UniChem
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Coverage of the UniChem convention concludes this
week. Several speakers outlined the benefits for pharmacy of POM-to-P
and P-to-GSL switching,
and urged pharmacists to support these changes. Hannah Pike (on the
staff of The Journal) reports
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The UniChem Convention 2004 was held in South Africa
and Zambia from 1–9 October. Hannah Pike attended courtesy
of UniChem Ltd
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Pharmacists should support switching
Terry Maguire: become more involved |
Pharmacy as a profession must become
more involved in determining what medicines, and for what indications,
are switched from prescription-only
medicines to pharmacy medicines, said Terry Maguire, vice-chairman of
PharmacyHealthLink. “It’s not good enough to leave this to
the pharmaceutical industry and simply comment when an application for
reclassification of medicines letter is produced by the Medicines and
Healthcare products Regulatory Agency or get irritated when a medicine
goes general sale list,” he said.
Dr Maguire explained that the Government is committed to promoting self-care
and that pharmacy must align itself with this agenda. “Some pharmacists
might argue that too many P medicines have gone to GSL and the more cynical
might suggest
that
pharmacy-only status is merely a stopping-off point on a product’s
journey to GSL. Sadly these views smack of self-interest and hold little
sway with a Government fighting hard to continue to fund its health service.”
Dr Maguire said that concerns have been expressed about pharmacists’ ability
to support quality in the self-care of common ailments, despite having
most of the required frameworks already in place, such as standard
operating procedures for the sale of over-the-counter medicines. He pointed out
that these SOPs must be used properly to ensure quality, and that they
must be written by the pharmacy or pharmacy group, and not by the Royal
Pharmaceutical Society or the National Pharmaceutical Association. “The
profession was not properly supported when SOPs were initially introduced
and perhaps it’s time to revisit this support again,” he
said.
Steve Duncan, managing director of Moss Pharmacy, told delegates that
pharmacists should support manufacturers with POM-to-P switches. “The
P medicine category is currently failing because the supply of new Ps
has all but dried up.” He said that the Government promised in
its Pharmacy Plan four years ago that it would make it easier for companies
to change the legal status of their medicines, and it has done so, but “the
manufacturers are not seeing it through and we’re not pushing hard
enough”.
Mr Duncan said there may be a dozen reasons why manufacturers are not
rushing to make switches and if pharmacists want more P medicines to
sell, they will have to arrange the switching themselves. “We must
link up with manufacturers who already have POM licences and lend them
our backing and, once we’ve collected it, our data to support the
switching process and the development of care programmes,” he said. “You
might argue that we are not qualified to sell such products, but I’m
afraid I must disagree. We have to stop thinking about selling products
and start thinking about providing packages of care that include medicines.”
The Proprietary Association of Great Britain and the over-the-counter
industry is working hard to ensure that growth in the OTC market is sustained
and that self-care is recognised as an essential part of health care
in the UK, Helen Darracott, director of legal and regulatory affairs,
PAGB, told delegates.
Switching is without a doubt going to continue to be a feature of pharmacy
in the future, whatever pharmacists think of it, she said. Mrs Darracott
explained that contrary to popular belief, switching does not result
in a loss of sales from pharmacies, but may alter the balance of P and
GSL sales. “The good news for pharmacy is that by far the majority
of OTC medicines are still purchased in pharmacies, but most of them
are GSL products, not pharmacy medicines.” Mrs Darracott also said
that switching does not result in a loss of prescription sales. For example,
when Eumovate was introduced as a P medicine three years ago prescription
sales remained higher than in the previous year, indicating that people
who were buying Eumovate are not the same people who go to the doctor
for a prescription.
“Switching products from POM to P is about widening access and increasing
choice about how people obtain medicines — it is not about limiting
their availability on the NHS,” she said.
Multiples and independents — in it together
The majority of factors currently having an impact on independent pharmacy,
such as changes in regulation, remuneration and tightened competition,
also impact on the multiples, Digby Emson, chairman of the Company Chemists
Association, reminded delegates. “As an industry, and as a profession,
we’re all in this together,” he said.
Mr Emson pointed out that all pharmacies are competing for business,
be it number of prescriptions, sales of medicines or toiletries, but
said: “We should not let this commercial reality obscure another
important reality — that we are all committed to the profession
of pharmacy and will achieve much more together than apart.”
He noted that the new contract places enormous pressure on community
pharmacy, whether multiples or independents, to deliver and added: “I
believe it also places an obligation on the representative bodies in
pharmacy to work closely together to support the delivery of the new
contract, and I call on them to do just that.”
Mr Emson stressed the importance of OTC medicines to community pharmacy
and said that pharmacists must strengthen their links with OTC manufacturers,
primarily through the PAGB.
“Pharmacy needs the support of OTC manufacturers,” he said. “We,
in return, need to support them through the quality of our advice and
display methods.”
NPSA initiatives
To minimise patient safety incidents, the NHS is learning from safety
critical industries, such as the nuclear power, off shore oil and air
transport industries, David Cousins, head of the National Patient Safety
Agency, said.
He explained that the new approach to health care safety recommends that
the users of the systems are placed at the centre of the issue, reducing
incidents through effective use of design in a whole system context.
Although the majority of patient safety solutions will be implemented
locally, there will be national initiatives undertaken by the NPSA each
year.
Other work currently being undertaken by the NPSA includes a risk assessment
of the use of anticoagulants, links with the National Programme for IT
to promote risk assessment of the proposed systems, and a number of patient
safety research projects.
