News summary

NPA calls for ban on promotions and a review of the GSL classification criteria The National Pharmaceutical Association has called for a legal ban on three-for-two promotions for medicines and for a review of the law and guidelines that govern the reclassification of pharmacy medicines as safe for general sale...[more]

NPA plans post-RPM campaign to support pharmacy The National Pharmaceutical Association is to launch a three-stranded campaign to try to bolster the position of community pharmacy after the abolition of resale price maintenance...[more]

PAGB invites bids for research funding The Proprietary Association of Great Britain is inviting bids for up to £25,000 from a fund that supports research into what community-based health professionals are doing to encourage self-care...[more]

Numark to test self-selection of P medicines Numark Ltd is to undertake a trial to allow customers to self-select both pharmacy and general sale list medicines at a concept store in Buckinghamshire...[more]

Dual pricing by Glaxo banned The European Commission has banned GlaxoSmithKline’s dual pricing system in Spain, where the company requires Spanish wholesalers to pay a higher price for pharmaceuticals which they export to other member states than when reselling the same products locally...[more]

Needle-free injectors get a boost Two companies producing needle-free injection systems have signed agreements to allow commercial manufacturing of their products to begin...[more]

Pharmacy Assistant 2001 competition Community pharmacy assistants in Great Britain can enter the 2001 Pharmacy Assistant assistant of the year competition by completing questionnaires distributed with the June, September and November issues of the National Pharmaceutical Association’s Supplement...[more]

Patient-centred flexible care by fewer pharmacies is vision of the future As a profession, we have not shaped care around patients. So said Professor Steve Chapman, professor of prescribing sciences at Keele University, who gave the keynote address at the first Primary Care Pharmacy conference held at the Royal Pharmaceutical Society on May 24...[more]

Weekend school planned to give Lessons on pricing services A weekend school is being planned to teach community pharmacists how to write and price bids for the provision of new services. Pharmacists desperately need to learn how to price the services they offer, according to Hemant Patel, secretary of the north east London local pharmaceutical committees...[more]

NICE to look at cancer, diabetes and epilepsy Drugs and treatments for cancer, diabetes, epilepsy and depression form part of the planned sixth programme of work for the National Institute for Clinical Excellence...[more]

NPA calls for ban on promotions and a review of the GSL classification criteria

The National Pharmaceutical Association has called for a legal ban on three-for-two promotions for medicines and for a review of the law and guidelines that govern the reclassification of pharmacy medicines as safe for general sale.

The call is made in a paper on public health policy and safe, effective self-medication, which has been produced as part of the NPA’s strategy to try to mitigate the effects on community pharmacy of the abolition of resale price maintenance.

The association believes that the ban and review are needed because current practice is not in line with government statements on promoting safe, effective and responsible self-care. It says that P-to-GSL reclassifications give people less incentive to visit pharmacies and encourage a perception that medicines are “ordinary articles of commerce”, contrary to principles which underlie the Medicines Act 1968.

In particular, the NPA is concerned that Medicines Control Agency guidelines on P-to-GSL reclassification place undue emphasis on the public convenience of wider sales. When this guideline was formulated, pharmacies tended to be open for only five-and-a-half days a week and closed at 5.30pm. Now, many pharmacies offer seven-day opening for extended hours and are more conveniently located. So the NPA is arguing that wider sale should no longer be a criterion for GSL classification.

Further, the NPA says that the restrictions often placed on pack sizes for new GSL medicines mean that there is official awareness of concerns over the safety of the product. It points out that there are no restrictions on multiple sales of GSL medicines from outlets that are not governed by a professional code of ethics, saying that reclassification should not take place if there is any question of restricting pack sizes.

“For public health reasons, the basic policy should be to classify relatively few products as GSL medicines,” the NPA says. “And if circumstances require GSL classification, the general principle should be that the medicinal substance which is considered to have the best safety profile in the relevant therapeutic group should be so classified. Any other policy is bound eventually to undermine the Government’s stated intention of promoting responsible self-care, including self-medication when that is appropriate, not only by encouraging people to purchase and treat medicines like ordinary items of commerce but also by threatening the viability of the existing community pharmacy network, which the Government recognises as important in the implementation of its overall health policy, as demonstrated in the pharmacy plan for the NHS.”

