HDA UK Media And Political Bulletin – 22 May 2018

Media and Political Bulletin

22 May 2018

Media Summary

Breaking: Pharmacy’s battle to overturn governments funding cuts resumes in court

PharmacyBusiness, Neil Trainis, 21 May 2018  

Pharmacy Business reports that community pharmacy’s battle to overturn the government’s funding cuts will resume today as appeals by two leading bodies against a judge’s verdict last year that ministers did not act unlawfully in imposing the measures is heard.

The National Pharmacy Association (NPA) and Pharmaceutical Services Negotiating Committee (PSNC) will have their cases heard at the Court of Appeal just over one year after Lord Justice Collins dismissed their judicial reviews of the decision to implement £320 million in cuts over a two-year period. The hearing is expected to last three days.

The PSNC’s original judicial review revolved around their belief that the government had failed to carry out a proper consultation on the cuts while the NPA’s argument was that ministers did not conduct an adequate impact assessment of the cuts on vulnerable groups such as the elderly, disabled and people living in deprived areas.

The PSNC said: “We do not expect the judges to make an immediate decision at the end of the hearing, which means that we may not know the outcome of the appeal cases for several weeks. It is not helpful to speculate on what the outcome may be at this stage.”

 

Parliamentary Coverage

 

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Full Coverage

Breaking: Pharmacy’s battle to overturn governments funding cuts resumes in court

PharmacyBusiness, Neil Trainis, 21 May 2018  

 

Community pharmacy’s battle to overturn the government’s funding cuts will resume tomorrow as appeals by two leading bodies against a judge’s verdict last year that ministers did not act unlawfully in imposing the measures is heard.

The National Pharmacy Association (NPA) and Pharmaceutical Services Negotiating Committee (PSNC) will have their cases heard at the Court of Appeal just over one year after Lord Justice Collins dismissed their judicial reviews of the decision to implement £320 million in cuts over a two-year period. The hearing is expected to last three days.

The PSNC’s original judicial review revolved around their belief that the government had failed to carry out a proper consultation on the cuts while the NPA’s argument was that ministers did not conduct an adequate impact assessment of the cuts on vulnerable groups such as the elderly, disabled and people living in deprived areas.

The PSNC said: “We do not expect the judges to make an immediate decision at the end of the hearing, which means that we may not know the outcome of the appeal cases for several weeks. It is not helpful to speculate on what the outcome may be at this stage.”

Despite his decision not to quash the cuts last year, Lord Justice Collins was critical of the Department of Health’s (since renamed Department of Health and Social Care) consultation process which he said was unfair albeit not unlawful. The department had failed to disclose its use of a Companies House analysis which it claimed showed community pharmacies had an operating margin of 15%.

Lord Justice Collins also said the department did not understand the duty to reduce health inequalities when making decisions about the NHS and highlighted the range of services being delivered by community pharmacies to some of the most deprived areas of England.

PSNC director of operations and support Gordon Hockey said: “PSNC has always regretted very much that it became necessary to take the unprecedented step of seeking a judicial review. We have always sought to work constructively and collaboratively with the NHS and Department of Health and hope to begin substantive discussions with them on the future of community pharmacy very soon.”

NPA vice-chair Andrew Lane said: “Pharmacies are disproportionately located in deprived areas, a rare exception to the so-called inverse care law under which people with the highest needs have the least access to advice and treatment.

“The high court judgment vindicated our stance on health inequalities and we now want to see that flow through to a logical and fair conclusion. Had the Department of Health properly considered the impact of its cuts, it would have realised that the cuts will ultimately have a disproportionate effect on people living in the most deprived areas of England, where there is already a lack of NHS provision.”

Media and Political Bulletin

12 February 2018

Media Summary

NPA announces appointment of new chief executive

National Pharmacy Association, 9 February 2018

 

The National Pharmacy Association has announced that Mark Lyonette is to join the Association as chief executive, from June 2018. Mark is currently chief executive of the Association of British Credit Unions.

