News summary

Research team moves from Nottingham university to the School of Pharmacy Professor David Thurston’s entire cancer research team is to leave Nottingham as a result of the university’s decision to accept money from a tobacco company to pay for business school developments...[more]

New ministerial team at the Department of Health There is a new ministerial team at the Department of Health with the replacement of one minister of state and one parliamentary under-secretary of state...[more]

Pharmacist MP holds seat Sandra Gidley, the only pharmacist member of Parliament, has been returned to Westminster in the June 7 general election...[more]

PATA to be wound up The Proprietary Articles Trade Association is to be formally wound up at its annual general meeting on July 11...[more]

Medical Research Council supports randomised pharmaceutical care trial Nearly £750,000 has been allocated by the Medical Research Council from its primary care research fund to support a randomised clinical trial of pharmaceutical care for older people delivered through community pharmacies in East Yorkshire and Hull...[more]

Risk team to be led by a pharmacist A medicines risk management team is being established at the Barts and The London National Health Service Trust...[more]

Boots to launch non-threatening risk assessment programme for dispensing Boots The Chemists Ltd is to launch a dispensing incident management programme in the next few weeks. The programme will be used by its pharmacists to analyse the causes of dispensing incidents and errors...[more]

Medicine sales rise after price cuts Cuts of up to 40 per cent in the prices charged by supermarkets for 12 tablet packs of Nurofen 200mg have generated increased sales of the product...[more]

PSNC’s nine pilot sites for medicines management There are to be nine pilot sites for the Pharmaceutical Services Negotiating Committee’s cardiac medicines management scheme. The project has been promised at least £1.5m of government funding...[more]

NEWS IN BRIEF

Medicines cost £5.6bn The cost of medicines dispensed in the community in England reached £5.6bn last year. Overall, 552m prescriptions were dispensed in England in 2000, at an average net ingredient cost of £10.12. A detailed cost analysis of prescribing in England at individual product level is available from the Department of Health, PO Box 777, London SE1 6XH (522 pages, price £12) or free on the internet.

Medicines information website A medicines information website has been launched by the Trent and West Midlands National Health Service regions. It offers information intended for both primary and secondary care workers. Most of the information is open access, although some is to be restricted to health professionals or to authorised staff. A national medicines information website is to be launched in the autumn.

Research team moves from Nottingham university to the School of Pharmacy

Professor David Thurston’s entire cancer research team is to leave Nottingham as a result of the university’s decision to accept money from a tobacco company to pay for business school developments.

Professor Thurston, a pharmacist who leads a 15-strong team developing new anti-tumour agents, announced his intention to leave the university some time ago, but the news that his team is leaving with him has been described as humiliating by Professor Malcolm Stevens, Nottingham’s head of cancer research, who is also a pharmacist.

Professor Thurston joined Nottingham university in 1999 and was to have become head of cancer research on Professor Stevens’s retirement in two years time. “I was put in charge of developing a new building for cancer research, with £1.5m of funding from the Cancer Research Campaign,” Professor Thurston told The Journal.

However, the CRC withdrew its funding and said that it would review all its core research funding for Nottingham university after the university announced that it had accepted £3.8m from BAT [British American Tobacco] to fund a new Institute for Corporate and Social Responsibility. Professor Thurston decided at that point that he could not continue to lead cancer research at Nottingham. He said that the BAT money had been accepted without consulting senior staff at the university.

Professor Thurston’s team is to relocate to the University of London School of Pharmacy in September and will work in a newly built laboratory costing the school and the CRC £520,000. The professor joins the school on July 1.

The move has been welcomed by the School of Pharmacy’s head of medicinal chemistry, Professor Laurence Patterson. He says that Professor Thurston’s team will add critical mass to an already vibrant cancer research team, which has a product in phase I clinical trials.

The matter will not end there, so far as Nottingham university is concerned. Another, as yet unnamed principal researcher has already accepted a job at another university as a result of the BAT grant and his team is likely to go too.

