|
Stephen Goundrey-Smith is a pharmacist and health
care development manager at SGS PharmaSolutions
|
The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
|
When I saw the correspondence in The Pharmaceutical Journal recently concerning the AstraZeneca-supported brochure on statin use that was distributed by The Journal my heart sank. This was not because comments made by the various respondents were not justified. Neither was it because, in the ever-changing NHS arena, the pharmaceutical industry is constantly
looking for different ways of targeting its customers, all of which must
comply with the recognised standards of the Association of the British
Pharmaceutical Industry code of practice for the advertising of prescription
medicines.
My heart sank because the correspondence clearly indicated that the working relationship between the pharmacy profession and the pharmaceutical manufacturing industry is as poor as it has ever been. In my view, this is to the detriment
of the whole of the health care system, and especially the end-user — the
patient. Furthermore, with a commitment to clear communication and to
understanding each other’s agendas, this need not be the case.
When I began my career in the late 1980s in hospital pharmacy, it was
acknowledged that there was a gulf between the NHS and the pharmaceutical
industry, in terms of their business processes and practices. There was
also a significant earnings differential for professionals employed in
the two sectors, with pharmacists in the industry earning significantly
more than those in equivalent roles in the NHS.
However, since then there have been a number of important developments
affecting both the NHS and the industry. The average cost of research
and development for new drugs has increased sharply; many of the new
products coming to market are highly sophisticated biological products,
with a high cost per dose unit. Since the late 1990s, there have been
primary care organisations responsible for implementing health policy
in primary care, in particular prescribing policy, setting and controlling
budgets and (until now) commissioning services from providers.
For these
reasons, PCOs have become important gatekeepers to the adoption of a
medicine in the NHS. Also, in recent years, as a response to government
concerns about shortages of doctors and skill mix in the NHS, there has
been an increasing emphasis on non-medical prescribing, and now a proportion
of prescribing is done by health care professionals other than doctors,
thus providing a more diverse marketplace for the industry. Moreover,
salaries in the NHS have risen, and are now more on a par with remuneration
for pharmacists employed by the industry.
These changes have had a number of effects on the interaction of the
pharmaceutical industry with the pharmacy profession. The increase in
high-cost specialist therapies coming to market, together with the PCOs’ role
as gatekeepers and influencers, has led to the “managed entry” of
new medicines, whereby the industry employs specialist NHS liaison personnel,
often health care professionals themselves, to network with the PCOs
in order to determine the factors that affect the local health economy
and the issues relating to the new product in the locality, and to advise
on clinical and budgetary aspects on the new product.
In general, in
response to the new NHS arena, the pharmaceutical industry has looked
beyond the traditional sales models, based on representative activity,
territory management and the use of standardised promotional material
towards newer marketing methods. These new approaches include initiatives
as diverse as specialist representative teams within pharmaceutical companies,
with greater background knowledge of the therapeutic area and the customer
base, network NHS liaison (to make representations with regional and
national bodies, such as the National Institute for Health and Clinical
Excellence and the Scottish Medicines Consortium), and specialist communications
agencies and peer-to-peer initiatives, where companies engage health
professionals to liaise with their professional peers, concerning a new
product or new clinical data.
In recent years, health professionals in primary care have been moving
into these roles in, and associated with, the industry because of the
similar skills required for the roles, together with parity in salaries
between the NHS and the industry. This situation is likely to continue,
given the amalgamation of PCOs at present, and the resultant loss of
jobs on the NHS side.
Yet in this environment of increasing communication between the two sectors,
there is still a healthy distrust between pharmacy professionals — especially
those working in secondary care and for primary care organisations — and
the pharmaceutical
industry.
It is not hard to see the issues and incidents that fuel this distrust.
Cases brought against companies under the ABPI code of practice are routinely
reported in the pharmacy press. Controversial pharmaceutical industry
initiatives — for example, the recent decision by Pfizer to use
a single supply channel — are hotly debated in the pages of The
Pharmaceutical Journal. It has been claimed that industry-sponsored
reviews of therapeutic interventions are not as transparent and methodologically
sound as those formulated by independent bodies such as the Cochrane
Centre. Moreover, there are pressure groups that encourage health professionals
to distance themselves from the pharmaceutical industry, and not to accept
the various promotional items that the industry provides, eg, the No
Free Lunch initiative (www.nofreelunch.org).
Nevertheless, in the current climate, it is essential that pharmacists
on both sides of the fence — in the NHS and in the pharmaceutical
industry — understand each other’s agendas and maintain good
communications and working relationships. New medicines are increasingly
complex and expensive; prescribing advisers and commissioners need timely
and accurate information from the industry in order to elucidate the
likely role and place in therapy of a product, and its potential budgetary
impact. The primary care arena is changing, with amalgamation of PCOs,
introduction of practice-based commissioning, and local variations across
Britain. In the past, the industry has struggled to make contact with
decision-makers and influencers in PCOs — and this challenge will
not be made easier by the current NHS changes.
So, in order for there to be a win-win situation for the NHS and the
industry — and an ultimate benefit for the patient, in that a new
product is rapidly adopted and available where appropriate — pharmacists
in the NHS and industry must work together.
I have argued previously that pharmacists should support the pharmaceutical
industry because of their common heritage: the way that notable pharmacists
have shaped the industry in the past, and the many useful products that
the industry has provided for community pharmacists to recommend. Now
I appeal to pharmacists in the industry and the NHS to work together,
in order to face the challenges of the future. |
The
Pharmaceutical Journal