Pharma and the High Street health shop
pharmafile | September 23, 2008 | Feature | Sales and Marketing |Â Â industry relations, pharmacyÂ
The April publication of the long-awaited pharmacy White Paper – 'Building on Strengths, Delivering the Future' – spells exciting times ahead for pharmacy and industry.
Pharmacists will start to work more closely with existing GP services and find themselves taking on bigger and more influential clinical roles. Pharmacists searching for ways to take on these new roles, may find themselves turning to pharma companies for support and information. This will no doubt strengthen pharmacist and industry relations, leading to closer working practices and greater opportunities for companies looking to invest in the emerging 'pharmacy clinician on the high street'.
Pharmacies as healthy living centres
Under the proposals in the new white paper, the focus will change from the supply of medication to a more encompassing role where pharmacies become 'healthy living' centres, promoting health and helping people to take better care of themselves. Pharmacists will be able to prescribe certain common medicines and become the first port of call for minor ailments. They will provide support for people with long-term conditions such as high blood pressure or asthma, 50% of whom may not take their medicines as intended. Screening will also become very important in the future of pharmacies, with easy-to-access schemes for people at risk of vascular disease and certain sexually transmitted infections, such as chlamydia. It is also hoped that pharmacies will play a bigger role in vaccination.
Today, pharmacists make up a large network of healthcare professions that provide easy access to medication and advice. The latest information shows that 99% of the population – even those living in the most deprived areas – can get to a pharmacy within 20 minutes by car, and 96% by walking or using public transport. Not only this, pharmacy opening hours tend to be more convenient for patients to get to. In the last few years there have been around 400 pharmacies licensed to open 100 hours per week, making pharmacists more accessible than ever.
Under the contractual framework for pharmacists, introduced in 2005, the services that community pharmacies provide fall under three categories: essential, advanced and enhanced.
Essential services that must be provided are dispensing and repeat dispensing services, health promotion and healthy lifestyle advice, signposting to other services, support for self-care, and disposal of medicines.
Provided that the pharmacist and premises are suitably accredited, a pharmacy can also provide advanced services. There is one currently – the nationally agreed medicines use review (MUR) service. A pharmacist reviews a person's use of their medicines, offers advice on appropriate use to promote compliance, and may make recommendations for changes to the person's GP. Over 1.25 million MURs had been conducted by February 2008.
A pharmacy can also provide local enhanced services, which are commissioned by primary care trusts (PCTs). The most common in 2006-7 were stop-smoking schemes; supervised administration (of methadone for drug misusers); patient group directions (PGDs), for example to supply emergency hormonal contraception or nicotine replacement therapy; and minor ailment schemes, where patients can visit a pharmacy for free over-the-counter treatment on the NHS without the need to see their GP for a prescription.
The white paper also outlined government plans to direct all PCTs to commission certain services from pharmacy contractors according to local community needs. These services, known as directed enhanced services, will provide a useful mechanism in addition to advanced and local enhanced services.
New services
The white paper highlighted a range of services that it wants pharmacies to implement in the future. Many of these come under local enhanced services, which need to be commissioned by the PCT. Examples of areas in which pharmacies could become more involved are:
* Healthy weight, healthy life: pharmacies could offer body mass index and waist circumference measurements; weight management clinics in the pharmacy or elsewhere; prescribing or PGDs to enable the supply of weight reduction medicines as part of an overall weight reduction strategy; and education, information and advice for all.
* Smoking: pharmacies could offer opportunistic and brief advice/interventions; NHS stop-smoking clinics, including through schools; supplementary prescribing of medicines that help people stop smoking; and stop-smoking medicines through PGDs.
* Sexual health: pharmacies could promote condom use and provide access to free condoms at screening and treatment sites; use prescribing or PGDs to enable the supply of medicines related to sexual health; provide advice, emergency hormonal contraception and other contraception in a secure and private environment; carry out the NHS teen LifeCheck and sexually transmitted infection checks; and supply the contraceptive pill.
* Alcohol use: pharmacies could offer screening and assessment; use prescribing or PGDs to enable the supply of medicines related to reducing alcohol intake; and carry out blood tests to detect levels of alcohol consumption and early risks of complications developing.
* An ageing population: pharmacies could provide healthy lifestyle advice; support for self-care; signposting to social care; guidance on aligning health and social care plans; focused medication reviews for the most vulnerable, eg to prevent falls; and a dispensing and delivery service for compliance aids.
* Long-term conditions: pharmacies could improve medicines-related care to reduce emergency admissions; provide screening services to identify those at risk of developing, or who have already developed, a condition but are unaware of it, eg raised blood pressure and diabetes; offer medication reviews and adherence programmes to improve medicine taking; and participate in the prevention and early detection of some cancers.
* Mental health: pharmacies could offer instalment dispensing and supervised administration; train patients and carers about medicines; become involved in evidence-based alternatives to medicines, eg information about/provision of computerised cognitive behavioural therapy and general information about talking therapies; provide information about local support networks and mental health helplines; and help to identify people who show signs of depression and refer them on appropriately.
* Drug-misuse-related harm: pharmacies could provide needle exchange services; supervised administration of drug therapies; and immunisation for and advice on blood-borne viruses. They could also use independent/supplementary prescribing and PGDs, as appropriate.
