The autumn weekend conference of the Institute of Pharmacy Management International (IPMI) took place in Lincoln on October 21 and 22, and had the theme of "Turning opportunity into practice"
Getting the most out of the Government’s plans for the future of pharmacy
required partnerships of various types, according to speakers at the IPMI conference.
The profession needed to work in partnership with the Department of Health to
ensure that new services did not adversely affect existing services. Pharmacy
organisations had to work together rather than rigidly sticking to their own
agendas. And pharmacy needed to work with other health care professions and
with patients if the Government’s plans for the National Health Service
were to be implemented effectively.
Opening the conference, the institute’s chairman, Mr MIKE RUDIN reminded
participants that the Government wanted fast and convenient access to NHS services
for patients. This offered a host of opportunities to be grasped by the profession.
Facing the threats
While the Government had delivered the goods in its pharmacy plan, competitive
forces would affect independent contractors, said Mr ALAN TWEEDIE (Pharmaceutical
Services Negotiating Committee member responsible for the project on medicines
management in community pharmacy). Threats included the entry of new service
providers. Internally, in pharmacy, multiples were increasing. As for potential
buyers, the Department of Health had monopolistic power and a possibility was
that health authorities and/or primary care trusts would open their own pharmacies,
while on the supply front distributors and manufacturers had near monopolistic
pricing power.
Other, internal, critical success factors were the need to construct a new service
contract and to match pharmacist capability to requirements. A review of the
traditional view of supervision would be needed. The pharmacist would continue
to be involved but not necessarily in the same fashion as now. However, community
pharmacies had the ultimate professional advantage that they could integrate
information on the use of over-the-counter and NHS medicines. And some things
that pharmacists perceived as threats were not really threats at all.
Concluding, Mr Tweedie said that a range of partnerships was needed to take
things forward in primary care. The key, though, was the need to engage patients.
A future, but not as we know it
“There is a future for community pharmacy, but not necessarily as we know
it now”, began Mr JOHN D’ARCY (director, National Pharmaceutical Association).
Referring to the specific references to pharmacy in the latest guidelines, Mr
D’Arcy pointed out that there would be challenges, including redefinition
of terms of service. Control of entry, he reminded the audience, would “not
be allowed to get in the way” of pharmacies in primary care centres.
So far as e-pharmacy was concerned, what was the difference between that and
delivery schemes? A significant number of medicines were already not delivered
to the final user. There was too, the new concept, of local pharmaceutical services
and these would mean competition for service payments. However, the plan was
an invitation to treat. Pharmacy had to formulate proposals and counter-proposals,
and strike a balance between its and the Department’s needs.
There was an inherent value in having 12,000 walk-in centres. The Department
could not push so hard that it wrecked the existing service. The two sides had
to work together, flexibly and creatively.
Pharmacy could not argue with the Government’s aims. The Department’s
agenda was clear but a lot of detail was not thought through, and pharmacy had
to make most of the opportunities presented.
Increased competition
Competition among community pharmacists would increase in three areas, said
Mr STEPHEN AXON (general secretary, PSNC). The first was retail parks, where
the freedom to open had everything to with competition but very little to do
with service. He described them as “little islands in a sea of control”,
and asked where the seashore would be. Regulations would need to be carefully
drafted.
The second area was primary care centres. The PSNC had stressed the necessity
of liaison to prevent a vacuum developing around them. What, he asked was the
motive for primary care centres? Was it an effort to get private capital into
NHS primary care?
The third area was competition in out-of-hours services, including dedicated
out-of-hours services. There was a current anomaly whereby to apply for a contract
for such services a contractor needed to open in normal contract hours. There
was already one contract application on the basis of desirability simply because
of extended hours. Health authorities would have to review such services in
partnership with existing contractors, and he agreed with Mr D’Arcy that
the words in the plan had to be read. In his view there was scope for extra
hours within the current regulations.
The danger to pharmacy lay in a lack of unity, since each pharmacy body had
its own agenda. He was concerned that what he described as the “divisive”
approach of the Royal Pharmaceutical Society’s October Council meeting
(PJ, October 14, p547) was playing into hands of the Government. He ended with
the thought that community pharmacists were likely to be most successful in
the competition stakes because they were used to it! — Contributed.
The contractor as prescribing adviser
A role for the pharmacy contractors as prescribing adviser for local medical practice was described to the conference by Mr MIKE WILLIAMS (proprietor pharmacist, Solihull). Giving advice on getting started, he emphasised the need to have clear objectives, to identify all costs and to bear in mind that any proposal should be a two-way exercise. During the process it was vital to audit, to review actions and to provide regular reports and recommendations, including projected savings. It was also necessary to see that agreed recommendations were implemented. Asked about costings, Mr Williams said that he charged £200 a session, or about £50 per hour. It was cost-effective: general medical practitioners were pleased and saw the service as cheap.
Human rights and the patient
Examining the issue of human rights from the point of view of the patient,
Mr CHRIS FRIEND (board member, Genetic Interest Group) said that the Human Rights
Act 1998 was likely to have an impact on pharmacy practice in both general and
specific ways. An important general principle was whether a patient would have
the right to receive what the health authority felt was an “unaffordable”
drug. More specific issues included informed consent and the right to refuse
treatment.
Mr Friend ended by quoting from the Alma-Ata declaration (International Conference
on Primary Health Care, 1978): “The people have the right and duty to participate
individually and collectively in the planning and implementation of their health
care.”