The 2015 Sigma Pharmaceuticals conference in Aamby Valley City provided pharmacists with a timely reminder of the challenges facing them. Neil Trainis reports from Mumbai, India…
The setting had changed but the messages were not particularly new. The 2015 Sigma conference at Aamby Valley City, a township embedded in the Indian state of Maharashtra, brought togther some familiar faces and some new ones.
They were there to listen to some well-known pharmacy personalities reiterate as bluntly and as honestly as they could the challenges and opportunities facing pharmacy. Yet the underlying message, a well worn one at that, was encapsulated by the title of the conference; partnering for purpose. 
Fin McCaul, chairman of the Independent Pharmacy Federation, took up the collaborative theme, warning community pharmacy that it needed to think about "more than just pharmacy."
If the profession was to sustain itself in a multi-disciplinary NHS where everything revolves around the patient, he said, pharmacy needed to work with general practice and other stakeholders. But as he spoke he could not resist pointing the mirror back in the direction of pharmacy so it could take a long, hard look at itself.
The New Medicine Service, he insisted, is "embarrassingly bad." In Lancashire, he went on, just 55% of pharmacies deliver the service despite the opportunity for pharmacies to add £10,000 to their bottom lines.
Then there was Ash Soni, president of the Royal Pharmaceutical Society, who spoke about the value of the professional leadership body, no doubt trying to reach out to those pharmacists who remain unsure of it's benefit to their profession. He too touched on the value of collaboration.
"We have to think how are you going to work with general practice best? My own view? It should be community pharmacists because we are the closest point of contact (with patients)," he told the 300-strong delegation which included pharmacists and representatives from generic medicine manufacturers.
Claire Ward, the former Labour MP for Watford who these days passionately garners support for pharmacy as the chief executive of the Independent Pharmacy Federation, grabbed everyone's attention with another lucid, stirring speech.
"The future for pharmacy is to put itself in a modern age and to go back to the future, back to a time when it was at the heart of the community, not simply dispensing medicines but that service and support and advice," she said. The urge to talk collaboratively also proved irresistible.
"One thing we already do in the IPF is we work in partnership. We've worked with industry, we've worked with NPA and AIMp and we will continue to work with the NPA because it is the right thing to do for independents," she promised. Ian Strachan, chairman of the National Pharmacy Association, insisted his organisation could provide effective leadership for independents.
Hemant Patel, the secretary of North East London LPC, matched Ward's passion in his attempt to infuse a sense of urgency in pharmacists to get involved in the pharmacy self care initiative. The scheme, he said, is unlike anything ever seen in healthcare. It is innovative, effective and cheap; music to health commissioners' ears. 
The sound of delegates networking and pharmacists engaging in a spot of pharmaceutical chit-chat with one another must have been music to the ears of Bharat Shah, the effervescent and affable managing director of Sigma. Yet his thoughts were on the future.
"We've done enough on partnering, it's time to take the next step," he said moments after a video interview with Pharmacy Business. It was a shrewd observation. 
The Sigma conference as always was a blend of the serious, the light-hearted and the sublime, a chance for pharmacists to raise their concerns and listen to the concerns of others.
It was staged to the backdrop of a typically warm, friendly, family atmosphere which allowed delegates the chance to let their hair down as well as let off some steam.
There were Moroccan, Mexican, Rajasthani and Gujarati themed dinners, there were Bollywood dance and Indian cooking classes and a variety of trips, notably a visit to Emcure, a pharmaceutical factory based in Pune and a tour through Dharavi, India's largest slum situated in Mumbai which first appeared in the 1880s during the British colonial era.
There was much to ponder. There was much to digest. But the need for action, for pharmacists to engage, collaborate, be proactive, has never been greater.
Earl Howe – pharmacy has turned a corner
Earl Howe, the Pharmacy Minister, insisted pharmacy has “undoubtedly turned a corner” in making healthcare commissioners aware of the role it can play in alleviating the pressure on a strained NHS.
In what was a hugely optimistic take on pharmacy’s future role in a health service that is seeking to make big efficiency savings, with A&E departments stretched to breaking point across the UK, Earl Howe told the Sigma conference in India that pharmacy’s profile has been raised significantly and compelled commissioners to sit up and take notice.
