The third annual Sigma Pharmaceuticals conference in Mauritius was graced by a series of high profile speakers who warned community pharmacy they must collaborate with doctors and other health practitioners to remain at the forefront of primary care. Shailesh Solanki reports from Mauritius…

Over 400 pharmacists and their families gathered in the tropical island of Mauritius for what has become a must-attend event for community pharmacists. There they were implored to proactively build partnerships with GP practices and engage with commissioners of services. The week-long conference attracted an array of eminent speakers including Baroness Thornton the opposition health spokeswoman in the House of Lords who delivered a written address from Labour health secretary John Healey warning that community pharmacy could be shunted to the sidelines under the Government’s reforms.
There was a video message from the Secretary of State for Health Andrew Lansley assuring pharmacy of its place in the new NHS framework and one from the Chief Pharmaceutical Officer for England Dr Keith Ridge. He told a packed audience that community pharmacy must adapt to changing times. “For pharmacy the future is not just medicines – the future is broader than that” he said. “It’s about delivering care to patients not just through optimisation of medicines but also through making improvements in public health within the context of the great challenges that society faces in preventing ill-health.” Hemant Patel chair of the conference and former president of the RPSGB added: “Collaboration (between pharmacists and other health professionals) must begin at home. Before we get to collaboration with GPs and others we need to give a clear message about where we want to collaborate.”
Many prominent leaders from the profession attended the conference including Mike Dent of the PSNC Tony Foreman of Alliance Healthcare and Trevor Gore of Reckitt Benckiser. Senior executives of the generics industry were also out in force alongside pharmacy buying groups accounting for nearly 2000 pharmacies in the UK. Bharat Shah managing director of Sigma provided pharmacy with a call to arms. “Over the last few days our speakers have given pharmacists many ideas to prepare them to win in the new NHS” he said. “Pharmacists must have a win-win attitude and the market is big enough for us all to win. I want independent pharmacists to win and I want you to prepare to win.”
The event has become a firm fixture in the pharmacy calendar having grown considerably in stature and clout. It provided a forum for debate for community pharmacists many of whom are worried about the pace of change which is surging towards them “like a super tanker” as leading GP Lisa Silver described it. Her message was clear; engage with GP consortia or face the consequences.
The conference however was a chance for pharmacists to take stock to the backdrop of quixotic surroundings with exquisite balls and banquets all laid on by Sigma. There were barbeques on the beach and lavish lunches followed by a majestic Bollywood Ball in a specially constructed marquee on the lawns of the Sugar Beach hotel where guests dressed in Indian salrwar kameez and elegant sarees. They danced to Bollywood classics and engaged in traditional bangra and raas garba dancing. A variety of food stations were dotted around the marquee serving Indian and western cuisine momentarily providing guests with a pleasant distraction from a period which promises to define the future of community pharmacy.


Pharmacists must engage with GP consortia or face the consequences

Leading G Dr Lisa Silver warned pharmacists that they must engage with GP consortia or face the consequences. “The NHS is about to go through the biggest single change there has ever been” she said. “If you guys are sitting in your pharmacies worrying about Category M fiddling around at the edges you’re actually not seeing the enormous super tanker that’s coming in your direction.”
She told pharmacists that procrastination was a dangerous thing for pharmacists who have failed to grasp the fact that GP consortia has already started forming. “We had a White Paper in July last year and we’ve already formed our consortium. We’ve already got together. I’ve had many pharmacists say to me ‘we don’t have consortium in our areas’ but you’ve had them there for the last three four years” she said.
“The new consortium of different bodies will hold the bulk of the NHS budget so don’t go away thinking this isn’t going to happen. It’s happening now and it’s extremely important that as a group of pharmacists you start to engage with GPs who aree holding the budget. Whether you like it or not it’s happening.”
Julian Brown a dispensing doctor at Litcham Health Centre in Norfolk added to the sense of caution engulfing pharmacists with the warning that revenue will be harder to generate during the NHS reforms as the government seeks to make substantial cuts.
“Everywhere there’s going to be cutbacks. Things aren’t going to continue as they have been” he said. “The reality is that it is going to get harder.” He suggested pharmacy alongside all health professionals will have to brace themselves for around £18 billion of savings to the NHS in the next three years but added that savings in chronic disease treatment will be particularly important. “One of the main areas where we are going to try and make savings is chronic diseases” he said. “Anyone who can contribute to making savings for chronic diseases will be loved looked after and supported.” Brown also suggested that GP commissioning “could be good for pharmacy could be bad depending on how things go.”

