their prostitutes.
(Top)
NPA/PSNC merger would increase pharmacy's influence (Top)
A majority of conference participants (78 per cent) felt that a merger between
the Pharmaceutical Services Negotiating Committee and the National Pharmaceutical
Association would increase the profession’s influence.
During a brief discussion on the aborted merger (PJ, June 24, p928), Mr SIMON
WHALE, who advises the PSNC on Parliamentary and public affairs, said that it
was important for the profession to speak with a single voice, but that this
was an idea whose time had not yet come.
Mr KIRIT PATEL (an NPA nominee to the PSNC and a member of the Royal Pharmaceutical
Society’s Council) was strongly in favour of a merger. There were too many
voices in pharmacy and none of them were heard.
Dr HOWARD STOATE (chairman, All-Party Pharmacy Group) said that the presence
of more than one voice meant that it was easy for the Government to divide and
rule the profession. There had to be one voice and one agreed position. (Top)
Pharmacy provides what the NHS needs - Unichem chairman (Top)
Community pharmacists provided what the National Health Service needed, Unichem’s
chairman (Mr Kenneth Clarke) told the meeting.
Pharmacists had always been front-line professionals who provided patient-friendly
face-to-face services. Community pharmacies had been walk-in centres before
the Government started adding its own. The professional and clinical skills
of the pharmacist had not been used to the full in the past and, just as the
skills of nurses were now being used more fully, better and more flexible use
should be made of pharmacists’ skills.
Community pharmacy was efficient and cost effective. Pharmacists did not have
to be introduced to private sector management; they had always been private
sector managers and entrepreneurs and had always been in a very competitive
environment. They knew at first hand the impact of information technology and
e-commerce. (Top)
Facts and figures on sex and contraception (Top)
 |
| Nick England: abortion rate is rising |
Facts and figures on sex and contraception and current attitudes were presented
by a number of speakers.
Mr NICK ENGLAND (managing director, Pharmacy Alliance) said that the importance
of teenage pregnancy as a social and public health issue was shown by the fact
that the United Kingdom had one of the highest teenage conception rates in the
developed world and the highest in western Europe. Approximately 8,000 conceptions
occurred annually in the under-16 age group. This represented 2 per cent of
all secondary school pupils and 35 per cent of these conceptions resulted in
abortion.
The financial and social cost of this was huge. Babies born to teenage mothers
had an early death rate which was double the national average. Many young women
who fell pregnant and kept their babies were themselves children of young mothers
and were likely to experience poverty and poor health and to pass such disadvantages
to the next generation.
Rates of teenage conception and abortion across all ages were rising in Britain.
The rate varied around the country, with some areas, such as Wear Valley, having
a conception rates for girls under 16 years of 22 in every 1,000, compared to
Woking, at 2.8 per 1,000.
Sexually transmitted infections were increasing, particularly among teenagers.
HIV and AIDS remained a serious threat. Early prevention efforts meant that
the situation in Britain was better than in many other European countries, nevertheless,
last year saw the highest ever number of HIV infections in the UK at nearly
3,000 — almost twice the figure for a decade ago.
Turning to emergency hormonal contraception, Mr England said that Schering PC4
had been launched in 1984 and usage had increased by 20 per cent annually until
1998, when over 900,000 prescriptions for it had been issued. Since then the
growth had levelled while the teenage pregnancy rate continued to increase.
The lack of quick access and lack of awareness of EHC were the prime reasons
for this.
Deregulation of EHC was not new to the agenda — the Royal Pharmaceutical
Society had been approached by the Royal College of Obstetricians and Gynaecologists
and patient groups as far back as 1985. The Society had considered a POM to
P switch to be the preferred option and protocols had been drawn up accordingly.
These had never been published because the debate had not progressed, largely
because of product licence holders’ concerns over litigation.
So what were some of the issues that surrounded EHC and its supply?
Quick and easy access was vital if the desired effect was to be achieved. Pharmacy
had always championed its superiority over general medical services in this
regard, so to turn its back on supply of EHC would seem perverse.
