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Letters to the Editor
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GlaxoSmithKline
Decision comes at the worst possible time
From Mr M. Embrey, MRPharmS
GlaxoSmithKline’s assumption that its decision
to amend its trading terms (PJ, 19 February, p197) will be cost neutral to contractors (except
for the reduced value of stock for which we will receive a paltry £61)
stands in stark contrast to the calculations done by many colleagues,
who estimate losses of thousands of pounds per annum. I certainly know
whom I believe. GSK’s decision comes at the worst possible time
when we in Scotland are trying to focus our full attention on finalising
the new contract.
I would urge all fellow contractors to unite with our negotiating body
and refuse to accept the new trading terms offered by GSK. Its arrogance
limits the effect of our opinions and concerns but no company likes to
take a hit in the pocket. There are alternatives to many of GSK’s
prescription and over-the-counter products; I suggest we all try to use
them.
Michael Embrey
Falkirk,
Stirlingshire
Fancy words and empty promises
From Mr J. G. Allan, MRPharmS
Yet again GlaxoSmithKline has demonstrated its arrogance and indifference
to the issues and problems faced by its customers with the announcement
of changes to be made
to its trading terms (PJ, 19 February, p197).
Behind the fancy words and empty promises lies another cynical attempt
to increase its own profits and at the same time increase the use of
its products. To present this as an opportunity for community pharmacists
to develop their professional role and at the same time being cost-neutral
would be laughable if it were not so sad. We are already working with
the Scottish Executive on developing our professional role through the
implementation of the new Scottish contract. We are at a crucial stage
in these negotiations and the last thing both sides want is for the market
to be turned upside down in this manner.
While GSK likes to have us believe that it has consulted members of the
profession, to my knowledge no one, including colleagues that I know
have advisory posts with the company, has been involved. Frank Owens
and the Standing Committee of the Scottish Pharmaceutical General Council
have made their opposition and the good reasons for that opposition clear.
GSK would do well to listen to those who know a great deal more about
the future of community pharmacy than it clearly does.
In the future more and more pharmacists will become supplementary and
independent prescribers and they will in turn have more input into the
medicines prescribed for patients. My colleagues and I all have great
deal of freedom and choice on which over-the-counter remedies to recommend
to customers and we should support those who support us.
James Allan
Edinburgh
Seriously damaging to Scottish community pharmacy
From Mr F. J. Owens, MRPharmS
It has been a frustrating few weeks. No one ever said introducing a
new contract was going to be easy, but at least both sides — the
Scottish Executive Health Department and the Scottish Pharmaceutical
General Council — shared a common goal. The opportunities were
there for all to see and successful delivery would mean securing the
future of community pharmacy for the next two decades, maximising that
future and empowering community pharmacy. Transitional funding arrangements
were agreed and proprietary discount issues had been addressed with the
conclusion of the 2003 enquiry. This led to a revised discount clawback
scale and the provision of a £2m fund to support the introduction
of the contract. The next step was to agree the service specifications
with the aim of publishing them in the next couple of months.
Then came GlaxoSmithKline’s announcement that it intends to withdraw
its universal discount scheme, offering no discount on those products
not subject to price competition but offering “competitive product
specific deals” on products with competition from other manufacturers.
Furthermore, it proclaimed its intention to provide a GSK-oriented medicines
support programme.
Community pharmacy is taken by complete surprise. GSK made no attempt
to conduct meaningful dialogue with any community pharmacy stakeholders
but presents its intentions as a fait accompli. This is despite Scotland
having had pharmaceutical care model schemes in place for almost five
years and despite appropriate, accredited training packages existing
through NHS Education Scotland.
Alarm bells ring across the pharmaceutical landscape. Discount is to
be removed from the system. GSK drug prices will fall. How will all this
affect community pharmacists? How will it affect wholesalers? Will discount
thresholds require to be revised? Will this initiative negate the recent
proprietary discount inquiry? Will another inquiry be needed? Will this
delay implementation of the new contract?
GSK said this initiative would be profit-neutral to community pharmacy,
a claim many would refute. The company suggested that the price cuts
would allow the health administrations to reinvest in community pharmacy.
Although a drop in drug costs would certainly produce a lower drug bill,
that bill lies with the primary care trusts/ health boards. How will
the Government retrieve the savings to reinvest into pharmacy? There
does not appear to be a mechanism for that. What guarantees can contractors
get that all of those monies will be reinvested in pharmacy?
Then GSK offered contractors a compensatory payment. So GSK thinks it
can buy us off for a mere £61. A flat payment, irrespective of
how many items a contractor dispenses each month. The payment is based
on a two-week stockholding, even though patients habitually receive a
minimum of four weeks’ stock. Does GSK really have such a poor
understanding of community pharmacy?
GSK has also said that the SPGC and the SEHD are discussing how best
to proceed. To date, the SEHD has agreed no concession on affected GSK
products being added to the zero discount list.
