The Healthcare Distribution Association (HDA) which represents wholesalers invited Andrew Lane, Chair of the National Pharmacy Association, to give a speech at their 2022 Business Day conference on Thursday (26 May). Here is some of what Andrew had to say…
On community pharmacy
Pharmacies are a local lifeline and vital to the health of the nation. Often the first port of call for advice and treatment, pharmacies are a key part of neighbourhood health services. Pharmacies provide a range of NHS services, ensure people can get face-to-face care without an appointment, and take pressure off GPs and hospitals.
Doing our job as community pharmacists well depends heavily on all of you doing your job well too; we know we are part of a large ecosystem that takes in wholesalers, manufacturers, the NHS, fellow healthcare professionals and of course patients.
That became very clear during the pandemic if it wasn’t already. The medicines supply chain had to come together in the most pressurised circumstances, to maintain access to medicines.
On the medicines supply chain & working with wholesalers
Several years ago, the NPA drafted a set of ‘wholesaler service standards’ to help our members put some structure around how to evaluate the performance of their suppliers.
This is a piece of work that our HDA colleagues are familiar with and we’ve had some frank exchanges about how to use these as an honest basis for discussion rather than a stick for us to poke you with.
Here are the broad categories:
- Fairness: e.g. The wholesaler provides a system that allows a pharmacy to avoid inadvertently triggering a low spend surcharge
- Responsiveness: e.g. The wholesaler responds to queries or complaints within three hours within the working day
- Timely communication: e.g. The wholesaler provides a facility for pharmacies to receive a daily update on their cumulative qualifying spend and cumulative returns through the month
- Efficiency: e.g. The wholesaler supplies promptly relevant invoices and refunds
- Transparency: Terms and conditions of accounts are clearly presented, including information on pricing, discounts, surcharges and rebates.
On medicines shortages
At this moment in time, there is a lot a noise, understandably, about the shortage of certain HRT products.
As you know, medicines shortages are frustrating and time-consuming for pharmacists and can be distressing for patients. Pharmacists work hard to get patients the medicines they need, when and where they need them, but this time could be better spent on giving healthcare advice and support.
The NPA attended the Secretary of State’s HRT ‘summit’ this month – as did representatives from the HDA. We are now in contact with the newly appointed HRT ‘Tsar’, Madelaine McTernan.
Fundamentally it’s a supply and demand issue, requiring manufacturers to up the overall volume of stock available in the UK.
But there are also things that can be done at the other end of the supply chain. This includes giving pharmacists the flexibility to make changes to a prescription or supply suitable alternatives when a product is out of stock. This has been provided for to an extent with 13 Serious Shortage Protocols, but SSPs are time limited and somewhat rigid, so not the answer long term.
On hub and spoke
Inter-company hub and spoke is now provided for in law. It’s not going away and it’s imperative that we engage with the challenge and opportunities it presents.
Yet there are three broad reasons why independent pharmacies remain sceptical about the benefits.
The first issue is related to costs associated with the model. The hub provider will charge a service fee for supplying the medicines. Potentially, the pharmacy may lose some of the discount that it gets at the moment [from wholesalers], some of the buying margin, which is a key part of the income of community pharmacy.
The lack of a competitive market among hubs is also putting contractors off the concept. You'll only get competition if you've got enough market players. Of course, quite a significant financial investment is required to set up a hub. Until we can see a vibrant hub market, with people competing to win the contract of those pharmacies, I think pharmacists will have a real concern.
The third reason is the operational challenges pharmacy contractors would face when using a hub. Part of the way you make hub and spoke work is actually to reduce your stockholdings in the pharmacy. So, you're less able to deal with unexpected situations. The hub is putting a new layer in place, making it harder to be as responsive as we are now.
On the future
Future success also depends on community pharmacists enthusiastically embracing a clinical future at the heart of the NHS. It has to be services and supply, not service or supply. We are always conscious that safe supply of medicines and giving expert advice on their use is at the core of what we do as community pharmacists.
Whatever else is to come, the future will inevitably see pharmacies and wholesalers continue to be part of each other’s lives and livelihoods.