“Pharmacy has undoubtedly turned a corner in terms of raising awareness with commissioners. For a long time, we have been challenging you to get out there, show what you can do and prove that pharmacy has what it takes to be a credible provider in the modern health and care system,” he said via a recorded message played to delegates at Aamby Valley, a recently built self-contained hill city which is hosting the conference.
Earl Howe said much of that awareness had come as a result of the work put in by the bodies representing the pharmacy profession, which had led to not only commissioners but also patients, the wider public and the media being made aware of pharmacy’s benefits.
“The Royal Pharmaceutical Society, through its Now or Never: Shaping pharmacy for the future report, the Pharmaceutical Services Negotiating Committee with its Vision for NHS Community Pharmacies and Pharmacy Voice with Community pharmacy a blueprint for better health, have all published credible roadmaps to enable pharmacy to play an enhanced role in the delivery of both NHS and public health services,” he said.
“Have you noticed just how many times pharmacy has been mentioned recently in connection with reducing the burden on busy A&E departments and GP surgeries? Through campaigns such as NHS England’s Feeling under the weather? The message is clearly getting across to commissioners, patients and the public and the media are picking up on this.”
He added: “Certainly NHS England’s urgent and emergency care review acknowledges that far better and greater use can be made of community pharmacy.
“NHS England’s Five Year Forward View makes it clear that the NHS needs to change if it is to continue to provide the high quality services that our patients deserve. I welcome NHS England’s recent call to individual organisations and partnerships to register expressions of interest in becoming a New Model of Care vanguard site.
“Community pharmacy, will want to consider what re-engineering might be needed to ensure that its contribution continues to be of direct relevance to the NHS and keeping the best that pharmacy has to offer, naturally.”
Earl Howe said having “robust technology in place will be critical in supporting this” but could not offer a definitive date for when pharmacy will be handed access to the summary care record despite a pilot showing some encouraging results.
“I am told that the initial findings are promising and that the final report is due in the coming months,” he said.
Meanwhile the Prime Minister David Cameron and Labour leader Ed Miliband sent letters to the Sigma conference expressing their support for the role of community pharmacy, something that was perhaps unsurprising with a general election looming.
“The public rightly values the contribution that community pharmacies make by providing clinical and public health services,” Cameron wrote.
In his letter Miliband said: “At a time when GPs and A&E departments are under immense strain, too often pharmacy is an untapped resource.”
Self care a “very attractive option” for commissioners
Hemant Patel, the secretary of North East London LPC, hailed the impact of the self care pharmacy initiative, describing it during the Sigma conference in India as “the cheapest form of care” and “a very attractive option for commissioners.”
The self care pharmacy programme, which aims to place the individual patient at the centre of their own care, has taken off across at least six London boroughs and Patel challenged pharmacists across the UK to get involved in it.
The innovative pharmacy scheme manages long term conditions, co-morbidities in community pharmacy and strives for parity between mental and physical health using therapeutic and psychological techniques.
The patient undergoes a bio-psycho-social assessment and, in collaboration with the pharmacist, produces a care plan which is tailored to that individual patient’s needs.
The intention is to educate and empower that individual to change their behaviour and improve their health and wellbeing outcomes.
“Self care is the cheapest form of care. How much time do you think patients spend looking after themselves compared to the healthcare professionals? It’s about one minute,” Patel said.
“It’s a very, very tiny amount of time to help these people, systems, carers, everyone (who) spends (time) with a patient. And that is why it’s a very attractive option for the commissioners. We have a real opportunity to make an impact.”
He added: “The fundamental change is there’s going to be a single care plan for the patient. It will have medical input, it will have nursing input. Where’s the pharmacy input? We need to create a care plan for the patients to look after themselves.
“The whole purpose of self care pharmacy is you build new business on top of repeat dispensing. That is your base. Instead of just giving medicines you are doing something extra which builds up the business.”
NHS would fall in a big heap but for India
Kumar Iyer, the deputy British High Commissioner in India, described the relationship between the UK and India as “phenomenal” and insisted the strength of that partnership was being played out in the pharmaceutical and life sciences sectors.
Speaking to delegates at the Sigma conference, Iyer said the strength of the UK-India relationship was highlighted by the fact that the UK invests more in India than any other G20 country and India invests more in the UK than it invests in the rest of the European Union.
