‘Survival of the fittest’ was the theme of the Numark conference in South Africa where pharmacists were asked to take a long, hard look at themselves. Neil Trainis reports from Cape Town…


There was one moment during the Numark conference in Cape Town that resonated above all others. As the delegates gathered for a gala dinner in the city hall, an event that brought five enjoyable days to an end, history reared its head.
Some 27 years earlier on the very steps which took pharmacists and their families into the grand building, Nelson Mandela addressed 60,000 people with an awe-inspiring speech just hours after his release from Victor Verster prison.
He spoke about his determination to secure equality for all regardless of the colour of their skin. After 27 years, six months and six days in prison, he was able to make his voice heard again. He was able to make his presence felt.
Heaven forbid independent pharmacy has to wait as long to make its presence felt with local commissioners and a government that, despite David Mowat’s kind soundbites, is determined to reduce the sector’s capacity in the name of frugality to the detriment of patients across England.
During the interactive business sessions which, in typical Numark fashion, got pharmacists to think and discuss how their businesses can improve to the backdrop of funding horrors, Phoenix CEO Paul Smith said he thought the government “doesn’t actually believe” that “independent pharmacy is fundamental to the success of the NHS.”
By that stage Numark managing director John D’Arcy had infused proceedings with sobering reality, suggesting: “England certainly seems to be under the cosh as far as the Department of Health and the NHS is concerned. However good or comfortable we might feel in the different countries, all of us are going to be hit with the same message. The reason for that is the NHS, whichever country you’re in, is bust. It is absolutely bust.”
He would add: “I’ve lost count of the number of times I’ve stood on a platform and said change is upon us, adapt or die. You do feel this time it’s different. Forty years I’ve been in pharmacy and we’ve seen bad times come, bad times go.
“Pharmacy is pretty adaptable. But I’ve never known a time when the government has gone back on an agreement on funding and ripped money out of that.”
It was pretty bleak stuff but D’Arcy was right not to hit his members with kid gloves. Reality is the best medicine for community pharmacy right now. There were warnings the government’s hub and spoke dispensing model, which has produced nothing but ominous silence lately, is not going to go away. D’Arcy indicated measures Ian Strachan and the National Pharmacy Association have spent months fighting to prevent were not all bad as long as the connection between pharmacist and patient is preserved.
“We are doing a final check, and pharmacists are doing that, on each and every prescription. I just ask you the question. Where is the real value in that final check?” D’Arcy pondered.
“And I’m not talking about clinical assessment, I am talking about final check. Actually, if you look at hub and spoke and you have a hub and spoke solution, you will build a final check into that.
“So we really do need to think significantly differently about the way we are operating our businesses from a professional and commercial perspective. And we need to differentiate ourselves. In terms of supply, that is very, very difficult to do.
“To be clear, I am not for one minute suggesting we shouldn’t have supply. We must have supply because it’s the supply that gives us the nexus to the patients, it’s the supply through which we can add the value.
“Whether we have hub and spoke or other technological solutions, we still need to retain supply…what we need is to retain nexus to our patients. That’s absolutely critically important.”
The press wondered if Numark can take leadership of hub and spoke. “Difficult to do that with the innate conflict of interest between wholesale and vertical integration,” tweeted PSNC, NPA and Pharmacy Voice board member Mike Hewitson.
There was a warning for pharmacy to embrace a digital revolution in pharmacy that has been going on for some time. Pharmacy must have access to its own clinical record, insisted Ian Taylor from EMIS Group. He said he wanted to get ProScript Connect into the market “as quickly as we can” before warning pharmacists in Wales to get on board with it before October.
“Is Ian Taylor paying for the upgrade from Windows XP. Hello #pharmacy cuts!!!!!!! The government won’t fund it,” tweeted Pharmthorrun.
Marshall Glynn from PharmAssist Solutions said first year charges for those who use Numark Analyzer, a platform designed to help pharmacists assess their businesses, will be scrapped if they help with its soft launch.
Numark’s Raj Nutan said pharmacists who fail to embrace technology will get left behind and Brian Fisher from Quantum Pharmaceutical urged delegates to do all they can to tap into the quality payments. “It’s not rocket science,” he said, having warned that the cost of poor quality in pharmacy can be severe. “I’ll let you fill in the gaps on that one,” he remarked.
The conference heard Phoenix’s Jeremy Meader tell delegates they can save a lot more money with Numark’s indemnity insurance as opposed to the NPA’s while GSK research found 40% of shoppers are unaware of “stronger” products behind the pharmacy counter. David Healey, GSK’s pharmacy and drug controller, said healthcare is worth £3.2 billion a year.
The debates were absorbing. Graham Fraser-Pye, the managing director of Aspire Pharma, tried to downplay the furore over generic drug price hiking, describing it as “not a hugely sigificant issue.”
Not everyone agreed. “Estimated to cost around £300m pa, more than double what (pharmacy minister David Mowat) is removing from community pharmacies,” tweeted community pharmacist Ben Merriman, treasurer of Cumbria Local Pharmaceutical Committee.
Delegates were not left to ruminate within the confines of Belmond Mount Nelson Hotel. There was a cable car trip to the summit of Table Mountain and a sojourn to Boschendal, one of the oldest wine estates in South Africa. It was quite an event. Indeed, there was much to ponder.