Future challenges for the Society
Rob Darracott, director of corporate and strategic development at the
Royal Pharmaceutical Society, outlined the current key areas of activity
within the Society. “Much is being done,” he said, “and
much more needs to be done if we are to lead and develop pharmacists
for the challenges of
tomorrow.”
Speaking about the Society’s education programme, Mr Darracott
asked delegates: “Are pharmacy schools producing scientists, clinical
professionals or a hybrid of both.” He said: “Post-registration,
there is a heady mix of qualifications, with no standardisation and little
direction.” He voiced concerns about the small number of pharmacists
in the academic workforce available to teach undergraduates the fundamentals
of the profession. He said that over the next 18 months the Society’s
education and research teams will be engaging stakeholders on this point
and the Society has commissioned research to gain a better insight into
the motivation of undergraduates and current teaching, learning and assessment
methods.
Turning to the Shipman enquiry Mr Darracott said: “Clearly the
impact of Shipman will have a considerable impact on pharmacy practice
in the future but we also have to ensure that the impact is measured
and practical and offers the right level of public protection while enabling
patients to get the medicines they need without delay.” He explained
that the Society’s working group, set up earlier this year to consider
the implications for pharmacists and the Society, has been working in
particular on possible future models of inspection, the format of Controlled
Drug registers and the possible role for Society inspectors within a
multidisciplinary CD inspectorate.
Regarding continuing professional development, Mr Darracott said that
although the roll-out of the Society’s CPD framework will be complete
at the end of this year, it is clear that many pharmacists do not fully
understand how it will impact on their daily working lives. He described
the recruitment of 21 part-time CPD facilitators who will each liaise
with local branches to help pharmacists manage their CPD requirements.
The Society has also produced a CPD toolkit to enable each branch to
include CPD support in their meetings.
Mr Darracott described how the Society has begun to examine
its internal structure (PJ, 9 October, p543). “We clearly need to ensure that
the Society in Scotland and Wales is able to respond efficiently and
effectively to local policy changes,” he said. “That may
mean some changes in our Edinburgh and Cardiff offices, but crucially
it also means a more responsive Lambeth using its skills to facilitate
the work on the ground in Scotland and Wales.”
Mr Darracott also summarised developments in the Society’s publications
business, including the new BNF for children and the online library MedicinesComplete.
Supplementary prescribing in a community setting
Jonathan Burton, a partner in Campus Pharmacy at the University of Stirling,
and one of the first community pharmacists to undergo supplementary prescribing
training, described how he will be putting his training into practice
with the opening of an asthma clinic in his pharmacy in the new year,
which will run alongside current nurse-led services.
“We are already discussing the finer points including access to
medical records, transfer of patient information between the pharmacy
and the
GP practice, and referral pathways,” he explained. Mr Burton said
that although it is doubtful that the new contract will contain a remuneration
structure for prescribing-related activities, they fit well with the
chronic disease management components of the contract.
Noel Wicks, Mr Burton’s business partner and past chairman of the
Young Pharmacists Group, described how the YPG has been working to promote
the concept of owning a pharmacy business to young pharmacists. He said
that a positive response has been generated by conferences held so far,
and a formal programme of these conferences is now being developed with
the support of UniChem, the YPG and the British Pharmaceutical Students’ Association.
Cure Wales of excessive “pilotitis”
The future looks bright for the pharmacy profession in Wales, albeit
at times a little frustrating, Chris Martin, chairman of Pembrokeshire
Local Health Board, told delegates.
He summarised current developments in Wales, including the start of supplementary
prescribing training earlier this year, the Welsh medicines management
collaborative and the production of a clinical governance tool to help
local health boards improve the quality of community pharmacy services
in Wales. Mr Martin described working groups that have been set up to
look at issues including repeat dispensing and implementation of the
new contract. “I believe that in the future there is an opportunity
for Wales to negotiate its own Drug Tariff and its own contract,” he
said.
Mr Martin admitted that progress on the implementation of “Remedies
for success”, the 10-year vision for pharmacy development, has
been slow, and that despite expressing its commitment to the strategy,
the Welsh Assembly Government has not yet supported it with major funding
or produced a timeframe alongside the action points.“We have the
vision but because of lack of funding we will fall behind our colleagues
in England and definitely in Scotland,” he said.
Mr Martin explained that a minor ailments programme is also being considered
in conjunction with General Practitioner Committee Wales, in direct response
to the planned abolition of prescription charges. However, other initiatives
such as healthy lifestyle clinics are currently only carried out on an
ad hoc basis due to time-limited funding, a problem Mr Martin called “pilotitis”.
“We don’t want any more pilotitis. We want the Welsh Assembly
Government to make a firm commitment to support ‘Remedies for success’ with
funding and timescales for delivery. We applaud the stance taken by the
WAG to reject the Office of Fair Trading report and reject Local Improvement
Finance Trusts. That stability, with the new contract, will make sure
that as a profession we will take our rightful seat at the table of primary
care and play an important role in the modernisation of the NHS in Wales,” he
said.
Pharmacy future is full of opportunity
Mike Smith: go out there and take it |
Summarising the key messages from this year’s convention, Mike
Smith, conference chairman and a non-executive director of UniChem, told
delegates: “The future for pharmacy is full of opportunity — but
only to those who have the vision to see it, the heart to embrace it
and the determination to go out there and take it.” |
The
Pharmaceutical Journal