The voice of community pharmacy |Pharamcy Digital Magazine September Edition|Latest Pharmacy News

www.pharmacy.biz September 2021

THE VOICE OF COMMUNITY PHARMACY

Volume 19 No 253

PHARMACY FUNDING Pharmacists in despair over frozen funding

GUEST COLUMN PAGB chief backs self care in community pharmacy

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IT’S A BIG PLUS THAT WE’RE BACK

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CONTENTS

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Founder and Editor-in-Chief: Ramniklal C Solanki CBE 1931-2020 GROUP MANAGING EDITOR: Kalpesh R. Solanki – 020 7654 7728 EXECUTIVE EDITOR: Shailesh R. Solanki – 020 7654 7779 EDITOR: Priyankur Mandav – 020 7654 7783 pri@pharmacy.biz HEAD OF CONTENT & SPONSORSHIP: Monica Bernal-Quiroz – 07870 638070 monica@pharmacy.biz SALES AND MARKETING MANAGER (DISPLAY): Louis Hird – 020 7654 7789 Mob: 07486 853590 louis.hird@amg.biz BUSINESS DEVELOPMENT MANAGER (Classified): Shubha Srivastava – 020 7654 7730 shubha.srivastava@amg.biz DESIGN & LAYOUT: Kamlesh Patel – 020 7654 7759 kamlesh@gujarat.co.uk EVENTS MANAGER: Tanuja Parekh – 020 7654 7740 tanuja.parekh@amg.biz CIRCULATION MANAGER: Saurin Shah – 020 7654 7737 ACCOUNTS: Kamal Desai – 020 7654 7748 kamal.desai@amg.biz Gloria Jones – 020 7654 7720 gloria.jones@amg.biz ADVERTISING & EDITORIAL ADDRESS: Pharmacy Business No. 1 Silex Street, London SE1 0DW T: 020 7928 1234 F: 020 7261 0055 E: editor@pharmacy.biz The views of our columnists are not necessarily the views of Pharmacy Business. Pharmacy Business is published

by Professional Media, a division of Asian Trade Publications Ltd. Pharmacy Business is a controlled circulation monthly magazine, distributed free to qualifying readers. To register for copies contact the circulation department at the given address. For readers who do not qualify for a free copy, annual subscription is £45 (UK), £65 (overseas), £5 (UK single copies) and £7 (overseas single copy).

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NEWS

TECHNOLOGY

4 Keith Ridge to retire as chief pharmaceutical officer

18 Tariq Muhammad discusses tactics for community

5 RB Healthcare acquires 11 pharmacies in North

19 Gary Paragpuri on pharmacies’ appreciation of

in Feb West

6 Bradford University wins grant to train pharmacists 7 RPS concerned over Vectura takeover bid

NEWS ANALYSIS

pharmacy to thwart Amazon

digital and in-person experiences

PAIN MANAGEMENT

22 Paul Battersby on acupuncture’s credibility as a viable treatment option for pain

8 Massive increase in demand for cannabis-related products during pandemic

SPECIAL REPORT

10 Pharmacists in despair after Treasury refuses uplift to the annual global sum

GUEST COLUMN

23 Dr Rod Hughes on helping patients suffering from inflammation of joints

CBD

27 Mikael Sodergren and Simon Erridge share their insights into medical cannabis

28 Bill Griffin on what pharmacy contractors need to consider when procuring CBD

11 PAGB’s Michelle Riddalls on promoting self care in community pharmacy

29 Alexej Pikovsky on market projections, consumer

trends and future of CBD industry

LAW

PB CONFERENCE

13 Michael Holden reveals who will be speaking at our sixth annual conference

31 Patricia Nathan-Amissah and Georgina Bernard

give an overview of practical completionFINANCE

INNOVATION HUB

14 Faheem Ahmed on how to position pharmacy services in a competitive market

VIEWPOINT

17 Mike Hewitson on the inevitability of hub and spoke in independent pharmacy

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CONTRIBUTORS: Faheem Ahmed Paul Battersby Georgina Bernard Simon Erridge

Bill Griffin Mike Hewitson Michael Holden Dr Rod Hughes

Umesh Modi Tariq Muhammad Patricia NathanAmissah

Gary Paragpuri Alexej Pikovsky Christian Rebholz Michelle Riddalls

Vinku Shah Mikael Sodergren Graham Tatham

Access FREE video CPD and use it towards your revalidation with the General Pharmaceutical Council (GPhC) Scan this QR code to begin learning today!

