Customer Insights

Customer Insights

Industry intelligence in association with STAR November 2008

The role of the pharmacist is undergoing significant change. The Government’s recent White Paper on Pharmacy foresees pharmacy becoming a more clinical profession. This month, Customer Insights profiles a Principal Pharmacist and finds the development of a clinical pharmacy service is a high priority.

What is your title?

Principal Pharmacist, Medicines Management and Formulary.

What are the main objectives/responsibilities within your role? How/why has it grown in importance in the past few years?

My role is to co-ordinate the liaison of the Specialist Pharmacists with medical, nursing and pharmacy staff to develop and monitor local prescribing policies and drug-related treatment guidelines. Another important responsibility is ensuring that the principles of evidence-based medicine are used to make positive recommendations for change where necessary, taking into account clinical and cost-effectiveness. I also need to ensure that mechanisms are in place to facilitate the introduction of new medicines and to ensure usage is appropriate and in line with current NICE guidance, local policies and decisions of the local PCTs.

Managing the formulary is also a major aspect of the role, with the key responsibilities being monitoring and assessing compliance with the formulary to ensure that prescribing is in line with agreed guidelines and policies. Other aspects include:
• Developing and implementing a safe and effective medicines management policy for the Trust in relation to non-formulary drugs.
• Ensuring that formulary developments are communicated to relevant staff both within the Trust and externally to local PCTs and secondary/tertiary care providers.
• Liaising with pharmaceutical industry representatives to discuss new products/licensed indications.
• Disseminating knowledge of developments to other staff and, where appropriate, obtaining financial information for drug reviews.

Another key responsibility is to provide a clinical pharmacy service as part of the multidisciplinary team to patients in a clinical specialty, to ensure maximum efficacy, safety and economic drug use and to demonstrate professional accountability to enhance patient care. This role involves supplying medication, reviewing complex medication regimens, taking medication histories and monitoring for any adverse drug reactions and interactions.

Finally, I need to develop processes with the departments of Service Performance and Finance, to inform and assist funding arrangements for high cost drugs. This involves:
• Minimising unexpected financial pressures by regularly reviewing and updating tariffs for such high cost drugs.
• Improving financial planning by working with other organisations and key decision makers (PCTs, Commissioners and Managers) to ensure provision of funding for high cost drugs as agreed by the Drugs and Therapeutics Committee (DTC) and the Financial Monitoring Group (FMG).

This role has grown over the last few years with the cost pressures from government on both NHS hospital Trusts and PCTs.

What does a typical working week look like? With whom would you expect to liaise during a week?

Most mornings will involve providing a clinical pharmacy service to a dedicated medical ward. Once wards are completed the week’s work can vary. Tasks include critically analysing and interpreting published data on new drugs or new indications, preparing drug evaluations for the DTC and updating and reviewing protocols. These tasks will generally involve liaising with consultants or other senior doctors, nursing staff and specialist pharmacists to ensure that every area is covered and all points of view are considered.

What and who are the major influences on the decisions you reach? How do you arrive at your priorities?

Medication and patient safety is one of the biggest influences on decisions that are made, coupled with evidence which supports changes to clinical practice.

Financial implications are also a major influence in the current climate, while ensuring the most cost effective treatments are used is important. These decisions are made in conjunction with consultants, the director of pharmacy and specialist pharmacists and are driven by requirements from NICE, the DoH, the NPSA and the Trust’s priorities.

Who are the other influencers within your local healthcare economy with whom you liaise?

Formulary and Lead PCT Pharmacists.

What contact do you have with people from pharmaceutical companies?

Contact with the pharmaceutical companies is limited to that with medical sales representatives. Appointments are made when a drug request has been made from a clinician. The process theoretically should work like this. Reps would arrange a meeting with the clinician in the therapeutic area the new drug is to be used in. They would then discuss the merits of the new therapy and whether there is a need for it as a treatment option. If there is, what should then happen is that the clinician contacts either myself or the pharmacist who works in their area. The pharmacist would then make contact with the rep to ask for any supporting information on the drug.

This is what should happen, but in practice we have reps who just come to pharmacy and ask to see myself or the pharmacist in that area. I do not actually see reps who do that as firstly, I don’t have time to waste, and secondly, I’m only interested in new therapies if the consultants are.

How can the pharma industry achieve greater access to people who perform your role? What kinds of information might they be able to provide you with to help you in your role?

Medical representatives should be well informed about the products that they are promoting. In addition to standard technical and clinical data, including information on comparative efficacy, the pharmacy will wish to know what is being promoted, the basis for the promotion, and the specific place that the product is expected to have in therapy. Non-published in-house information would be very helpful to achieve a better understanding of the medication that the company would like to have on the formulary.

What do pharmaceutical sales professionals need to do to improve their communications with this group?

Pharmaceutical sales professionals will generally tend to discuss cost before efficacy. Cost is an important factor; however, as health professionals our main objective is to ensure that the medications patients receive are safe and effective. Changing the focus to these areas will help a build a better relationship.

What would be your top tips for medical sales professionals in how to improve relationships, and therefore productivity, with this group?

• Know your product and its target audience.
• Focus on patient safety and the efficacy of your product.
• Do not give free samples to clinicians.