ABPI Comment

by Admin 1. September 2004 05:00

Responding to Government proposals to extend legislation to tackle animal rights extremism, Dr Trevor Jones, Director General of the Association of the British Pharmaceutical Industry has said recently: “The Government is now committed to solving the problem and has recognised that animal rights intimidation is now an issue of terrorism. Action has been needed for some time and they are plugging some important loopholes in the existing law. We earnestly hope that the extension of police powers to arrest, banning of intimidating protests outside people’s homes and widening laws relating to harassment will make a difference.”

The announcement of the House of Commons Health Select Committee inquiry into the partnership between the pharmaceutical industry and those responsible for health policies, outcomes and future direction in the UK has been welcomed by the Association of the British Pharmaceutical Industry (ABPI). The ABPI notes that the Health Select Committee recognises the contribution made by the pharmaceutical industry to the health of the nation as well as the substantial economic benefits that it brings. The ABPI looks forward to co-operating fully with the committee as the inquiry progresses.

The wide-ranging inquiry will cover six main areas:

Drug innovation: The The UK-based pharmaceutical industry is a world-leader in discovering and developing innovative new medicines, with 25 of the world’s top 100 medicines originating in the UK. The industry invests nearly £10 million every single day in the search for new medicines.

Conduct of medical research: Medical research in the UK is conducted to the highest standards, and UK-based clinical trial work is highly regarded throughout the world.

Provision of drug information and promotion: The inquiry is particularly timely as the codes of conduct regulating the promotion and marketing of medicines are already being reviewed within the industry across Europe. As part of this, the ABPI is carrying out its own consultation and review of the ABPI Code of Practice, and will take into account the conclusions of the Health Select Committee.

Professional and patient education: The pharmaceutical industry carries out a large and extensive programme of education for GPs and other healthcare professionals that forms a vital element of their professional development.

Regulatory review of drug safety and efficacy: Companies have to demonstrate that each new medicine is safe and effective either to the UK regulatory authority, the Medicines and Healthcare Products Regulatory Agency, or the European body before it can gain a licence for use.

Product evaluation, including assessments of value for money: Medicines are an extremely cost-effective health intervention. Each prescription costs the NHS about £10, while a week’s stay in hospital costs at least £1,500. The industry in the UK makes a huge contribution to the health of the men, women and children of Britain as well as to the national economy. One of the key planks in achieving this success is to work in partnership with the Government and its various agencies and bodies, and we look forward to giving details of this activity to the Health Select Committee,” said Vincent Lawton, President of the ABPI.

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Features

Pharma Hurdles Ahead But Failure is No Option

by Admin 1. September 2004 05:00

THE PHARMACEUTICAL INDUSTRY is facing testing times. There is a growing concern that the drugs pipeline is drying up, attractive drug discovery technologies have stagnated and the investment circle is becoming conscious of the risk involved during drug development. So far, the pharmaceutical companies have been focussing on small molecule-based chemical drugs. The idea has been to develop a small molecule blockbuster drug and expect it to generate huge revenue. Increasingly, pharmaceutical companies are interested in biopharmaceuticals and are actively involved in biopharmaceutical development and manufacturing activities.

At least 30% of the drugs currently developed are biopharmaceuticals and this trend is on the rise. There are around 500 biopharmaceutical drugs in various stages of clinical trials. Around 150 biopharmaceutical drugs are in Phase III trials in Europe and around 15-20 of these are expected to be marketed in the next three years. Some biopharmaceutical drugs are moving towards blockbuster status: peakyear sales potential for Erbitux and Avastin, both biopharmaceuticals, are likely to make around $1 billion and $1.8 billion, respectively. Consultants at IBM Consulting Services believe that pharmaceutical industry will need to move from “small molecule-based blockbuster” model to “biological individualised therapy”. Apart from this fundamental shift, the pharmaceutical industry will need to put emphasis on early validation of targets. This can be achieved by testing on several endpoints and using more than one technique to validate drug targets. An early drug failure can save huge amounts of money and resources that could be used for other important projects.

