The Pharmaceutical Journal Vol 267 No 7179 p873-877
22-29 December 2001

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One step forward and three steps back

Throughout the year, politicians and other opinion leaders have paid fulsome praise to pharmacy, continually singling it out as a profession that is being underused. However, these warm words have not been backed by firm action, let alone hard cash, and the profession's aim of being at the centre of medicines management within the country's health care system looks as far away as ever. Indeed, those actions that have been taken look like moving pharmacy backwards not forwards.

The English, Welsh and Scottish parts of the National Health Service are undergoing yet more major reorganisations even though the dust does not seem to have settled after the last lot. Details of pharmacy's place within the new NHS are as hard to come by as ever. The Journal started the year by reporting on what is now the Health and Social Care Act 2001 (PJ, 6 January, p5). This paves the way for pharmacist prescribing and local pharmaceutical services (LPS) pilots. As the year closes, guidance on LPS is expected from the Department of Health "in the early spring" of 2002 (see p876). The Royal Pharmaceutical Society has set up a working group led by Dr June Crown to look at how pharmacist prescribing might work in practice. This will report next year.

The first steps towards formal NHS medicines management schemes in England were taken during the year with the appointment of a team at the National Prescribing Centre, Liverpool, and subsequent selection of pilot sites. The Pharmaceutical Services Negotiating Committee also moved slowly towards starting its pilot scheme for medicines management within community pharmacy.

During the year three consortia were selected to undertake trials of the electronic transfer of prescriptions (ETP). The first test prescriptions were sent by one of the consortia just before the end of the year (PJ, 15 December, p841).

Resale price maintenance on medicines came to an abrupt end on 15 May (PJ, 19 May, p666). So far the end of RPM does not seem to have had the effects feared but it has added to the financial uncertainty for community pharmacy businesses.

Further uncertainty came with the Department of Health consulting on two options for reviewing the market for generic medicines (PJ, 28 July, p109) and the Office of Fair Trading reviewing the control of entry into pharmacy contracts (PJ, 6 October, p451).

The Society

For the Royal Pharmaceutical Society, and its Council in particular, 2001 might be a year to draw a veil over. The year started with a row with the membership over the appointment of a new editor for The Pharmaceutical Journal and ended with a row with the membership over the Society's museum. The view expressed by the Society's President (Marshall Davies) in his address to the British Pharmaceutical Conference in Glasgow (PJ, 29 September, p430) that the Society needs to put patients' interests above those of its members will prolong the debate well into next year.

The Society has had some things to celebrate. The Scottish Department celebrated its 150th anniversary in style with a gala dinner at Stirling Castle, part of a series of events during the year. The Princess Royal was made an honorary fellow of the Society and returned the favour giving a well-received address to the Conference.

Clinical matters

Pharmacy politics may have moved on slowly in 2001, but clinical matters have certainly progressed. The National Institute for Clinical Excellence started the year with recommendations for the use of Alzheimer's disease treatments (PJ, 27 January, p103) and has continued to churn out guidance ever since. For most of the year, NHS organisations were able to make their own judgements on whether to fund NICE guidance but they no longer have a choice about this.

As well as digesting and acting upon NICE guidance, pharmacists have had national service frameworks (NSFs) to consider. The latest NSF, on diabetes, was launched this week (see p874). The NSF for older people, launched in full in March, gave a boost to pharmacists' roles in medicines management.

As a class of drugs, statins are the ones that have been in the news most often this year. Despite the withdrawal of cerivastatin (Lipobay) in August, trials have continued to herald the benefits of these drugs. The latest proposes that anyone at risk from vascular disease would benefit from receiving one (PJ, 17 November, p701), which has cost implications for the NHS.

Real benefits from innovations in pharmaceutical science have also been seen in 2001. Imatinib (Glivec), a much-praised drug for chronic myeloid leukaemia was launched this year (PJ, 17 November, p708) and promising results have been seen for an inhaled insulin product (PJ, 10 Febuary, p179).

Health issues resurface

Familiar health issues resurfaced several times during the year. The over-the-counter sale of emergency hormonal contraception remains controversial and the combined measles, mumps and rubella vaccine (MMR) was rarely far from the headlines in both professional and lay media (PJ, 20 January, p71 and 8 September, p313).

Deep vein thrombosis or traveller's thrombosis sprung to new prominence with a number of well-publicised deaths. Pharmacies can now supply compression hosiery products aimed specifically at travellers (PJ, 27 January, p116).

Increasing prominence has been given to the problems and consequences of medical errors with reports issued by the Department of Health in April (PJ, 21 April, p528), the Committee on Safety of Medicines in August (PJ, 1 September, p286) and the Audit Commission in December (see p873). All identified hospital pharmacists as having a key part to play in reducing errors, but this will be difficult to achieve while many hospital pharmacy departments are understaffed.

In and out

A new team, Barry Andrews and Sue Sharpe, took over at the PSNC in the summer. Following the Government's imposition of a harsh remuneration settlement in England and Wales at the end of this year, they will have their work cut out negotiating a new contract for community pharmacy next year.

Bill Darling stood down from the Royal Pharmaceutical Society's Council after serving continuously for 39 years.

Sandra Gidley returned to the House of Commons as the only pharmacist Member of Parliament.

Along with RPM, the Proprietary Articles Trade Association disappeared. It was wound up in July after 105 years of defending fixed prices for medicines.

Looking ahead

If 2001 has been a year in which much happened but little changed for pharmacy, then 2002 is shaping up as a year in which much will change. Pressures on community pharmacy are reaching a head and unfavourable verdicts on generics and control of entry could change the fundamental dynamics of the market and even lead to the pharmacy closures many have prophesied. Medicines management and ETP pilots should get off the ground and steps may be taken toward pharmacist prescribing, at least in hospitals. However, none of these will change the way pharmacists work unless the Government is willing to pay to make them happen. This year has not given much evidence that it is.

Jonathan Buisson is on the staff of The Pharmaceutical Journal