The Pharmaceutical Journal
Vol 277 No 7483 p707-708
22/29 December 2007

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2007: A year of upheaval for pharmacy

With the announcement of the Royal Pharmaceutical Society’s divorce from regulation, uproar over proposed fee increases and the start of the “responsible pharmacist” consultation, it has been a year of considerable change for pharmacy. Tom Moberly (on the staff of The Journal) looks back over 2007

Pharmacists and interested observers have often asked what it would take to unite and engage the profession. A clear answer came back this year — a 50 per cent increase in retention fees. In July, the Royal Pharmaceutical Society’s Council proposed to raise the retention fee for practising pharmacists from £283 to £425.

An online petition protesting against the fee increase received almost 3,500 responses in its first 24 hours and over 10,000 in total. And the Society’s own consultation on the subject received 1,145 responses, the vast majority of which objected to the increase.

In November, the Council said it had listened to members’ concerns and accounted for external changes and set the fee for practising pharmacists at £395 (a 40 per cent increase on 2007).

This failed to quell disquiet from other pharmacy organisations and individual members, however. The Society was accused of failing to explain adequately how the money raised by the fee increase would be spent and concerns were also voiced about introducing such a substantial rise at a time of significant change for regulation and representation of the profession and for the Society itself.

Society split

The extent of such change should not be underestimated: in February, the Government revealed its intention to strip the Royal Pharmaceutical Society of its regulatory functions and to establish a General Pharmaceutical Council (PJ, 24 February, p207).

The plans, set out in the Government’s White Paper on the regulation of health professionals, also proposed the creation of a royal college-type body to provide leadership for the profession.

Although pharmacy bodies supported the creation of such a body, tensions soon emerged over the form it should take. The Society saw itself as the ideal body to fulfil such a role; others did not.

Lord Hunt of Kings Heath argued that the royal college-type body should be a new entity. The Society countered that, freed from the shackles of regulation to represent the profession, it would itself be a new body (PJ, 26 May, p597).

In May, a working party led by Lord Carter of Coles concluded that the future of the Society was uncertain, but that it had a year to determine what its future would be (PJ, 19 May, p573). And an economic analysis conducted alongside the working party’s report estimated that developing a royal-college type body from the Society would cost £4.3m, rather than the £5.2m needed if the two bodies were created independently of the Society.

Some financial worries of the profession were eased in September when it was announced that the Government would provide £3m to support the establishment of the General Pharmaceutical Council. And progress towards the council being fully functional by January 2010 continued in November as legislation to enable its formation was tabled in the House of Commons (PJ, 24 November, p575).

Supply and services

Amid criticism over a lack of consultation and concerns over the resilience of a single distributor supply model, Pfizer began its direct-to-pharmacy scheme in March, using UniChem as its sole distributor.

An AAH survey conducted in the first weeks of the system suggested it had reduced service levels and damaged Pfizer and UniChem’s reputations. In April the Office of Fair Trading announced it would scrutinise the direct-to-pharmacy model of medicines distribution

Three months into Pfizer’s scheme, opposition to it continued. Community Pharmacy Scotland criticised Pfizer’s use of quotas, independent pharmacies said they had seen service levels deteriorate and small manufacturers warned that direct-to-pharmacy schemes threatened the sustainability of their businesses (PJ, 9 June, p661, and 16 June, p695).

Nonetheless, other manufacturers followed Pfizer’s lead and overhauled their own supply schemes. First, AstraZeneca revealed that, from sometime in 2008, it would be using only two wholesalers (AAH and UniChem). In October, Napp began a scheme using AAH, Phoenix and UniChem. In November, Sanofi-Aventis followed suit with a similar scheme and, in the same month Astellas Pharma appointed UniChem as sole distributor for its tacrolimus products in the UK.

In December, the OFT reported the findings of its investigation of changes to pharmaceutical distribution. It recommended that measures should be put in place to limit the impact of direct-to-pharmacy distribution deals on the NHS drugs bill and service levels to pharmacy.