The pharmaceutical industry will be better off providing pharmaco - medicine that involves an integrated healthcare solution approach providing not only the drug but also diagnosis, treatment, monitoring and patient support as a package solution. Cholesterol testing has helped Merck achieve blockbuster status with Mevacor although it was offpatent in 2001. Diagnostics integral to Roche’s breast cancer drug Herceptin generated sales of $385 million in 2002, up by 11% when compared to sales in 2001. Growth in the Herceptin market is expected and annual sales are expected to cross a billion dollar mark in 2004. One of the major challenges the pharmaceutical industry needs to overcome is the high level of ineffective bureaucracy that is prevalent in big pharmaceutical companies. The industry needs to move towards a risk versus reward management culture. Pharmaceutical industry board and management teams should make investments and resource allocation on the basis of overall corporate risk profile. The industry must have clear vision and corporate strategy so that the resources can be allocated accordingly. Expert portfolio management allows efficient resource management and also makes management make decisions in line with corporate goals and vision.

Drug development can take anywhere between 8 to 16 years, and average cost of developing a drug is around $500- $800 million. Investors expect quick return on their investment. It is thus very important for pharmaceutical companies to find ways to meet short-term investor expectations. Communicating with investors is important to keep them in the loop with company strategies and to convey risks associated with the pharmaceutical industry. Financial transparency, target performance, and efficient communication are important in keeping the investors interested in pharmaceutical activities within the industry. Pursuit of creative collaboration and partnership is also a key requirement to success. The current move is towards establishing strategic alliances with small to mediumsized biotechnology companies allowing pharmaceutical companies to harness entrepreneurial skills from the former. This can help reduce the cost of marketing and help with market penetration. Successful examples of marketing partnership include those between Genentech and Roche for please check and Merck KgaA and ImClone for colorectal anticancer Erbitux.

A healthy alliance is the way forward and will be of mutual benefit to both pharma and biotech companies. As more generic drugs are entering the market, building and maintaining distinctive, recognisable brands is crucial. Faced with drying pipeline for the blockbuster drugs, crowded therapy areas and aggressive generic entrants, pharmaceutical companies need to bring their act together to develop and maintain new brands and also build on existing brand names to remain competitive in the market. The global healthcare industry is currently growing at approximately 8%, but part of the reason is because this year has been biopharmaceutical’s year of the bear. Biopharmaceuticals are likely to continue to take fair share of the healthcare market and be in direct competition to the small molecule drugs. The pharmaceutical industry also needs to keep investors interested for the successful transition from a small molecule-based blockbuster model to a biological-based individualised therapy model.

Background Frost & Sullivan, an international consultancy firm, has been supporting clients’ growth for over four decades. Our market expertise covers a broad spectrum of industries, while our portfolio of advisory competencies include strategic consultancy, market intelligence and management training. Our mission is to work with our clients’ management teams to deliver market insights and to create value and drive growth through innovative approaches. Frost & Sullivan’s network of more than 500 consultants, industry experts, corporate trainers and support staff, spans the globe with 19 offices worldwide. Media contact: Katja Feick Corporate Communications Katja.feick@frost.com T +44 (0) 20 7915 78 56 frost.com

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Features

The Politics of Health

by Admin 1. September 2004 05:00

It is the very Tory-ness of Labour’s policies that continues to give Tory front-benchers nothing to actually disagree with Labour over and keeps the all-important middle England voter on-side. So, how have Labour performed in terms of “saving the NHS”, since coming to power, and what are their plans for health under a third Labour term? Let’s start by reminding ourselves just what a demanding child the health portfolio is Table 1: NHS Activity 2004 Every day in the NHS:

  • Almost a million people visit their family doctor
  • 33,000 people pass through the doors of A & E
  • 1.5 million prescriptions are dispensed
  • 25,000 operations are carried out
  • 8,000 people are transported by ambulance
  • 2,000 babies are delivered

In June, John Reid, the third SoS for Health since Labour first came to power, reported in “The NHS Improvement Plan”3, progress made since the original NHS Plan and the priorities that those in the NHS need to focus on over the next five years. Like the NHS Plan before it, this document sets out Labour’s marketing plan for health going forward and so is a “must read” , if you want to stay abreast of Labour’s planned English market environment changes. The NHS Improvement Plan is described by Reid “as an extension of the ten year NHS Plan, not something completely new”. And the word “Improvement” is not in there by accident, but by design, to make Gordon Brown feel assured that the 7.2% real increase given to health in the recent spending review, will generate tangible improvements that the electorate can feel as the election looms large. Reid’s stock take on performance in health includes: Table 2: NHS Achievements under Labour Since 1997:

  • an NHS budget that has grown from £33bn to £67.4bn
  • the maximum waiting time for an operation has fallen from 18 months to nine months
  • the maximum waiting time for an outpatient appointment has fallen from 26 weeks to 17 weeks
  • 97% of patients are able to see a GP within 2 days, and
  • 94% of patients are seen, diagnosed and treated in A & E within 4 hours

But Reid is not letting those who work in health sit back and relax with the £250 billion spend on health alone over the next 3 years. Hot on the heels of the NHS Improvement Plan, July saw the release of “National Standards, Local Action”4, the new round of performance targets that our customers will be expected to deliver on between 2005-08. Sensitive to two major planks of opposition attack – “over bureaucracy” and “targets that have grown like weeds”5 - in one deft blow, Labour have removed some of the opposition’s best platforms, by reducing the number of civil servants by 76,000 (720 in health, with 1,120 “relocations”) and national health targets that have already been slimmed down from over 200 post NHS Plan, to just 20. The target headlines in the new round of Performance Planning Framework (PPF) suggest no let up on driving down the big four killers:-

  • CHD and stroke to be reduced by at least 40% in people under 75 by 2010
  • cancer reduced by at least 20% in people under 75
  • Suicide reduced by 20%

And obesity now gets a raised profile in the great scheme of planned public health improvements-ten years too late many would argue. Following the Healthcare Commission’s (formerly CHI) annual report to Parliament6 that local variations are “still rife” in the NHS, (citing issues such as twice the rate of compulsory admissions for people from black Caribbean backgrounds compared with the rest of the population and uptake of flu vaccinations in older people varying from 78% to 49% across PCTs), Labour have put renewed emphasis (and targets) behind improving the health of the most vulnerable in our society in the new PPF. Next Month: Part II References/Further Reading Mori Opinion Poll; The Independent on Sunday. 1 August 2004 The Daily Telegraph. 2 August 2004 The NHS Improvement Plan: Putting People at the Heart of Public Services. June 2004 National standards, Local Action: Health and Social Care Planning Framework 2005-2008 New Statesman, 16 February 2004 The Healthcare Commission: State of Healthcare Report. July 2004

HealthGain Solutions aligns the goals of pharmaceutical companies to the needs of primary care organisations (PCO). HealthGain achieves this through the outsourced management of sales, nurse and pharmacist teams who implement jointworking initiatives that help PCOs and their constituent GP practices realise their strategic targets. HealthGain works with an expanding network of PCOs – currently standing at 150 – adding service value that makes a difference to patients, doctors and NHS managers, thereby enhancing the reputation of its client customers with the NHS. For more information contact HealthGain Solutions Telephone: 01635 277200 Email: headoffice@healthgain.co.uk www.healthgain.co.uk The copyright of this article is owned by HealthGain Solutions Ltd © HealthGain Solutions 2002

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Features

The Matrix - Do you have Customer Agreement?

by Admin 1. September 2004 05:00

As the discussion continues I see one or two objections to her reasoning. Firstly, I don’t think that her company’s statistics on cost-effectiveness is numerically sound and secondly I feel she has glossed over a safety issue without really alluding to her reasoning. She seems to be progressing further down her line of argument but my mind is still mulling over items brought up about 10 minutes ago . . .

IF THIS REPRESENTATIVE is watching me carefully for cues to following our interactions I am probably giving out some worrying signs. Do not presume that overt acknowledgement means agreement with due process and argument. At the beginning I was probably providing factual and agreement nods – which she probably read as ‘this is going well’. More recently however I have probably been providing softer acceptances. The understanding nod, which displays ‘I see what you mean’ should not be interpreted as ‘I agree with your argument’ Furthermore, the encouraging nod (wow that’s interesting) allows me to share enthusiasm and excitement without any equivocal shift in attitude. Many appointments go like this. You must remember that prescribing/sales involves an ‘action’ from your customer. Universally, a person’s actions are as a result of their attitudes. And if you are not shifting attitudes, then you will not get the actions you require (to hit bonus). The ‘nods’ I am giving do subconsciously change but I won’t be aware of it. And very frequently neither is the representative. You should be training yourself to notice the variation in nods of agreement – I can assure you that you will notice the shifts in the types of ‘nods of agreement’ if you look for it. Use these cues as mild warnings that the customer is going through the motions. The weakest level of agreement is the acknowledgement nod (yes I am still listening) which may or may not be true (yes I am still hearing but not listening!). Life would be much easier (though unpleasant) if your customers always told you what they think. It would be easier than keeping you guessing or worse still coming out of an appointment with a beaming smile and sagging sales