The editor of the BMJ, Dr Richard Smith, recently resigned as Nottingham’s visiting professor of medical journalism after a poll of BMJ readers’ views.

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New ministerial team at the Department of Health

There is a new ministerial team at the Department of Health with the replacement of one minister of state and one parliamentary under-secretary of state.

The new minister is Jacqui Smith, who replaces John Denham; the new under-secretary of state is Hazel Blears, replacing Gisela Stuart.

In the previous government, Jacqui Smith, member of parliament for Redditch, was a parliamentary under-secretary at the Department for Education and Employment. She was responsible for school standards. Hazel Blears (Salford) had no role in the previous government.

Alan Milburn continues as Secretary of State for Health, as does John Hutton as a minister of state and Lord Hunt and Yvette Cooper as parliamentary under-secretaries.

No announcement of ministers’ individual responsibilities had been made as The Journal went to press.

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Pharmacist MP holds seat

Sandra Gidley, the only pharmacist member of Parliament, has been returned to Westminster in the June 7 general election. The Conservatives failed to regain the seat they lost to her in last year’s Romsey by-election (PJ, May 13, 2000, p713), when she overturned a Tory majority of 8,585 to win by 3,311 votes for the Liberal Democrats. Mrs Gidley held off the Tory challenge to win by a reduced margin of 2,370 votes. She secured 22,756 votes (47.0 per cent) compared with the Tory candidate’s 20,386 (42.1 per cent).

In Worcestershire West, pharmacist Mike Hadley came second for the Liberal Democrats with 15,223 votes (34.0 per cent). He was 5,374 votes adrift of the Tory winner’s 20,597 (46.0 per cent), but well ahead of Labour’s 6,275 (14.0 per cent). In the 1997 general election, he was 3,846 votes behind the Tory candidate.

In Brent East, Ashwin Tanna failed to repeat his recent success in the Royal Pharmaceutical Society’s Council election. Standing for the UK Independence Party, he received 188 votes (0.6 per cent), coming last of six contenders and losing his deposit.

Pharmacy graduate Archy Kirkwood, who has been LibDem MP for Roxburgh and Berwickshire since 1983, increased his lead over the Conservatives. Mr Kirkwood studied pharmacy at Heriot-Watt university but never undertook his preregistration training.

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PATA to be wound up

The Proprietary Articles Trade Association is to be formally wound up at its annual general meeting on July 11.

The association was founded in 1896 with the aim of promoting, defending and enforcing fixed prices for medicines as a means of maintaining the profitability of independent pharmacies against the rise of price-cutting multiples.

Gerry Harraway, director, PATA, confirmed to The Journal that a motion to wind up the association would be put to its governing council at the meeting in July. If carried the association would be wound up leaving a trust as the controlling body, which would be dissolved in turn once the association’s assets had been disposed of.

Announcement, p836

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Medical Research Council supports randomised pharmaceutical care trial

Nearly £750,000 has been allocated by the Medical Research Council from its primary care research fund to support a randomised clinical trial of pharmaceutical care for older people delivered through community pharmacies in East Yorkshire and Hull. Four primary care trusts in the area will provide a further £150,000 in funding to support the pharmaceutical care and treatment aspects of the trial. The trial will be known as the OSPREY (Offering shared care prescribing: research in East Yorkshire) project.

Dr Ian Wong, senior lecturer in pharmacy practice, University of Bradford, and principal investigator, says that the trial is the only pharmacy project being supported by the MRC. The trial aims to demonstrate the clinical and economic effectiveness of classical pharmaceutical care within the National Health Service.

“Work on the trial started around two-and-a-half years ago with a literature review of work on medicines management and pharmaceutical care. This revealed that few randomised trials had been conducted, either with older people or in community pharmacy,” Dr Wong told The Journal.