Currently, there was no age restriction on use, but there was limited data on
use in females aged 14 years and under. It was believed that Schering’s
application for Levonelle-2 reclassification was for 16 years and over. The
question arose as to whether EHC should be governed by the same criteria as
other non-prescription medicines, rather than subject to judgments in line with
the legal age of consent.
If the reclassification went ahead as proposed, pharmacists who supplied under-16-year-olds
would commit a criminal offence. A due diligence defence arising from care based
on the provision of misleading information by the client would be needed to
avoid liability.
Finally, a conscience clause in the Society’s Code of Ethics could be used
by pharmacists with religious or moral objections to EHC. With a growing number
of pharmacies being run under locum management, patients could be confused over
whether EHC would be available on any particular day.
Further information was provided by Mr IAN ADAMSON (UK marketing director, SSL
International). He said the Brook Advisory Service had suggested that 50 per
cent of first-time sexual encounters involved no form of contraception at all.
Dr Margaret Jones (chief executive, Brook) had recently said: “We need
to inform young people about safer sex, covering the importance of condoms as
well as a chosen method of contraception, so that they are protected against
infections as well as pregnancy. We are especially concerned about boys’
lack of awareness about their sexual health.”
Mr Adamson said that the latest Durex report on sex and sexual attitudes in
Britain had shown that almost half of adults felt that Britain’s high teenage
pregnancy rate was due to a lack of information on contraception. Teenagers
themselves said that inadequate information, particularly in schools, coupled
with increasing sexual activity contributed towards the high pregnancy rate
among their peers.
Recently figures from the public health laboratory service had revealed the
highest rise for a decade in cases of HIV, Mr Adamson went on. There had been
a 25 per cent rise in cases of gonorrhoea and a 16 per cent increase in new
cases of chlamydia. These were worrying statistics, particularly given that
the biggest increase was in teenagers aged between 16 and 19 years. Although
most adults were aware of the protective benefits of condoms against HIV and
AIDS, fewer knew that they offered protection from other sexually transmitted
infections.
Pharmacists were in an ideal position to help by offering confidential advice
because young people viewed ease of purchase and availability as important factors
in choosing where to buy condoms. (Top)
Smoking kills 320 people daily (Top)
Two speakers at the convention addressed smoking and smoking cessation. Both
agreed that smoking and smoking related diseases were the cause of, on average,
320 deaths daily in Britain.
Mr HOWARD HOPKINS (sector manager, Glaxo Wellcome UK Ltd) said that 13m British
adults smoked and that the annual cost to the National Health Service of smoking
related ill-health was estimated to be £1.7bn. At one in five of all deaths,
Britain had a worse mortality rate from smoking-related disease than other European
Union countries.
Smoking-related illnesses accounted for 8m general medical practitioner consultations
each year. Over 7m smoking-related prescriptions were written annually and there
were 1,000 smoking-related hospital admissions every day. Smoking-related sick
leave and cigarette breaks accounted for at least 34m lost working days each
year. This made the total annual cost of smoking to the UK greater that the
£10.5bn annual revenue collected from tobacco taxation. It was no surprise
that smoking cessation was a health care priority at both national and local
level.
So why did smokers continue to smoke, Mr Hopkins asked.
A report of the Royal College of Physicians’ tobacco advisory group had
stated that nicotine was as addictive, or possibly more addictive, than heroin
or cocaine.
Mr PETER HINCKLEY (sales director, Smithkline Beecham Consumer Healthcare) said
that around 10.5m of the 14m smokers in Britain wanted to give up and about
half of these people were trying to do so at any one time.
There were a number of factors of which many smokers were unaware that triggered
the need for a cigarette. It could be drinking a cup of coffee, answering the
telephone, drinking in a pub, stress or anger. Aside from this, smokers found
that smoking made them more alert, reduced aggression, enhanced memory and improved
mood. (Top)