4. NEUROLINGUISTICS – JUST PLAIN LIES!

She stops talking – looks back at me and smiles. Before I have chance to say anything she beats me to it. So – is the PCT thinking of funding this agent? Do you think the drug is good? Wouldn’t you agree that the service we can offer is far better than our competitor’s? Much of relationship building in sales is in listening. Not just listening to what we say but how we say it. This is difficult in today’s hectic world of one appointment after another with intermittent bouts of stop-start traffic, car park road rage and listening to your own echo in a hands-free conversation whilst driving to your next appointment. But much is obtained from questioning and importantly listening. I have noticed some pharmaceutical companies are really taking note of this and employing it as part of the sales and marketing strategy. I have been party to many conversations where agreement, nodding and almost any type of activity which encourages the representative to shoo out of the surgery/office/practice and bring the ‘sales call’ to an end is applied. There are many situations in our daily lives when we wish to hide our true feelings. We say one thing, but feel another. This must happen on a daily basis in appointments all over the country. But whilst this can’t be avoided, representatives can be sensitive to cues so as to have a better understanding of their customer’s attitudes. Key psychological experiments have attested observed behaviours that people do when they are lying or deceiving. Remember your customers are not necessarily lying as a motivated action, but they may feel uncomfortable in overtly agreeing with all of the sales pitch but are under obvious pressure to answer your questions/call to prescribe. A study in nurses who were told to lie to relatives revealed reduced frequency of hand gestures normally used to support the spoken word (it seems if we know we are lying we don’t want our hands to give us away!) - when lying, auto-contact is increased (we all touch our face/ear/nose/chin, but the frequency of this increases when we lie). - In particular covering the mouth and touching the nose. - Increased body shifts (trying to get out of the situation) - Hand shrugging is common (like expressing ‘I don’t know’ even though you are stating something) - Facial micro-expressions (most of which are too quick for human eye, especially if we are not looking for it). Fascinating – it seems even when we want to lie, the face registers this inner conflict, even if it is only for a fleeting moment before it is consciously suppressed. - Increased hesitation before replying to a question and speaks slower than usual when finally responding to the question - Tone of voice is uneven, sometimes higher pitch and often rises at the end of sentences The final aspect of lying is the directional gaze, an observation which is very much within the domain of neurolinguistics. The brain has evolved two hemispheres which differ in specialisation. The left hemisphere (logical side) tends to favour logic, rationale, analysis and linguistics. The right hemisphere (creative side) seems devoted to creative, artistic and spatial thinking. When observing hemispheric activity of the brain during the process of answering a question, when expressing facts based on logic we use the left side, but when confabulating or creating an answer we use the right side. Studies have shown that the individual who is telling the truth tends to gaze to their right (your left). When lying, the eyes gaze to their left (your right). This is because the brain controls visual fields to the opposite side to that of the hemisphere used. In fact there are distinct visual field sectors to which the eyes will briefly deviate to depending on whether the individual is recalling a fact, fabricating a story, or stating a fact. It’s by no means fool proof. But it is well studied and increasingly of importance as the understanding of human psychology during the sales process is realised by pharmaceutical companies.

5. NEUROLINGUISTICS – WHEN WILL WE MEET AGAIN ?

After some Q&A, I notice I seem to be shifting in my seat, looking at my watch and fiddling with the free gift pen that I have just accidentally broken . . . I guess I am exhibiting contradictory messages. I want to appear interested but I am not. I want to answer her questions - but don’t want to start a protracted argument. I am not bored - but my attention span is waning… Besides, her product is important and we are evaluating it in the near future. After making some subtle motions (and some unsubtle ones) I abruptly stand up and thank her for her time. I have scribbled some notes and request one or two papers from her. Inevitably, the most interesting part of her ‘presentation/discussion’ is not allowable for me to take away, though I can expect a visit from the ‘men in black’ from head office if so requested. I make effort to see her out and ask if she knows where she is going/how to find her way out of this place. An interesting social junction occurs as she sees one of her competitors wave to me as we gather at the top of the stairs. I prepare myself for the next appointment as no doubt, she is preparing for hers . . . Please – do come in, and step into my office.

