Veterinary Pharmacists Group
Partnership working will be the key to future pharmacist-vet relationships
Andrew Cairns: vets inclined to be dismissive of pharmacists’ competence |
Andrew Cairns, chairman of the Veterinary
Pharmacists Group, considered the future role of the veterinary pharmacist.
He said that it was hardly
surprising that the majority of veterinary surgeons jealously guarded
their right to supply medicines since they claimed that 30 per cent or
more of their practice income came from this source.
They were inclined
to be dismissive of newly qualified pharmacists’ competence to
deal with animal medicine issues, despite the fact that they were specialising
in areas such as cardiovascular disease, asthma, epilepsy, pain relief,
mental health and other major clinical areas as human supplementary and
independent prescribers.
Mr Cairns acknowledged that, apart from a limited number of specialised
pharmacists supplying medicines to livestock farmers and a dedicated
core of community and internet pharmacies, the competencies required
to handle animal medicines were still to be developed by most pharmacists.
However, the Royal Pharmaceutical Society’s veterinary pharmacy
education programme was growing in popularity and the VPG was strongly
advocating the inclusion of veterinary pharmacy in the undergraduate
course.
Mr Cairns proposed setting up of pilot projects to investigate the benefits
of joint working between pharmacists and vets in the future. These may
serve to demonstrate the feasibility of removing the focus of attention
from the profit on supply of medicine to an evaluation of the health
benefit in the animals being treated. Manufacturers should see the benefits
in their market growth and be able to recognise that the combined approach
of the pharmacist and the vet would lead to substantially greater uptake
of appropriate and desirable treatment regimens.
A suitable model might
comprise a combination of marketing support from the manufacturers,
enhanced margin on the medicine sale and some form of per capita payment
from
the Government for services to livestock units (possibly linked to
a minimum health status on flocks and herds).
Mr Cairns said the development of mutual trust between the two professions
would be an interesting and challenging exercise. The Office of Fair
Trading had failed to understand pharmacists, stereotyping them as
shopkeepers in the drive to create a downward pressure on the price
of medicines
for the end user.
Turning to the future Mr Cairns suggested that • Veterinary medicine must be brought clearly into the Society’s
2020 agenda
• The practice framework project must incorporate veterinary pharmacy
• Research must be undertaken to investigate the true incidence of zoonotic
infections in the UK and their cost to the public health budget
By 2020, strategic partnerships and, perhaps, amalgamations of veterinary
and pharmacy practices could be in place. A series of well run multidisciplinary
practices could develop, with competency levels significantly above those
currently enjoyed. Community pharmacy would have a potentially pivotal
role. After a clinical diagnosis was made and the medicine chosen the
follow-up could be carried out under pharmacy supervision.
The pharmacist
working in (or in conjunction with) the veterinary practice would ensure
that medication regimens were followed and the right outcomes achieved.
In addition there could well be an extension of the classification
system with more medicines being placed in the category that could be
prescribed
by pharmacists and suitably qualified persons. New models of working
Richard Hammond, of the School of Veterinary Medicine and Science at
the University of Nottingham, explained that the current model for
the supply of prescribed medicines is mainly through a veterinary
surgeon.
POM-V and POM-VPS medicines provide a considerable subsidy to the practice
turn-over. Reaction to the new distribution arrangements created following
the OFT report were mixed. They varied from comments such as “provides
an important opportunity” to “an attack on livelihood”.
Dr Hammond considered three new business models:
• Prescription and dispensing by a vet as at present
• Prescription by a vet and dispensing through “hostile” internet
pharmacies where price and convenience were major factors
• Prescription by a vet and dispensing by a pharmacist employed by the
vet
• Prescription by a vet and dispensing by a pharmacist with profit share
He said that the schools of veterinary medicine, pharmacy and business
at the University of Nottingham are to develop a study proposal to evaluate
these models and proposed direct collaboration with the Royal College
of Veterinary Surgeons and the Royal Pharmaceutical Society as to the
use of the findings.
Dr Hammond told delegates that there is increased pressure for change
within the veterinary profession from owner expectation and continuing
development and specialisation. A change in mind-set is necessary. Traditionally
the aim at undergraduate level was to provide a knowledge-based skill
set but now it is necessary to provide skills that included communication,
critical thinking and problem-solving as well as marketing and business
behaviours, and a commitment to continued learning.