Copies of the report have been sent to the government, the MCA and the World Health Organization. A briefing note has also been sent to all candidates in the general election.

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NPA plans post-RPM campaign to support pharmacy

The National Pharmaceutical Association is to launch a three-stranded campaign to try to bolster the position of community pharmacy after the abolition of resale price maintenance.

At its May meeting, the NPA management board approved a policy paper which argues for legal and policy changes in relation to medicines on public health grounds (see above). Board members also decided to adjust the key messages of the “Ask your pharmacist” advertising campaign to emphasise the added value of obtaining medicines from the pharmacist compared to selecting from supermarket shelves.

Thirdly, NPA members are to be given advice about how to respond to the hard price cutting tactics of supermarkets and will be reminded of the range of resources available from the NPA to help them maximise their business and compete on value rather than price.

NPA Chairman, Gerald Alexander, said: “We know that our members will be under tremendous pressure as large retailers begin to slash prices on a narrow range of medicines in order to lead customers to believe that all medicines will be cheaper at their stores. We must learn to adapt to this new environment and put the emphasis on providing a high quality professional service so that people will choose value over price.”

He added that the government had a responsibility to support the network of community pharmacies.

“In all the arguments against RPM, it was never suggested that community pharmacies were not necessary. Without RPM many pharmacies will become unviable and the pharmacy network will be put at risk. We need an alternative mechanism to RPM to ensure pharmacies remain viable in communities where they are most needed. Now is the time for discussions with the government to find that mechanism.”

Some other matters considered at the NPA board’s May meeting are reported below.

Standard operating procedures The Royal Pharmaceutical Society’s proposed document on developing and implementing standard operating procedures for dispensing will be supported by the NPA if the section on checking procedures is changed. Board members want pharmacists to be allowed to decide for themselves whether staff are competent to check the assembly process of dispensing. They say that because pharmacists are accountable for dispensing it is inconceivable that checking will be delegated to anyone in whom they do not have sufficient confidence. Board members do not support the view of some Society Council members that self-checking by trained technicians is acceptable.

Medical information guidelines Changes have been recommended to guidelines for medical information departments being drawn up by the Association of Information Officers in the Pharmaceutical Industry. The NPA believes that pharmacists need

• easier access to medical information officers
• information on nutrients which can be lost as a result of treatment with medicines
• ways of contacting representatives after they have visited pharmacies
• visits from representatives before new products are launched

In addition, the NPA’s information department wants details of new products before they are launched.

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PAGB invites bids for research funding

The Proprietary Association of Great Britain is inviting bids for up to £25,000 from a fund that supports research into what community-based health professionals are doing to encourage self-care.

Eligible research projects are likely to be based in community and primary care settings and address such questions as

• What is the role of patient group directions in pharmacies in providing fast and convenient access to medicines?
• How could the extension of nurse prescribing for minor ailments and over-the-counter medicines improve access to fast and convenient care?
• What mechanisms might be necessary in primary care to encourage, inform and educate patients in using medical practices more wisely for common ailments?
• What will be the effect on self-medication patterns of extending prescribing rights to other health care professionals?

Projects will be expected to produce results of sufficient quality to be published in peer-reviewed literature. Short-listed applicants will be asked to submit detailed proposals in advance of an interview with a research board on December 6.

Application forms can be obtained from Libby Whittaker, PAGB, Vernon House, Sicilian Avenue, London WC1A 2QS (tel: 020 7421 9318, e-mail: libby.whittaker@pagb.co.uk).

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Numark to test self-selection of P medicines

Numark Ltd is to undertake a trial to allow customers to self-select both pharmacy and general sale list medicines at a concept store in Buckinghamshire.