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JULY 2021

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NEWS

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Amanda Pritchard named first female chief exec of NHS England

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HS England has appointed Amanda Pritchard as the new chief executive officer, making her the first woman in health service history to hold the post.

In her new role, Pritchard will be responsible for an annual budget of more than £130 billion while ensuring that everyone in the country receives high quality care.

“I am honoured to lead the NHS, particularly as the first woman chief executive of an organisation whose staff are more than three quarters female,” she said.

stepping down as NHS “I have always been inchief executive at the end of credibly proud to work in July after more than seven the health service but never years in charge. moresothanoverthelast18 She began her NHS months,” she added, praiscareer as a graduate maning pharmacists and other agement trainee in 1997 healthcare professionals after studying at Oxford for having “responded so University and has held magnificently to the Covid a variety of other NHS pandemic”. management positions.

She took up the role Amanda Pritchard Before joining NHS after serving as the NHS’ chief operating officer for two years. England and NHS Improvement in Pritchard replaced Simon Stevens 2019, Pritchard served as chief execuwho announced in April that he was tive of Guy’s and St Thomas’ NHS Foundation Trust, London.

She attended Durham Johnson Comprehensive School, in County Durham, before studying Modern History at StAnne’s College, Oxford. She Pharmacy, spending his early years is married with three children. as a registered pharmacist in cliniThe Royal Pharmaceutical Society cal practice and the pharmaceuti(RPS)welcomedthenewsthatAmanda cal industry.

Pritchard has been appointed as the NHS England and Improvement first female chief executive of NHS has invited applicaEngland. tions from senior Thorrun Govind, chair of RPS pharmacy leaders England, said: “This appointment registered with the comes at a crucial time for the health General Pharmaceutiservice in England; recovering from the cal Council, with a pandemic, with teams under continued master’s degree in pressure, growing demand on services, pharmacy (or equivaand forthcoming NHS reforms. lent) and a postgradu“Pharmacists and pharmacy teams ate or management have given their all during Covid-19 qualification, or and amid all these changes it’s vital equivalent experience to apply staff get the support they need. for the top pharmacist role in the “Akey challenge for the NHS will country. be implementing new Integrated Care Candidates with demonstrated Systems and this must include a focus excellent knowledge and experion medicines optimisation across care ence of working in or with the settings.

Department of Health and Social “I’d urge NHS England to ensure Care, the NHS, and other health a voice for pharmacy to help make organisations can apply till August these changes a success.”

19 for the post.

Keith Ridge to step down in Feb A fter 16 years in the position, Keith Ridge, England’s chief pharmaceutical officer (CPhO), will step down in February 2022.

The chief advisor on pharmacy and the use of medications, as well as the head of the pharmacy profession, Ridge has over the years played a leading role on issues such as medicines optimisation, digital medicines and pharmacy educational reform.

Keith Ridge He has been instrumental in establishing the National Institute for Health and Clinical Excellence, which was later renamed as National Institute for Health and Care Excellence, and the General Pharmaceutical Council. Ridge has also been the driving force behind the ‘healthy living’ pharmacy.

Ridge began his training at the University of London’s School of

Alison Strath is new CPO for Scotland

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lison Strath has been appointed as the chief pharmaceutical officer (CPO) for Scotland.

In her new role, Strath will lead NHS pharmaceutical care and medicines policy, providing advice to the first minister, the health secretary, the wider ministerialteamandstrategicleadership to the pharmacy profession in Scotland.

Health secretary Humza Yousaf

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as a principal pharmaceutisaid: “The past year has calofficerand,sinceOctober highlighted just how im2020, as an interim CPO. portant health and social She was appointed a felcare is to the work of the lowoftheRoyalPharmaceuScottish government, and tical Society of Great Britain I’m delighted to welcome in 2010 and as an Emeritus Professor Alison Strath as Alison Strath Professor at the School of Pharmacy chief pharmaceutical officer.”

Strath has been working with the and Life Sciences at Robert Gordon Scottishgovernmentsince2002,initially University in Aberdeen in 2018.

