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Laying the foundations for the future

Although there were financial problems and setbacks in IT developments, important foundations — including a White Paper and the professional body prospectus from the Transitional Committee — were laid for the future of pharmacy in 2008. Leila Taheri looks back over 2008

by Leila Taheri

Although there were financial problems and setbacks in IT developments, important foundations — including a White Paper and the professional body prospectus from the Transitional Committee — were laid for the future of pharmacy in 2008. Leila Taheri looks back over 2008

 

In years to come, 2008 will likely be remembered for the global financial crisis. And pharmacy did not escape as money woes rocked the profession. The substantial reduction of Category M reimbursement prices in the October 2007 Drug Tariff hit pharmacy contractors hard during 2008 as the Government sought to reduce purchase profit income by £400m.

On top of this, contractors saw their income affected by the NHS Business Services Authority Prescription Pricing Division’s computerised pricing system introduced in 2007. Pharmacists were penalised for mistakes made by the computer system in patients’ declarations of exemption from prescription charges. To counter these financial losses, contractors in England learnt that they would be offered £3.5m in compensation in October.

Financial issues were further recognised as a rescue package of £150m was announced by the Department of Health in September to help improve financial stability for pharmacy contractors in England.

Meanwhile, in Scotland, financial planning appeared more stable. In November, funding of £3,600 for each community pharmacy contractor was announced. The funding formed part of the contract preparation payments programme, designed to support further implementation of the new Scottish community pharmacy contract.

Hospital pharmacists were not without their own financial worries. For the first time in more than 20 years, members of the Guild of Healthcare Pharmacists were involved in industrial action over the proposed three-year NHS pay deal. Health union Unite, which includes the guild, advised its members to reject the pay deal because it offered a real-term pay cut during years 2 and 3, were the rate of inflation to continue to rise.

Industrial action was taken in December and Unite warned that if the Government did not make concessions to improve the proposed pay deal, industrial action would include strikes in January 2009.

Midway through the year, pharmacists learnt that the DoH looked likely to negotiate a 5 per cent saving on the prices of branded medicines, with the UK-wide price cut initially due to come into force in January 2009.

However, towards the end of the year, the pharmaceutical industry and the DoH announced that their revised pricing deal would be staged, and agreed to defer the first price cuts until February. This went someway to allay fears of medicines shortages over the Christmas period since pharmacies had been expected to reduce their stock to try to minimise losses had the cuts not been delayed.

Services

In August, Scotland announced two new public health services as part of its community pharmacy contract: a smoking cessation service and a sexual health service. Pharmacists will be able to supply emergency hormonal contraception, azithromycin for chlamydia infection and nicotine replacement therapy under national patient group directions.

Scotland’s chronic medication service also came a step closer in 2008. In December, the Scottish Government outlined how the service would work and suggested that it would formalise pharmacists’ role in the management of long-term conditions. Negotiations are ongoing so this is one to watch out for.

White Paper

Big changes came to Wales this year as the reorganisation of the NHS was announced in July, and in October it was announced that an overarching National Advisory Board is planned to be in place by April 2009.

A major development for pharmacists in England was the publication in April of the pharmacy White Paper.

Set to change the pharmacy landscape for decades, it signals a significant further push towards a clinical profession.

A national minor ailment scheme will be developed, support provided for people with long-term conditions, screening for vascular disease and some sexually transmitted infections offered and a bigger role created for pharmacists in vaccination services.

Suggestions for hospital practice include collaboration with primary care to provide specialist services closer to people’s homes or supporting others to develop their clinical roles.

New professional and regulatory bodies

New professional body

This was also the year it was revealed what form the professional body for pharmacy might take after the Royal Pharmaceutical Society hands regulatory functions to the General Pharmaceutical Council in 2010.

In April, Nigel Clarke — chairman of an inquiry to determine the structure and function of the professional body — concluded the Society should form an integral part of the new professional body.

Later, in November, a prospectus was published by the Transitional Committee.

It gave pharmacists a taste of what membership of the professional body could involve: consultation on the proposals continues until 9 January 2009.

During the past month the draft legislation underpinning the establishment of the General Pharmaceutical Council was published by the DoH.

The draft Pharmacy Order 2009 details the powers and obligations that the GPhC will have for regulating pharmacists, pharmacy technicians and pharmacy premises. Consultations on this closes on 9 March 2009.

NHS

In February and March two events in London and Manchester aimed to canvass the opinions of pharmacists for health minister Lord Darzi’s next stage review of the NHS for England. The events focused on issues relating to urgent seamless care, easy access to medicines, supporting people with long-term conditions and staying healthy.

NHS at 60

To tie in with the celebration of the 60th anniversary of the NHS, the Darzi review was published at the end of June and contained proposals to transform the quality of healthcare received by all NHS patients.

It put quality at the centre of the NHS with patient choice as the principal driver.

The report revealed significant variations in the quality of care, and tackling this was made a priority. Promoting healthy living and preventing illness through pharmacies is central to the DoH’s care strategy.

