The Pharmaceutical Journal
Vol 270 No 7253 p836-837
14 June 2003

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Veterinary Pharmacists Group

Time to "get our act together"

The day long plenary sessions were introduced by Andrew Cairns (Dumfries), chairman of the Veterinary Pharmacists Group. He said that the title for the conference "Exciting new opportunities in veterinary pharmacy" reflected the fact that the two recent reports on the supply of veterinary medicines had produced recommendations that should result in a much greater pharmacy input to animal health. Mr Cairns said it is necessary to "get our act together" by the end of the year especially with regard to offering appropriate training to those colleagues who wish to be involved. Liaising with manufacturers and wholesalers to ensure that previously denied supplies become available is also crucial to success.

John Fitzgerald: OFT is about to consult

John Fitzgerald, policy director at the Veterinary Medicines Directorate, gave a comprehensive analysis of the recommendations contained in the Competition Commission report published earlier this year. The report confirms the existence of a complex monopoly in the supply of prescription only veterinary medicines within the UK and offers nine remedies for consideration by the Secretary for State at the Department of Trade and Industry and a further 11 recommendations for the attention of the Secretary of State in the Department for the Environment, Food and Rural Affairs (DEFRA). Collectively these measures will provide a much more transparent system of supply for veterinary POMs with clients being charged a fair price and being in a position to choose whether they wish to have their prescriptions dispensed by a vet or a pharmacist. Other important recommendations include changes in licensing procedures with medicines being placed in the lowest distribution classification consistent with their assessment of a product's safety, efficacy and quality. The creation of new classification categories is also recommended to allow specific categories of persons (such as agricultural merchants and saddlers as well as veterinary surgeons and pharmacists) to dispense certain veterinary medicines.

Mr Fitzgerald told the audience that the Office of Fair Trading has prepared draft legislation to implement the remedies and that this will be issued for formal consultation shortly. The recommendations are also being considered by DEFRA but he was unable to give the timescale for their response.

Douglas Davidson (Blairgowrie) said that in the past human medicine wholesalers had been denied products by the veterinary manufacturers. He asked if this situation would now change. Mr Fitzgerald said that providing the wholesalers have the appropriate licences they should be able to distribute veterinary medicines to pharmacies.

Nigel Graham, head of practice at the Royal Pharmaceutical Society, refreshed delegates' memories on the findings of the Marsh report. He then presented a proposal recently agreed by the Society's Council for a new classification that he claimed would achieve the government's goal of increased POM availability and still ensure that professional advice and information is available. The classification, to be known as POM(E), would allow a range of POMs that complied with one or more of the following criteria to be supplied without prescription and without a prior diagnosis by a veterinary surgeon:

• The medicine is used for regular health care or prophylactic treatment

• The medicine is necessary for control of an animal health problem

• The medicine is one for which record keeping or reporting of suspected adverse reactions is required

• The medicine could cause environmental harm or may be dangerous to the operator

• The medicine requires pharmacy intervention for the calculation of dosage and may require preparation in a form suitable for target species

• The medicine is for therapeutic use in minor medical conditions not requiring diagnosis by a veterinary surgeon

The circumstances under which the medicine could be supplied in a pharmacy include a requirement for the pharmacist to be involved during the sale process. The veterinarian does not need to administer the product personally or directly supervise its administration. Mr Graham said that a steering group has been set up to promote the idea to stakeholders. The Veterinary Medicines Directorate has agreed to con-sider POM(E) formally upon completion of the EU review of veterinary legislation that is currently taking place. In the meantime it is imperative that the selling of veterinary medicines is promoted to community pharmacists for they have unique skills that could be applied to this extension of their existing activities, he said.

Rory Culliton, of Pharmachem, Ireland, said that a POM(E) classification in Ireland containing a number of vaccines appears to be working well for cattle, sheep, fish and, to a lesser extent, pigs. An eight hour training course over two evenings is provided for pharmacists.

Professor Phil Thomas, chairman of the Animal Medicines Training Regulatory Authority, supported the notion that pharmacists should be involved in the retail supply of veterinary medicines but questioned the need for a POM(E) category. He pointed out that the Irish experience was principally gained from the agricultural market where farmers were able to administer medicines with a degree of expertise. In the UK pharmacists are much more likely to be involved in the pet market, where owners were less qualified to carry out procedures such as vaccination and would be better off consulting their vet. Concerns about potential over-vaccination of pets were also expressed.

Dudley Gradwell, a veterinary surgeon from South Africa and technical manager at Janssen Animal Health, gave his own industry perspective of the Competition Commission's recommendations. He said that he could see a few problems arising as pharmacists enter the market, but none would be insurmountable. These developments had been widely predicted for many years and are considered inevitable by his colleagues. Mr Gradwell estimated that around 1,000 pharmacies might take on the distribution of veterinary medicines and their contribution to pharmacovigilance would be an important asset in addition to the commercial benefits to the industry. One of the "remedies" in the Competition Commission's report requires manufacturers to inform veterinary practices and pharmacies at least every three months of ex-manufacturer prices net of discount or rebate at which POMs were supplied in the previous three months and, on request, the price for supply in the next three months. Presently there is a complicated system of retrospective rebating that means veterinary practices might not know accurately how much they are being charged for a medicine until many months after supply. This would have to be simplified to comply with the new requirements. A reclassification of POMs could have a substantial positive effect on manufacturers' sales revenue and veterinary pharmacists would clearly benefit from this, said Mr Gradwell.