NPA chairman Ian Strachan said of the appointment:

“Mark brings with him a great deal of experience of running trade associations, membership bodies and leading a complex, regulated sector through change. The NPA Board has asked him to further develop the capabilities and performance of the NPA in order to help transform the prospects of the pharmacy sector. We therefore look forward eagerly to his arrival in June.”

 

 

Xanax and teenagers: the facts

The Times, Rachel Carlyle, 10 February 2018

 

In its weekend supplement, The Times reported on the rise of the use of Xanax among teenagers in the UK. The prescription anti-anxiety medicine has rapidly established itself on the teenage party scene.

 

The drug is exceptionally addictive and potentially dangerous. Last week six pupils from Burntwood School, a well-regarded girls’ secondary school in southwest London, were admitted to hospital after taking Xanax during their lunch break. This came after a spate of hospital admissions from “Xans” or “Xannies” over Christmas in Sussex, Somerset, Kent and Cumbria.

 

“Its availability in the UK has really rocketed in a very short time,” says Nick Hickmott from the charity Addaction.

 

Xanax, or alprazolam, is part of the benzodiazepine family of drugs, which also includes Valium. It isn’t prescribed on the NHS (although it is available on private prescription), but is used to treat anxiety disorders in the US and is 10 to 20 times as strong as diazepam (Valium).

 

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NPA announces appointment of new chief executive

National Pharmacy Association, 9 February 2018

 

Mark Lyonette is to join the National Pharmacy Association as chief executive, from June 2018. Mark is currently chief executive of the Association of British Credit Unions.

NPA chairman Ian Strachan said:

“Mark brings with him a great deal of experience of running trade associations, membership bodies and leading a complex, regulated sector through change. The NPA Board has asked him to further develop the capabilities and performance of the NPA in order to help transform the prospects of the pharmacy sector. We therefore look forward eagerly to his arrival in June.”

Mark Lyonette said:

“I am delighted to be joining the NPA later this year. It is an honour to have the opportunity to serve the thousands of independent community pharmacies who rely on the NPA to provide essential services, a strong voice and a vehicle for collective progress. I am looking forward to working with the board and the executive team to strengthen the NPA, and develop this vital service for its members.”

 

Xanax and teenagers: the facts

The Times, Rachel Carlyle, 10 February 2018

 

If you were to invent a drug designed to frighten parents, it may look something like Xanax, the prescription anti-anxiety medicine that’s rapidly established itself on the teenage party scene.

For a start, the distinctive white oblong tablets come in a clinical-looking blister pack, not a grubby bag, and their status as a medicine gives them the illusion of safety and legality to naive teenagers. In fact it’s a Class C drug. They’re also cheap, costing about £1 a pill, are available on the internet and are not easy for parents to detect because there’s no smell or drug paraphernalia.

They are, however, exceptionally addictive and potentially dangerous. Last week six pupils from Burntwood School, a well-regarded girls’ secondary school in southwest London, were admitted to hospital after taking Xanax during their lunch break. This came after a spate of hospital admissions from “Xans” or “Xannies” over Christmas in Sussex, Somerset, Kent and Cumbria.

“Its availability in the UK has really rocketed in a very short time,” says Nick Hickmott from the charity Addaction. “Some of what we’re seeing is teenage experimentation, but there’s also an element of self-medication among teenagers who feel very pressured.”

Xanax, or alprazolam, is part of the benzodiazepine family of drugs, which also includes Valium. It isn’t prescribed on the NHS (although it is available on private prescription), but is used to treat anxiety disorders in the US and is 10 to 20 times as strong as diazepam (Valium). In clinical use, the maximum dose is usually 4mg, or two “bars” (tablets), a day. It’s a sedative that takes away inhibitions and can make users feel less anxious.

Many teenagers are taking it with cannabis or alcohol at parties to intensify the sedative effect, or with caffeinated energy drinks, or in some cases with the prescription drug modafinil to counter the calming effect. “You become sedated and lethargic as Xanax slows down your central nervous system and heartbeat,” Hickmott says. “The first time, blackouts and memory loss are common.”

