The Numark international conference, ‘The Script for Longevity,’ attempted to infuse pharmacists with a sense of purpose and urgency as they bid to survive in a demanding new NHS. Neil Trainis reports from Hanoi, Vietnam…

When you cross the roads here you must cross with courage,” Lynne Armstrong, director of marketing at Numark, told delegates at the company’s international conference in a large room at the lavish Sofitel Legend Metropole in Hanoi, Vietnam’s colourful, vibrant capital city.

It was a reference to the cat and mouse relationship road users and pedestrians endure night and day and where the golden rule for those daring to cross is keep walking with conviction. It was hard to escape a sobering analogy with community pharmacy back in the UK.

Indeed, pharmacists must move forward, evolve, progress, engage and be proactive in a demanding new NHS. And move forward with conviction. Depending on which pharmacist you talk to, the latest landscape healthcare finds itself in is either exciting and enticing or perplexing and ghastly.

“It wasn’t made any clearer to me, it’s still very confusing,” said one pharmacist after Ash Soni, Numark’s keynote speak, had attempted to navigate delegates through the NHS lexicon complete with it’s Clinical Commissioning Groups, Local Education and Training Boards and NHS Commissioning Boards.

In stark contrast there was Jignesh Patel, a community pharmacist based in Newham, east London, who has had little trouble adjusting to the demands facing every 21st century pharmacist, all of whom face intense competition just to survive, never mind make a profit.

“It’s so easy to do. You just need to get out there and do it,” he said, referring to the collaboration he has established with Dr Petre Jones, his local GP. Numark’s conference was entitled ‘The Script for Longevity.’ Jignesh appeared to have found the script for longevity.

There were positive sound-bites from John D’Arcy, Numark’s managing director, who opened the conference in buoyant fashion by insisting pharmacy has reason to be optimistic about its future. Pharmacists, he said, must resist temptation to believe their future is dark as the health reforms gather pace.

“We can get very negative when we talk about pharmacy. It’s very easy to think we’re in a bad place. I believe, actually, we’re in a good place. It’s just what we do from here that’s important,” he said.

His positivity, however, was tempered by a timely warning to pharmacists that they should no longer rely solely on the supply function to survive in the reformed NHS. It would be their holistic service offering, he said, which would ultimately decide their survival.

“While margins are decreasing on supply, the opportunity must come from services in the future,” he said. “We’ve got to look at the NHS reforms to see where that opportunity is for us.”

The pharmaceutical theme of the conference was broken up by tastes of Vietnamese history and culture. Delegates paid a visit to the entrancing Ho Chi Minh Mausoleum in the centre of Ba Dinh Square, the place where the Vietnamese communist revolutionary leader read the Declaration of Independence on September 2, 1945 to establish the Democratic Republic of Vietnam.

Those who made it to Hỏa Lò Prison, used by French colonists to house political prisoners and later by the North Vietnamese during the Vietnam War, stumbled upon unnerving reminders of a past that is destined to forever attach itself to Vietnam.

American prisoners of war who stayed at Hỏa Lò referred to it sardonically as the ‘Hanoi Hilton’ and there remained a strong sense that some wounds will never heal.

Alongside pictures of bombed out Vietnamese houses and utter carnage reaped on the country’s population by American B-52s, there were shots of captured American soldiers apparently being treated with dignity and humanity by their hosts, receiving medical attention, eating decent food and even playing a game of basketball in the prison yard.

Whether you interpreted that as propaganda to insult the intelligence or a realistic portrayal of events, it somehow resonated.

The friendliness of the local people, many of whom were old enough to remember, indeed live through, what they still refer to as ‘the American War’ also resonated.

As delegates were given a cyclo ride through the crowded streets of Hanoi, they were greeted with smiles and a few waves, amid the honking of horns and odd screeching of tyres.

The Numark conference concluded with a gala dinner at the Temple of Literature in Hanoi, built in 1070 at the time of King Lý Nhân Tông, where guests were serenaded with traditional Vietnamese music by a flamboyant orchestra.

You might say it was more than enough to take pharmacists’ minds off the sobering challenges facing them back home.