Government doesn’t think independents are fundamental to NHS success
Paul Smith, the CEO of Phoenix, said he does not believe the government is committed to placing independent pharmacy at the heart of a service-driven NHS and is more concerned with driving volume instead of patient care.
Describing Scotland as “more progressive” than England when it came to designing services and utilising pharmacy’s expertise, Smith painted a bleak picture of ministers’ attitudes towards independents in England despite pledges from David Mowat, the community health and care minister, that the government is keen to develop services and exploit pharmacy’s clinical know-how.
“Independent pharmacy is fundamental to the success of the NHS. And if we believe that it must be actually true. I’m always convinced that everybody else believes that and at the moment the government doesn’t actually believe that. But it is true,” Smith said.
“They’ve unfortunately decided that it is all about volume. I don’t buy in yet that it is a government service agenda. I think it will get there but I don’t think the government see that, particularly more about England.
“In Scotland they’re more progressive. In England it’s a struggle and they’re just looking at volume and the cost of delivering that volume, not the cost of delivering excellent care.”
Smith also insisted he was not in Cape Town to persuade Numark members to buy from Phoenix but “buy from the best source you can.”
“I’m not here trying to say you should buy from Phoenix. I’m here saying you should listen to Numark. Numark should be at least capable of saying to you ‘buy from the best source you can,’” he said.
“I don’t believe anybody else would stand up here in front of you as a wholesaler and say ‘please buy from somebody else.’ If my service is not good enough in Phoenix, you should buy from somebody else because that’s what an independent Numark should tell you.”


New entrants will not ‘take away existing business’ with hub and spoke
Steve Anderson, the managing director of Phoenix UK, told the Numark conference in Cape Town that he did not believe new entrants to the pharmacy market will “take away existing business” with hub and spoke.
As questions around hub and spoke persist, with community pharmacy still largely unsure how the dispensing model driven forward by chief pharmaceutical officer Keith Ridge will work, Anderson attempted to allay any concerns around new threats to the market in terms of hub and spoke.
“We are working really hard on designing and thinking through how we can use our existing wholesale platform as a way of providing some kind of hub and spoke services to our membership,” he said.
“The one thing about the wholesale platform in this regard is it makes the system stockless. The system is not stockless. If you are currently a pharmacy or if you’re a new player to the market or you have a solution you want to bring to market and you don’t want a wholesaler or you don’t want pharmacy already holding stock, the solution is virtually impossible.
“So I don’t see new entrants coming to the market with hub and spoke to take away existing business. It is in our own (interests) to drive our own solutions and be more collaborative and more innovative and more in it together to try and (find) solutions which makes sense for everyone in the game.”
David Reissner, senior healthcare partner at Charles Russell Speechlys who was not present at the conference in South Africa, took to Twitter during the event to suggest hub and spoke was “only likely to be used for repeat scripts when patient-facing interactions wouldn’t be usual.”


