• MPs call for incentives for pharmacists
• Brighton staff to help train doctors
• Society wins £1.3m for concordance
• EC help for pharmaceutical industry
• Napp fined £3.21m for competition abuse
• New NHS funded courses for pharmacists in Yorkshire
• Nurses want legible prescriptions
• Reservations expressed over Society's proposals for discipline and competence
• Downturn in pharmacy numbers
• Parliamentary pharmacy group calls for joint work towards prescribing
• Nucare to build chain

News in brief

MPs call for incentives for pharmacists

Community pharmacists should be given an incentive to play a more active role in public health, a report by the House of Commons Health Select Committee says.

The report on public health, published on March 28, says that pharmacies can act as general health resource centres and that this would better use the considerable expertise that pharmacists have.

The committee notes that community pharmacists come into contact with a large proportion of the population, both well and ill, on a regular basis, can be spoken to without an appointment and represent a non-threatening source of advice for the public. It also records that pharmacists are highly skilled and that their training focuses increasingly on social issues such as communication with customers and interaction with the health care team.

“However,” it says, “they are currently largely restricted to dispensing medicines and giving a small amount of health advice. As such, they represent an under used resource. A small number of pharmacists are already playing a much more active role in community health but they are not incentivised so to do.”

The committee takes the view that to change this requires a strong lead from above and reorganisation of the remuneration system.

It says that community pharmacists currently rely for much of their income on the sale of non-clinical goods to ensure that they remain profitable. To shift their focus to public health issues they would have to be compensated for

• restructuring premises to create more appropriate public and private spaces
• giving advice
• extra training for staff in public health skills
• additional information technology and media facilities
• supplying information
• additional time spent on planning and delivering public health outreach programmes
• any lost earnings from sales which public health interventions might replace

The committee says: “Pharmacists could be used more systematically to deliver public health interventions such as health advice and lifestyle information, a range of health tests, advice on medicine management, and could even engage proactively with the community by offering an outreach advice service to particular interest groups and acting as a referral point through to other appropriate health care services.

“The pharmacy itself could potentially be developed to act as a resource centre or an access point to other services, including non-health services.”

Public health second report session 2000–01. Vol 1: Report and proceedings of the health committee. ISBN 0102210012, price £12.50. Also available on the internet.

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Brighton staff to help train doctors

Staff at Brighton university's School of Pharmacy and Biomolecular Sciences are likely to be involved in training some of the next generation of doctors.

Brighton university, together with the University of Sussex, is to host one of two new medical schools announced by the Secretary of State for Health (Mr Alan Milburn) on March 30. The second new medical school is to be at Hull and York universities.

The Brighton pharmacy school was a participant in the development of the Brighton/Sussex universities bid and is expected to make a significant contribution to science teaching for the medical students.

Professor Stephen Denyer (head, School of Pharmacy and Biomolecular Sciences, Brighton university) said: “The presence of a medical school, due to recruit its first students in October, 2003, will ensure an extended multidisciplinary environment in which pharmacy students are taught. Brighton will now provide training in pharmacy, medicine, nursing, midwifery, physiotherapy, podiatry, occupation therapy and social policy.”

Professor Denyer, along with Professor Adrian Bone (head of research, School of Pharmacy and Biomolecular Sciences), are part of an eight-strong curriculum working group established by the two universities. Previously they were part of the group which developed the bid to the Higher Education Funding Council for England and the Department of Health.

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Society wins £1.3m for concordance

The government is to spend £1.3m over the next two years on a national joint task force to support concordance, which is to be based at the Royal Pharmaceutical Society.

Speaking at the Society's West Midlands regional conference on April 1, Lord Hunt (Parliamentary Under-Secretary of State for Health) said that the task force would bring together representatives of patients, the National Health Service, social care, health professions and the pharmaceutical industry. The money is to be used to support a project team at the Society which will work under the direction of the task force.

Lord Hunt said: “Up to half of all people with chronic disease end up using their medicines incorrectly, with potentially serious consequences. This new initiative will find ways to improve advice and support for patients on understanding their medicines and how to take them.”

He added: “Empowering patients to take an active role in their own care is a key theme in the NHS plan and we know that people are more likely to take their medicines correctly when they understand and agree with their treatment and have been active partners in prescribing decisions.” Nominations to the task force are to be sought shortly.

Forum (80K PDF)

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EC help for pharmaceutical industry

The European Commission has set up a group of experts to help the European pharmaceutical industry sharpen its international competitive edge.

The group is to report to the commission's president (Romano Prodi) in a year's time. Members of the group includes Chris Viehbacher (GlaxoSmithKline's European chairman), Jean-François Dehecq (president, European Federation of Pharmaceutical Industry Associations), Andrew Kay (chairman, European Generic Manufacturers Association), and the EU's enterprise commissioner (Erkki Liikanen) and consumer protection commissioner (David Byrne).