Regulations governing the role of the responsible pharmacist were laid before Parliament in November and are set to come into force across the UK in October 2009.

The new regulations will allow a pharmacist to be absent from a pharmacy for up to two hours during normal business time and, significantly, will allow non-pharmacists to sell general sale list medicines in the pharmacist’s absence.

The regulations have divided the profession: they are opposed by the guild and the Society’s Hospital Pharmacists Group, both of which believe they are unworkable in registered hospital pharmacies, because the pharmacist deemed responsible is often a senior pharmacist who is not necessarily based in a hospital dispensary.

Prescription charges continued to make news. In Wales, NHS prescriptions remain free and charges will be phased out in Scotland by 2011. In England, the situation is not so clear cut because prescription charges rose to £7.10 on 1 April.

But there was good news for cancer patients as prime minister Gordon Brown announced in September that prescription charges for cancer patients are to be scrapped in England from 2009.

In November, the DoH announced that patients in England will be allowed to top up their NHS care by paying for medicines not available on the NHS without forfeiting their right to free NHS care.

However, the abolition of charges in England seems not to be on the agenda (see p722 for developments for Scotland).

IT development

Which?

In September, an undercover Which? investigation found that pharmacy staff need more training to provide satisfactory advice.

However in November a Which? survey put pharmacies top for out-of-hours services.

This year was meant to be when the electronic transfer of prescriptions took off. Concerns were raised in February that GP surgeries were not yet producing enough bar-coded prescriptions to make dispensing via the service feasible.

Doubts were raised when it was announced that testing of release 2 of the electronic prescription service was to start at least six months later than originally planned. Things seemed to improve in March as the number of prescriptions being dispensed via release 1 of the electronic prescription service was consistently growing.

However, in April most contractors using barcoded prescriptions reported problems. Latest reports from Scotland have been that the implementation of ETP is continuing successfully.

In October, a series of fact sheets on developments in information technology in Wales was published to raise awareness among the pharmacy workforce. The Welsh implemented two-dimensional bar-coded prescriptions in 2007. Phase 1 of the system has been under way since January and the Welsh aim is that all GP printed prescriptions will be bar-coded by February 2009.

EPS uses technology to good effect but the internet has enabled the development of businesses that offer drugs without a prescription with accompanying concerns about the quality of the medicines purchased, not to mention the hazards of self-medication.

In January legitimate pharmacies received a boost as the Society launched a voluntary internet pharmacy logo to help the public identify pharmacies registered in Britain and avoid those operating illegally.

In keeping with the theme of IT development, a new interactive version of PJ Online was launched on 1 July. The new website also incorporates the PJ Careers website.

Medicines distribution

EU prescriptions

From November, UK pharmacists were given the option to dispense prescriptions that have been written by a practising doctor or dentist in Switzerland or the European Economic Area.

Following the Office of Fair Trading’s announcement in December 2007 that it would not outlaw direct-to-pharmacy distribution, several manufacturers began such schemes in 2008. In June UniChem was the only wholesaler to reach an exclusive direct-to-pharmacy deal with a manufacturer (Pfizer).

In the same month, Novartis announced AAH and UniChem as its only two wholesalers and in November, Lilly UK announced that from next summer, all of its drugs will be supplied to pharmacies by AAH Pharmaceuticals and Phoenix Healthcare acting only as distribution companies.

POM-to P switches

The year was a busy one in the world of prescription-only to pharmacy medicine switches. In April, naproxen 250mg became a P medicine for period pain following approval of its reclassification by the Medicines and Healthcare products Regulatory Agency.

The European Medicines Agency recommended that orlistat 60mg (Alli) be available without prescription and in June the MHRA also announced its switch.

Consultation opened in November on the POM-to-P reclassification of tamsulosin, used to treat benign prostatic hyperplasia. Significantly, this will require for the first time a diagnosis to be made by a pharmacist that would then be verified by a doctor for further supplies of the drug to be made.

In the same month, azithromycin became the first oral antibiotic to be available without prescription from pharmacies for the treatment of chlamydia infections.

These developments seem to be further stepping stones for pharmacists to leave their dispensaries and offer patients more clinically oriented services. The challenge for 2009 will be to make sure that patients recognise that this has happened.

New faces in the profession of pharmacy

Steve Churton

Martin Stephens

Jonathan Mason

Steve Churton
Martin Stephens
Jonathan Mason

The Royal Pharmaceutical Society’s Council elected Steve Churton President of the Society at its meeting in June 2008.

Two new clinical directors with exclusive responsibility for hospital and community pharmacy in England were announced by the Department of Health in October — Martin Stephens and Jonathan Mason respectively.

Two top positions on the Royal Pharmaceutical Society’s Disciplinary Committee were filled as His Honour Judge Mota Singh QC (since retired) was appointed chairman and Patrick Milmo QC was appointed deputy chairman in February.

Citation: The Pharmaceutical Journal URI: 10043889

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