Targeting and Marketing to Community Pharmacists – a new opportunity for the pharmaceutical industry
(Published March 05)

Everyone knows that community pharmacists are the newest additions to the NHS family! The new pharmacy contract, which will go live from April 2005, provides the legal framework to allow the skills, experience and expertise of pharmacists and their staff to be fully utilised in a modern NHS. It makes clear the role of community pharmacy and how it will contribute to the achievement of targets for the health sector on improving access and choice and helping people with long-term conditions. Additionally, the new pharmacy contract will allow PCTs to develop community pharmacy services that can support GP practices in fulfilling the new GMS contract.

So what has changed to make community pharmacists integral to the NHS and just how important are they going to be? This article describes how the role of the community pharmacist has changed in recent years and some of the new roles that community pharmacists will take on with the advent of the new pharmacy contract. It then considers how influential this professional group will be and how the pharmaceutical industry might identify appropriate community pharmacists to engage with and in what way.

What does a community pharmacist actually do?

It takes five years of study and training to become a community pharmacist – four years studying for a pharmacy degree at university and one year post graduate training in a pharmacy, with a registration examination which must be passed in order to practice. And yet until recently community pharmacists have been an under utilised resource in the NHS who have been seen as separate from the NHS and perceived as retailers rather than health professionals.

Although more than 6 million people visit a community pharmacy each day and the community pharmacist is an accessible first port of call to help people manage such ailments as colds and flu, there is still an inherent view in the general population that the only person who can deal with their symptoms is their doctor. However, in many cases such minor ailments will resolve on their own and do not require prescription medicines – and could be managed by a community pharmacist. One of the core features of The NHS Plan of 2000 is to make better use of the skills and experience of other health professionals working in the NHS, freeing up doctors’ time to deal with those patients who needs require it and providing alternative and more easily accessed care for those who do not.

What roles will community pharmacists be doing in the future?

Over the last few years many community pharmacists have taken on challenging new roles in the development of medicines management services, working more closely with other health professionals and primary care organisations. Success in these roles has been demonstrated in terms of quality and cost effectiveness and benefits to patients and the NHS. The new pharmacy contract is the mechanism by which community pharmacists can be remunerated for delivering these services which will help PCTs achieve objectives of the NHS Plan around Patient choice, Public Health and Chronic Disease Management. As a result the community pharmacist is now an integral member of the NHS family and as such has become an important addition to the network of health professionals involved in the planning and delivery of local services.

The new pharmacy contract divides services that can be provided by community pharmacists into three tiers of services: essential services, advanced services and enhanced services. Essential services are defined as those core services that must normally be provided by all community pharmacy contractors and include dispensing, repeat dispensing and importantly clinical governance. Such services together with advanced services will form the ‘nationally agreed’ services and will not be open to local negotiation. Advanced services will require accreditation of the pharmacist providing the service and/or specific requirements to be met in regard to premises. Advanced services currently include medicines use review and prescription intervention. Enhanced services are services, which will be commissioned locally by PCTs and will also require further training and accreditation. It is these services in particular that will result in some community pharmacists becoming important members of the NHS medicines management network. Examples of some enhanced services include: minor ailments schemes, anticoagulant monitoring, medicines assessment and compliance support, care home support, patient group direction service, full clinical medication review and supplementary prescribing.

In addition to the new pharmacy contract roles, some community pharmacists are already increasingly active in promoting the clinical and cost effective use of medicines through undertaking medication reviews for targeted patients and managing services such as hypertension clinics with their local GP practices. As more community pharmacists become supplementary prescribers, and indeed independent prescribers in the future, they will become more involved with the practice team in decision-making about use of medicines within their specialist area.

How important are community pharmacists going to be?

The new pharmacy and GMS contracts mean that there will be much greater interaction between GPs and community pharmacists and consequently the community pharmacist will become more influential where prescribing decisions are being made. Community pharmacists are also making a valuable contribution as members of PCT professional executive committees and members of the PCT prescribing and medicines management committees.