Mr Liikanen said that he hoped the group would agree on policy approaches that did not necessarily require the commission to take legislative action.

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Napp fined £3.21m for competition abuse

Napp Pharmaceuticals has been fined £3.21m for abuse of a dominant market position in its pricing policy for MST Continus. The fine is the first financial penalty to be imposed by the Office of Fair Trading under powers given to it by the Competition Act 1998.

The OFT found that Napp had supplied its sustained release morphine products for use in the community at excessively high prices while supplying hospitals at discount levels that blocked competitors.

The company will also be ordered to bring the infringements to an end, in particular by immediately reducing the basic NHS price paid by community pharmacists and by limiting the the degree to which that price can exceed hospital prices. The company will be required to supply the OFT with information to enable the direction to be monitored. The direction is to be made shortly, once the OFT has considered representations from Napp.

The Director General of Fair Trading, John Vickers, said that Napp's discounting policy to hospitals had impeded competition in the market for sustained release morphine by anticompetitively targeting rivals' products. Napp had offered discounts of well over 90 per cent in tendering for hospital contracts where it faced a rival, and at least one competitor had been forced to withdraw from the market.

“Community prices were excessive, typically more than 10 times higher than Napp's hospital prices and up to six times the MST export price,” Mr Vickers said. In addition to immediate annual savings of the order of £2m, his proposals would lead to competition, producing further savings for the NHS and the taxpayer.

Napp is to appeal against the decision to the Competition Commission Appeals Tribunal. The company said that discounting in hospitals was commonplace and had been actively encouraged by purchasing authorities. Napp's discounts were normal, lawful competitive conduct.

The company said that the OFT's decision could be seen as an across-the-board attack on pharmaceutical companies' prices contrary to the Pharmaceutical Price Regulation Scheme agreed between companies and the Department of Health.

“The OFT accepts that Napp has complied with the PPRS but seems to believe that that the profit controls applied by the Department of Health under the PPRS are too lax,” the company said.

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New NHS funded courses for pharmacists in Yorkshire

Leeds university has won £120,000 from the West Yorkshire NHS Education and Training Consortium to pay for three new training programmes, including one which will prepare pharmacists for a role in medicines management.

Professor Theo Raynor (head of pharmacy practice at the University of Leeds) says that the foundation module in prescribing management in primary care, developed from an existing Master's course, is aimed at pharmacists who want to start working collaboratively with general practitioners and get closer to patients without committing themselves to a full postgraduate programme. The three-month course includes five taught days and work with a GPs. The key aims of the module are to provide updated therapeutic knowledge in priority areas of medicines management and to develop skills in managing change.

The second new course, for preregistration tutors, aims to provide updated underpinning theory and skills. It is jointly delivered by the university's division of academic pharmacy practice and school of continuing education.

The money is also to be spent on an introductory course in hospital pharmacy practice. This course, a joint initiative between the division of academic pharmacy practice and Leeds Teaching Hospitals Trust, combines study days with work placements and is designed for pharmacists wishing to return to hospital pharmacy practice or move into hospital practice from another area of the profession.

Details, including free places available to pharmacists in the Northern and Yorkshire NHS region, are available from Jacky Nunney at the Division of Academic Pharmacy Practice, Baines Wing, University of Leeds LS2 9UT (tel 0113 233 1251, e-mail J.M.Nunney@leeds.ac.uk).

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Nurses want legible prescriptions

Doctors are to be urged by the United Kingdom Central Council for Nursing, Midwifery and Health Visiting to include a specific reference to the legibility of prescriptions in new practice guidance.

To support its action, the UKCC wishes to hear from health professionals who have had difficulties with hard-to-read prescriptions. Submissions can be e-mailed to communications@ukcc.org.uk.

The issue of illegible prescriptions was raised at a recent UKCC meeting, when it was noted that the General Medical Council was consulting on a revised version of its “Good medical practice” document. Council members expressed concerns that unreadable prescriptions placed nurses who administered medicines in a difficult position. Doctors who did not provide clearly written prescriptions were not respecting the needs of other care professionals. They should be told to print prescriptions clearly and not write them in illegible cursive script.

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Reservations expressed over Society's proposals for discipline and competence

Reservations over the proposed power of a new Royal Pharmaceutical Society disciplinary committee to award costs and impose fines have been expressed by the National Pharmaceutical Association's management board. Members are also concerned about aspects of the proposed competence-based right to continue in practise. The proposals are contained in a Royal Pharmaceutical Society consultation paper circulated to pharmacists in February (PJ, February 17, p220).

At their March meeting, members of the NPA board welcomed the proposed introduction of a range of disciplinary measures short of striking-off. But they were concerned that costs should only be awarded where a case had been obstructed or made unduly complicated and that fines were not an appropriate sanction for a professional disciplinary committee.

