The Pharmaceutical Journal
Vol 269 No 7221 p623
26 October 2002

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Institute of Pharmacy Management International

Managing knowledge and yourself

Business growth will be fuelled by the effective management of knowledge, said Mike Rudin, former chairman and member of council, Institute of Pharmacy Management International (IPMI), after welcoming participants.

Chris Loughlan, research and education manager, Addenbrooke’s NHS Trust, gave a presentation on the management of change and how conflict may arise and stress develop as a result. He said: “The Government is strong on culture and we have to manage cultural diversity.” He went on to ask: “Is pharmacy too critical of those who do not share our beliefs?”

He explained that if pharmacy is to influence health care providers it must clearly articulate a vision of the value it adds to services. It will not be easy to change a culture that already exists in the National Health Service. It takes time, and pharmacy’s challenge is increased because the Government wants quick results but tends only to look at the surface, or at the visible artefacts level, while not addressing underlying assumptions that support the current culture. Pharmacists must develop their own change agenda. They need to have a strategy, to have foresight and to have an awareness of what is going on around them in health care. They cannot operate in isolation, he said.

He added that pharmacists should improve their skills in submitting bids to primary care trusts for finance for initiatives, do it at the right time and get on to the right committees where resources are allocated.

Relationship with PCTs
Ruth Rodgers, lead community pharmacy pharmaceutical adviser to Kent and Medway PCTs, explored community pharmacists’ relationships with PCTs. “We are in a big period of change, but this time it will affect how pharmacy goes forward in the future.”

She went on to say: “PCTs want value for money and will be expected to balance their books. They want to control their prescribing costs and achieve good star ratings, tying in their activities with other related initiatives and targets in health and social care.”

From this month, the management of community pharmacy contracts has devolved to PCTs but they are facing a huge agenda and we have to tell them what we have done and how we have improved services if we are to bid successfully for money in the future, said Ms Rodgers. She advised participants to get closer to these organisations and to get to know the individuals. She warned that the Government is about to announce how out-of-hours services will be provided and it is looking at the possibility of supplying medicines at the point of prescribing, perhaps with a full course of treatment.

The debate — “This house believes that pharmacists should charge for consultations — but with whom and who pays?” — was led by Mark Koziol, managing director, Provincial Pharmacy Locum Services, Pharmacy Insurance Agency, and chaired by Ciaran McSorley, sales director, Lloydspharmacy and IPMI council member.

Mr Koziol favoured the creation of win-win situations where mutual gain for all stakeholders means that patients do not have to pay directly for a service, for example, medicines management. The patient wins because their illness improves more quickly and the manufacturer wins because its product is used more effectively and credibility leads to more use. The primary care organisation wins because waste is reduced and prescribing costs are cut, and the pharmacist wins because the prescription is dispensed and a value adding service, saving other parties time and money, forms a positive basis for a bid for funding.

Participants in the debate agreed that pharmacists should carry out properly constructed consultations, in an appropriate and discreet environment, keeping records and, where possible, using pre-booked appointments.

The debate highlighted the problem that pharmacists have traditionally seen margins on over-the-counter medicines as financing the provision of OTC advice. The public, however, do not see it that way and believe it is a price for a product. There is a danger that, given the choice, customers may opt for a cheaper product without advice rather than taking a recommended product with the necessary professional counselling.

Switches in categories of medicines
Mel Smith, global professional relations manager, Reckitt Benckiser, talked about managing and benefiting from changes in the categories of medicines. Mr Smith said that the OTC market is presently flat. The trend is away from buying a product in a pharmacy to buying it in a grocery. Statistics show that pharmacists are only intervening in one-quarter to one-third of sales and that public choice of where to shop is driven by familiarity and convenience. Evidence shows that community pharmacists are not supporting the P medicines category. GSL lines now account for 75 per cent of the brand sales over the counter and a large proportion of those are through pharmacies.

Sheila Kelly, executive director, Proprietary Association of Great Britain, told the conference that the Government has a huge problem tackling escalating demand on health care services, with declining numbers of general practitioners exacerbating the situation. The POM-to-P switch programme aims to release pressure on doctors’ time. With the development of patient group directions, the collaborative care model, with pharmacists and general practitioners working together focused on patient care, is becoming a reality. Some previous POM-to-P switches did not have the best information packs but more recent ones, such as Levonelle, have addressed that issue. Switches need real training packages and advertising support. Lord Hunt set a target of 50 switches by 2007. This will be a big exercise, with public education programmes and support for health care professionals expected.

Medication error reporting
Wendy Harris, senior pharmacist, safe medication practice — primary care, National Patient Safety Agency, talked about the work of the new NPSA. She confirmed that pharmacists’ concerns about reporting medication errors, with potential PCT punitive action, were recognised. However, all contractors have a responsibility to report errors and near misses to the PCT. She said: “Pharmacists operate true multiskilling with time pressures, staffing issues and error-provoking conditions. They need to manage their knowledge base — do they know the information they should hold in order to practise as a professional?”

To make individual contractor reporting successful, the NPSA aims for:

• Supportive management


• Fair blame culture


• Ease of reporting


• Local teaching


• Team spirit


• Apoliticism

Mike Keen, chairman of the IPMI conference committee, concluded the conference by saying that although community pharmacists are busy and time is at a premium, failure to take on these new roles and gain and manage the knowledge and competencies necessary will constrain the profession’s development and credibility in the competitive marketplace. Failure to participate in some strategies, such as medication error reporting, will have profound and serious consequences.

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