Unprecedented link between Alliance Healthcare and Sigma
Tony Foreman the commercial director of Alliance Healthcare told delegates at the conference that his company would start channelling their products exclusively through Sigma Pharmaceuticals in an unprecedented partnership.
Foreman who has over 20 years’ experience in the pharmaceutical industry and has instigated some of the most eye-catching innovations to grace European pharmaceutical wholesaling in recent years spoke about the potential to harness independent pharmacy. That included improving the supply line of medicines to pharmacists through the new link-up between Sigma Alphega and Alliance which forms part of the international pharmacy-led health and beauty group Alliance Boots.
Foreman also insisted that products as well as services run by Alphega a network of independent pharmacists in Europe would be channelled through Sigma. “With all these things we do in (Alliance) Boots and all these service brands and product brands wouldn’t it be great if we could take these ideas to Sigma to develop for us for independent pharmacy” Foreman said.
He added that the plans would also see a combined generics operation between the companies and the offer of a branded ethical drugs portfolio to Sigma customers who do not have an account with Alliance.
“The rationale behind this partnership is very simple” he said. “We both have a very strong base of independents (but) however hard we’ve tried to crack (Sigma’s) customer base we haven’t managed it. I’ve spent 23 years in this business figuring out how to do it.”
Foreman was self-effacing and honest in his appraisal of the collaboration maintaining that in Sigma here was a business model he and his employers could learn from. “We modelled our business on Sigma” he said. “We went to visit sigma we looked at what they did and said ‘this is amazing.’ The one thing we never managed to do was win the Sigma customer base. The old adage is ‘if you can’t beat them join them.’ And that’s what we’ve done.”

Pharmacy funding for support to patients with long-term conditions
Mike Dent head of finance at the PSNC proposed a new medicines service allowing pharmacists in England to be paid for providing medicines support to patients with long-term conditions. The initiative known as the first prescription service would be knitted into the community pharmacy contract and Dent intimated it would subject to ministerial approval begin this year.
“We will see change (this year) we will see targeted MURs and most importantly the new medicines service” he said. “This will be a part of what you do for every single opportunity for a new patient on a new medicine as part of your daily life. It will be an advanced service but we would need to prove very quickly that this service works. It should work if contractors can embrace it.

Pharmacy must drive itself towards the heart of health care
Community pharmacy can earn a central role in health care provisioning but must earn the right to provide services according to Dr Keith Ridge the chief pharmaceutical officer at the Department of Health.
Addressing an audience of pharmacists drug company representatives and other delegates via video message he talked about the pharmacy jigsaw “coming together over many years” and expressed his hope that the economic climate and proposals to restructure the NHS could “accelerate the pace towards completing the puzzle.”
However he said that pharmacists have to prove their worth with a strong evidence base of services to gain recognition. “Take a new medicines service where pharmacists would support patients newly prescribed a medicine with a long-term condition” he said. “If that comes to fruition and I have no reason to believe that it won’t then there is an evidence-based approach to improving outcomes for patients.
“For pharmacy the future is not just medicines – the future is broader than that. It’s about delivering care to patients not just through optimisation of medicines but also through making improvements in public health within the context of the great challenges that society faces in preventing ill-health.”
He maintained that the health system has not been getting the best value out of medicines but insisted the finger of blame should not be pointed at any one profession and thus remains an issue for everyone – “the public patients and professionals.” Pharmacy was again the focus of his argument. “As pharmacy professionals you should want to be at the centre of that team effort” he said. “And I suggest that the economic position shines a spotlight on these issues like never before.”
Ridge used the example of Healthy Living Pharmacies in Portsmouth and the vaccination and sexual health work of pharmacists on Isle of Wight to illustrate how pharmacy can propel itself towards “the centre of the public health world.”

