The Government’s recently announced independent review of the current arrangements for dispensing prescription-only veterinary medicines was the subject of a one-day seminar on September 28 during the annual congress in Chester of the British Veterinary Association. Steven Kayne reports
The review is primarily aimed at commercial animal practices, but it has implications
for small animal veterinary practices, too. Allowing veterinary surgeons to
prescribe and dispense prescription-only medicines may represent a conflict
of interests, resulting in overprescribing and high prices which in turn could
encourage illegal imports.
The review group, chaired by Sir John Marsh, intends to consider the reclassification
of POMs to determine whether certain products should be more widely available
and review dispensing procedures and the perceived monopoly held by veterinary
surgeons, with the possibility of requiring veterinary surgeons to issue prescriptions
to be dispensed by pharmacists rather than selling medicines direct to their
clients as at present. The review group was initially seeking responses by October
6, although some leeway was likely to be given if the timetable proved too tight.
“The review of dispensing by veterinary surgeons will give an opportunity
to consider what might be in the future best interests of the animal, the owner
and the health of the general public,” Mr
ANDREW CAIRNS (chairman of the Royal Pharmaceutical Society’s Veterinary
Pharmacists Group) told the meeting. Mr Cairns was one of 14 speakers who presented
their views on the costs and benefits of the present system of distributing
veterinary POMs and the advisability of involving pharmacists in the future.
The speakers included representatives from manufacturers, veterinary wholesalers,
veterinarians and animal owners as well as regulators.
Mr Cairns outlined the advantages of having pharmacists more involved in the
supply chain, emphasising the opportunities pharmacists had to add value to
the transaction. They would check the prescription carefully, label the container
with full instructions and counsel the owner as appropriate.
“With 12,000 pharmacies on the streets of Britain, compared with only 3,000
veterinary practices, there would be a substantial increase in availability,”
Mr Cairns said.
Under present regulations, animal owners could ask for a prescription from their
vet if they wished and take it to the pharmacy of their choice, but few of them
were aware of this option. Mr Cairns assured his veterinary colleagues that
it was not the intention of pharmacists to usurp the expert role played by veterinarians
in the promotion of animal health. Instead, they wanted to realise their own
professional potential as medicines experts. The Veterinary Pharmacists Group
was of the opinion that a number of POMs should be reclassified.
Mr Cairns was supported in this view by Dr ROGER DAWSON (secretary general,
Animal Health Distributors Association) who agreed that the arrangements for
initiating reclassification also needed to be overhauled.
Practical problems
Most of the speakers, including many who spoke from the floor, identified practical
difficulties that would be involved in any change from the current situation.
It was generally felt that, given the small proportion of total pharmaceutical
sales that veterinary medicines would represent, community pharmacies were unlikely
to stock the full range of products required for animal treatment. For example,
the market value of Losec (omeprazole) alone was equal to the veterinary market
in total.
It was also argued that a change would not necessarily lessen the cost of the
medicines or the overall cost of treatment to the animal owner. At present veterinarians
derived about 42 per cent of their income from selling POMs and used the profits
to subsidise their consultation fees. A recent survey in London had revealed
the average mark-up to be 33 per cent. If this income was lost, veterinary surgeons
would be obliged to raise their fees. A fee to issue a prescription might also
be levied and then the pharmacist could also add a mark-up.
It was pointed out that the potential savings which could be made from a change
in the system were small. The total sales of POMs, at £244m per year,
represented only 2 per cent of the farming industry’s production costs.
Speakers were also concerned about possible adverse effects on animal welfare.
Out-of-hours supply might be a problem; in many cases it was vital that medicines
were administered quickly and it was likely that substantial delays might result,
particularly at weekends, if farmers had to find a pharmacy in order have prescriptions
dispensed.
The wider European and global framework was mentioned during the session as
being worthy of consideration. The European Commission’s current review
of the licensing of prescription medicines would include the regulation of veterinary
medicines and it was suggested that it might be prudent to await its outcome
before altering the arrangements in the United Kingdom.
During the summing up, Dr STEVEN KAYNE (committee member, Veterinary Pharmacists
Group) conceded that changes in practice could not be initiated overnight. Pharmacy
did not have the necessary infrastructure in place at present to deal with many
of the concerns expressed. He told the meeting that pharmacy was a highly flexible
profession used to co-operating in primary and secondary care environments and,
if required to do so, it would discuss with its veterinary colleagues how best
to make the new arrangements work. He said that the addition of veterinary dispensing
in rural areas could lead to pharmacies reopening with wider benefits to the
local community.
Dr Kayne encouraged his veterinary colleagues to consider the review as an opportunity
rather than a threat. He suggested that the Society and the British Veterinary
Association should discuss the review and see what could be realistically achieved.