OMAR ALI is the Formulary Development Pharmacist for Surrey and Sussex Healthcare NHS Trust and is a PCT Formulary Adviser to 2 PCTs. He is a lecturer on the MSc on Pharmacy Practice at Portsmouth University and is also an adviser to three Drugs and Therapeutics Committees in the South of England. Omar is a National Speaker in the UK (cardiovascular, diabetes, mental health) and is an Executive Board Member for the National Obesity Forum. He can be reached directly on ‘alipha@aol.com

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Features

Never mind the width, feel the quality!

by Admin 1. September 2004 05:00

Paul Midgley of the Healthcare Partnership reviews the impending new GMS contract-related ‘Quality and Outcomes framework’ (QOF) practice assessment visits that every PCT will be making on every practice across the UK during the period October 2004-January 2005. This article outlines the process, the concerns this will raise for practices, and how you can use this as an opportunity to support key practices in their hour of need and boost your credibility and contacts with key target customers into the bargain.

Introduction

The new GMS contract, introduced into General Practices across the UK in April 2004, brings with it a platinum-plated, (voluntary) incentive scheme (QOF) for all practices to earn substantial additional income in addition to their guaranteed patient population-based monthly payments (known as the ‘Global Sum’ for GMS practices). Practices engaging in the QOF scheme achieve points by providing a wide variety of chronic disease management and practice organisation services to nationally prescribed standards (email HCP for details of the QOF scheme – see next page). An average sized practice, achieving full marks in the QOF scheme (1050 points), will earn an extra £78,750 in year 1 (April 04-March 05) and £126,000 in year 2 (April 05-March 06). It is estimated that by the third year of the contract, high achieving practices could derive a third of their income from the QOF! Needless to say, every practice is actively engaged in trying to gain as many points as they can – because as we know, points make prizes . . . With this much money at stake, the Department of Health has insisted that PCTs ‘risk manage’ the process by visiting each practice involved in the QOF scheme, to verify certain aspects of their compliance (including fraud prevention), and to help practices to aim high and achieve good results, as this benefits both patients and practices alike.

Where are we now?

Every PCT has now appointed QOF Assessment visit teams, each team comprising the following roles at a minimum:

  • Visit lead – a PCT manager involved in the new GMS contract
  • A local GP
  • A lay member (ie non healthcare person to represent patients’ concerns) Other individuals may be co-opted onto these teams – e.g. a practice manager representative. In addition, practices may request that their LMC representative attends, or even an accountant or solicitor! The DoH released details of the QOF Assessment visits in the middle of July, and aimed to have visit dates in the diary for every practice by the beginning of August. Given the tight timescale, the intervening Summer holiday, September being the start of the frenetic ‘flu vaccination season, and that practices are only 1/3 of their way into the new GMS contract at time of writing, means many practices are panicking about providing the level of information required to fulfil the visit team’s needs. Also, practices being visited in October may find it difficult to demonstrate significant progress towards their year-end QOF points aspiration which they estimated back in January, after only 6 months of the contract. An additional factor causing concern is that QMAS, a national computer system on which all the practices’ data must be present, does not go live across England till September, giving some practices only one month to learn how to use QMAS and add their own data manually! (for more information on QMAS, which links to all practice IT systems, visit www.npfit.nhs.uk/qmas).
  • Timings around the QOF Assessment Visits

    Here are the timelines of the visit process, which all occurs within a 2 month period around the visit date itself. Every practice will be visited within the period October 2005- January 2006.

