The picturesque township of Belek was the setting for the Avicenna Conference where pharmacists were given a timely reminder of what faces them in a reformed NHS. Shailesh Solanki reports from Turkey...

Having trekked around the Machapuchare mountain in north central Nepal with his family late last year, Salim Jetha was recently acquainted with the notion of uphill struggle. The Avicenna chief executive, like many within pharmacy, is only too aware that his exertions are analogous with that of the profession's own challenges. “Last year two things happened at the same time, in the same week,” he mused. “That was Category M. For those of you who are not pharmacists, Category M is a way the Government takes money away from us and last year we lost about £10,000. The second Category M was Category Mountain,” he added to a backdrop of chuckles from a congregation of pharmacists, drug company executives and health stakeholders at the Avicenna Conference, enititled Navigating Revolutionary Change, in Belek, a township in Turkey's Antalya Province. “I had never ever done trekking before but I had to pretend I am strong and everything else.” There is no scope for community pharmacists to hide behind any facade. Machapuchare, regarded as sacred by the locals, has never been scaled. Community pharmacists cannot afford to fall short of their targets if they are not to be swallowed up by reforms designed to reshape the national health service. A typically jovial Salim, however, interspersed sober realism with an infectious humour. “One of the concerns within pharmacy is abuse and crime. It is a concern to all of us,” he said. “It reminds me of an incident when a robber armed with a gun walks into a pharmacy and demands controlled drugs. He then points the gun at a waiting customer and aks 'did you see me rob that pharmacy?' and the customer replies 'yes, I did,' so he shoots him.

Hard-hitting

“He then points the gun at a couple and asks them 'did you see me rob that pharmacy?' The man says 'I didn't...but my wife did.'” Laughter erupted amongst the audience but this was Salim's way of cushioning them with a dash of humour for more hard-hitting discourse. Violence and abuse against pharmacy staff, indeed all health professionals, is no laughing matter and Salim announced that Avicenna are to distribute posters to community pharmacies raising awareness of a subject that has largely gone unnoticed. “In pharmacy we take this very seriously,” he said. “I've seen many posters on abuse in hospitals and GP surgeries but there hasn't been one for pharmacy, so Avicenna has decided to produce our own. “We will send this poster to all our members. It emphasises three points – that we like to serve our local community. The second point is that we do not accept abuse of staff and the third point is that we are your local, independent pharmacy.” If that provided reassurance for those Avicenna members who had made the trip to Turkey, there was more to come in the shape of keynote speaker Ash Soni, the sole pharmacy appointee to the NHS Future Forum, whose abilities as a pharmacist are matched by his capacity to speak in elevated company with intelligence and composure. As he told the conference he will reside on the clinical advice and leadership section of the Forum, he spoke about pharmacy's prospects with undeniable enthusiasm. As did Gul Root, the Principal Pharmaceutical Officer at the Department of Health, via video message. “The new system for the NHS and public health provides a real opportunity for community pharmacy,” she said. “Based in the heart of your local community and with real understanding and knowledge of the needs of patients and the public, pharmacists, as respected professionals, can take on roles working alongside local authorities, health and social care professionals and the public to make a real difference to the health of your local population.” Realism, though, quickly returned. “For those of you who have not yet done so, it is really important that you start forming strong and effective relationships with directors of public health, councillors in local authorities and GP consortia now,” she said. “They all need to be made aware of the important contribution pharmacy makes to improving the population's health locally and reducing health inequalities. You need to demonstrate the added value that pharmacy brings. Local authorities will receive an incentive payment. This will be dependent on the progress that is made locally in improving the population's health and reducing health inequalities.” Support for Avicenna members was not in short supply. There was news that Avicenna will launch the second part of its Ace Plus scheme which offers business support, advice and facilities as they attempt to increase the efficiency of pharmacy businesses in challenging times. The scheme, which began last year, boasts 50 members and will include another 50 pharmacies. Avicenna chairman David Gration also announced the group's plans to purchase some independent pharmacies who would all benefit from new service test-runs. Amid distractions such as alluring, traditional Turkish belly dancing and golf, there was indeed plenty for pharmacists to ponder.

