Hive Health

So POM to P switches are 25 years old, but for me everything changed in 2002 with the publication of the list by a RPSGB led working group of potential candidates for reclassification from POM to P. At the time there was talk of an avalanche of switches coming through the system, the industry got itself all expectant, the pharmacy profession was nervously excited and everyone prepared themselves for the new era.

So what happened? Despite all the positive hype, it hasn’t quite worked out as hoped for, either for the industry or the profession. Certainly the avalanche never arrived, and I doubt now it ever will.

I think if you asked industry executives, hand on heart, has switching been commercially successful, so far most would admit it hasn’t. If we believe POM to P has a role to play in the future of treatment management, and that pharmacy has a key role to play in diagnosing and managing conditions – both of which I passionately believe in – we really need pharmacists to start proving that they believe it too.

I have no doubt that for a host of conditions and ailments, the best place to treat and manage (and even diagnose) is in the pharmacy. Some 30 per cent of GP consultations are for minor or self-limiting conditions, most of which are in areas that pharmacists are either well or sometimes better equipped to deal with.

Couple this with the fact that our healthcare system has disenfranchised so many people and that vast tracts of patients/consumers are increasingly looking to their high street clinician – the pharmacist. One begins to wonder how it could go wrong.

I run a communications agency and over the years I’ve worked on a host of switches. I’ve spent a great deal of time talking to pharmacists about their role, their attitudes to conditions and treatments, and most importantly how they interact with their customers.

We develop training and tools to support pharmacy knowledge, and to help create a positive dialogue with customers around a condition or treatment. We also spend a great deal of time talking to the pharmaceutical industry about how to support pharmacy – so I do see things from both the industry’s as well as the profession’s side.

As far as the industry is concerned, innovation drives growth. Generic proliferation and own-brand competition mean that you can’t sit still. POM to P switching provides a huge area for innovation. It’s a ready-made pipeline of proven products for key conditions and it can breathe extended life into brands coming off patent.

With the new community pharmacy contracts and the evolution of pharmacists into service providers, the case to move more chronic care into pharmacy is compelling. Diagnose simple and even not-so-simple conditions, and the management of complex conditions follows closely behind. Whether pharmacists acknowledges it or not, the industry believes that the high street has a vital role to play in the future health management of the nation.

There is no doubt that the pharmaceutical industry produces fantastic support for pharmacy. The quality of support that exists for POM to P switches keeps getting better and better. The extent of investment in pharmacy for launches is now greater than I’ve ever seen. And it’s not unrecognised. Pharmacists acknowledge it openly. So why is it so difficult to get lift-off with a new POM-P medicine?

We acknowledge that the industry believes in pharmacy, but I believe, more importantly, that consumers believe in pharmacy too. So who is missing from this picture?

In truth, no one. Industry, consumers and the profession are passionately committed to an extended role for pharmacists. So it’s a perfect storm then? Sadly not. Because whilst the profession is supportive, there is a latent caution that affects launches so overtly that it brings to question whether switching is a viable long-term option.

From conversations with pharmacists this new world seems exciting, but quite daunting too. Diagnosis, long-term management, counselling, guidance, advice… all words that to a greater or lesser degree create nervousness. This new way has an impact on the way pharmacists operate – much more front of counter, the visible face in the store, more time intensive. So who sorts out the prescriptions? Who does the things that keep pharmacists so busy normally? Are they really able to diagnose? It’s a brand new world, and for many a scary one.

In reality switches should be the ideal conduit for this transition. The regulatory framework around switching is rigorous, designed to protect all, often to the detriment of efficacy. The products switched invariably fulfil a clear consumer need, and driving new people into pharmacy for new solutions should be good for all.

Consumers are open. They too like innovation, they want better treatments, to be able to quickly fix problems, get an appointment on their terms.

Sure it’s true that they are not yet used to more complex discussions with pharmacists. They feel a bit uncomfortable, unsure – but that’s easy enough to fix, isn’t it? Professionals, on the high street, ready to put people at ease? Perhaps the truth is that pharmacists aren’t used to these sorts of discussions either or just scared to have them.

The traditional role of symptom management will never disappear, but with the competitive environment the industry operates in being unsustainable without innovation, the truth is that without pharmacy engaging with POM to P switching and supporting it as a category, the industry will have to change tack. It cannot afford for innovation to go unrewarded in terms of sales.