Rob Morris, large animal business manager, Intervet UK, reviewed the commercial opportunities that could arise from expanding the veterinary market through pharmacies. He said that, according to the National Office Animal Health figures published in March 2003, the total animal health market is worth £393m annually, about 5 per cent of the value of the human medicines market. POMs form by far the biggest segment of this market; a 6 per cent year on year increase had brought the value to £250m. Pharmacy only products currently account for just £1m of sales. Over half POM sales are attributed to the companion animal sector; there are also many opportunities to engage in other aspects of the total UK pet market that includes such items as over-the-counter health care, accessories, pet food and cat litter and was worth a staggering £4.2bn in 2001.

Mr Morris told the audience that one area with substantial growth potential is pet wormers. This market is currently made up of 11 non-POM products worth £24m at retail with just two — Drontal and Panacur — accounting for 97 per cent of sales. It is estimated that 60 per cent of dogs and 70 per cent of cats are not taken to a vet in a given year; proactive involvement by pharmacists could have positive health care implications as well as being profitable. In theory, the flea market offers a £100m untapped market value, as well, and if some POMs were switched to a lower classification there would be further opportunities in this sector.

Turning to the equine market, Mr Morris explained that it is an extremely competitive environment but there is certainly room for expansion and the provision of better advice to horse owners. A nationwide study of 200 horse owners in 1999 revealed that feed merchants were the main source of equine wormer purchases. On eight out of 10 instances of wormer purchase no advice was sought or given proactively by the seller. Most owners who wormed their animals infrequently got their advice from friends and family despite the fact that they perceived their vet as being the best source of information.

The livestock sectors are highly specialised with several well established pharmacy based companies operating, said Mr Morris. Vaccines for cattle, sheep and pigs could be switched from the POM to a lower classification or included in the proposed POM(E) if it were to be accepted.

Concluding, Mr Morris stressed that there are real opportunities in a number of different areas but it is up to pharmacists to generate the will to become involved. "You can lead a horse to water but you cannot force him to drink," he observed.

David Evans (Ilkeston, Derbyshire) said that little progress had been made in increasing the turnover of veterinary medicines through pharmacies in recent years. Pharmacy veterinary wholesale turnover is static, with one or two exceptions. Community pharmacies, especially multiples, appear not to be interested in the market, he said.

The recent OFT/Competition Commission report could open up the prescription market and the VMD could have the power to classify "properly" many prophylactic treatments. "Over a million pet owners visit a pharmacy each day yet we are still failing to grasp the opportunity and make an impact on the lives of companion animals in the UK," said Mr Evans.

The route to success is exactly the same as one would follow in any other market within community pharmacy, Mr Evans went on. Preparation is vital. It involves market segmentation appropriate to geographical location and the seller's knowledge, sourcing supply channels, choosing product ranges and reviewing the competition. Marketing includes deciding on product, price, placement and promotion. Education and having the enthusiasm to achieve implementation are equally important.

"So what does the future hold? Will we grasp the opportunity and have a prescription for success or will it be much ado about nothing?" asked Mr Evans.

The theme of education was taken up by the final four speakers. Dr Michael Jepson (Birmingham), a member of the VPG committee, outlined the curriculum for the revamped diploma in agricultural and veterinary pharmacy scheduled for launch in January 2004. The diploma would comprise four components:

• Four teaching modules (of which the student must choose three)

• A period of practical experience

• A dissertation

• Examination and oral assessment

Dr Jepson explained that any module could be studied independently and if the student achieved the assessment standard a certificate would be awarded. Module 1 (companion animals) would be available by distance learning, and the other three would each be equivalent to a half-week residential programme probably at Harper Adams University College in Newport, Shropshire, where access to a wide range of animal units would be a major advantage. Module 2 would cover agriculture and crop protection, module 3 would cover animal health and husbandry and module 4 would cover crop protection in greater detail.

Dr Steven Kayne (Glasgow), also a member of the VPG Committee, described the resources that would be available to support the diploma course. He and Dr Jepson have been commissioned to edit a contributed textbook on veterinary pharmacy by the Pharmaceutical Press and the book is now in production. It is expected to be published in October. In addition, use would be made of the Veterinary Formulary, the National Pharmaceutical Association resource pack entitled "Pet medicines in pharmacy" and the Compendium of Data Sheets for Veterinary Products.

Michelle Styles, NPA information services, and Trefor Williams, NPA business support, claimed that we could bring back animal health to everyday life experience, making veterinary medicines available from scientists on the high street. They made a distinction between specialist veterinary pharmacies who could grow alone through wholesaling as well as retailing and community pharmacies who need help to expand into the market. Key steps for community pharmacies include identifying local markets, building relationships with professionals and consumers and building the environment by effective promotion. Building inventory is also important and this would become easier as access to manufacturers and veterinary wholesalers opened up.

Currently the NPA is lobbying hard on behalf of its members, encouraging suppliers and distributors to provide products.