Two years on… LPCs are still failing pharmacists
Ash Soni, member of the Pharmacy and Public Health Forum and Numark keynote speaker, urged pharmacists to vote people off LPCs that continuously fail to act in their constituents’ best interests.

Reprising his staunch criticism of LPCs at the NPA conference two years ago, when he said the majority of them were “not fit for purpose,” Soni said some are still falling below the required standard.

“I said this (two years) ago (during the NPA conference), are LPCs fit for purpose? I think a number of them are but I think a number of them still haven’t got it all. A number of them still have an issue about understanding the relationship particularly with local government,” he said.

“I’ve had conversations with some, and some of them are absolutely fantastic, but there are a number and you talk to them and they just haven’t got it. Considering the fact this has been going on for the last two years, they should be in that place by now.

“I would turn around to all of you, whether you’re part of an LPC or just a contractor, and think about your LPC. Does it deliver and does it act in your best interests and understand the new system?

“Because if it doesn’t, either it needs to have people learn that or it needs to change the people on it. So think about how you vote for your LPCs and choose the people for (it).”

Soni also warned pharmacy to be proactive and engage or risk being marginalised by increasing competition.
“One of the interesting things about local government is they are not necessarily wedded to the medical model. They are looking at what delivers best for their population. So we have greater opportunity to be commissioned.

“But at the same time, they are looking at what we are doing for their population, so if you don’t deliver, they’ll go for someone else. A number of services I know they are looking at other providers because they are looking at who’s going to get them the outcomes they want. At the end of the day, if you’re parting with money, you want the answer.”

Quota systems are not right but are allowed by government
Paul Smith, the chief executive of Phoenix Healthcare Distribution, told the Numark conference in Vietnam that manufacturers should have a requirement to supply medicines to pharmacies and, from a moral viewpoint, refrain from using quota systems, widely perceived to be a major cause of the drugs shortage.

Speaking during a question and answer session with Numark pharmacist members, Smith admitted he did not believe quota systems “to be right” but insisted that manufacturers will continue to use them simply because the government allows them to do so.

“We should have a requirement to supply. Manufacturers do quotas for a commercial benefit. It’s not good to say that but it’s true. You should look after the patient first, absolutely, but manufacturers are allowed to do quoting,” he said.

“You wouldn’t be doing it if it wasn’t commercially viable, so we shouldn’t ignore it. I don’t believe it to be right but the economy benefits, it’s good for healthcare.

“You can’t then moan when it goes against you. I can’t see anything stopping it. The government will have to solve it but they don’t seem to want to.”

On the issue of drug shortages, Michael Cann, director generics at Actavis, told delegates: “We will all benefit from a multi-supply market. Choose your partners and choose them very carefully.”

Generics and healthcare are not commodities
Michael Cann, the director generics at Actavis, drove home the message to delegates that generic medicines should not be regarded as commodities because their significance in saving people’s lives is beyond value.

“People have said to me ‘generic medicines is a commodity.’ Well it cannot be true that generic medicines are commodities because they save people’s lives and they save people’s lives at very, very low cost,” he said.

“The generics industry makes reasonable returns and the (big) role it plays in our society for the long-term benefit of our patients. How to be differentiated from what can be perceived as a commoditised offering and pharmacy isn’t taken for granted, people are expected to work long hours, that’s not a commodity. My star point is we are all differentiated.”

He also said it was crucial for pharmacists to understand the needs of everybody relevant to their business, from patients to CCGS, and employ staff with the right attitude.

“We had to understand customer needs much more deeply. It was a question of can we understand every customer with the same depth, and the answer to that is clearly not but that’s a journey. Incrementally you learn over time and that’s the journey we’re still on.

“Do we have the right attitudes to our relationships? Do we have the people with the right attitude to relationships? (It is about) simple decisions about doing the right thing to ensure your business, and in my business, in our businesses, we have people with the right attitude to carry out what you expect.”
Should pharmacy trust government over funding?
Numark managing director, John D’Arcy, questioned whether community pharmacy should after all be placing its trust in the government to reimburse the profession properly.

