News feature: Learn from pharmacy across Europe

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The Pharmaceutical Journal Vol 267 No 7169 p502
13 October 2001

News feature

Learn from pharmacy across Europe

Pharmacists across Europe face similar problems, but the responses seen in individual countries have been far from the same. Clare Bellingham describes some of the differences outlined at a pan-European meeting hosted by Gehe UK on 2 October 2001

Some of the problems facing pharmacy and pharmacists in different European countries are similar, but the way these problems have been tackled are far from similar. And while pharmacy has evolved differently in order to cope with the challenges in each individual country, progress can be made if knowledge is shared across borders and pharmacists learn from their neighbours’ experiences, according to Mike Ward, chief executive of Gehe UK.

Colette McCreedy, head of practice division, National Pharmaceutical Association, says that deregulation is one of the most important issues affecting pharmacy at a European level. “There are moves throughout Europe to break down the traditional rules regarding ownership of pharmacies, pharmacy monopolies on dispensing medicines and supplying non-prescription medicines, and on restrictions on opening new pharmacies,” she says.

In the Netherlands, changes have been made so that pharmacists no longer have to be present when medicines are dispensed or sold. Cees Schaap, a pharmacist from the Netherlands, explains that the law making it a requirement for a pharmacist to be present in each pharmacy has been abolished. “A pharmacist can now run more than one pharmacy if they can demonstrate that they have fully professional systems in place,” he says. “This allows resources to be shifted through a chain.”

However, Miss McCreedy describes the change as a worrying development. “If pharmacists do not need to be present then what value is placed on their expertise in medicines and will there come a time when they are not needed at all?” she asks.

In the United Kingdom, display of pharmacy medicines for self-selection is a hot topic. In other countries, the issue focuses on whether non-prescription medicines should be displayed at all. Currently, non-prescription medicines are hidden in drawers is some countries and prominently displayed in others. Where medicines are sold also differs greatly. In the Netherlands, a new law has abolished the position of druggists, who have a separate role from pharmacists, being responsible for sale of over-the-counter medicines. This has created an opportunity for supermarkets to sell OTC products.

Miss McCreedy says that there is recognition at European level of the important role that pharmacists can play in self-medication. “One of the greatest tensions is the negative attitude of doctors,” she says.

In the UK, doctors are positive about people seeking advice from pharmacists for minor ailments because they see it as a way of freeing surgery time. This is not the case in Austria, for example, where doctors are paid per patient visit rather than on a capitation basis (as in the UK) so they see the developing role of the pharmacist in self-medication as a threat to their income.

The proportion of prescriptions written generically varies widely across Europe. The UK has the highest figure at 66 per cent, with Denmark and Germany not far behind at 60 and 55 per cent, respectively. In contrast, just 3 per cent of prescriptions in France are written generically, 5 per cent in Austria and 3 per cent in Belgium. In Norway, where generic prescriptions are also low, generic substitution has been made legal. However, doctors and the industry have mobilised against the substitution scheme and results so far indicate an actual decrease in the sale of generics.

Some differences

The Netherlands has fewest pharmacists per population: one for just over 4,000 people. Spain, Italy and France have the most: one for less than 1,000 people. The UK figure is one for between 1,500 and 2,000 people.

Denmark has pharmacies that serve the largest populations: about 18,000 people each. This contrasts with Spain and France where the population per pharmacy is around 2,000 people and 4,800 in the UK.

The proportion of pharmacists working in the community differs substantially, from nearly 100 per cent in Luxembourg, Austria, and Sweden, to less than 50 per cent in France, Norway and Finland. In the UK, the figure is 70 per cent.

Pharmacy ownership differs across Europe. Countries with no chains of pharmacies include Denmark, Spain, France, Germany and Austria.

Countries where pharmacies have a monopoly on distribution of OTC medicines include Belgium, Spain, France, Italy and Sweden.

Balancing the business

A common theme in pharmacy across Europe is balancing the professional and commercial aspects of practice. In the Netherlands, pharmacies are held in high public esteem because they are not viewed as commercial businesses. “The status of a pharmacist is almost equal to that of a doctor,” says Cees Schaap. The profession has evolved so that about 95 per cent of the pharmacists’ role is in supply of prescription-only medicines and druggists were, until recently, responsible for distribution of OTC medicines. Pharmacies are not shops. He believes that another reason for pharmacists’ equal status with doctors is that education for pharmacists is longer than in other countries, lasting for seven-and-a-half years.

In Italy, the role of the pharmacist is being transformed from drug distributor to health adviser — a reference point for advice on self-medicine for citizens, says Italian pharmacist Marta Fregna. In addition, there is a move towards introduction of a number of services in pharmacy, eg, blood pressure measurement, dietary advice, and food intolerance, diabetes and cholesterol tests.

Introduction of such services in pharmacies is also happening in the UK, but the development is being held up by the current remuneration system in which there is little recognition for roles other than dispensing. In addition, Andy Murdock, superintendent pharmacist, Lloydspharmacy, points out that over the past 10 years in the UK, there has been a 30 per cent growth in prescriptions processed but a 30 per cent reduction in real terms of payment. “This is unsustainable,” he says.

In Norway, the introduction of a new pharmacy act in March this year has brought a number of changes. The act made ownership of chains possible. As a result, one-third of all 450 pharmacies in Norway are now chain-owned. Norway, like many countries in Europe, is facing a shortage of pharmacists. Norway is using a familiar tactic to try to overcome its recruitment crisis. Norwegian pharmacist Vibeke Dalen explains: “We are increasing the capacity in the education system and bringing pharmacists in from Sweden, Denmark and other countries,” she says. In addition, the profession is looking at working procedures to ensure that pharmacists are only used for essential duties.

E-pharmacy is the subject of huge debate at present, according to Miss McCreedy. It is permitted in about half of European countries, including Norway, Denmark, the Netherlands and the UK, and banned in others, such as Germany, Greece, France and Belgium. The problem is that the internet has no national boundaries and pharmacists in countries where it is not permitted are not happy with the idea of customers being able to purchase medicines from pharmacies in countries where e-pharmacy is permitted.

Electronic transfer of prescriptions (ETP) trials are about to start in both the UK and Norway. Mr Murdock says that ETP “could revolutionise the way pharmacy operates in the future”. Norway may move forward more quickly than other countries on electronic developments because all pharmacies have a common dispensary computer system. In Belgium, ETP is not imminent because of issues surrounding the need for a doctor’s signature on a prescription. However, Belgium has an electronic health record (SIS card) in place. This is a card with a chip that links every person to a national medical database, and a development that would be welcomed in many European countries.

Clare Bellingham is on the staff of The Pharmaceutical Journal