The course at Nottingham
integrates clinical and practical skills from the first year. A network
of clinical associates ensure that students are exposed to a range
of different environments. An opportunity for the integration of pharmacy
teaching has been identified. A veterinary pharmacist’s perspective
David Evans, VPG committee member, said that if pharmacy is to contribute
to the distribution of veterinary medicines it must be seen to offer
benefits over previous distribution channels.
It should:
• Improve animal health
• Improve the integrity of the supply chain
• Provide value for money — not necessarily cheapest treatments
but the best therapeutic outcomes for a reasonable price
It needs to demonstrate its efficiency to regulatory authorities, the
Veterinary Medicines Directorate, the veterinary profession and the public.
Mr Evans said said that pharmacies’ locations, lack of need for
an appointment and long opening hours contributed to accessibility. With
an estimated three million pet owners entering a community pharmacy each
day there is a tremendous opportunity to promote an awareness of both
animal health issues and animal-related public health problems. More
choice of distribution routes means the public are more likely to use
a wider range of veterinary medicines — either on grounds of cost
or, more probably, convenience associated with the access issues outlined
above.
Mr Evans said that in his experience more requests for information
about animal medicines and treatments mean more referrals to veterinary
colleagues. He found that if he gave owners free advice to go and visit
the vet, they generally did. He welcomed this opportunity for closer
professional collaboration although currently this initiative has not
been reciprocated by his local vets, he said.
Many owners only visit a vet when their pet needs vaccinations or for
acute conditions. If their pet has a chronic condition, visits may be
more frequent. Pharmacy is ideally placed to provide ongoing care in
a number of areas. Having more efficacious products in pharmacy will
shift the balance of sales from older generation wormers to the newer
ones — benefiting both animal and public health.
There are data
to support the fact that “pharmacy”-treated animals are wormed
and receive flea treatments more frequently than those treated solely
at veterinary surgeries. Improved collaboration should raise awareness
of animal health issues and allow pet owners to be signposted by pharmacists
to the most appropriate source of treatment.
Preventive health care for pets and stocking the right medicines
Phil Sketchley, chief executive of the National Office of Animal Health,
presented a review of the opportunities for pharmacists in the animal
medicines market. He said that currently pharmacy has less than 10
per cent of the market and there is plenty of scope to increase this.
For example half of the seven to eight million cats in the UK appear
not to be wormed. Of those that are, few are being wormed four times
a year, as recommended. Similar arguments applied to dog worming and
flea treatments.
Mr Sketchley questioned whether it is productive for community pharmacists
to try to win share from the current market by dispensing one or two
veterinary prescriptions or selling products to clients occasionally — especially
as it was so small compared with the human pharmaceutical market. He
suggested it is far better to put energy into creating a bigger market
by persuading owners to commit to regular health care for their pets.
Working in synergistic partnerships with vets and medicines manufacturers
is far more likely to gain greater direct support of the animal medicine
companies.
Mr Sketchley then described NOAH’s new campaign to promote positive
information on pet health care and encourage regular use of preventive
medicines. A small number of dog and cat owners in the north, south and
the Midlands of England were selected at random and divided into “preventer” and “non-preventer” groups.
Qualitative research was carried out using focus groups. The research
was designed to determine:
• Why some owners take preventive health care measures (vaccination,
worming, flea control) while others do not
• If we can learn from the first group how to persuade the second
• What media influence pet owners concerning pet health care issues
It was concluded that the non-preventer groups were essentially caring
people who wanted the best for their pets, but they:
• Did not routinely associate responsible ownership with health care
• Believed they knew everything they needed to know about pet health
care if they had had a pet for two years or more
• Did not go looking for information, unless the pet was unwell
• Were wary of self-interest from both vets and the industry
• Preferred to consult other pet owners (personally or via the internet)
rather than professional sources
Pharmacists were not mentioned in the responses although they are skilled
and trusted communicators and “referral” experts for human
illnesses, so could provide services for pet care. There are a number
of resources to help pharmacists obtain information on veterinary medicines,
including the NOAH
compendium.
This is an online editing system allowing companies to keep their information
up to date. Information is available immediately on new medicines. Customers
and users of animal medicines can easily access UK data sheets and use
medicines even more responsibly.
Mr Sketchley encouraged pharmacists to be involved with National Pet
Month 2008. He said that there has never been a better time to be involved
with animal medicines — the regulatory environment is right and
the profile of preventive health care for animals is being raised.
Selling a veterinary medicine
John Toole, marketing executive at Merial Animal Health Ltd, told the
audience that the product Frontline Spot On is worth around £30m
annually and that this compares favourably with the leading pharmacy
advisory brands, and future incremental growth in sales is forecast.