As more medicines become available as pharmacy only medicines, pharmacists will make clinical and therapeutic decisions in their own right as health professionals in order to provide their patients with the most appropriate medicine for their symptoms. Similarly community pharmacists who run specialist clinics from their pharmacies as supplementary prescribers will make decisions about the appropriate medication for the condition through care plans that have been developed with the supervising GP.

How will the pharmaceutical industry identify the community pharmacist influencers?

As the number of influencers increases in the NHS, pharmaceutical companies who wish to work in partnership with the NHS must become more sophisticated in the way they engage with it. Pharmaceutical companies must do their homework and research who is most likely to be their best suited point of contact and what that point of contact into the NHS will be looking for and requiring from pharma marketers.

Clearly not all community pharmacists will take on all the opportunities that the new pharmacy and the new GMS contracts bring. In addition not all PCTs will progress at the same speed to implement the new pharmacy contract. It is likely that PCTs who have had little engagement previously with community pharmacy will need to focus entirely on implementing the essential services in the first year, whereas PCTs who have involved their community pharmacists in the early medicines management pilots around for example prescription intervention schemes and practice prescribing support will be more ready to develop advanced and enhanced services. The latter PCTs will provide the pharmaceutical company with the greatest initial marketing opportunities.

For the pharmaceutical industry there are a number of steps that will need to be taken to drill down to the community pharmacists influencers in a given PCT. The first step is to identify which PCTs have been innovative in developing new pharmacy services, the second step will be identifying those community pharmacists who are involved in medicines management initiatives and the third step will be finding who are the influencers in the local health economy.

The first step is probably the greatest challenge as it is unlikely that the pharmaceutical company will have the means to identify how effectively PCTs are working with their community pharmacists as this is a new group of health professional not previously targeted. Answering the following questions may help to rank PCTs in terms how quickly they are likely to implement the new pharmacy contract and thus narrow down the areas to be covered:

• Is there a community pharmacist on the PCT professional executive committee?
• Is there a Pharmacy Development Group?
• Is there a Community Pharmacy Clinical Governance Facilitator?
• Has the PCT developed any accreditation schemes for community pharmacists?
• What schemes has the PCT involved its community pharmacists in? For example: prescription intervention schemes, medication review service, GP practice prescribing support, repeat dispensing pathfinder site, smoking cessation services, minor ailments schemes

How should the pharmaceutical companies market to community pharmacists?

Pharmaceutical companies should consider community pharmacists as key stakeholders in their business planning and a new target for their marketing. Communicating accurately to them – and treating them as sophisticated influencers - will lead to new NHS networks to work with.

There are several areas, related to the new pharmacy contract where the pharmaceutical industry may begin to engage with Community Pharmacists. For example:

• Clinical governance is an essential requirement for the new contract and there are opportunities to help community pharmacists achieve this;
• Pharmacists are now rewarded through advanced and enhanced services for offering services such as smoking cessation programmes, diabetes screening, palliative care or Healthy Living programmes. In order to provide such services, pharmacists will require adequate training;
• Assistance in new service development, such as a minor ailments schemes and mediation review by sharing knowledge of successful schemes in other parts of the country.

Involving community pharmacists in educational and training initiatives will develop good relationships as well as providing a protected environment in which to understand what their needs and aspirations are and identifying who are the key influencers in their new role.

As far as providing clinical information, community pharmacists must be treated with the same respect as PCT Prescribing Advisers. They will need access to good evidence based information from reputable sources in order to communicate effectively and accurately with their GPs. They will need hard facts about things that will help their prescribing support role, such as clinical data about how a drug works, the diagnostic techniques needed to ensure that the right patients are targeted, and the cost benefits of a treatment. The format in which this information is presented will have a major impact on the responsiveness of the pharmacist; community pharmacists are busy people with little time to spend and so expect to receive concise and accurate information in which they can have confidence. If the pharmacist cannot understand the benefits or how a drug actually works, or harbours any doubts about its effectiveness or side-effects, then it is unlikely that he or she will consider recommending such medicines for patients.

With the right approach and the right market intelligence, there is now a clear window of opportunity for pharmaceutical companies to grow their revenues by providing support to community pharmacist’s to deliver these ‘added-value’ products and services. If pharmaceutical companies can help the NHS to carry out its plans and directives then that can only benefit consumers.