Teenagers will generally break a bar into four along its vertical lines and share it out, taking between half a tablet and two tablets over the course of a party. You build up tolerance quickly and it’s extremely addictive. “If someone takes a couple of tablets the first time, the next time they might take the same again, but the third time they will need to take more to get the same effect,” Hickmott says. “Withdrawal also comes quickly. If I could tell teenagers one thing it would be not to mix Xanax with alcohol, even on different days, because the drug stays in your system for around 50 hours and you could overdose.”

That’s because Xanax and alcohol work on the same part of the brain, Dr Owen Bowden-Jones, from the Royal College of Psychiatrists in London, says. “Both alcohol and benzodiazepines are potent sedatives and work on the GABA receptors in the brain, so mixing them magnifies that sedative effect and therefore magnifies the harm.”

Possible long-term effects of taking Xanax regularly include memory problems and depression, and withdrawal symptoms include anxiety, tremors, numbness and muscle pain.

Last week Dr Bowden-Jones opened the UK’s first NHS clinic for addiction to online-purchased prescription medicines in London, and Xanax has been a hot topic. He worries that it’s the young and naive who are particularly attracted to it. “Buying drugs on the internet is attracting new people who might not otherwise be tempted,” he says. “The fact it is a medicine rather than an illicit drug can make users feel it is safe. That’s reinforced by the ability to buy it with a credit card from the safety of their own home, rather than by meeting a dealer down an alley.”

Much of the supply in the UK is thought to be fake, because the drug isn’t readily available here. “Unfortunately, people don’t really know what they are getting,” Dr Bowden-Jones says. “It might be Xanax, it might have another chemical substituted for the alprazolam, or it might have no medicine at all.”

Some teenagers get Xanax from local dealers, but others are clubbing together to buy packs over the internet via Instagram and Snapchat, where dealers advertise, from US online pharmacies or on the dark web using bitcoins.

Mandy Saligari, an addiction specialist and clinical director of the Charter Harley Street rehab centre in London, says that, in her experience, teenagers who take Xanax tend not to take other drugs and may be on the periphery of the “cool” crowd. “It’s not the ones out there taking cocaine who are taking Xanax, it’s the next social layer down, who are using Xanax so they can feel part of the crowd,” she says.

This is echoed by parents who describe their teenagers’ slightly clumsy efforts to get hold of Xanax. One mother found herself receiving an online-pharmacy package addressed to her daughter, who was at school, leading to a tearful confession that evening. Another twigged when her 17-year-old son was more uncommunicative than usual the day after a sixth-form party. “It was like he was behind a wall almost,” she says. “He could hardly speak and seemed not really there — much worse than a hangover. In the end he admitted he’d taken two Xanax tablets at the party.”

There may not be tell-tale smells like cannabis, but you’ll often know if they’ve taken it. Saligari says: “They’ll do more than slur their speech as if drunk. They’re anaesthetised to a degree: muted, not responding. If it’s weed they have more of a sparkle in their eye, and will want to talk about life and meaning. With Xanax they seem blurred at the edges and they’ll be sluggish next day.”

Other signs to look out for include your teenager sleeping longer than usual, having bumps and grazes from falling over, and seeming moodier and more withdrawn.

Dr Bowden-Jones, who wrote The Drug Conversation (RCPsych, £12.99) to help parents, says that the key is to understand why your teenager may be taking it. “Some people are attracted to drugs to enjoy the feeling of disinhibition,” he says. “Others use drugs to take away feelings they don’t want — anxiety, panic or low mood.”

MEDIA SUMMARY 

Group behind delivery safety review sets out next priorities
Chemist and Druggist, Grace Lewis, 5 July, 2017

The Community Pharmacy Patient Safety Group has released a joint report with the National Pharmacy Association (NPA) examining best practices in medicine delivery. The group aims to improve delivery and distribution, as well as improving the reporting of patient safety incidences. They examined in particular how to improve children’s safety. The report looked at improving lettering on prescriptions and figuring out ways that drug packaging could be improved to reduce dispensing errors and over-prescription.