Members were also concerned that the proposed 28-day restriction on appeals, down from three months, was too short.

Although they supported the proposal to introduce a competence requirement for practising pharmacists, board members felt that there was confusion at the Society over the difference between continuing education and continuing professional development. The NPA board believes that the amount of time spent on continuing education is not an appropriate assessment of CPD. Further, it says that the appropriate measure is one of reasonable competence, rather than a gold standard.

Other matters considered at the NPA board's March meeting are reported below.

Code of ethics The Society's draft Code of Ethics and Standards was considered to be problematic, particularly the requirement that pharmacy owners, superintendents and managers be responsible for the skills and knowledge of their staff (PJ, March 10, p325). Other concerns arose from the requirement for CPD to be measured in terms of time spent, specifications for repeat dispensing and a presumption against extemporaneous dispensing.

Supervision All prescriptions should be examined at least once by a pharmacist, but they do not need a final check, board members decided. Indeed, pharmacists should be encouraged to stay out of the dispensary and spend their time with patients. Although there was total opposition to pharmacies being allowed to operate in the absence of a pharmacist, it was agreed that occasional short absences were necessary from time to time. It should be permissible to hand out previously dispensed prescriptions during such absences, board members decided.

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Downturn in pharmacy numbers

Pharmacy numbers have shown the greatest change in England and Wales for five years with a reduction of 18 in the number of National Health Service dispensing contracts over 12 months.

The Department of Health's latest statistical bulletin says that there were 10,474 pharmacy contracts in England and Wales on March 31, 2000, compared to 10,492 a year earlier. The percentage of pharmacies belonging to chains of more than five rose from 43 per cent to 46 per cent.

As in previous years, pharmacies closing tended to be nearer to another pharmacy than those opening. In 1999–2000, 68 per cent of pharmacies closing were within 500 metres of another pharmacy, while 73 per cent of new pharmacies were more than 1km from the nearest pharmacy.

Pharmacy numbers

Although the annual change in the number of pharmacy contracts is small, pressure on pharmacy remuneration intended to halt increasing numbers may now be reflected in a real downturn.

1996

1997

1998

1999

2000

Number of pharmacies

10,490

10,489

10,493

10,492

10,474

Change

—

+9

+4

-1

-18

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Parliamentary pharmacy group calls for joint work towards prescribing

The All-Party Pharmacy Group has called on the government and the pharmaceutical and medical professions to work together to overcome obstacles to pharmacist prescribing as soon as possible.

The call is made in the group's report on pharmacist prescribing, which arises from its recent meeting on the same topic (PJ, March 10, p304).

Sent to Lord Hunt (Parliamentary Under-Secretary of State for Health) on March 29, the report says that the success and extent of pharmacist prescribing will depend on the ability of pharmacists and general practitioners to work together as a team with a strong degree of trust. Trust would be based on: a clear understanding that pharmacists possess the necessary skills and training; agreement as to how pharmacists can make best use of patient records; achieving clarity as to whether pharmacists are part of a GP-led primary care team or have a more informal role; and ensuring confidentiality between pharmacist, patient and GP.

The group agrees with the government that only pharmacists with the right skills and training should prescribe, but says that the nature of the training needs to be clarified. It also sees as necessary the provision of quiet areas in pharmacies where patient and pharmacist can speak privately and raises the question of whether and how the government might underwrite the costs involved.

The full text of the APPG's report can be be downloaded from PJ Online.

It is a 64K PDF file that requires Acrobat Reader 4 or later. Click below for the latest version.

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Nucare to build chain

Nucare Plc is to build a chain of pharmacies by offering cash and shares to purchase pharmacies anywhere in the United Kingdom. Mr Veni Harania (chairman, Nucare) said that a retail division would allow the company's branding and marketing programmes to be accelerated, strengthening its profile within pharmacy.

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News in brief

Medicines coding

First DataBank, which produces the Multilex drug data file, has launched a coding method for recording medicines information in electronic patient records. The eDrugID codes are 16-digit numbers intended to provide for better communication between health care systems.

IDIS educational website

IDIS World Medicines wants pharmacists to rank nine topics for inclusion in a new pharmacist education programme to be established on the company's website (www.idis.co.uk). Authors will then be commissioned to write modules on the most popular topics, which will be accredited by the College of Pharmacy Practice.

Solutions website

University College London Hospitals NHS Trust has put its Solutions newsletter dealing with pharmaceutical supply problems on the internet at www.uclhsolutions.com. The website will carry updated information on current supply problems, together with lists of recent product withdrawals and discontinuations. The newsletter will continue to be distributed by e-mail and as a printed version on request. Access to the website is free for hospital, community and primary care pharmacists. Pharmaceutical suppliers will be able to gain access for a small fee. Pharmacists can register through the website.

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