Although now retired, Harold Porter remains the longest serving member of the PSNI, having joined the register on 2 July 1943. He has built an awe-inspiring collection of pharmacy related paraphernalia over his career and is now making it available for sale.

One could almost forgiven for thinking that the M in Category stands for ‘money’. The shrink on purchase profits in Northern Ireland has rapidly become a strangulation over the past few months, although the situation has been present for the past two years.

Following in the exemplary footsteps of Professor Sean Gorman, the new head of Queen's University Belfast's School of Pharmacy is relishing the opportunity to maintain and develop the high quality of teaching and research within the School.

One of the most valuable opportunities for an insight into arguably the most important year for budding pharmacists was taken by over 130 third year students from universities across the UK and Ireland, recently. The annual Ulster Chemists’ Association Pre-registration and Tutor Evening welcomed speakers from across the pre-reg spectrum, including current students, tutors and recently qualified pharmacists, to talk about their experiences.

Outgoing president, Paul McDonagh, attended his last official engagement to see the Ulster Chemists Associations chosen charity receive a valuable and very high-tech donation from Northern Ireland computing experts, McLernon Computers.

How do you feed thousands of children who have been caught within a crippling war with limited resources to not only meet their immediate needs, but to even locate those affected by conflict? Tuesday's Child, a recently established charity that campaigns for children's humanitarian rights, was founded over eighteen months ago by Northern Ireland pharmacist Orla Sheehan.

The public have remained largely protected from the issue and indeed associated safety risks of counterfeit medicines, with the majority of contraband batches withdrawn from sale promptly after they are identified.

Some regard it as the silent threat that refuses to subside while some former manufacturers have washed their hands of it entirely but the issues surrounding central generic drug tendering continue to rumble on in their characteristically vague fashion for contractors in Northern Ireland. The proposals have attracted all the hallmarks of something that ought to have resigned itself to failure – lack of stakeholder involvement, opposition from professional bodies and an absence of clarity from the Department – but officials are persisting, still rebuffing suggestion that Health Minister Michael McGimpsey will shread the plans. Representing the Pharmaceutical Contractors’ Committee, chief executive Terry Hannawin and outgoing chair Gerard Greene attended a recent Health Committee meeting at Stormont but although there was an overwhelming support for the PCC’s fight for answers and all MLAs who spoke voiced their disapproval at the Department’s choice not to consult the profession before exhorting their plans during summer last year.

Dr Kieran Deeny, MLA for West Tyrone and general practitioner was outraged that a healthcare profession could be entirely overlooked by their responsible Department. “I think it is a disgrace that you were not consulted prior to these proposals being put forward,” he said. “As a healthcare practitioner I know the value of community pharmacy and I know my patients are very dependable upon pharmacy services. This is definitely a matter we need to look into and get answers to.”

Acting chair, Michelle O’Neill MLA also voiced her disapproval at the Department’s actions. “We will be investigating why the Department acted without prior consultation with pharmacy and its representation as this is unacceptable,” she said.

“We were grateful for the opportunity to discuss an issue of great importance to healthcare and patients in Northern Ireland,” explained Terry. “The Department’s policy objective to encourage the prescribing of generic medicines where appropriate in order to achieve maximum value for money for the NHS is one wholly supported by PCC but tendering is not.”

The use of generic medicines in the NHS has been growing steadily in recent years and there is no evidence to suggest that tendering will act as a catalyst for this growth. In 2003 generics accounted for 41 per cent of items dispensed in community pharmacies and by 2007 this figure had risen to just short of 51 per cent. It is a policy objective to encourage the prescribing of generic medicines where appropriate in order to achieve maximum value for money for the NHS.

“Currently, generics are supplied to patients through a well-established and extremely reliable system,” Terry explained to the Committee. “Community pharmacies are able to order their NHS stock from a number of wholesalers. Wholesalers provide efficient logistics cover, ensuring prompt delivery of products into pharmacies on a daily, often a twice daily, basis.

“This arrangement has been in effect for many years. It has guaranteed a prompt, safe and cost effective supply system. The presence of a number of wholesalers and the astute purchasing practices of pharmacies have ensured both healthy competition and good value for the NHS. Most importantly, the system has ensured that patients are able to obtain their medicines when they need and where they need them. The system is able to manage market shortages, which though very rare are always a possibility in an international market such as this, to avoid any disruption to patients.”

Given that many stakeholders have probably forgotten the original motives for this programme and why it even initially surfaced, a spokesperson for the Department said; “Last year, in support of the Pharmaceutical Clinical Effectiveness programme, an explorative tender exercise was undertaken for the range of generic medicines, including injectables, and modified release products prescribed in secondary care and, for the first time, primary care.  

“The aim of this exercise was to identify options for standardising the range of generic products between the primary and secondary healthcare sectors in order to ensure that patients’ generic medicines are of a high quality and of uniform presentation thereby optimising confidence and concordance with the medicines. A report on the outcomes of the completed exercise together with some options for its potential implementation has been shared with a range of stakeholders for comment.”   

When asked about what the next plausible step was, the spokesperson simply added; “The Health Minister, Michael McGimpsey will be giving consideration as to how these options have the potential to improve the quality, safety, uptake and cost-effectiveness of generic medicines before making any decision on the way forward.”

Generic tendering appears to be one of the most robust pieces of proposed legislation that has been drafted in some time, since, despite the volume of opposition, its think tank of officials seem to be undeterred. If the proposals do go ahead, the PCC Board is particularly concerned that;
•    It would create problems in the security and safety of supply of medicines (e.g. through administrative errors and reduced diversity of supply sources)
•    Prices and the quality of service would be adversely affected
•    The process will result in reducing access for patients to a diverse range of generic medicines,
•    And community pharmacies will suffer significant financial loss, raising the prospect of service reduction and pharmacy closures.

“The PCC has grave concerns not only about the proposals themselves but about the way in which the Department has conducted itself since raising them,” Terry continued. “There has been no consultation with the PCC, and the concerns we – and many other organisations - have raised seem to have fallen on deaf ears. The fact that three of the major wholesaler companies have declined to endorse or to take part in the prospective central tendering arrangement should have caused the Department to think again.”

Terry’s argument strengthened when he highlighted pharmacy’s role in purchasing medicines. “Pharmacy contractors in Northern Ireland are efficient and effective procurers of NHS medicines,” he explained. “The supply chain arrangements are secure, reliable and safe. Any proposal for radical change such as this needs to have been carefully developed, risk assessed and the case for change needs to be proven in advance.

The Department made a similar change in relation to the supply of wound care products in July 2007. That has resulted in 95 per cent of the wound care products available in the UK not being available in Northern Ireland.  In our view that bodes ill for this even more radical proposal.

The PCC has commissioned an analysis and critique of the proposal from an independent world-leading expert, Professor George Yarrow of Oxford University. At the time of going to press, the report’s publication was anticipated. Ultimately however, the issue is still just presenting an unwanted, inconvenient matter that is diverting the PCC from other contractual negotiations. “The generics central tendering proposal is a distraction from more important, patient-related matters that we should be discussing with the Department, in particular the introduction of new pharmacy services building on the recently-agreed minor ailments service,” Terry said.