ABPI respond to statement of UK Government’s medicines regulation plans
European Pharmaceutical Review, 4 July, 2014 

The European Pharmaceutical Review continued coverage of Jeremy Hunt’s and Greg Clark’s letter to the Financial Times regarding the pharmaceutical industry. In the response letter from the Association of the British Pharmaceutical Industry (ABPI) Mike Thompson, APBI CEO, stated that the letter was “a welcome recognition that the future of medicines regulation is a key priority”. The article also noted that the ABPI are at the heart of establishing a “consensus on key Brexit issues” such as trade and science research. The work encompasses over 200 experts, leading academic and public institutions as well as several regulatory agencies.

PARLIAMENTARY COVERAGE

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Group behind delivery safety review sets out next priorities
Chemist and Druggist, Grace Lewis, 5 July, 2017

The Community Pharmacy Patient Safety Group has set out its next priorities, following the publication of its review of medicines delivery services.

The group (see more details below), which consists of representatives of all of the larger pharmacy chains, as well as the National Pharmacy Association (NPA), published a report on best practices for medicines delivery services last month.

As well as delivery services, the group’s other priorities include working with the NHS to improve the systems by which pharmacies can report patient safety incidences, as well as creating “top tips around dispensing children’s medicine”, according to Company Chemists’ Association senior policy adviser Kate Livesey, who provides secretariat support for the group.

“Children are one of the most vulnerable patient groups. So that is an area we’re focusing on, because different pharmacies do things in different ways,” Ms Livesey told C+D last Friday (June 30).

“There’s a really simple tip somebody mentioned the other week, which was…using a stamp that said ‘child’ in red ink. Every time a prescription came in for somebody who was under 14, they stamped it.”

“It draws the team’s attention to that script in a different way,” Ms Livesey said. “They think about the small person behind the prescription, rather than potentially just seeing a piece of paper.”

The group will also follow up on some of the issues featured in the NPA’s medication safety officer’s reports, Ms Livesey explained.

“Everyone just accepts [what] the most common errors in [pharmacies] are. But we don’t want to accept that.”

As well as “looking at lettering on prescriptions”, she added that the group will consider if there is “a different way dispensaries can be organised that would help reduce the likelihood of some of those errors?”.

“It’s recognising that packaging…will be a contributory factor, but there may be other things that come into it – especially human factors.”

ABPI respond to statement of UK Government’s medicines regulation plans
European Pharmaceutical Review, 4 July, 2014 

The ABPI has responded to a joint letter from Jeremy Hunt, Secretary of State for Health, and Greg Clark, Secretary of State for Business, published by the Financial Times, that outlined the UK Government’s plans for the regulation of medicines as the UK leaves the European Union (EU).

In the response from the Association of the British Pharmaceutical Industry, Mike Thompson, ABPI Chief Executive said:
“This letter is a welcome recognition that the future of medicines regulation is a key priority for the Government as we negotiate a new relationship with the EU. It also signals a readiness to take a pragmatic approach to Brexit negotiations that puts people’s health first. This is a great first step and we look forward to seeing more detail in the coming weeks and months.

ABPI aims to strengthen UK Life Sciences

The Association of the British Pharmaceutical Industry (ABPI) are at the heart of a health sector-wide effort, post-Referendum, that aims to establish consensus on key Brexit issues such as a regulation, trade, immigration and UK science. This has been to ensure that patients and public health are central to Brexit negotiations, and that UK Life Sciences is in as strong a position as possible as the UK establishes a new relationship with Europe.

UK life sciences sector productivity doubles national average

This work is ongoing, and continues to involve more than 200 global experts from leading pharmaceutical and biotech companies; leading academic groups and research charities (such as the Wellcome Trust); the UK’s Medicines and Healthcare products Regulatory Agency (MHRA); the NHS and Public Health England; as well as a vast range of UK Government departments.