“I approached the MRC and was advised to seek assistance to develop what would undoubtedly be a complex clinical trial protocol. I worked with Professor Ian Russell, professor of health service research, and Professor Christine Godfrey, professor of health economics, at the University of York and with Professor Peter Campion, professor of primary care medicine, University of Hull, to develop the randomised multiple interrupted time series design.”

The project was short-listed for funding by the MRC’s primary care fund and following a further literature search, in which Dr Wong was aided by the Royal Pharmaceutical Society’s technical information department, approval was given last month.

The trial will last 21 months and take place in four primary care trusts in East Yorkshire and Hull, Dr Wong explained. “Each trust will be randomised and patients identified by GP practices will receive pharmaceutical care for one year. At other times they will receive a standard pharmaceutical service of dispensing and advice.

“Entry into the pharmaceutical care period will be staggered at three month intervals [see Figure 1 below] and patients will form the control groups at times when they are not receiving pharmaceutical care. There will be a final assessment at the end of the trial to see if patients have benefited from pharmaceutical care even if it has subsequently stopped.”

Dr Wong added that GP practices will be paid £50 for each patient recruited. A total of around 700 patients are to be recruited from 20 practices. Patients will be referred to pharmacists at around 40 pharmacies associated with the practices. All the pharmacists will receive training in pharmaceutical care and drawing up care plans from the Centre for Postgraduate Pharmaceutical Education. Each patient will be seen by a pharmacist, either in a pharmacy or at home. Pharmaceutical care plans will be drawn up and drug related problems identified. The pharmacists will discuss these with the GPs and follow up changes with patients. All interventions and care plans will have to be documented for the trial.

“Pharmacists will receive £60 per patient for completing the documentation in full and a further £220 per patient for undertaking pharmaceutical care. It is expected that pharmacists will spend one hour with patients on the first assessment and half-an-hour per monthly assessment afterwards. If home visits are justified, pharmacists will be paid £50 per visit plus £10 travelling costs, based on a two-hour visit,” Dr Wong said.

Three research staff are to be recruited to run the trial. GP and pharmacist recruitment will start in October with the first patients entered in the new year.

The primary outcome measure for the trial will be a medication appropriateness index developed in the United States. The trial will also look at quality of life, compliance, adverse events and patient knowledge as well as the cost of treatments to the NHS.

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Risk team to be led by a pharmacist

A medicines risk management team is being established at the Barts and The London National Health Service Trust.

It is to be led by a newly recruited principal pharmacist (PJ, June 9, pA17) and will work to reduce medicine related adverse events. Other members of the team will include a nurse and researchers, with part-time support from a doctor. Michael Cross, director of pharmacy at the Royal London Hospital, believes that risk control offers a huge growth area for pharmacy because there is a large, unmet need.

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Boots to launch non-threatening risk assessment programme for dispensing

Boots The Chemists Ltd is to launch a dispensing incident management programme in the next few weeks. The programme will be used by its pharmacists to analyse the causes of dispensing incidents and errors.

Steve Eastham, the new head of clinical governance at Boots says that the programme will encourage pharmacists to look at the whole dispensing process to identify the factors that contribute to dispensing incidents.

The programme, to be sent to all Boots pharmacists, will form the basis of a protocol that pharmacists will have to follow after a dispensing incident or near miss. Mr Eastham says that there will be an emphasis on reporting near misses as the company recognises that employees will be less defensive and that more learning could come from this approach.

As part of the programme, pharmacists will be expected to record details of any dispensing incidents and use the record to identify patterns.

“We want to get discussions going in a non-threatening and supportive way at a local level,” Mr Eastham says. The reports are to be fed up through the management hierarchy so those responsible for clinical governance are aware of the issues at the dispensary level. “If standard operating procedures are found to be risky then they will be challenged and changed.”