News In Brief

NI appointments Northern Ireland’s health minister Robin Swann has appointed four non-executive members to the Council of the Pharmaceutical Society of Northern Ireland. Scott Gill, currently the lead pharmacist in Ards Federation of GP practices has been appointed as a Registrant Member and Gary McMurray, Brendan Garland and Philip Knox as Lay Members. All four appointments commenced on 1 August 2021 and will end on a date no later than 31 July 2025.

Essential service Pharmacies are considered as the most essential services in the UK, followed by convenience stores and post office, a new public opinion poll revealed. It is recognised as the second most important service which has the most positive impact on the local communities. The report by the Association of Convenience Stores presented new insight into the provision of local commercial services, their role in benefitting the community, and how people feel about them.

Pharmacy fee Pharmacy contractors in England have started receiving a single activity fee of £1.29 per item following a revision. The 2p increase is based on an “analysis of funding delivery and the latest projections for the year.” Contractors receive a single activity fee for every item dispensed including medicines and appliances. The fee was first introduced in England in December 2016, and replaced payouts for dispensing, practice payments and the electronic prescription service.

Booster jabs Britain has ordered 35 million more doses of the Pfizer/BioNTech Covid-19 vaccine to prepare for booster shots and to counter any new variants. The government has yet to decide on a potential rollout of third doses, but could begin a booster programme in early September, alongside the flu jab.

The Joint Committee on Vaccination and Immunisation is still assessing the data on whether boosters will be needed, and which groups might need them the most.

SEPTEMBER 2021

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NEWS

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RB Healthcare acquires 11 pharmacies in North West M

erseyside-based independent community pharmacy group RB Healthcare has entered a deal to buy 11 more sites in Manchester and Merseyside after receiving a £12.5 million funding package from Santander UK. The company has added the new sites in a ‘one-off deal’, and the funding package comprises property loans, term debt, working capital and overdrafts. The pharmacy has also switched its day-to-day banking to Santander UK. The acquisition of 11 new pharmacies would significantly build

on the group’s existing portfolio of three pharmacies, which are in the same area.

It also plans to grow its online pharmacy, Clear Chemist, with support from Santander UK’s Rishi Bhatia funding.

Rishi Bhatia, RB Healthcare co-director, said: “Santander UK has an in-depth understanding of the healthcare sector, our business’ growth plans, and, crucially, our core values - all of which are essential qualities in a banking partner. The

funding structure that Santander UK has put in place has allowed us to start achieving our goals from the outset.

“Community pharmacies have been at the forefront of healthcare during the pandemic, and Santander UK is the ideal bank to be beginning our next chapter with.”

RB Healthcare was involved in England’s vaccination effort this year, vaccinating local residents after winning a number of Covid vaccination contracts with the government.

Andy Casey, head of medical at

Boots, Deliveroo ink delivery deal

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oots UK has announced an exclusive partnership with Deliveroo to provide 400 plus health and beauty products to consumers at their doorsteps.

The new partnership will launch at 14 pilot stores across the country including in Edinburgh, London and Nottingham. The offered product range varies from toiletries, baby essentials to bestselling beauty and medicines for minor ailments along with food and drink options.

With this, Deliveroo customers will now be able to access Boots products on-demand.

Paula Bobbett, director of boots. com at Boots UK, said: “We are very excited about this new partnership with Deliveroo… It will be super handy for times when you need something urgently but can’t leave the house, like if you’re feeling unwell or are looking after your kids.

Pilot to include 400 products

“Our online business continues to grow, and this partnership offers our customers a new way to access our products quickly and easily.”

Boots saw a continued rise in online sales during successive lockdowns. Sales on the retailer’s website were up 85 per cent between 1 March 2020 and 1 March 2021 compared to the same period the previous year as shoppers turned online in lockdown.

The pharmacy multiple offers next day ‘click & collect’ and home

Lloyds launches VideoGP app L loydsPharmacy has launched a VideoGP app that provides access to an experienced GP seven days a week, in just 30 minutes.

GPs are available through the app from 8am to 8pm and payment options for the service are flexible. Patients can pay for one-off appointments or through low-cost monthly and annual subscriptions. Prices include medication, next-day delivery, refer-

delivery for online orders and this new partnership with Deliveroo allows it to provide even greater speed to customers that need it in as little as 20 minutes.

Carlo Mocci, UKI chief business officer at Deliveroo, said: “The new partnership builds on a period of strong growth and consumer engagement for Deliveroo in 2021 as it continues to rapidly expand its on-demand grocery and convenience offering with leading retailers. The new Boots partnership allows Deliveroo to further increase the choice and selection of on-demand convenience products to consumers.”