Independents rally to call for coordinated response to cuts

P3 Pharmacy, Sam Healey, 4 January 2016

P3 Pharmacy reports on the National Pharmacy Association’s initiative, which already gathered hundreds of independent pharmacists to respond to the NHS’s plan for efficiencies. Ian Strachan, NPA Chairman, stated that these efficiencies could potentially result in the closure of many local pharmacies. A petition supporting this action has reached nearly 8,000 signatures, close to the 10,000 necessary to receive a response from the government.

 

6,000 signatures on petition to stop pharmacy funding cuts

C&D, Samuel Horti, 4 January 2016

An online petition calling for the Government to scrap the announced funding cuts has been launched by Paul Mason, chair of the Barnsley local pharmaceutical committee (LPC), at the end of December and has already reached more than 6,000 signatures.

 

The NPA’s initiative and the online petition are also covered by Pharmacy Business.

 

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Independents rally to call for coordinated response to cuts

P3 Pharmacy, Sam Healey, 4 January 2016

Hundreds of independent pharmacists have signed up to take part in a coordinated response from the independent sector to NHS England proposals for ‘efficiencies’, says the National Pharmacy Association.

Pharmacists who sign up will be given resources and hands-on support to build the evidence base required to make a compelling case to Government and NHS.

“The Government is conducting a dangerous experiment which could see local pharmacies close, thereby reducing people’s access to pharmaceutical and healthcare advice, and putting extra pressure on GPs and hospitals. The current drift of policy puts at risk a part of the health system that holds the key to solving many of its problems. Patients would be the biggest losers,” said NPA chairman, Ian Strachan.

“Our voice is most powerful when NPA members are actively involved, so we are asking independents to step forward at what could be an important moment in pharmacy history. It is vital that we all play our part in the coming months.”

A petition to stop the cuts has also been launched with nearly 8,000 signatures. The petition titled ‘Stop cuts to pharmacy funding and support pharmacy services that save NHS money’, is currently 3,112 signatures away from reaching 10,000 at which point the government will have to respond. If it reaches 100,000 signatures it will be considered for parliamentary debate.

 

Hundreds of independents join campaign against NHS plans

Pharmacy Business, Neil Trainis, 4 January 2016

The National Pharmacy Association has claimed that hundreds of independent pharmacists have backed its campaign opposing NHS England’s controversial plans to introduce centralised dispensing hubs and support for the online supply of medicines.

Pulling no punches, Ian Strachan, the chairman of the NPA (pictured), accused the government of “conducting a dangerous experiment” with its attempt to generate efficiency savings. He said that, coupled with the £170 million cut to pharmacy’s funding for 2016-17, “could have serious unintended and irreversible consequences” for pharmacies and patients.

“The government is conducting a dangerous experiment which could see local pharmacies close, thereby reducing people’s access to pharmaceutical and healthcare advice, and putting extra pressure on GPs and hospitals,” Strachan said.

“The current drift of policy puts at risk a part of the health system that holds the key to solving many of its problems. Patients would be the biggest losers.

“The Government’s approach is to combine funding cuts with jumbled proposals for productivity gain, including support for ‘large scale automated dispensing’ and increased online supply of medicines.

“The proposals imply that pharmacy is just a distribution mechanism for product, rather than a valuable health and social care asset at the heart of communities.”

In a rallying call to independents, he added: “Our voice is most powerful when NPA members are actively involved, so we are asking independents to step forward at what could be an important moment in pharmacy history. It is vital that we all play our part in the coming months.”

The NPA said independents “will be given resources and hands-on support to build the evidence base required to make a compelling case to Government and NHS (and) mobilise public opinion and political support for local pharmacies.” The NPA urged those interested in getting involved to visit npa.co.uk/independents voice.

