EU-Länder wollen Pharmaplan blockieren[en] 

What are the major issues facing community pharmacy as a profession in Europe today? 

The major challenge for the profession is to further develop its role as a major contributor to health systems, not only in the core function of helping to ensure rational and appropriate use of medicines, but also in expanding the range of services available to patients at the pharmacy. The UK has to some extent lead the way here, but now we are seeing interesting developments in, to name three, France, Italy and Portugal. 

I think European policymakers are increasingly waking up to pharmacy's potential. At the same time, we are seeing traditional regulatory structures under threat, falling remuneration, new forms of distribution, and even, as has been suggested in Sweden, de-skilling of the profession itself. All in all, we are living through an extraordinarily dynamic period in Europe. New opportunities are opening up at the same time that old certainties about regulation and the economic position of pharmacists are beginning to weaken. 

You have issued a number of documents in recent weeks stressing the role pharmacists can play in combating obesity, dealing with an ageing society, and getting value for public spending on medicines. Are pharmacists feeling somewhat defensive at present? 

Well, I am surprised by the suggestion that issuing policy statements is a sign of defensiveness. We often issue policy statements - for example we did a major one on adherence last year. There is a lot of activity in connection with obesity and the ageing issues at European level at the moment, and naturally we must respond to that. It is important that we pro-actively participate in the broader health debate. And some issues – such as the contribution pharmacists make to reducing costs in the health system - need to be better understood by policymakers. 

But it is true that over the last few years in some parts of Europe, pharmacists have felt a little bit under siege, principally as a result of the legal action brought by the European Commission against ownership and establishment regulations. If the Commission had won its case at the European Court of Justice against ownership restrictions, then there would have been a revolution in European pharmacy, literally overnight. 

Obviously that was an unsettling prospect for many. Generally however, the fact that we try and make sure pharmacy's voice is heard in connection with major health agenda issues is a sign of our going on the offensive in my view. 

Is there a concern that governments are trying to squeeze pharmacists' margins in order to cut their medicine bills? Is this a function of the credit crunch, or has it been ongoing for several years? 

Medicine budgets have been under pressure for years, and this would be the case with or without the credit crunch. Demand keeps on growing. And there are those in the pharmaceutical industry who are all too ready to blame supply chain costs for excess expenditure. New forms of distribution such as direct-to-pharmacy threaten to shake up traditional remuneration structures. In addition, we are now seeing an increasing readiness on the part of EU governments to compare notes on exactly how costs can be controlled. 

There is a growing 'Europeanisation' of cost issues in relation to medicine. I think we can see some moves to squeeze pharmacists and wholesalers. And I think we cannot rule out more margin squeezes in the coming years, even when the credit crunch is over. I also think governments will look at ways of both driving down the prices of generic medicines, which has been done very successfully in Germany and the Netherlands, and increasing generic use. 

Depending on the remuneration system in place, falling generic prices can have a significant negative impact on the bottom line for pharmacists, and this a major concern. 

What is your position on the apparent trend towards privatisation of pharmacy and the increasing number of chain stores? 

What matters is that practice is at the highest level possible and that patients continue to trust their pharmacists to the extent that they do so now. Some EU countries take the view that they need to exclude chains in order to achieve this; others think that chains bring benefits without diminishing quality. 

At PGEU, we have always taken the view that it is for each member state to decide what is best for its own citizens, and that is why we have been critical of the European Commission's attempts to deregulate the entire European market. But Commission action notwithstanding, I think there will always be a major role for independent pharmacy in Europe. 

What is PGEU's view of the pharmaceutical package? Do you expect the Information to Patients Directive to be kicked to touch by the Council of Ministers? 

I do expect it to be kicked out to be honest. Most countries really do not see the need for it, and despite the proposed safeguards in the text, it is still perceived as being too close to the agenda of the pharmaceutical industry, which, to be frank, has a credibility problem on information issues. We are pleased with the explicit recognition of the role of the pharmacist included in the pharmacovigilance proposal, and we think that by and large the proposal is a step forward. 

However, it is the counterfeiting proposal that has the most potential to impact on pharmacy practice – if, as seems to be intended, pharmacists will in future be required to authenticate medicines in the pharmacy, then we will need to deal with a number of issues relating to workflow, the use of data, and cost. But we recognise of course that we need to tackle the counterfeit threat now, before it gets out of hand. Europe's pharmacists are ready to play their part. 

Does Europe have enough pharmacists? If not, are there different levels of need across the EU? 

It depends on the country. In some countries there is quite a shortage, as there has been in Ireland in recent years, in others the supply is healthy. Some of these problems have been addressed by professional mobility. More generally, we need to ensure everywhere of course that our best young people are attracted to the profession. And where there may be shortages, we need to avoid the temptation to rely on lesser-qualified personnel. 

Does the PGEU have a position on the EU Green Paper on the Health Workforce? Are community pharmacists 'mobile' (i.e. are their qualifications/experience recognised across member states, etc.)? 

Community pharmacists are among the most mobile of professionals, because as the result of a European directive, their qualifications are automatically recognised across borders. Provided you can speak the language (although this in fact may not be strictly necessary), there is nothing to stop pharmacists from working anywhere they like in Europe. Ireland and the UK are major importers of pharmacists as a result of the recognition system. 

We have published our response to the Green Paper on Health Workforce. We emphasise the fact that some workforce issues (for example, the declining number of general practitioners in many EU countries) can be addressed by spreading the workload more widely among health professionals, where there is appropriate competence. We stress the importance of prevention and self-care and the key role the pharmacist plays in those areas. We also suggest that appropriate planning strategies need to be put in place by health authorities to ensure that health professionals are available throughout the territory. We call for shortages in states who export professionals to be addressed through, for example, bilateral agreements with importers. 

We welcome new technology as a tool to help address health workforce issues, with the proviso that it must be patient-centred. We reject facile notions of 'productivity' in the health arena. Finally, we reject the notion that de-skilling in any health profession should be advanced as a means of addressing shortages. 

How is technology changing the way pharmacists do business? 

E-prescription systems are gradually being developed in EU states, and the European Commission is investing heavily in the creation of electronic patient records in primary healthcare settings. In France, pharmacies now have an electronic dossier which records patients medicines, both prescription and OTC (with the patient's consent of course.) I think these are positive developments. 

First, the benefits in terms of more efficient workload (freeing up time to spend with patients) and patient safety (fewer prescribing and dispensing errors, a more systematic approach to medicine interactions, etc.) are clear. Second, one of the ways forward for the profession is to develop closer working relationships with other health professionals, and I think technology has the potential to facilitate this.