Pharmacy can reduce hospital admissions and improve medicines adherence
Dr Ridge expressed his belief that pharmacy has a crucial role to play in health care including reducing wastage hospital admissions and improving medicines adherence.
“(Pharmacy services) will improve concordance reduce wastage potentially reduce admissions to hospitals and overall improve outcomes and value from the medicines used” he said. “But it will require teamwork to make it work effectively. Similarly targeting MURs to where they are really needed in asthmatics or care homes for example.”
He said that pharmacy has already contributed a great deal to health care and will continue to do so once GP consortia take budgetary and commissioning reins. “Time and time again we all marvel at and rightly shout about the accessibility of community pharmacies” Dr Ridge said. “And of course the high street pharmacy has been the source of what might now be called public health advice for a long time. Now there are many examples of public health services being delivered through pharmacies.
“Medicines cut across all aspects of healthcare. From acute illness to long-term conditions medicines underpin patient care. We should be very grateful to the researchers and the pharmaceutical industry who continue to create these tools for without these effective care for patients would be difficult.”

Natural medicine can help two billion anaemia sufferers worldwide
Mark Turrell a director at Nelsons the UK’s largest manufacturer of natural healthcare products maintained that natural medicine Spatone can help improve the health of two billion anaemia suffers worldwide.
Turrell said that people across all continents with the condition can be helped to live normal lives thanks to natural treatments and he waxed lyrical about his company’s natural liquid iron supplement Spatone.
“There are about two billion people in the world suffering from anaemia. One billion of them don’t get a regular diet but one billion do eat healthily and still suffer from anaemia. It’s a big big problem” he said. “Spatone is a fantastic natural iron supplement which Nelsons acquired in 2003 and which is going from strength to strength in the UK and around the world.”
He added that Spatone has no unpleasant side-effects such as sickness haedaches and diarrhea unlike many other iron supplements which clog the health market. “It’s a concern for people who need their iron and find there’s no alternative” he said. “The great thing about Spatone is its absorbancy. Forty percent of it gets absorbed from one sachet a day.”

Pharmacists can avoid losing valuable revenue
Rajiv Shah the business development manager at Sigma Pharmaceuticals assured pharmacists that they will no longer be at risk of losing valuable revenue after his company introduced a new prescription service.
A pay-as-you-go private prescription service for independent pharmacies known as My D.O.C service will allow independents to benefit from an initiative that would cater for a plethora of conditions ranging from hair loss and dysfunction to travel health
For £25 per consultation the pharmacist would receive the prescription and subject to authorisation from a GP could provide emergency treatments over the phone and from the comfort of the pharmacy. The process Shah suggested would take no more than 15 minutes.
“What are the options for the patient when they leave the pharmacy and have been refused supply? Firstly they can leave the problem unresolved” he said. “The second option is that you’ve probably told them you can’t supply this medicine (because) it a prescription only medicine and that they may have to go to their GP to get a private prescription. That doesn’t guarantee their prescription will come to you if you’ve lost that and it’s gone somewhere else.
“The third option is (for the customer) to go on the internet an internet pharmacy legitimate or not (which ends) up taking supply and you’ve lost out. Up until now in my eyes there’s never been an option where you’re in control but M. DOC is hopefully giving you an alternative option which guarantees supply from the pharmacy.”

UK parallel import marketplace has dwindled with weaker sterling
Richard Freudenberg secretary-general of the British Association of European Pharmaceutical Distributors claimed that the pound’s struggle against the Euro has seen the UK parallel import market dwindle and lag behind Germany.
“The UK has been overtaken as the largest EU import market by Germany” he suggested. “The last data I received indicates that German parallel imports were approaching €3 billion annually. We contribute around 10% of the MHRA’s (Medicines and Healthcare products Regulatory Agency) annual budget which clearly shows we have to punch our weight.
“There has been growth in parallel distribution licences issued by the European Medicines Agency for the whole of European parallel trade. Parallel distribution across Europe is in much more robust health (than in the UK).”
He estimated that the European parallel trade is worth around €5 billion annually and is growing by about 10% in sales volume. He said that such sales growth “is driven by the expanding German market year on year by 27%.” He added: “The UK has always competed with Germany Sweden and Holland (but) the sterling’s weakness has meant that the UK cannot apply in such large volumes as in the past.”
Sigma’s business development manager Bhavin Shah talked about the trends in the parallel import industry in the UK noting that the paradigm had shifted drastically during a crippling global recession. “It’s very important to independent pharmacy and there have been some major changes in recent years” he said. He applied that model to the UK and painted a pretty bleak but realistic picture. “Historically we’ve been more of a parallel import market but (now) we’re a bit less of a parallel import market” he said. “One of the major reasons for this is that our currency relative to the Euro (has weakened). One of the dynamics of our industry now is that we are more of an exporter rather than an importer.”