Five-year NHS strategy only mentions pharmacy twice

C&D, Emma Weinbren, 23 December 2015

The 5-year NHS plan only mentions pharmacy twice, compared to 13 references to GPs and 3 to nurses. The document promises a community pharmacy reform to improve primary care productivity but the nature of the reform is not specified. Another pledge is to increase access to primary care, in particular on weekends and evenings.

 

Pharmacy2U supply problems

PSNC, 24 December 2015

NHS England has issued a letter on the disruption to services that Pharmacy2U (P2U) is experiencing over the Christmas period.

The technical issues at P2U have resulted in some patients being unlikely to receive their ordered medicines until 11th January 2016.

The letter contains details of the arrangements being made to mitigate risk and inconvenience to patients.

NHS England letter – Important note regarding services provided by ‘Pharmacy2U’ over Christmas and New Year

 

Independents rally to NPA call for coordinated response to NHS England ‘efficiency’ plans

NPA, 4 January 2015

The National Pharmacy Association reports that hundreds of independents pharmacy have decided to take part in a joined-up response to the NHS proposal for “efficiencies”, including centralised dispensing and an increase of online medicine supply. This action will aim to:

  • Present a strong case to the Government and the NHS
  • Mobilise support from politics and the general public

 

Parliamentary Coverage

 

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Five-year NHS strategy only mentions pharmacy twice

C&D, Emma Weinbren, 23 December 2015

NHS England plans to “support community pharmacy reform”, according to the document, but does not specify what that will involve

The strategy also references the role of pharmacists in GP practices

The Delivering the Forward View document, released yesterday (December 22), makes reference to the role of pharmacists in GP practices and improving primary care productivity by “supporting community pharmacy reform”.

But there is no mention of what the reform will entail in the document, designed to help the NHS achieve the goals set out in last year’s Five Year Forward View.

The original document outlined a vision for pharmacists to form large-scale primary care practices with GPs and pledged to make “far greater use” of the profession.

This week’s update stresses the importance of “balancing” the NHS budget in realising the plans, which aim to give 20% of the population “enhanced access” to primary care by March 2017. They also include improving access to primary care at weekends and evenings.

But it makes no mention of using community pharmacies to achieve this vision.

The document makes 13 references to GPs and three to nurses.

In June, NHS England’s deputy chief pharmaceutical officer Bruce Warner told C+D that pharmacy has a “huge role to play” in NHS England’s plans for the future.

 

Independents rally to NPA call for coordinated response to NHS England ‘efficiency’ plans

NPA, 4 January 2015

Hundreds of independent pharmacists have already registered to take part in a coordinated response from the independent sector to NHS England proposals for ‘efficiencies’, such as centralised dispensing and more online supply of medicines.

They will be given resources and hands-on support to build the evidence base required to make a compelling case to Government and NHS mobilise public opinion and political support for local pharmacies.

The NPA’s overall approach is to robustly oppose the current policy drift, which, together with funding cuts, risks undermining the community pharmacy network. At the same time, the NPA will help independents adapt to meet the genuine long-term challenges that exist in terms of patient expectations and NHS productivity.

NPA Chairman, Ian Strachan, said:

“The Government is conducting a dangerous experiment which could see local pharmacies close, thereby reducing people’s access to pharmaceutical and healthcare advice, and putting extra pressure on GPs and hospitals.  The current drift of policy puts at risk a part of the health system that holds the key to solving many of its problems. Patients would be the biggest losers.

“The Government’s approach is to combine funding cuts with jumbled proposals for productivity gain, including support for ‘large scale automated dispensing’ and increased online supply of medicines.  The proposals imply that pharmacy is just a distribution mechanism for product – rather than a valuable health and social care asset at the heart of communities.

“Fundamentally, the answers lie in universal implementation of what we know works well, not about relying on unproven measures that could have serious unintended and irreversible consequences.

“Our voice is most powerful when NPA members are actively involved, so we are asking independents to step forward at what could be an important moment in pharmacy history.  It is vital that we all play our part in the coming months.”

From Factory to Pharmacy

As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.

See the Infographic

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