Forum

Nucare

The annual Nucare conference took place at Ferndown, Dorset, on June 16 and 17

Pharmaceutical care in conflict with the demands of public health
Pharmacists must negotiate locally
Independent pharmacy — alive and well in the United States

Pharmaceutical care in conflict with the demands of public health

Pharmaceutical care and public health may be incompatible with each other, according to Professor CLARE MACKIE, professor of pharmacy at Aberdeen’s Robert Gordon University. This is because pharmaceutical care is concerned with what is best for an individual while public health concerns benefit for a population as a whole. An example of where the two come into conflict is the control of cholesterol levels. Pharmaceutical care suggests that a patient with high blood cholesterol should be treated with a statin because of the great personal benefit that can be gained, but the pharmaceutical public health view is that such treatment for a population is too expensive.

Commenting on pharmacists and evidence-based practice, Professor Mackie said that the profession had not evaluated enough of what it did. Evidence-based practice needed a base and this was not there for pharmacy because pharmacists did not keep records. A third of all medicines were sold over the counter, but there were no data on these transactions.

Turning to the challenges that lay ahead, Professor Mackie said that the chief of these related to professional boundaries, both within pharmacy and between pharmacy and other health professions. There was insufficient awareness between the professions of the expertise that others had and this led to fears that one profession was trying to take over the job of another. Other challenges that needed to be addressed included the exchange of information. Exchange of patient information was often restricted on grounds of professional confidentiality when it was the really the professional who was afraid of having weaknesses exposed to scrutiny, whereas the information was about patients and it should be patients who decided on access to it. However, pharmacists could not criticise because they did not even keep records.

Further challenges that had to be faced included shared learning, which involved more than putting groups of different professionals in the same lesson, flexible working practices and redefining the skill mix, and the development of clinical skills-based career pathways.

Pharmacists must negotiate locally

Community pharmacists and local pharmaceutical committees must accept that they are going to have to negotiate services and remuneration locally.

That was clear from questions asked and answers given during a discussion session. A number of pharmacists asked what the Pharmaceutical Services Negotiating Committee was going to do to ensure fair remuneration for services across the country.

The PSNC’s chief executive designate, Sue Sharpe, said that a principal change would be to refocus the PSNC on supporting negotiations for local pharmaceutical services schemes. Competition law meant that price recommendations could not be made. What the committee could do was provide LPCs with tools for benchmarking, costing and negotiating.

“We cannot provide old-style union negotiations,” Mrs Sharpe said.

She added that where LPCs were not active or effective in promoting pharmacy, people who were dissatisfied should get involved. Pharmacists would have to recognise that the idea that somebody else was going to negotiate for their professional future was not going to run. “It’s your future that is walking away,” she warned.

The new way of doing things in the National Health Service would favour independent pharmacies, Mrs Sharpe suggested. There would be many different local models leading to a great range of local services rather than one centrally driven model. This would be more of a problem for the multiples, which were head office based, than it would be for independents who could react locally and quickly.

Independent pharmacy — alive and well in the United States

Independent pharmacies have been termed the comeback kids of retailing in the United States because of the recovery in their sales levels in recent years.

Glenn Hall, general manager of Leader Drug Stores, a 2,300 member association, said that the US Consumer Reports nation-wide survey for October, 1999, described independents as the best pharmacies in America for personal attention, speed and efficiency of dispensing and for the provision of medical information.

The recovery in their position in the pharmacy market was such that prescription volume was up 6,000 per store in two years, to an average of over 47,000 items a year by 1999, and annual sales were up 15 per cent to $2m. The rise was expected to continue.

Despite this, independent pharmacists on both sides of the Atlantic faced similar issues. Both found it hard to get paid for providing care, rather than products, both faced intense retail competition, and both faced increasing costs and lower margins making them less profitable than other retail businesses. Both also faced pressure from health maintenance organisations or the National Health Service to keep it that way.

Mr Hall explained that the answer to the problem is to form an association of independents that presents a brand image and looks like a multiple while still emphasising its local strengths.

George Savvides, chief executive officer of Healthpoint Technologies in Australia, said that one in five prescriptions opened up the possibility of a legitimate over-the-counter sale. Technically, these could be highlighted by pharmacy computers, but the necessary knowledge systems were often not there because the focus was on dispensary systems. In Australia, this had potential to increase average pharmacy revenues by A$1,000 (£370) a week.