* Health and work: pharmacies could support people in self-care, especially for common causes of sickness absence, eg back pain and stress, and carry out outreach work with local employers.
Funding services
Although the white paper has a vision of pharmacy moving in a new direction, becoming involved in more clinical roles and services that will enhance the health of the community, the issue of funding is still unclear. Many pharmacists are concerned about implementing changes that they have no way to fund.
One route is by working more closely with industry. By fostering relationships between pharmacists and pharma companies, there is an opportunity to set up pharma-sponsored schemes that support clinical roles for pharmacists and also increase loyalty and visibility.
Pharmacists will need a lot of support, both financial and otherwise, to get these services off the ground. Examples of information they might need include training and professional services; developing a business case for a new service, including how to get funding and alternative sources of funding outside the PCT; setting up services, eg promotional material and screening devices; and support with the execution of the new services.
Another route is for pharmacists to actively seek funding from local PCTs or GP surgeries under practice-based commissioning (PBC) guidelines. Pharma companies can also make the most of PBC to engage with pharmacists.
Practice-based commissioning
PBC was introduced in England in April 2005. Under this framework, GP surgeries can directly commission clinical services. Each surgery or 'cluster' of services receives a budget from the PCT. The aim of this change is to transfer the balance of care, focusing more services in primary care so as to better meet the needs of the local community. As many GP practices will be able to keep up to 70% of their savings, there is a real incentive for them to find cost-effective service providers such as pharmacists.
With the advent of many new pharmacy-based schemes, especially around medicines management, pharmacists are in a good position to become providers of services. For pharmaceutical companies, this means a number of new prospects for pharmacy relations.
Pharma companies could facilitate pharmacists to obtain funding. By supporting pharmacists they will be simultaneously increasing loyalty to brands that improve health benefits and offering pharmacists and patients the support that they need.
Pharmacies can make bids to provide services to GP clusters. Examples of services that a pharmacy could provide include community diabetes services; sexual health services such as emergency hormonal contraception and chlamydia screening; multi-disciplinary pain clinics, eg involving pharmacy and physiotherapy; MUR schemes centred around specific conditions and therapies; screening and monitoring, eg anticoagulation, blood pressure and blood-glucose testing; medicines management; immunisation; patient education and health promotion initiatives; minor ailments schemes; stop-smoking schemes; and GP practice-based services such as pharmacist-run clinics. Some of these services could be provided through pharmacists with special interests or pharmacist prescribers.
How can pharma companies get involved?
There is an unprecedented level of opportunity for pharma companies to get involved in PBC, especially with pharmacists and the NHS becoming more open to such partnerships.
Pharma companies can get involved from two angles: driving pharmacy services by working with PBC groups, or working with pharmacists and local pharmaceutical committees to demonstrate to PBC groups the cost-effectiveness of pharmacy-led services.
Pharma companies and pharmacies already have strong links, so it is a great opportunity for building deeper partnerships through PBC. By helping pharmacists pitch ideas to GP clusters, pharma companies can play an invaluable role in promoting services and products. This mutually beneficial partnership means that, the more pharmacies willing to provide services, the bigger the portfolio for pharma companies wishing to participate in PBC and the better value for money for GP clusters.
Start by scrutinising and understanding the local area and the possible targets and objectives for each GP cluster. This information is invaluable for targeting your customers. Recruit pharmacists in the local area willing to provide these services and facilitate them to prepare pitches and get accredited for new roles.
Pharma companies may need to change tactics, moving the emphasis away from a particular brand, to providing services and advice that, in the long-term, will become synonymous with the brand. Companies can integrate into the PBC framework by providing pharmacist service providers, as well as business information.
Bringing it all together
Pharmacy is changing. The White Paper reinforces the changing role of pharmacists and shows clear support from the government. New services will be incorporated into the contract, meaning that, in the future, most if not all pharmacists will become influential pharmacy practitioners of some sort. What type depends on the individual and also what funding and support are presented to each of them.
By working more closely with pharmacy, pharma companies can support new emerging services and facilitate pharmacists in creating their vision of healthcare in the future. The reward for industry is increased loyalty and recognition from this key healthcare professional in primary care – the pharmacist.
Box: A heavyweight nation – the obesity challenge
A quarter of the adult population in England is classified as obese, along with almost a fifth of all children under the age of 16.
The government have predicted that if no action is taken, 60% of men, 50% of women and 25% of children will be obese by the 2050.
Obesity is responsible for 9,000 premature deaths each year in England. It reduces life expectancy by nine years on average and increases the risk of a range of diseases, such as diabetes and some cancers (endometrial, breast, and colon).
Obesity has huge economic costs. It costs the NHS approximately £4.2 billion per year, expected to more than double by 2050. Reduced productivity costs the wider economy in the region of £16 billion, estimated to rise to £50 billion per year by 2050 if left unchecked.
Proposals to tackle the problem include pharmacies offering weight management clinics, prescribing weight-reduction medicines and education, and information and advice for the overweight.
Fawz Farhan and Paul Lowndes are directors of Mediapharm, a marketing communications consultancy specialising in pharmacy education. For more information visit: www.mediapharm.co.uk
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