The partnership could expand to more Boots stores in the future if the pilot stores are successful, the company said. Last year, Lloydspharmacy also partnered with Deliveroo, piloting a similar OTC medicines delivery service.

ral letters, and fit notes if required.

Dr Kieran Seyan, chief medical officer at LloydsPharmacy’s Online Doctor, said: “Our VideoGP app App will have GPs available from 8am to 8pm provides a digital solution that conaccelerated the adoption of digital nects patients with healthcare profes- technology and empowered more sionals, whilst ensuring continuing people to look after their health online, safe, quality care for patients.” and it’s because of this that we have The service is available in all iOS significantly invested in bringing this and android devices. proposition to market,” a company “The pandemic has undoubtedly official added.

Santander UK, said: “We are delighted to support RB Healthcare’s major acquisition of 11 community pharmacies, and to bring it on board for all its day-to-day banking.

“The company is a well-known and much valued operator in the community pharmacy sector in the North West, and we look forward to helping it achieve its growth plans in coming months and years.”

Earlier this year, Bhatia won the Pharmacy Business Community Pharmacy Heroes Award 2020.

Watchdog warns PCR test providers

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he competition watchdog has warned PCR Covid test providers against enforcement action over misleading advertising and potential failures to deliver results on time.

In an open letter to providers, the Competition and Markets Authority (CMA)saidarangeofharmfulpractices could breach consumer protection law.

The practices of concern to the CMA include advertising up-front prices for PCR tests which do not include additional charges that everyone must pay; advertising cheap PCR tests which are only actually available in very small quantities or are not available at all; failing to deliver PCR tests or provide results within stated timescales, or at all refusing to provide consumers with refunds where tests are not provided within advertised and/or agreed timescales, or at all.

The letter also instructed PCR test providers to ‘immediately review their practices and policies to make sure they are in line with the requirements of consumer law and to make any changes where necessary’.

The move follows the government announcement on August 23 that 82 companies face being removed from the government list if they advertise misleading prices.

The letter also lists 11 steps providers should take, including not focusing their advertising on cheap tests which are only available in small numbers; showing the full cost of tests including all compulsory charges; and providing ‘honest, accurate and clear’timescales on when tests will be received.

SEPTEMBER 2021

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NEWS

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Bradford University wins grant to train pharmacists T

he University of Bradford has won a Health Education England (HEE) grant worth £400,000 to train pharmacy students across the north of England.

It won the money as part of a consortium with Buttercups Training and Imaan Healthcare to prepare trainee pharmacists who are currently working in hospitals. The training will help them prepare for assessments at the end of their pre-registration year.

Dr Gemma Quinn from the Faculty

of Life Sciences at the university said: “The assessments require knowledge of hospital and community pharmacy, so these courses will help ensure that students address any gaps in their knowledge, particularly in areas that are more commonly seen in community pharmacy or primary care.”

“Our approach is very much about team-based learning, using innovative ways to apply knowledge, which really helps in terms of preparing students for the workplace, not just in

GPhC takes action over pharmacy codeine linctus sales T he General Pharmaceutical Council (GPhC) has taken serious enforcement action against 36 pharmacy premises and a pharmacy professional after investigations revealed unusually high sales of codeine linctus.

The drug is classified as a Pharmacy (P) medicine under the Medicines Act 1968 and the Human Medicines Regulations 2012 which allows it to be sold only under a pharmacist’s supervision, by a pharmacy, without prescription.

The medicine, occasionally used for a dry cough, is high risk because of known problems associated with its misuse, abuse or overuse.

The investigation found that pharmacies involved did not properly identify and manage the risks related to obtaining or selling codeine linctus, GPhC said in a statement.

“Our unannounced inspections identified that appropriate safeguards were not always in place to ensure sales were managed safely and appropriately. There were often insufficient controls to prevent repeat sales or to identify trends in requests. In some cases, repeat sales were even made knowingly to the same people,” it said.

After the inspections, the offending pharmacies had conditions put on their registration that they “must not sell or supply any codeine linctus preparations” without an NHS prescription.

Additionally, a warning was issued to the superintendent pharmacist and regular responsible pharmacist in of one of the pharmacies involved who were found to have allowed the supply of codeine linctus without sufficient checks.