Pharmacists can help prevent surge of fake medicines
UK pharmacy’s responsibilities already set to sell under the Government’s reforms will increase even more by plans to involve them in medicines security according to Freudenberg.
He claimed there is a desire to make pharmacy “the last bastion of medicines security” under legislation ratified by the European Union known as the Falsified Medicines Directive. That legislation is designed to stop fake pharmaceutical products entering the medicines supply chain. Pharmacists he suggested would play an integral part in the electronic verification of medicines which is to occur in European pharmacies.

Community pharmacy must protect the P medicine to remain viable
Trevor Gore sales development controller at Reckitt Benckiser warned community pharmacists that they must protect pharmacy medicines in the wake of a growing threat from general sales list medicines if they are to remain “viable” as health care providers.
Gore’s note of caution was timely given that pharmacists face a stern challenge to establish themselves as health care providers as competition for service provisioning intensifies under the government’s reforms. He said that maintaining and promoting P medicines is crucial for pharmacies.
“Your share in the P market is declining. The concern is that grocers are growing faster than you. You have to defend the P market. P is your Godsend. It is your point of difference on the high street and unless the supermarkets have bought the 100-hour pharmacies (customers) have got to come to you. That’s a concern. GSL (is) up P (is) down” he said.
Time and again he reiterated the importance of defending the “P market.” The ripple effect of that played on pharmacists’ fears that under the ‘any willing provider’ model they could find themselves marginalised if they are not regarded as “viable” healthcare providers. “If you say ‘well my focus is on the NHS that’s where my business is’ a lot of it is I don’t deny that” he continued. “But over the years how have your nappy sales gone? Where’s your baby food sales? You’re losing huge chunks of your business. And whilst it’s not big numbers it’s the reason people come into pharmacy.
“Young mothers don’t visit pharmacy any more for their nappies and baby food. They pick them up when they’re in Sainsburys or Tesco. So defending your P business is absolutely vital for being a viable pharmacy.”

Sigma managing director tells pharmacists they can succeed
Pharmacists can succeed with determination and forward planning in a restructured health system according to Sigma managing director Bharat Shah.
His closing remarks were a call to arms to community pharmacists many of whom are apprehensive about their industry’s prospects in the wake of the government’s reforms. “This conference has been about preparation to win” he told onlookers. “If you want to prepare yourself to win ask yourself some questions; do you have a clearly defined plan of action? Do you have a can-can attitude?
“Everybody has the will to win but very few have the will to prepare to win. The market is big enough out there. I want (independent pharmacies) to win and I want you to prepare to win.”

Pharmacy must go out and earn health services
Hemant Patel the former RPSGB president said that community pharmacy must actively strive to earn a role in healthcare provisioning rather than waiting for services to fall into its lap.
During a question and answer session he said: “It shouldn’t be about ‘it’s our right (to provide services) don’t give us up.’ It should be about ‘we can bring a different perspective to the table.’ We need to be working together to improve patient care. It is about patient care and managing change to improve patient care.”
He asked pharmacists whether they thought the health reforms were being instigated too quickly and Baroness Thornton the shadow health minister maintained Labour’s stance that the changes are being implemented too rapidly.
Patel added that pharmacists can plan ahead to cope with the changes. “Effective succession planning is very important for us to think about what’s going to happen in six months’ time a year’s time five years’ time” he said. One pharmacist in the audience however raised the concern that pharmacy is still in the dark.
“My concern is not the pace of change. My concern is the lack of detail” he said. “We’ve had lots of soundbites from politicians about how good pharmacists are what pharmacists can do. We’ve had that from politicians for the last 10 years. I cannot see any detail of engagement. It’s about time that if politicians say something they respond with a concrete action plan.”

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