In a sea of change, pharmacy services continued to progress steadily in 2007. In January, Beth Hird qualified as the first pharmacist independent prescriber and in February began writing prescriptions. In Wales, discussions were under way about the introduction of a national minor ailments scheme and, in April, the Welsh Assembly Government took the bold step of scrapping prescription charges in the hope of tackling health inequalities by enabling people to take all the medicines they need rather than just those they can afford.

In December, roll out of Scotland’s Acute Medication Service began at a series of pilot sites (PJ, 8 December, p642), with the aim that the service would in place across Scotland by September next year.

In addition, pharmacy demonstrated the degree to which it had moved up the political agenda when both the Prime Minister and the Health Secretary specifically mentioned expanded roles for pharmacy in their speeches to the Labour Party conference in September.

Disappointments

However, developments in other areas fell short of the hopes of many in the profession. Research published in February showed that less than 7 per cent of the medicines use reviews for which funding was allocated were carried out in the first year of the new community pharmacy contract.

An evaluation of the new contract showed that, although progress had been made, there was still room for improvement and that many pharmacists believed they were worse off under the new arrangements (PJ, 15 September, p280).

In addition, in June, the All-Party Pharmacy Group warned that pharmacy’s potential as health care providers was not being realised quickly or consistently enough (PJ, 30 June, p757).

Its report into the future of pharmacy stressed that, although good examples of pharmacy practice and innovation were in progress, these had only happened through the determination of the pharmacists concerned and the willingness of local stakeholders to collaborate.

“These good examples are too few and far between,” the report warned. “We do not see sufficient signs of a momentum that might improve this patchy picture.”

Community pharmacy contractors were hit by a significant drop in income after October following revision of reimbursement prices for Category M medicines. Individual contractors, multiples and wholesalers all reacted with anger to the financial instability the changes introduced.

This followed the announcement in July that the Government was proposing to devolve the global sum for the community pharmacy contract in England to primary care trusts.

Pharmacy bodies were concerned that PCTs might use funds for other services if money were not ring-fenced for pharmaceutical services, citing trusts’ poor records in implementing and funding locally negotiated services. But NHS organisations supported the suggestion and said they wanted to be more closely involved with negotiations over payment for services (PJ, 17 November, p549).

The Government announced in March that it was looking at reclassifying products containing pseudoephedrine or ephedrine as prescription-only medicines, in response to concerns over the use of these medicines to manufacture the Class A Controlled Drug methylamphetamine (PJ, 10 March, p269).

The Medicines and Healthcare products Regulatory Agency argued that reclassification was the only was to restrict availability of these products. Pharmacy bodies, however, argued that such a move was a disproportionate reaction to the risk posed and, in October, the MHRA decided that products containing pseudoephedrine or ephedrine should, for the time being, remain available over the counter, albeit with new pack size restrictions in place (PJ, 1 September, p221).

And for 2008 …

The coming year already looks as if it be will as full of change and controversy as pharmacists have found 2007 to be. At the end of October, the Government launched its formal consultation on regulations relating to the “responsible pharmacist”, the concept that is to replace “personal control” (PJ, 27 October, p457).

This followed an announcement at the British Pharmaceutical Conference by the Department of Health’s head of pharmacy Jeannette Howe that the concept of “responsible pharmacist” would be separated from that of “ supervision”.

The Royal Pharmaceutical Society’s Council has recommended that responsible pharmacists should only be absent from a pharmacy for a maximum of two hours per day (PJ, 15 December, p667). The consultation closes on 20 January 2008.

In the new year, the Government will be responding to the Office of Fair Trading’s recommendations on direct-to-pharmacy schemes and continuing negotiations with the pharmaceutical industry, following the OFT’s recommendation that the Pharmaceutical Price Regulation Scheme should be renegotiated so that the prices the NHS pays reflect the medicines’ value to patients (PJ, 24 February, p208 and 11 August, p143).

Finally, a White Paper setting out future proposals for developing pharmaceutical services (PJ, 4 August, p118), due to be published before the end of the year, now looks set to come out early in the new year.