D’Arcy pointed to underpaid prescription payments as a reference point for what he described as “a complex and opaque remuneration reimbursement system” which continues to pose pharmacists with difficulties.

“We have a system where we dispense, on average six and a half thousand prescriptions. At the end of the month you stick them in a paper bag and send them to a pricing unit, no records kept in the pharmacy, no idea what’s gone on,” he said.

“And when you say ‘how do we know we’re being paid correctly,’ we say ‘we trust the government.’ And we have trusted the government because we’ve had no alternative. But actually, is this trust misplaced?

“The whole checking procedure for prescriptions now well…we’re being paid off not to have prescriptions checked.” He added “there was no way of knowing whether you’re being paid correctly.”

D’Arcy also insisted pharmacy must get to grips with EPS or risk being left “out the game.” He said: “Electronic Prescription Service actually started in 1997, so we’re now getting on for 20 years later and we still haven’t got it. It never got dropped from the government’s IT agenda and it is now round the corner.

“The GPs are catching up on deployment for EPS. There are some pharmacies in a cluster of GPs and other pharmacies, who are deployed, who are not deployed. And suddenly when EPS comes along, they’re going to be out the game.

“EPS will fundamentally shift the way the game is going. It will shift the decision-making for patients, it will shift the decision-making for GPs and could fundamentally alter the business model.”

There is a ‘huge, screaming need’ for pharmacy to engage commissioners
Brian Fisher, the commercial director of Quantum Pharmaceutical, challenged pharmacists to “get out there and engage” with commissioners if they want to survive in the new NHS.

A simple meeting over a cup of coffee or lunch with commissioners, who will largely be GPs heading CCGs, Fisher said, would help pharmacists to sell themselves effectively and open the doors of opportunity.

“There’s a huge, screaming need for you guys to get out there and engage with doctors. Engage with GPs, engage with commissioners, because the doctors and GPs are, effectively, the commissioners,” he said.

“When you get back (to the UK), make a few phone calls, go for a few cups of coffee, have a few bites of lunch, get to know these people, spend some time one-on-one, just have a chat, because through chats, opportunities will arise.

“It’s not rocket science. It’s nothing too taxing or too stretching. Unless you do this, things will pass you by.”

Your retail environment is 100% of your image
Numark director of marketing, Lynne Armstrong, insisted pharmacists must maintain the quality of their retail environment as that is ‘the best marketing tool’ they have.

“(Retail) might only be between seven and 15% of your turnover but it is 100% of your image. Your customers do not walk into your dispensary. They walk into your retail environment,” she said.

“That is what depicts a pharmacy to one of your customers. You have to absolutely delegate, not abdicate, on retail. Some research we did about six, seven years ago (showed) eight out of 10 patients would not pick up a prescription from a pharmacy if the pharmacy environment wasn’t up to the expectation of that patient or customer.

“It is vital you look at your retail environment as your pharmacy. People don’t walk in there to buy products. You need to make the most of that while they’re in there. Your pharmacy environment depicts your professionalism. It will show people what you can do. It is the best marketing tool you have.”

Don’t be afraid…talk to your GP and collaborate
Jignesh Patel, a pharmacist from Newham, east London, said pharmacists must not be afraid to talk to their local GPs if they want to establish a collaboration.

“To get effective collaboration, you’ve got to understand each other. It’s all about making sure you trust each other. It’s about making sure you can communicate well and about making sure information flows that you can use effectively,” said Jignesh, who runs Rohpharm Pharmacy in Plaistow and has collaborated effectively with his local GP, Dr Petre Jones.

“Most pharmacists believe they can’t collaborate because there’s mistrust between the different professions. There are pharmacists who have too much workload. Everyone has workload. GPs have workload. To help yourself in the future, you need to be able to talk to each other.

Jignesh established his collaboration with Petre after setting up “social meetings to get to know each other.” Jignesh added: “When you get to know each other you get to have trust… in terms of informal meetings, we talked about what we do, what services I provide and Petre provides. Each time wed have ideas, we phone each other and meet informally.”