Who Controls The UK Pharmacy Industry? Part Two: The Battle For Customers:

Which one do you trust most: Your doctor or your pharmacist? In her “Sunday Times” column on March 30th, Associate Editor Camilla Cavendish was unequivocal about her preference. Her pharmacist, she declared, is “Highly trained, reliable and available. He doesn’t hide behind a receptionist and a premium phone line. He beavers away behind his little counter six days a week, dispensing medicines and good advice”. When she does go to see her GP (General Practitioner) she feels apologetic about “bothering him” and is anyway unconvinced that he (or she) will be able to “diagnose a worrying symptom in a 10-minute appointment”. She also referred to a survey conducted in Essex last year which indicated that people questioned would like many services to be transferred from the “increasingly unresponsive” GPs to (in their opinion) the more dependable pharmacists.

The NHS (National Health Service) website describes pharmacists as “experts in medicines” who deploy their clinical expertise and practical knowledge “to ensure the safe supply and use of medicines by the public. They have to be registered with the “GPhC” (General Pharmaceutical Council), whose role is (among others) to approve the  qualifications for pharmacists and pharmacy technicians, monitor their fitness to practise, deal fairly and proportionately with complaints and concerns and thereby “uphold standards and public trust” in the profession. The NHS also stipulates that they must have worked “for at least a year under the supervision of an experienced and qualified pharmacist either in a hospital or community pharmacy such as a supermarket or high street pharmacy”.

If (having abided by all this criteria) a pharmacist then decides to set up as an “independent” operating from “behind a little counter”, what are the chances of their business becoming financially viable? As emphasized in Part One of this analysis, they will be immediately confronted by fierce competition from retailers such as Boots and most supermarket chains. According to IDP (the “indignant, disenchanted pharmacist” quoted in Part One) between 70%-80% of the independent pharmacist’s income is derived from dispensing NHS prescriptions. However, the fee they receive from this is very low: around 70p per item. This applies even if the drug itself is worth £1000 or more. The number they dispense on a daily or weekly basis thus becomes a vital matter – and also explains why they would be unlikely to favour GPs writing out prescriptions for three or six months instead of just 28 days as at present. It would immediately hit their pockets.

The Government appears to be moving towards a system whereby patients have to be registered with their chosen pharmacy as well as a GP. This would make it obligatory for the prescription to be transmitted electronically from the GP’s surgery to the nominated pharmacy. At the moment, this arrangement is voluntary. Once it comes into force, all pharmacies will be fighting each other for the business.

Another important source of revenue – especially for the “independents” – is the “Medicines Use Review” (MUR). This is a scheme set up under the previous Labour Government whereby (says IDP), your pharmacist can “check that you’re happy with your medicines, taking them regularly, if not why not, do you know what they are for, do you know how to use your inhaler”. The pharmacist is allowed to conduct a maximum of 400 “MUR’s per annum. How much they are paid for these is specified in the “Drug Tariff” issued monthly by the Welsh Office. Patients are not charged for an MUR appointment.

It is thus perhaps unsurprising (asserts IDP) that some pharmacists resort to less scrupulous ways of boosting their income: One method is to order more drugs than they need and then export these to Europe if the equivalent medicines are more expensive there, resulting in a considerable profit. The same applies in reverse when the medicines are cheaper abroad, though the label on the package and the leaflet inside both have to be translated into English. The drug manufacturers dislike “Parallel Importing” as it makes it more difficult for them to keep track globally of where their products are being distributed & sold and by whom – so sometimes react by limiting the availability of their medicines. Which of course creates problems for the genuine pharmacists as well as the dishonest ones.

In the UK, the safety, quality and efficacy of pharmaceutical drugs is monitored by the MHRA (Medicines and Healthcare Products Regulatory Agency). They assess a medicine’s content, how it is advertised and for which condition(s) it will be used. This especially requires checking generic products (equivalent to the “original formulation” whose patent has expired) arriving from abroad. In IDP’s view, the standards of those manufactured in countries such as India, South Africa, China and Brazil are “not necessarily as high as in Europe or the USA”. There can be “serious repercussions” if the system fails. The tendency is for fraudulent drugs “not to be as effective or as strong as they should be”. They might contain “adulterants” – bits of other chemicals that shouldn’t be there. Wholesalers “will buy from the cheapest generic source”. The pharmacist will have no knowledge of or control over the origins of the medicines they are dispensing.

In addition to the PDA (Pharmacists Defence Association), the  industry is represented by several other bodies. The National Pharmacy Association (NPA) “counts among its members the nationwide pharmacy multiples, regional chains and independent pharmacies (in other words, says IDP, the owners). The mission of the Royal Pharmaceutical Society (founded on April 15th 1841) is to “ensure that the voice of the pharmacy profession is heard and to increase the recognition that pharmacists enjoy as valued partners with the NHS and wider society”. The Independent Pharmacy Federation (IPF) was inaugurated in September 2006 and “arose out of the concerns for the infrastructure of the independent sector at a time of rapid commercial and political change”.

In the “Guardian” on 28th March, journalist Julia Kollewe reported that the world’s best-selling drugs earnt £46 billion in 2013. The current “Top Five” are: “Humira” (anti-rheumatic, made by AbbVie), “Embrel” (anti-rheumatic: Pfizer/Amgen), “Remicade” (anti-rheumatic: Johnson & Johnson/Merc ), “Seritade/Advair”  (asthma: GlaxoSmith Kline),”Lantus” (diabetes: Sanofi). None of them, however,  “ have yet come close to the $141 billion of revenue generated for the US drug multinational Pfizer by its anti-cholesterol drug ‘Lipitor’. It remains the biggest money-spinning drug of all time”.

 

 

Filed under: Healthcare | Posted on April 6th, 2014 by Colin D Gordon

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