NHS staff and representatives from the pharmaceutical industry debated the topic "You are the problem because. . .”
The first to speak was Mr STEPHEN POTTER (University hospital, Birmingham), who argued that many problems existed but the biggest one was that the pharmaceutical industry "do not see my problem, "he said.
His problem was wholesaler performance. Picking error rates had increased from all three of the wholesalers that supplied his pharmacy department and his staff were spending a great deal of time sorting out problems created by the wholesaler. Staff costs incurred as a result included double-checking goods received, invoices, reordering, re-sourcing supplies, transport costs and clinical risk.
The industry did not seem to monitor the performance of wholesalers and Mr Potter wanted to know what was going to be done about this.
Mr NEILL MORGAN (Aventis Pharma) replied that the problem was that the NHS did not see the industry's problems.
Companies spent a great deal of time planning and forecasting what would be sold, to whom and how much. This allowed them to organise their manufacturing plants to produce the required quantities of products to maintain a consistent supply.
Sudden changes of supplier meant that all of this forecasting became irrelevant, which caused two problems. First, an inability to supply stock because production had been scaled down in response to decreased demand. Secondly, manufacturers were left with excess stock that was no longer required.
"Your planning affects our planning and, if you do not see that, then you are the problem, "he said.
Seconding Mr Potter, Mr DAVID SAMWAYS (pharmacy services director, East Gloucestershire NHS trust) retorted that good communication was vital to good supply chain management.
The industry was the problem because different companies had different cultures, mergers prevented decisions being made and people with the same job title in different companies did different things. Job titles given to representatives usually meant nothing to the NHS customer, making it difficult to know whether the right person was being dealt with. It was much easier when only one representative per company visited, as rapport could be established. In addition, once a representative became any good, they were either promoted or moved.
"The industry is the problem because you constantly change and we do not understand your organisational structures, "he said.
Mr KEITH DAVIES (Pfizer) seconded Mr Morgan, saying that in the 1970s, the NHS had complained that doxorubicin was too expensive, in the '80s, it had been etoposide and in the '90s, it had been taxanes.
Drug and therapeutics committees constantly demanded value for money from the industry but rarely measured outcomes for any interventions carried out by the NHS. These were the committees which spent hours debating which drug should be used, only for the patient to be forgotten as soon as they were discharged from hospital. The NHS was happy to spend a fortune giving treatment to a pair of foreign conjoined twins but could not ensure that patients who had suffered an acute myocardial infarction were given something as simple as an aspirin both during and after the event.
The NHS was the problem because it was inconsistent in its decisions, he concluded.
The audience agreed that the NHS needed to monitor its own performance more systematically. Companies were asked to provide earlier and better information when they discontinued products and to consider what patients with a genuine need for these products should do.
It was suggested that using e-mail might be a better way for companies to circulate information but that it would need to be targeted to the right person. Both the NHS and companies had problems understanding each other's structure and this was an area that both sides could work on to overcome.
The debate was a draw.