Speaking at the company’s conference in Boston, United States, on May 29, David Wood, deputy managing director, said that research had shown that customers preferred to buy medicines by self-selection. Numark believed that this was possible for P medicines so long as professional control over the sales was retained.

At a concept store, Lansdales Pharmacy, High Wycombe, P medicines are displayed alongside relevant GSL products. All P medicines have red price labels applied. Under Numark’s protocol, which has been approved by the Royal Pharmaceutical Society, all sales of P medicines must be carried out by the pharmacist or trained medicine counter assistants. Signs warn customers that they will be asked about the medicines they are buying and that sales may be refused. Electronic point of sale equipment prompts staff to counsel customers. The concept pharmacy has only one till and the medicines are displayed adjacent to this. Certain newly reclassified medicines or those open to abuse are not on open display.

A full report of the conference will be included in next week’s issue of The Journal.

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Dual pricing by Glaxo banned

The European Commission has banned GlaxoSmithKline’s dual pricing system in Spain, where the company requires Spanish wholesalers to pay a higher price for pharmaceuticals which they export to other member states than when reselling the same products locally.

GlaxoSmithKline had hoped to reduce parallel trading of its products within the European Union, but its move sparked the commission into action. The commission has consistently defended the right of distributors in a variety of sectors to partake in such grey market activities, limiting the right of manufacturers to prevent the re-export of their products. The company claimed that the dual pricing system did not restrict competition because the price differences between member states resulted from differences in regulation regarding the setting of sales prices and reimbursement.

But this was rejected on legal and factual grounds, by Brussels, which said: “[GSK’s] system interferes with the EU’s objective of integrating national markets and restricts price competition for GW products.”

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Needle-free injectors get a boost

Two companies producing needle-free injection systems have signed agreements to allow commercial manufacturing of their products to begin.

Weston Medical Group Plc will see a filling and assembly line for its Intraject product installed at Patheon UK Ltd at Swindon, Wiltshire. Commercial amounts of the liquid-filled devices will be available by the end of 2002. Weston Medical has signed licensing agreements with Roche and GlaxoSmithKline for the technology.

PowderJect Pharmaceuticals Plc has signed a deal with BOC Gases Ltd to build a full-scale production facility for the 75mm-long helium microcylinders which power its PowderJect dry-powder injector. The facility will be at BOC’s plant at Leatherhead, Surrey. It will have four production lines each capable of welding, filling and sealing 100 microcylinders per minute. Installation will start in November. Last year, PowderJect Pharmaceuticals acquired the Evans Vaccines business from Medeva Plc.

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Pharmacy Assistant 2001 competition

Community pharmacy assistants in Great Britain can enter the 2001 Pharmacy Assistant assistant of the year competition by completing questionnaires distributed with the June, September and November issues of the National Pharmaceutical Association’s Supplement.

This year, the competition is a tripartite arrangement between The Pharmaceutical Journal, Reckitt Benckiser and the NPA and aims to help pharmacy assistants expand their knowledge and understanding of the pharmacy profession. The questionnaires will be part of four-page Pharmacy Assistant inserts in the Supplement.

Assistants will receive a certificate for each questionnaire they complete plus feedback on their answers. Those with the highest scores will be entered into the competition at the end of the year.

Assistants who work for non-NPA members can obtain copies of the Pharmacy Assistant inserts by sending a SAE to Harriet Adcock, The Pharmaceutical Journal, 1 Lambeth High Street, London SE1 7JN.

All community pharmacies should already have received the first issue of this year’s Pharmacy Assistant which included the first entry form for the 2001 award.

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Patient-centred flexible care by fewer pharmacies is vision of the future

As a profession, we have not shaped care around patients. So said Professor Steve Chapman, professor of prescribing sciences at Keele University, who gave the keynote address at the first Primary Care Pharmacy conference held at the Royal Pharmaceutical Society on May 24.

“The NHS Plan makes it clear that we have to do this. All the rest is just window dressing,” Professor Chapman said. He went on to point out that the plan was about pharmacists not pharmacies and that there may not be as many pharmacies in the future. “This is no bad thing,” he said.