Programme will benefit over 230 trainee pharmacists

terms of having the necessary skills but being able to interact with a team and make decisions,” she said.

Dr Quinn, who worked as a hospital pharmacist for seven years, before joining the university in 2008, said it was one of the largest grants they had ever secured.

The training programme that includes a series of specially designed workshops will benefit more than 230 trainee pharmacists across the north of England.

The importance of pharmacy has increased dramatically, particularly during the pandemic, as they were one of the few services that remained open for face-to-face consultations, Dr Quinn said.

Pharmacists played a key role in the vaccination programme and are emerging as leaders in healthcare sector, she added.

“There is currently a drive to increase the number of pharmacists in primary care, which has led to shortages in other sectors, so it’s the case that, upon graduation, those who want a job get a job,” Quinn said.

In March this year, pharmacists were added to the Home Office’s shortage occupation list.

‘Pharmacy can help long Covid patients’ T he Royal Pharmaceutical Society (RPS)hassetoutkeyprinciplesand recommendations for pharmaceutical care in the management of the illness to ensure that people get the greatest benefit from pharmacy teams.

These outline how the provision and access of pharmaceutical care should be embedded across the care pathway for patients with long Covid.

Thedocumentincludesprinciplesin utilising pharmacists’knowledge, data andresearchcapabilitywhenresearching

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pathophysiology and pharmacological treatments for long Covid; and working towards an infrastructure that enables recognised referral pathways, access to records and shared decision making.

RPSpresidentClaireAndersonsaid: “We strongly believe that access to a pharmacist must always be considered whennewservicesareplannedanddelivered to support people with long Covid.

“To ensure that people with long Covid see the right professional at the right time recognised pathways must

be established – ranging from self-care to specialist interventions.

“To help those suffering it’s essential that pharmacy teams themselves are supported. RPS continues to work at all levels to represent pharmacists who have experienced the impact of long Covid.”

RPS will use the recommendations in conversations with governments and the NHS across Great Britain to ensure patients with long Covid get access to the care they need.

News In Brief

GPhC warning The General Pharmaceutical Council (GPhC) has issued a warning relating to online prescribing services after identifying serious patient safety concerns. It has reminded pharmacy owners and professionals to adhere the guidance for providing pharmacy services at a distance, including on the internet, whenever they provide online pharmacy services. The regulator said its inspectors were continuing to identify serious patient safety concerns.

Pharmacists axed The Pharmaceutical Society of Northern Ireland has removed 26 pharmacists from its register due to statutory non-compliance of regulations relating to CPD. The regulation stipulates that if a registered pharmacist fails to comply with the requirements or conditions of the CPD framework, then the registrar may ask the registered person to take remedial measures or remove their name from the register.

CPCS systems A national procurement model in place to support community pharmacy contractors with the delivery of the Community Pharmacist Consultation Service has been extended to the end of March 2022. Contractors will now get additional time to complete the transition to their own CPCS IT systems via one of the four assured IT providers: Cegedim, Positive Solutions, Sonar Informatics, and PharmOutcomes.

MHRA approval The Medicine and Healthcare products Regulatory Agency has approved Nuromol, a medicine that contains 200mg of ibuprofen and 500mg of paracetamol per tablet, for sale without the need to visit a pharmacy. The reclassification means that drug will now help people manage their “mild to moderate pain” where paracetamol or ibuprofen alone have not provided adequate pain relief.

SEPTEMBER 2021

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Numark launches pharmacy roadshow T

o engage pharmacies with its efficient and effortless dispensing solution, Numark is taking its new ‘pick to prescription’ service on the road.

Over the course of the next 12 months, the company hopes to visit as many pharmacies as possible to help them see how they can relieve operating pressures and showcase improved prescription assembly.

‘Golden Tote’is a market leading dispensary management system using bar code scanning technology to increase efficiencies, improve patient safety and significantly reduce stockholding of dispensary lines.

The new service helps in directly assembling multiple patients’prescriptions from the tote box, saving time and taking away the need to place stock on shelves, date checking and stock rotation duties.

It enables clinical and accuracy

checks, which releases the pharmacist from any other part of the process.

With this assembly can quickly and confidently be handed over to members of the team Bar code scanning technology reduces the risk of human error, increasing patient safety and providing peace of mind. To showcase the new state-of-the-art interactive, digital installation, Numark is taking to the road on-board two Luton vans.