Pharmacy will be dead in water if it fails to go beyond supply
John D’Arcy opened Numark’s international conference in Cape Town with a warning that if pharmacy fails to deliver a quality patient service beyond supply it will “be dead in the water.”
D’Arcy began the conference, entitled ‘Survival of the Fittest,’ in typically frank fashion, insisting that he was by no means against pharmacy’s supply function but cautioned it will not have a future in an NHS that is demanding more from the profession if it does not develop its service offering.
“In my view time has finally been called on pharmacy. Unless we come up with some patient-centred, quality-focused value propositions as opposed to simply supply, we’re going to be dead in the water,” he said.
D’Arcy also warned pharmacists not to ignore hub and spoke which he insisted “is coming” and promised Numark members that it would be speaking up for them more regularly on issues despite acknowledging it is not a representative body.
“We can say the law won’t allow it. We can say there isn’t a proper technological solution for it. But trust me, it is coming,” D’Arcy said.
“I do recognise the difficulty with hub and spoke. But equally, we ignore hub and spoke and the possibilities of hub and spoke at our peril.
“If we can get hub and spoke working and create an efficient system, it is that that should create headroom for us to do other services.”


Generic drug price rises ‘not hugely significant issue,’ pharma chief insists
Graham Fraser-Pye, the managing director of Aspire Pharma, played down the issue of generic drug price rises which have seen the cost of some products increase by over 1,000%, by describing it as “not a hugely significant issue.”
Fraser-Pye said the generic drug industry in the UK provided the lowest costs in the developed world and insisted prices in India were higher than those in the UK, an idea contradicted by a study by researchers from the University of Liverpool, presented to the European Cancer Congress in Amsterdam last month, which found the price of generic cancer drugs had increased by 1,000% over the last five years.
That report also found that 20 cancer treatments had risen in price by 100% while other drugs such as tamoxifen, used to treat breast cancer, had gone up by 1,100%. It costs two pence per tablet in India compared to £1.21 per tablet in the UK.
“We have the best and lowest costs in the developed world for generics in the UK,” Fraser-Pye told the Numark conference in Cape Town.
“I went to India and we were buying some products there and we were trying to negotiate the prices and they look at me with absolute amazement to say ‘hold on, we pay more in India than you do in the UK.’ That is the scale of the advancement of our industry.”
On the scale of the problem of generic drug price rises, in which some companies have exploited a loophole by de-branding drugs and selling them under a generic name thus allowing for huge price increases, he said: “I know there’s a great concern that generics prices, or de-branding in particular, have escalated.
“The point here is we need to keep this in perspective. There have only been five products referred to the CMA (Competition and Markets Authority) at this stage. There may be more, I don’t know.”
A Times investigation last year found that some companies made huge profits after raising the price of generics such as anti-depressants, adding £260 million to the NHS drugs bill.
“But we need to keep it in perspective. You look at what The Times were saying about this. It was something around ‘has the NHS been ripped off by two hundred and fifty million?’ Whether they get ripped off or not, I really don’t know,” Fraser-Pye said.
“But two hundred and fifty million on a 14 billion bill, although it’s bad and no-one should be ripped off or prices shouldn’t be hiked unnecessarily, you need to keep it in perspective about the extent of the problem.”
He added: “With all generics the scale of the problem is only around 1.38%, therefore not a hugely significant issue.”


Embrace digital agenda or you’re stuffed, pharmacists warned
John D’Arcy, the managing director of Numark, warned community pharmacists they will be “stuffed” if they fail to get to grips with the digital agenda which is increasingly impacting on pharmacy and the wider NHS.
D’Arcy reminded pharmacists that failure to prepare for the electronic prescription service which will soon be in use across England will be disastrous for their businesses and he urged them to get on top of information governance regulations.
“We need a system that interacts with GPs, we need a system that provides you with information, we need a system that builds around the PMR to allow you to do your professional role,” he said.
“The more you can move to IT, the more efficient you will become, the more compliant you will become, the better you will become.
“It will create headroom for you because you’re busy. Chances are you’re going to be thinking about the number of scripts you’re going to be doing. It is volume, it is huge. You need as a matter of urgency to get headroom.”
D’Arcy added: “As we move forward in the compliance and regulatory agenda, the focus of information governance is not going to be less. It’s going to be more. In May 2018 there is a new general data protection regulation coming in.
“It is putting tighter controls on how you regulate data, how you store data and what you do with data. Is your system going to pass muster against what’s required under the GDPR and what’s required in terms of information governance within the NHS?
“But also business continuity. Any system will at times fail. But you want to make sure that whatever system you’ve got, it’s the one that’s least likely to fail. And we’ve seen just the week gone Cegedem system went down.
“Once we move to universal EPS, and that’s coming, if your system doesn’t work how are you going to do your prescriptions? I’ll tell you. You’re not. You’re stuffed. So you need to be focusing on IT. That’s why we’re focusing on a digital agenda.”