Health reforms represent “dramatic” evolution rather than revolution
Ash Soni, the pharmacist representing the profession on the clinical advice and leadership group of the NHS Future Forum, described the Government's health reforms as “dramatic” evolution rather than a revolution.
Under plans proposed by Health Secretary Andrew Lansley, commissioning consortiums were to go 'live' in April 2013 but that has been derided by the Deputy Prime Minister, Nick Clegg, as “articifial” and “disruptive.”
However Soni, who described the health White Paper as the “fastest White Paper produced by Government in history,” countered the arugument that the reforms are moving too quickly. “The Health and Social Care Bill is basically the revolution of the NHS. Is it revolution? I contend that it may not be,” he said. “I think it's evolution but I think it's evolution in a more dramatic way than we've seen before.”
Soni revealed that the Forum is considering four areas; Leadership and advice, public accountability and patient involvement, education and training and choice and competition. He will hear the concerns of community pharmacists in a series of listening events for health professionals. “It's important to find out what's going on in your area, to go along and participate,” he said. “I really want to hear what you've got to say, what you think, what your fears are. I think for us, as pharmacists, (my place on the forum) is probably the most important. The first thing is that there is a real issue in recognising our role in leadership and advice.”

GP-led consortiums could lead to sef-interest and harm pharmacy
Pharmacy could be marginalised if GPs are given majority control over the NHS budget, according to Avicenna chief executive Salim Jetha. The Government's health reforms, under the Health and Social Care Bill, are currently undergoing a listening exercise where pharmacists, among other health stakeholders, have been given the chance to voice their opinions and concerns about the restructuring of the health service.
Amendments to the Bill are anticipated and there has been staunch opposition to plans to hand GPs 60% of a £103 billion NHS budget and commissioning responsibilities. Jetha insisted that scenario is disastrous for pharmacy. “If (GPs) are the fund holders or budget holders in the end, and this is my big fear, they will be much more self interest-orientated,” he said. “It would be about what they can grab and that worries me. It will be about grabbing all the crumbs for themselves. That's the thing that worries me more than anything else. But on a fair, level playing field, we're quite happy to compete with GPs.”
Jetha echoed a point made by PSNC chief executive Sue Sharpe in an interview with Pharmacy Business this year in which she suggested that NHS commissioners could “commission themselves to provide everything.” Jetha added: “Transparency and fairness is the best way forward in terms of commissioning. The cost-effectiveness of the contributions pharmacists could make towards health outcomes is something which should be embraced.”
He said he would like to see the interests of pharmacy safeguarded against self-interest but added that it must promote itself more assertively. “I'd like to see the health Monitor which is supposed to safeguard self interest. I'm not sure how they're actually going to set the scene. Also, involving the public health authority, which is elected and accountable, is a good thing,” he said. “There's a great deal of expertise (within pharmacy). The thing is that we're not very good at marketing ourselves. We lack confidence. We have a wealth of knowledge to contribute.”
Jetha also announced the second part of the Ace Plus scheme, offering business support, advice and facilities to pharmacists. An injection of £250,000 from Avicenna means membership is currently free of charge and Jetha insisted that further developments would see it operate as a virtual chain in future.


Networking gives pharmacy funding and an integral health role
Dr Nikita Kanani, a GP consortia clinical executive, warned pharmacy that it must engage on all levels to earn funding and an extended health role.
“An example is taking smoking cessation to a whole new level, she said. “In Kent, a group of local pharmacists and pharmacies came together. They got funding from PCT/GP commissioners, came together and said 'we can look for people who smoke and help them stop smoking. But what else can we do? If we figure out who's got lung disease, we can stop them going to the GP in the first place.'
“And they found them. They had 47 visits and found 16 people with lung disease. Out of those, 10 had never been diagnosed because they never went to their GP. They came to their pharmacy instead for smoking cessation. It's great that we can come together, network and share best practice.”
Kanani provided another example of collaboration bringing results. “Some optometrists came together in their own consortia that mirrors our consortia and said they could take care of our (patients') eye problems,” she said. “We thought 'great' because most eye problems cost about £250 per time in secondary care, at a hospital.
“They told us about a unique service set up in their consortia allowing patients to stay in their community. We helped fund it. It's about developing partnerships, ways of exerting influence on commissioning (bodies), innovating together. There is money through pathfinder consortia money and local authority money.”

