The Pharmaceutical Journal
Vol 268 No 7188 p311-320
9 March 2002

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Fewer switches, more PGDs?

Supply of more prescription-only medicines through patient group directions (PGDs) rather than a push towards deregulation was suggested at an All-Party Pharmacy Group meeting at Westminster on 5 March.

Dr Howard Stoate MP, chairman of the group, said: "My own view is that pharmacists should supply more medicines under PGDs, which would mean that they would be paid for the supply. Rather than concentrating on POM-to-P switches, more POM-to-protocol changes should be rolled out."

Harry Cayton, chief executive, Alzheimer's Society, said that there is a large wastage of drugs in the United Kingdom, mostly because of a lack of adherence to treatment. "Will deregulation help this or will it shift poor medicines management from the NHS on to the consumer," he asked. Increasing access to medicines does not necessarily equate to patient empowerment: knowledge is needed as well, he said.

Professor Nick Bosanquet, professor of health policy, Imperial College, London, suggested that a staged move towards direct-to-consumer advertising of POMs would allow patients to become more informed about medicines. "This would promote patient-professional partnerships," he said. The alternative to DTC advertising was covert operations of companies through activities such as placing stories in newspapers about the latest "wonder drug", he said. "This is a much less controlled and less responsible form of communication than advertising. It is not subject to the tight controls that adverts are." He did not advocate television advertising but rather informative websites and advertising in specialist journals. However, Christine Glover, member of the Royal Pharmaceutical Society's Council, did not think that it could be contained in this way.

Mr Cayton agreed that DTC advertising could not be relied on at present. "There is an overwhelming amount of information available on the web about drugs but much of it is advertising disguised as information. It is difficult for consumers to decipher the difference."

Emergency hormonal contraception (EHC) is a recent example of a deregulated medicine. Chris Miller, Schering Healthcare, said that deregulation of Levonelle-2 had increased access to information. It had also had other benefits in increasing communication between health care professionals and as a result had sped up the introduction of PGDs to cover EHC supply.

Linda Stone, member of the Royal Pharmaceutical Society's Council, pointed out that in terms of cost, EHC was a special case. Price was a barrier for regular medicines, whereas EHC involved a one-off payment. "There are other ways of freeing GPs' time where patients would not have to pay, such as pharmacist prescribing."

Eileen Neilson, head of the Society's policy support unit, said that the transfer of time from the GP to the pharmacist had to be considered. She asked if pharmacists would be able to cope with the consultation volume if there was wholesale deregulation. However, Sheila Kelly, executive director, Proprietary Association of Great Britain, pointed out that 80 to 90 per cent of patient consultations with a health care professional were related to a medicine that they had taken previously.