  • By end July, agree date for QOF Assessment practice visit
  • September – QMAS global IT QOF measurement system goes live in England. Practice needs to be able to use QMAS to calculate Chronic Disease Management points aspect of QOF, and to input other areas of QOF achievement onto QMAS manually via a web link
  • 1 month prior to visit – practice submits written portfolio and QMAS data to PCT QOF visit team
  • 2 weeks prior to visit – PCT assessment team reviews written portfolio & QMAS data, to identify areas of focus for practice visit – contacts practice to resolve areas of concern/gain extra info
  • 1 week prior to visit – PCT sends practice outline agenda for the visit
  • Assessment Visit – review achievements; assess likely QOF points outcomes at 31/3/05; confirm data quality and accuracy of reporting via random checks; discuss QOF points aspirations for 2005-6; agree outcomes of the visit and any action plans
  • 2 weeks post-visit – PCT drafts report and shares with practice
  • 1 month post visit – PCT finalises report, signed off by Chief Executive
  • Outcomes of the QOF assessment visit for every General Practice

  • Written report
  • Likely QOF points achievement
  • Areas of good practice
  • Remedial action plan
  • Learning points for future assessment visits
  • Formative Development Plan for the practice (suggestions where the practice might focus)
  • Areas of QOF requiring written evidence from the practice for the visit

    Practices will be sent a 20-page pro-forma inviting them to submit written evidence of achieving standards against individual QOF indicators under the following headings:

    Records and Information about patients 19 indicators, 85 points), including Smoking Cessation and Blood Pressure measurement targets Information for patients (8 indicators, 8 points) – includes information about smoking cessation Education and training (9 indicators, 29 points), including PDP, appraisal, CPR training and Significant event reviews Practice management (10 indicators, 20 points), including Hep B vaccination status Medicines management(10 indicators, 42 points), including drugs for treating anaphylaxis, and medication reviews for all patients on repeat medicines Patient experience (4 indicators, 100 points), including running an approved patient survey and involving a patient group in the results feedback Additional services including: Cervical screening (7 indicators, 22 points) Child health surveillance (1 indicator,6 points) Maternity services (1 indicator, 6 points) Contraceptive services (1 indicator, 2 points)

    Support required to make QOF Assessment visit process a success

    The following areas require training and meeting support:

  • PCT QOF Assessment visit team training events
  • Training for Practice Managers/GPs by PCTs on the process
  • How to use QMAS correctly
  • Effective use of practice IT system to gain maximum points on QOF
  • Training within practices to brief staff on how to prepare for the visit
  • Post-visit Development Planning to sharpen the practice’s focus on key priority areas
  • Post visit process meeting for PCT QOF assessors to learn from their experiences in advance of year 2 visits
  • What can you do?

    Does your product help practices meet key targets outside the chronic disease areas where you may well have already been focusing, for example, smoking cessation? Are there any areas above where your company provides training or information that will help practices provide written evidence that they have achieved the required standards? Look carefully at the QOF indicator areas mentioned above (contact HCP for a copy of the full QOF indicators document).

    If your company does not provide the required services or support themselves, could you provide these to key practices via a third party supplier? (see below). Talk to key target GPs, or practice managers in target practices, to find out what their needs are around the new GMS contract, and discuss the QOF Assessment visits. Your help could range from simply providing lunch at a meeting they have already scheduled, to providing a bespoke workshop for a practice etc on a specific aspect of the visit process or follow up development action planning.

    What have you got to lose? Customers will be impressed at your knowledge, delighted that you are taking an interest, and keen that you are helping wherever you can. You in turn will gain better access to key customers, and will sell more as a result . . .

    If you would like further information on the training provided by the Healthcare Partnership, and the range of 25 topical talks and skills development workshops designed and run specifically for NHS and Pharma customers via our team of expert facilitators, then please call us on 0870 2413506 or email enquiries@healthcarepartnership.com Find out how we can help improve your access to key customers by providing ‘Preparing for your QOF Assessment Visit’ and other GMS contract related talks/workshops that attract good numbers of high quality customers. We can tailor these talks with a clinical slant if required.