The plan “Pharmacy in the future” laid down three challenges, Professor Chapman explained. The first was to meet the changing needs of patients, which included having access to medicines and pharmaceutical advice when and where they wanted it, and more support when using medicines. Much good work had already begun in medicines management, but it needed to be spread more widely. The National Prescribing Centre and Pharmaceutical Services Negotiating Committee initiatives were catalysts.

The second challenge for pharmacists was to respond to the changing commercial and technological environment; the third was to ensure that patients were confident that they were getting good advice.

Professor Chapman emphasised deadlines set in the plan. By 2002, there should be a greater range of over-the-counter medicines in pharmacies, better access to medicines out of hours — which meant more than re-organising rotas — and NHS Direct would be sending patients to pharmacies. In other words, there would be more deregulation and improved access.

Repeat dispensing schemes, the cornerstone of medicines management, which could be used to sort out issues such as concordance, had to be in place by 2004 and would enhance the role of pharmacists, provided they had the time to do it properly. By 2008, electronic prescribing would be the norm, and as part of this continuum, e-pharmacy would grow swiftly. Channelling energy into resistance was foolish.

Pharmacist prescribing was important, but was not the be all and end all of the profession. It needed to be put into perspective alongside other initiatives because pharmacists had vital skills in medicines management and in helping patients and other health care professionals.

Pharmacists would have to work more flexibly as part of a team, and having a good relationship with local practices would have to be the norm, not the exception. Undoubtedly, the national contract would change to allow the development of one-stop centres with pharmacists in them. Pharmacists needed to divest themselves of responsibilities like dispensing, delegate it to others, and spend more time on individual patients’ clinical needs.

See also Forum

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Weekend school planned to give Lessons on pricing services

A weekend school is being planned to teach community pharmacists how to write and price bids for the provision of new services. Pharmacists desperately need to learn how to price the services they offer, according to Hemant Patel, secretary of the north east London local pharmaceutical committees.

Mr Patel said: “It is clear that there is a fundamental weakness in pricing. While pharmacists have been happy to live off cost-plus, resale price maintenance and Pharmaceutical Services Negotiating Committee negotiations, they have no idea how to price a service. With local pharmaceutical services (LPSs) on the horizon, the pricing of cognitive services cannot be left to chance or guess. The future profitability of the pharmacy network depends on proper and timely analysis.”

Mr Patel indicated that although pharmacists generally did not believe that LPSs would be introduced quickly or in great numbers, health authorities were taking them seriously.

“If we look at the medical model for personal medical services contracts, 20 per cent of pharmacy contracts could be LPS contracts by the end of the year,” he said.

The school that Mr Patel is planning for the first weekend in July is intended to teach people how to write compelling bids for service developments and to price cognitive services.

National Health Service Executive and health authority speakers are being sought to explain national policy and what health authorities look for in bid submissions.

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NICE to look at cancer, diabetes and epilepsy

Drugs and treatments for cancer, diabetes, epilepsy and depression form part of the planned sixth programme of work for the National Institute for Clinical Excellence. There is to be a re-examination of the use of antiviral drugs, including zanamivir (Relenza) in influenza.

Fourteen topics are included in the work programme. They are: capecitabine (Xeloda) and tegafur uracil (Uftoral) for advanced breast and colorectal cancer; new drugs for bipolar disorder (manic depression); electroconvulsive therapy for depression; patient education models for diabetes; insulin glargine and other long-acting insulins; insulin pump therapy; immunosuppressive regimens for renal transplantation; home versus hospital dialysis; raloxifene (Evista) and other selective oestrogen receptor modulators for the treatment of osteoporosis’; tension-free vaginal tape for stress incontinence; thermal endometrial ablation for heavy menstrual bleeding; new drugs for epilepsy in adults and children (in preparation for the national service framework on neurological conditions); recombinant interleukin-1 receptor antagonist (Anakinra) for rheumatoid arthritis; and antiviral drugs to prevent and treat influenza.

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