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All things Pharma


The new Pharmacy Contract places the pharmacist firmly within the network of Key Opinion Leaders.

FOR A LONG TIME, pharmaceutical companies have had to focus their sales efforts on only one sector of the medical profession: the doctor. Now, with the changing emphasis on improving long-term primary care, both nurses and pharmacists are becoming important factors of the influence network. And while some companies are beginning to address nurse prescribers, they continue to ignore the role of the pharmacist.
But the writing is on the wall. Pharmacists are already taking a leading role in influencing Primary Care Trusts (PCTs), who are involved in the setting of formularies and are working closely with GP practice managers to create standardised policies (more often than not based on the use of generics). Over time, this highly-skilled, highly-educated group of professionals will attain supplementary prescribing status. Already, they provide unprecedented opportunities for educating and influencing the patient. Pharmaceutical companies need to start addressing this area of opportunity.

The Pharmacy Contract
The pharma industry still needs to adapt to the rapid pace of change throughout the UK health service. From the implications of the new GP contracts to the changing role of the PCT and the growing influence of nurse prescribers, the Key Opinion Leader (KOL) network is expanding dramatically. Given the challenges now faced in identifying the influencers and working out how best to deliver a relevant sales message, it is little wonder that many pharmaceutical companies have, as yet, paid little attention to the changing role of the pharmacist within the health service.
And, to be fair, the recently-introduced Pharmacy Contract has not, at first pass, provided pharmacists with the overall influence that many had hoped for. Unlike Scottish pharmacists, who can now prescribe over-the-counter medicines under the Minor Ailments Scheme, those in England and Wales have yet to be allowed any more professional services.
Pharmaceutical companies may thus be tempted to look on the new Pharmacy Contract as a reason to go on ignoring this element of the primary care team. But this attitude completely ignores the fact that not only do pharmacists now have a growing influence at both PCT and GP level, but they also have a far closer relationship with the patient – particularly in the monitoring of important issues such as compliance, advising on potential side effects and (to some extent) managing ongoing chronic conditions. Such relationships offer unprecedented opportunities for any pharmaceutical company that recognises the growing trend towards an ‘informed’ patient community.

Growing influence
While the pharmacy contract may be less robust than was initially expected, it does represent significant change. For the first time, the PCT is responsible for the pharmacy; and pharmacists are taking a more central role in advising on formulary decision-making. The PCTs are waking up to the valuable insights that pharmacists can offer – most notably into the dangers of drug interdependency. With an average of 10%* of hospital admissions being due to drug-related issues, the importance of this expertise should not be overlooked.
Furthermore, proactive pharmacists are now working closely with surgery GPs to review prescribing habits and develop a consistent formulary across the practice. There is growing evidence that the result of such reviews is more rapid adoption of generics, enabling the practice to reduce costs.
The relationship between the GP and the pharmacist will also be changed as a result of the new Medication Utilisation Reviews (MURs) to be undertaken with a subset of patients by pharmacists. While the current reviews are an assessment of medication and regimen, it is possible that future reviews will have a clinical element and will enable the pharmacist to change medications in order to improve the patient’s quality of care.

Informed patients
While direct to consumer advertising is still prohibited in the UK, the use of international websites to attain information about diseases, drug therapies and side-effects is growing – as any GP can attest. Therefore, as pharmacists evolve beyond filling prescriptions towards delivering added value services (for example, the monitoring of chronic conditions such as diabetes), they will become an increasing source of information for the increasingly wellinformed patients.
There is, therefore, no doubt that the pharmaceutical companies need to tap into this resource. The question is how best to target pharmacists, and just how to deliver what must primarily be an educational message.

Relevant message Of course, the pharmacists cannot be considered in isolation. They are a component of an ever-broadening KOL network throughout the NHS. To understand the changing influence and influencers, pharma companies increasingly need a way of drawing insight from multiple information sources – from wholesale data and prescription data to inferred practice-based information. By leveraging this insight, they can keep up to date with the changing NHS and gain maximum value from their sales and marketing budget.
Many companies now admit that persisting with a GP-only policy is ineffective in dealing with the new NHS. But without understanding the components of the new KOLs and the specific influence they have, pharma companies will see their own sales and marketing efforts further undermined. The role of the pharmacist may, as yet, appear less significant than that of other groups – but it is not only their influence at PCT and GP level that is important. As the informed patient becomes increasingly prevalent, the pharmacist delivering added value services will gain unprecedented closeness to the patient – not only providing the opportunity for improved education on new drug therapies, but also advising on therapy alternatives to enhance the overall quality of care.
So why do pharmaceutical companies continue to treat pharmacists as nothing more than prescription fillers who are responsible for the growth in generics and parallel imports?

* Pharmaceutical Journal, 26th April 2003.

Simon Driver is Managing Director of Infopharm
(www.infopharm.ltd.uk), a subsidiary of the Cegedim Group.


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