This brings me to a final conundrum. I regularly hear cynicism from the profession that POM to P switches are just a route to GSL, and that pharmacists are being ‘used’. There is a truth that brands switched from P to GSL see improved sales performance, but for me it’s just a natural extension of life cycle.

An established brand with a profile for broader access, one that doesn’t need the time commitment from pharmacists, should be GSL. It’s not some conspiracy; it’s just a business reality. I worry that if pharmacy does not start to properly support POM to P switches, their cynical worrying becomes a self- fulfilling prophecy.

Pharmacists must demonstrate that they believe they are the rightful place for condition treatment and management to exist. This is so important, because once this true partnership is in place, the value of the consultation and improved experience for consumers will not only enhance their view of pharmacy as a solution, it will radically change the industry’s view. Why switch to GSL a brand where the role of a pharmacist is so intrinsic to the consumer’s experience?

This post also features in this months Pharmacy Magazine supplement reviewing 25 years of POM to P.

Any healthcare industry observer knows that today’s patients participate more actively in decisions affecting their health than ever before. This is facilitated by a less stigmatised approach to personal health, and by the internet as the ‘premier’ source of healthcare opinion and information.

Aside from some downsides (see previous posts) , most of us see knowledge-empowerment as a promising impact on health outcomes. However, it’s unfortunate that EU citizens are restricted to gaining information online peer to peer (via discussion forums) or from company sites in unrestricted markets, such as the US. This information rarely represents local indications or local market conditions. As a result the patient reviews information that is not always relevant to them, with products that are not always available in their market.

The European pharmaceutical industry has become an outsider to this information exchange. They are legally liable for the products they produce, but prevented from providing a regulated information source to the concerned consumer.

Isn’t it about time that Pharma be recognised as important contributors to health information alongside healthcare professionals, patient groups and regulatory bodies?

The recent European Federation of Pharmaceutical Industries and Associations (EFPIA) call on policy makers to improve access of citizens to medical information seems sensible and long overdue.

The EFPIA have proposed 4 main information categories to clarify the discussion. Firstly, pro-active information, which is provided unsolicited to the public, should be limited to general information on diseases, e.g. covering awareness, prevention etc. but not mentioning specific medicines. Secondly, reference information, covering diseases and medicines, which is sought by patients as in a library, e.g. through the internet. Thirdly, reactive information on medicines in response to enquires received from patients. And finally, support information supplied to support compliance with a prescribed medicine.

The European Commission is also in the process of reviewing the current practice with regard to information to patients on medicines and plans to announce its findings in October 2008.

The European Commission fully supports that better information available to patients can contribute to achieving better health conditions, a more efficient use of resources and better adherence to treatments. And has further concerns over inequalities of information provision across EU members, and the lack of quality standards. In addition to this it also recognises that Member States authorities may not be in a position to fully address patients’ needs in terms of the substance of information and the access via different means.

It would appear that the EFPIA and the European Commission are on the right track and we could expect to see at least a recommendation of harmonisation across member states.

In the mean time consumers of medicines in the EU remain exposed to inaccurate information and at potential risk to their health.

A Cambridge University academic is leading a call to dispense with medical jargon in favour of everyday language. Dr Melinda Lyons claims in the Lancet that patients can get dangerously confused by unfamiliar and similar-sounding terms (intra vs inter; hypo vs hyper), particularly in stressful and noisy situations.

This is something to be grateful for, because it’s more proof that healthcare is becoming more patient-focused. While not without its challenges, communication built on the needs and expectations of the end user is clearly the way forward. Dr Lyons’ work, and the fact her research featured in the morning Metro, reminds us that everyone has a stake and a growing interest in what happens in the healthcare world.

But it also reminds us that people aren’t the same. Words that are necessary to one person may patronise another. At Hive we play our part by first understanding who the end user is. Only then can we get the dialogue right between that person and the person looking after them. We do this by letting the HCP know more about who’s in front of them.

It’s a subtle thing, joining the dots between different mentalities and creating proper engagement, but it’s not new in marketing. Without the correct delicacy however, you get a fumbling disaster which tries too hard and fails.

So, between the patronising and the ancient Greek, lies a tone of voice that resonates. Finding it is a beautiful thing.