Pharmacy regulator run by people without pharmacy knowledge
The General Pharmaceutical Council (GPhC), pharmacy's regulatory body, consists of people who know nothing about the profession, Sultan Sid Dajani told the Avicenna Conference.
A scathing critique of the GPhC's ability to function and regulate effectively will have done nothing to improve the organisation's reputation, which has come under the spotlight in the past, notably when it took over regulatory duties from the Royal Pharmaceutical Society of Great Britain last year.
Dajani, a pharmacist who serves on the Royal Pharmaceutical Society's English Pharmacy Board, insisted that the GPhC contains people in its hierarchy who lack any understanding of pharmacy.
"It's about people at the top level of pharmacy putting the wrong view forward. You want to to be involved in that. However, the General Pharmaceutical Council is not concerned with work pressures - it's not in their remit to talk about beaurocracy – it is there to regulate,” he said.
“If you make an error (they will act). There is the vast majority of people on there who have never worked in pharmacy, who don't know pharmacy, so they don't know why you made that error. So the Royal Pharmaceutical Society, very importantly, tempers the excesses of the regulator. It's a very important role.”
Dajani also said he was no fan of the community pharmacy body Pharmacy Voice, who he described as “Corporate Voice,” and insisted that an alternative organisation should be set up to speak on behalf of independent pharmacy.
“(The RPS) is your last line of representation. Pharmacy Voice, Corporate Voice, call it what you like, I personally don't agree with it,” he said. “I've always thought it would be great if Sigma, Avicenna, joined the RPS and we had an alternate Pharmacy Voice, a Community Pharmacy Voice, with the RPS as the professional body helping you.”
He spoke about what his organisation, the RPS, can offer the industry politically as it enters a period of upheaval and change. “A lot of the things that happen in healthcare is inexcusable even if it is unintentional. GP consortia, fine, clinical consortia, fine, but we're still not round that table. There is still not that cultural shift in how we do things,” he said.
“Why are GPs still at the centre of (healthcare). If it's a truly multi-disciplinary role, why not have everybody in one room. (We need) a helping hand to make it change and the Royal Pharmaceutical Society is the organisation to do that. Political reforms are extremely important. One thing that has been consistent throughout is that politicians say one thing but do another.
“They might be serious about talking to pharmacists and creating a better healthcare system but they still don't know how to do it. That's why you need to join the Royal Pharmaceutical Society. You need a voice, you need representation and you need to have your voice heard.”


RPS can promote community pharmacy like no other body
Helen Gordon, the chief executive of the Royal Pharmaceutical Society, insisted that pharmacy's leadership body is unrivalled in its ability to promote the profession during a time of uncertainty and reform.
“We can raise the reputation of pharmacy because I know the fantastic service you give, but it's still a bit confusing to other health professions. We have a really big role in speaking out about what it is (pharmacists) do and making sure the environment is tuned into what pharmacy can offer,” she said.
“When we're looking at enforcing change with other health professions and the NHS at the highest level across the UK, we have membership and scope that is meaningful as we talk to our colleagues across the other health profession bodies.”
She added that the RPS' membership allows the organisation to form partnerships with health specialist interest groups in sharing knowledge and expertise. “I'm excited about the partnerships we are building. Our membership is really powerful and allows us to build partnership with a whole range of bodies. We have about 15 specialist interest groups in pharmacy ranging from mental health to paediactrics and oncology who've entered into partnership agreements with us,” she said.
“Every time there is a medicines issue in the media, the RPS is able to get a specialist in front of the camera speaking on behalf of the RPS, someone who is absolutely skilled and the best person to do that.”


UK's dwindling parallel import market has impacted medicines supply chain
The pound's demise against the Euro not only brought the UK's downfall as a parallel importer of drugs but played a significant role in the delay of medicines supplied to pharmacists. That was the view of Brian Fisher, head of sales at Alliance Healthcare, who said problems pharmacies have experienced with the medicines supply chain was largely caused by a less attractive UK PI marketplace.
“There are people who will tell you that export does not impact on product availability but we have access to manufacturing data and I can tell you it does,” he said. “When we had a strong pound versus the Euro, the UK was a (big) import market and supply percentages were (up).
“The pound (then) becomes weak, the Euro becomes strong, the PI imported products are no longer available, no longer attractive, no longer exist, and there's a gap between ourselves and our other BAPW (British Association of Pharmaceutical Wholesalers) partners.
“They worked with manufacturers to instruct and encourage them to oversupply the UK market to generate enough products to go around. But the pound is weak, export is attractive and we can't satisfy the UK market any more.”
He vowed Alliance would adhere to the Government directive stating that UK pharmacies should receive drugs from suppliers within 24 hours. “We all believe the situation is unacceptable. We are doing all we can, working with the trade bodies, to control the situation and make it as painless as possible in trying to ensure stock for all,” he said.
“We absolutely subscribe to the recent directive of 24-hour delivery guidelines as an absolute minimum. The sooner manufacturers get on board with this (the better). But the position is unlikely to change until the pound versus the Euro exchange rate changes, making export less attractive.”