Mr Toole said that 86 per cent of pet owners regard their pet as a
family member. He also said that 46 per cent of consumers in a survey
of 319
shoppers got advice on products for flea and tick control from the seller;
only 18 per cent consulted a vet. “All
this is good news for pharmacy business,” he said.
Choosing a powerful brand to stock gives a good start to involvement
in a new sector, and customer awareness (and satisfaction) leads to repeat
purchases. Reclassification of the world’s biggest animal health
brand means it is now available through pharmacies – and more products
are predicted in pharmacy outlets to follow as the category grows.
In
order to grow the market it is necessary to increase consumer awareness
of pet health products in pharmacies and identify clients’ needs
(possibly with the help of a short questionnaire) and satisfy them. This
will increase foot-fall. Preventive health care is a key driver in animal
health as it was in human medicine and this is what leading manufacturers
will invest in their promotional campaigns. Stocking decisions
Raj Nutan, pharmacy business manager at the National Pharmacy Association,
said that decisions on what to stock depend on:
• Assessing what is needed
• Whether the need is currently met
• The cost of procurement
• The profit margin that can be achieved
• The space required
• The profit per shelf
Mr Nutan then highlighted the scale of the opportunity for pharmacy:
in 2006 companion animals accounted for 55 per cent of the total animal
medicines market representing £189m. Of this, worming and flea
treatments made up 70 per cent of the value. Food-producing animals accounted
for 37 per cent of the animal sector on 2006.
In 2005 the pet flea treatment market — at £96m — was
larger than either the market for antihistamines or nicotine replacement
therapy. It offered an opportunity for linked sales because of the importance
of treating a pet’s whole environment.
Conference debate: British Veterinary Association president says pharmacists are not essential
Opening a debate chaired by Douglas Davidson, the VPG’s longest-serving
member, Rod Jones, VPG committee member, proposed the motion that “Pharmacists
are an essential part of the future animal health team”.
Mr Jones reminded the audience that pharmacists have an important role
in the identification and management of zoonotic risk as well as in animal
welfare. Many owners are reluctant to visit a veterinary surgeon except
in an emergency, are not using veterinary medicines at all or, if they
are, are using them ineffectively. Pharmacists are readily accessible
and can encourage owners to engage in routine health procedures and refer
to the vet when appropriate.
If vets and pharmacists were to work together at a local level under
a team approach similar to that already operating in human medicine,
the market would grow, benefiting both practitioners and animals. As
an example Mr Jones mentioned bovine virus diarrhoea, a disease that
is found in 90 to 95 per cent of the UK national cattle herd; the uptake
of vaccine is only 30 to 50 per cent, leaving a large margin for future
expansion. Furthermore, the temptation to use illegal or black market
supplies would be reduced with better availability and lower prices.
David Catlow: adopting a pragmatic view |
Opposing the motion, David Catlow, president of the
British Veterinary Association, said competition in the market is vicious,
with some suppliers
offering uneconomic margins in a scramble for market share. “Everyone
is trying to pinch everyone else’s business,” said Mr Catlow
The
veterinary surgeon is vital for animal health and there is a real threat
to the viability of farm animal practices in rural areas if the
income from selling drugs were to be reduced further by pharmacies entering
the market. Vets might have to diversify or relocate, leaving small communities
bereft of veterinary cover.
Veterinary consultants were now available
to provide assistance with expensive or complicated procedures to single-handed
practices once or twice a year, but these colleagues could not replace
the immediate first opinion service provided by a local vet.
Mr Catlow claimed he was adopting a pragmatic view. There is certainly
an opportunity for vets and pharmacists to work together to educate the
public in providing better health care for their animals, he said. If
a mutually acceptable business model could be established then the two
professions might establish a partnership — but pharmacists are
not essential to the successful working of the animal health team.
Speaking from the floor, Michael Jepson, VPG committee
member, criticised Mr Catlow’s position saying that blind emphasis on competition
is destructive, lowers standards and causes division in the professions.
There are real public health and animal welfare issues to be considered.
Some competition is good — “it keeps one sharp”.
Paul Hawkins, of Paul Hawkins Consulting, said that
most manufacturers base the size of their promotion budget on the potential
market value.
Growing the market would draw more publicity and increase income for
all.
Summing up, Mr Jones said that vets are not a one-stop shop any more.
Animal medicines are an extension of pharmacists’ current work
and there is much to be gained from their involvement. He asked the audience
to support the motion.
The motion was carried. |
The
Pharmaceutical Journal