That, he said, was particularly apparent in the pharmaceutical industry.
“Companies like Wockhardt and Cipla are huge investors in the UK, recently investing £100 million earlier this year in the UK,” he said.
“The macro relationship is also borne out in pharma, life sciences and healthcare. I mentioned Wockhardt and Cipla. The NHS would fall over probably in a great heap if it wasn’t for India.”
Iyer said the extent to which the NHS relies on India is reflected by the fact that 25% of the drugs consumed on the NHS originate from India and 40% of the active ingredients are sourced in the country.
PSNC assures payment parity with general practice
Mike Dent, the chief financial officer at the PSNC, reassured pharmacists that the negotiating body is intent on achieving equality with general practice when it comes to remuneration for services.
Addressing the Sigma conference in Aamby Valley, India’s self-contained new hill city, Dent warned contractors to ensure they get to grips with what he described as “a much more complicated” funding model than pharmacy has been used to but was adamant that when it came to securing funding, pharmacy would not be left trailing in GPs’ wake.
“Where pharmacy is doing something which GPs are doing exactly the same then we’re very clear; we want complete parity,” he said.
“If you look at urgent care, NHS England and Monitor are working together particularly around urgent care to try and get a payment system that helps put the right incentives in place to move people to the right place.
"Pharmacy would be part of a much bigger system. We need to be aware of the changes the NHS is proposing for itself. But there’s another side to it. There’s a big risk issue.”
He added: “The way the NHS works, its budgets are fixed a year or so in advance and they cannot overspend and they hate their contractors being paid on an item of service basis because they are then effectively carrying all of the risk.
"Behind the acute care thinking (it) is all about risk sharing and different systems to make sure risks are at an appropriate place in the chain of healthcare delivery. It’s a much more complicated model than we’re used to and it’s a much more integrated model than we’re used to and it’s something contractors are going to have to adapt to.”
Sigma acquire new picking and packing site, director reveals
Rajiv Shah, a director at Sigma Pharmaceuticals, revealed that Sigma Pharmaceuticals has acquired a new site next to its Watford headquarters which will see the company improve its distribution of medicines.
"We are still in Watford but we've acquired a site next door to us which will become our new picking, packing operation which will see us moving away from the site we've occupied for the last 25 years or so and move into a new premises where we'll see automation taking place," he said.
"What that will mean will be a better delivery service, a better picking service as well and far greater stockholding than we already have. It's so important to our customers. Price is key but service and availability are paramount in what we do."
On the issue of medicines shortages, Shah said Sigma was working with suppliers to ensure there is an effective forecast system in place to pre-empt the risk of a drug shortage.
"(Shortages are) there, it is evident. One thing that we probably don't do and should do is ring our customers to let them know and letting some customers wipe stock out," he said.
"We don't do that because we want everyone to have stock. So when we manage shortages we restrict stock effectively and sensibly so people across our customer base can get stock. The worst thing is to be able to get stock and get someone come in, completely drain the stock and leave everyone else out of (stock).
"We are working with the suppliers to make sure that the stock order that we have with them is forecasted to make sure our customers aren't left out in the cold."
We will work with the NPA moving forward
Claire Ward, the chief executive of the Independent Pharmacy Federation, insisted the organisation is committed to working with the National Pharmacy Association to drive forward the interests of the independent sector.
Both bodies have in the past claimed they are best equipped to represent independent pharmacists. While the NPA has revealed it has over 5,000 independent members, the IPF has not officially divulged the size of its membership.
"One thing we already do in the IPF is we work in partnership. We've worked with industry, we've worked with NPA and AIMp and we will continue to work with the NPA because it is the right thing to do for independents," Ward said.
Fin McCaul, chairman of the IPF, warned pharmacy "to stop thinking about just pharmacy" if it is to thrive in patient-centric NHS. 
He added: "We either join with GPs or, like they've done in Northern Ireland, form a social enterprise and invite GPs in to do it."
Describing pharmacy's rollout of the New Medicine Service as "embarrassingly bad," he added: "Currently in Lancashire, 55% of pharmacies only deliver NMS yet we would add £10,000 to our bottom line."