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    Features

    Movements in the NHS

    by Admin 1. September 2004 05:00

    Community pharmacists have a lot going for them. They know a great deal about medicines, they are spread around the community and, so far, they are the biggest untapped resource for health improvement. In contrast doctors are in short supply and are hard pressed. #

    SO IT IS NOT SURPRISING that the Government, which has a major task on its hands convincing the electorate that it is actually doing something effective in public health and chronic disease management, has spotted the chance of ramping up the role of the pharmacist. It desperately needs to boost the local infrastructure to provide the chronically-ill with more communitybased services. Although the planned introduction of 8,000 community matrons – working as “search engines” to find solutions to patient problems - will help, they will take time to recruit and train, whereas the pharmacists are already in place. Because the DoH is not quite sure how to use this resource, it is employing a number of organisations - the charity Pharmacy HealthLink, the Royal Pharmaceutical Society of Great Britain, the Faculty of Public Health and the UK Public Health Association - to consult with pharmacists and come up with new ways of using them to improve health and reduce inequalities. These four bodies are working as a consortium, talking to pharmacists, carrying out surveys, and exploring how pharmacists could enhance their contribution to public health when they are providing health advice health, particularly to disadvantaged and vulnerable groups. These moves are all part of the programme which stemmed from the NHS Plan, was set out in the 2000 document Pharmacy in the Future - Implementing the NHS Plan, and followed in 2003 by A Vision for Pharmacy.

    It is accepted that pharmacists are well placed to assist in areas such as smoking cessation, sexual health, reducing obesity and minimising health inequalities and the plan, Tackling Health Inequalities: A programme for action, highlighted the importance of community settings and services in addressing inequalities. The new pharmacy contract will reflect the public health contribution of community pharmacists, and the government aims to “develop a coherent framework for a pharmacy public health strategy that is fully integrated with its overall approach to improving public health by 2005.” The scope for the pharmacists to play an extended role can be seen from the 10 key tasks as set out by the Chief Pharmaceutical Officer:
  • provide convenient access to prescription and other medicines
  • advise patients and other health professionals on the safe and effective use of medicines
  • be a point of first contact with healthcare services for people in the community
  • provide medicines management services, especially for people with enduring illness
  • promote patient safety by preventing, detecting and reporting adverse drug reactions and medication errors
  • contribute to seamless and safe medicines management throughout the patient journey
  • support patients as partners in medicines taking
  • prescribe medicines and to monitor clinical outcomes
  • be a public health resource and provide health promotion, health improvement and harm reduction services
  • promote value for money in the use of medicines and to reduce wastage. A Vision for Pharmacy said that the provision of enhanced services will require the accreditation of the pharmacist – usually with additional training. Such moves might also encompass quality measures relating to pharmacy premises such as a consultation area. Services will increasingly continue to be developed locally by pharmacists and PCTs in order to meet identified needs and to improve patient care. These, which evolve from the key roles, are likely to cover:
  • the supply of medicines under patient group directions to improve access to care such as emergency hormonal contraception and smoking cessation
  • monitoring of patients and recommending alteration of doses. For example, for people taking medicines that require careful monitoring such as warfarin or lithium
  • medication reviews where there is clinical need. For example, as required in the Older People NSF, for patients taking a complex range of medicines, or for people with specific conditions such as coronary heart disease
  • free supply of medicines for minor ailments, where significant numbers of patients consult their GP, which eases unnecessary burdens on GPs, improves access and is more convenient for patients
  • medicines management support for people who experience difficulty with their medicines, for example with poor compliance or side effects. And this might include home visits to help people with their medicines
  • supplementary prescribing within an agreed clinical management plan, particularly for people with enduring conditions such as asthma, hypertension or diabetes
  • smoking cessation services – with PCTs commissioning appropriately trained pharmacists to provide one-to-one advice
  • diagnostic or monitoring services, for example for hypertension or diabetes, as part of an integrated local service
  • substance misuse services, for example, needle exchange schemes and supervised consumption. With supplementary prescribing by pharmacists already up and running and the movement towards full independent prescribing underway, there is enough here to make pharmaceutical companies realise that they need to modify the tone and content of their promotional programmes aimed at pharmacists. With the current focus on chronic disease management there are bound to be initiatives in that area emerging in the near future, even though there was no specific mention of chronic disease in A Vision for Pharmacy. Until the Government has decided exactly how it will exploit the pharmacy sector, the pharmaceutical industry has a significant opportunity to influence the outcome to its benefit. As more of the GP’s role gets transferred, the importance of the pharmacist in the sales process will grow. Although this will require a whole new marketing and sales strategy, at least for the foreseeable future the pharmacists will need all the support and training they can get, meaning that making appointments should be a lot easier than trying to see GPs.
    Further Information Contact Gordon Blackwell, The National Health Intelligence Service at www.nhis.info
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