As part of its approach to clinical governance, the company is developing a policy aimed at driving improvements in standards. New terms have been introduced within Boots to strengthen pharmacists’ roles, such as “pharmacist in charge” and “area accountable pharmacist”. This is to make clear to patients who is responsible for the delivery of a service throughout the organisation.

The term “primary care pharmacist” has been replaced with “professional development pharmacist” to reflect what is actually involved in the role.

Boots’s regional professional development managers will be involved in auditing and observing pharmacists and, where problems are identified, support programmes will be developed to help individual pharmacists.

A clinical risk manager position has been introduced to examine what happens at the dispensary level, and to evaluate the risks involved with standard operating procedures.

Mr Eastham accepts that pharmacists have been doing clinical governance for many years but says that the use of the term allows pharmacists to focus on improving standards.

“The pharmacy profession is guilty of not demonstrating what a good job it does. Clinical governance allows us to prove that we are doing a first class job and to assess our improvements over time.”

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Medicine sales rise after price cuts

Cuts of up to 40 per cent in the prices charged by supermarkets for 12 tablet packs of Nurofen 200mg have generated increased sales of the product. So great are the additional sales that independent community pharmacists have lost 29 per cent of their market share in the first week after the end of resale price maintenance even though the actual volume of sales in pharmacies has remained virtually unchanged.

Market researcher IMS Health says that independent pharmacies which kept their price unchanged saw their market share fall from 55 per cent to 39 per cent, while national multiple pharmacy companies other than Superdrug and Boots saw their market share fall by only 1 per cent.

The 12 tablet pack of Nurofen was the most heavily discounted medicine in supermarkets, with prices cut by more than 40 per cent in comparison to the previously enforced price. The price of 16 tablet packs was reduced by 26 per cent. Before the lifting of RPM, supermarkets held a 39 per cent share of the market for 12 packs of Nurofen, but held 93 per cent of the market in 16 tablet packs. After the abolition of RPM, their share of the 12 tablet pack market rose from 17 per cent to 56 per cent.

IMS says: “The supermarkets appear to be giving greater reductions in prices for lines for which they have a lower market share where they can potentially attract the most business from pharmacies.”

IMS finds a similar pattern of change for Rennie tablets.

In this case, grocers without pharmacies cut the price by 28 per cent after the lifting of RPM, compared to 26 per cent price cuts in grocers with pharmacies. As with Nurofen, the supermarkets saw their market share rise, this time from 60 per cent to 75 per cent, again through extra sales rather than capturing sales from pharmacies.

IMS says that independent pharmacies have not rushed into lowering the prices of any of the lines it surveyed. Indeed, in some cases the average price in pharmacies has risen, possibly because pharmacists are choosing to put a value on their expertise and advice. It adds that 89 per cent of pharmacists are expecting manufacturers to discount their trade prices so that pharmacies can reduce their selling prices, and 74 per cent are expecting discounts from wholesalers.

The greatest price reductions overall were in grocers that did not have pharmacies, where price cuts of at least 15 per cent were implemented.

Grocers with pharmacies cut prices by at least 10 per cent.

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PSNC’s nine pilot sites for medicines management

There are to be nine pilot sites for the Pharmaceutical Services Negotiating Committee’s cardiac medicines management scheme. The project has been promised at least £1.5m of government funding.

The nine locations chosen are in the North Tyneside, Bradford North, Salford, Crewe and district, Burntwood Lichfield and Tamworth, Portsmouth City, and Poole Central and North primary care trusts, and the Walsall East and North Southwark primary care groups.

The nine successful bids were chosen from 33 submissions, all of which have been described as good.

John Dixon, the PSNC’s project manager said: “Credit is due to all the people who submitted bids, we could have worked with any of them. They were all good.” Mr Dixon said that the researchers had chosen a good set of representative locations from the 33 bids. “They are a good spread of people who are typical of the whole country.”

The nine locations chosen cover almost 50 medical practices with 180 doctors, and 80 community pharmacies.

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