This initiative, if implemented, has the potential seriously to damage
Scottish community pharmacy. Scottish contractors did not ask for this “support”,
nor do they want it. If GSK genuinely wishes community pharmacy an exciting
future as a core prescribing member of the primary health care team,
then it should apologise for the unnecessary upset caused and sit down
with stakeholder groups to agree how we might together work to ensure
delivery of quality NHS pharmaceutical care services across Scotland.
Frank Owens
Chairman
Scottish Pharmaceutical General Council
Universal condemnation
From Mr J. G. Inkster, MRPharmS
Regarding GlaxoSmithKline’s proposed changes to their pricing
structure, whom exactly has it consulted? One of my colleagues is on
the GSK Pharmacy Advisory Board and he knew nothing of this scheme before
it was announced to the pharmacy world.
Given that, and the fact that the scheme has received universal condemnation
from all pharmacy bodies involved in the community sector, will GSK think
again?
Clearly GSK has no idea as to the consequences of its actions and until
it is prepared to discuss rather than dictate my door will be firmly
closed to any offering from it be it on branded products, over-the-counter
products or training.
J. G. Inkster
Director
Edinpharm
Totally inadequate compensation
From Mr P. S. Nightingale, MRPharmS
GlaxoSmithKline continues to demonstrate a misunderstanding of its customers’ requirements.
First it unilaterally withdrew discounts from its products and now it
has further angered community pharmacists by offering totally inadequate “compensation” against
any GSK stock currently being held.The offer of £61 per pharmacy
regardless of stockholding is neither fair nor equitable and certainly
does not begin to reflect the true shortfall faced by pharmacy contractors.
Going forward, community pharmacies need to develop sustainable, meaningful
services for their patients. The GSK plan to loan equipment temporarily
does not help community pharmacists to deliver long-term patient benefits.
Co-operative Group Pharmacy wants to work together with all pharmaceutical
companies to achieve our common aims for the benefit of patients. GSK
does not appear to share these common interests, certainly with regard
to Scottish contractors.
Paul Nightingale
Operations Manager
Co-operative Group Pharmacy
An almighty spanner in the negotiations
From Mr C. C. Shimmins, MRPharmS
GlaxoSmithKline’s recent “declaration of support” for
community pharmacy displays only its self-interest, or at best a breathtaking
naivety in understanding that one would not expect from a business of
this scale.
It is well recognised that the community pharmacy network is supported,
currently, by both professional fees and an element of profit on purchases.
Government discount clawback means this profit sharing provides an almost
constant downward pressure on drug prices to the NHS and the taxpayer.
Put simply, GSK has decided that its products should be exempt from this
market. Thus the “discount” earned by the NHS via community
pharmacy is largely retained by the company. The price reductions it
has announced will affect only generic rival products in those markets;
meanwhile where it has no competition in therapeutic areas it will adopt
a policy of zero discount to pharmacy.This removes any downward market
pressure on its portfolio of products, actually depriving the NHS of
savings and an important community pharmacy income stream. There is a
double-edged sword here though: zero discount status can only be granted
by the Government and as yet only GSK is saying that the Department of
Health has agreed to this proposal. So, potentially, community pharmacy
will still pay for this initiative through clawback. As far as I can
see GSK is the only real winner here.
In Scotland this announcement could not have come at a worse time as
contractors are “locked” into a transitional arrangement
before the start of an ambitious new contract in April 2006. Theoretically
the funding for that contract was also “locked” in. The lack
of consultation from a company that employs community pharmacy advisers
I find astonishing. What it has achieved in Scotland has been to put
an almighty spanner in the negotiations towards a more transparent system
of payment for community pharmacy. While I am still looking forward to
our new contract and being paid to deliver pharmaceutical care, I do
not envy the light GSK has cast itself in with both our profession and
the Scottish Executive Health Department.
Finally, GSK’s meagre proposals to aid the new contract and its
implementation in Scotland with its educational packs is a case of too
little and five years too late. “The right medicine” in Scotland
has been with us since 2000 (drafted in 1999) as have the pharmaceutical
care model schemes that introduced new levels of care and new working
practices within Scottish community pharmacy. All support has already
been tailored,developed and delivered under the auspices of NHS Education
Scotland. These have provided us, in Scotland, with a taste and an insightful
and rewarding vision of where our future lies. I do not see GSK fitting
into this future other than as a manufacturer of drugs.
Campbell Shimmins
Doune, Perthshire
Think again
From Mrs E. F. Roddick, FRPharmS
I am utterly astonished at the lack of understanding shown by GlaxoSmithKline
about the impending new Scottish
community pharmacy contract. GSK has
proposed a medicines support programme which flies in the face of the
Scottish model schemes. It should surely know that all Scottish training
packages are approved by NES.
Finally, the one-off payment of £61 by way of compensation takes
no account of individual contractors’ spend with the company. I
strongly urge GSK to think again.
Elizabeth Roddick
Community pharmacist
Glasgow
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In accordance with our policy we invited GlaxoSmithKline to provide
a response that we could publish alongside these letters, hence the delay
in their appearance in these columns. This week, the company declined
to respond.
— Editor
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The
Pharmaceutical Journal