During the roadshow, a Numark representative will provide a welcome introduction to pharmacy teams, video testimonials of member pharmacies on-board along with a ‘benefits wall’, allowing the pharmacy teams to gather all the information they need about the new service, exclusive to Numark members.

The new system helps pharmacists free up time at the dispensary bench to allow them to engage more with

Roadshow van interior

patients, generate more income streams and increase profitability.

Golden Tote offers its members a pivotal opportunity to radically change their assembly process for prescriptions, which has already been recognised by more than 4,700 UK community pharmacies.

Jeremy Meader, Managing Director of Numark, adds: “We’re on a mission to help our members with everything we possibly can, to help pharmacy practices thrive, through innovation in products and services.

Golden Tote is a first of its kind –

‘Scottish contractors not reporting closures’ A Scottish health board has confirmed that some pharmacy contractors are not reporting their closures to the NHS despite this being a requirement of their contract.

A communication sent to community pharmacies in Greater Glasgow and Clyde confirmed that the NHS became aware of three closures in that area that week, only due to “third parties” notifying them, the Pharmacists’ Defence Association (PDA) has reported.

There is no clarity about other unreported closures where no third

party notified that NHS health board that week, but three confirmed closures in one health board area, in just week’s period should be significant enough for concern, it added.

Shortage of pharmacists or lack of support staff is often used as a reason to justify such closures. Many contractors in Scotland have been reminded to report unplanned/planned pharmacy closures.

The issue of avoidable closures is increasingly being discussed on social, print and broadcast media and this could therefore become a signifi-

cant issue for the public, politicians, and taxpayers, PDA said.

Such cases of unscheduled and un-notified pharmacy closures will damage the reputation of pharmacy and pharmacists. This also risks undermining the great work being done my many in the sector to help pharmacy reach its full potential in the health system.

The PDA called upon employers, and their representative bodies to take this situation seriously and honour the NHS contract which they have committed to deliver.

MHRA approves antibody cocktail for Covid-19 T he Medicines and Healthcare products Regulatory Agency (MHRA) has approved Ronapreve as the first monoclonal antibody treatment for Covid-19 in the UK. Following on from a thorough review of the evidence carried out by the MHRA, and recommendation by the Commission on Human Medicines (CHM), the government’s independent expert scientific advisory body, the MHRA has approved Ronapreve as the first monoclonal antibody combination product indicated for use in the prevention

and treatment of acute Covid-19 infection for the UK. Developed by Regeneron/Roche, the drug is administered either by injection or infusion and acts at the lining of the respiratory system where it binds tightly to the coronavirus and prevents it from gaining access to the cells of the respiratory system.

Clinical trial data assessed by a dedicated team of MHRA scientists and clinicians has shown that Ronapreve may be used to prevent infection, promote resolution of symptoms of acute Covid-19 infection and can

reduce the likelihood of being admitted to hospital due to Covid-19.

Health secretary Sajid Javid said: “The UK is considered a world leader in identifying and rolling out lifesaving treatments for Covid-19, once they have been proven safe and effective in our governmentbacked clinical trials.

“This treatment will be a significant addition to our armoury to tackle Covid-19 – in addition to our world-renowned vaccination programme and life-saving therapeutics dexamethasone and tocilizumab.”

breaking the mould, providing a revolutionary change in dispensing practice, which haven’t changed in decades.

“The Covid-19 pandemic has further highlighted the pressures faced by community pharmacies. By making the dispensing of prescriptions as fast, efficient, and as effortless as possible, we hope to help our members free up more time to concentrate on patient care and business retention.”

RPS concerned over Vectura takeover bid

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he Royal Pharmaceutical Society (RPS) is deeply concerned about the proposed takeover of Vectura by the tobacco company Philip Morris International.

The potential £1.1bn purchase of the UK company which makes products used in the treatment of asthma, COPD and other respiratory diseases by cigarette maker PMI has been seen as controversial by health charities in particular, who claim it could Vectura is a UK negatively impact company Vectura’s future work.

RPS has written to innovation minister Lord Bethell expressing ethical concerns about the proposed takeover.

RPS said tobacco companies should not profit from the illnesses their products cause. This takeover, if allowed to proceed, would send wrong signals for the kind of health and research community the UK seeks to promote.

RPS president Claire Anderson said: “This takeover not only raises ethical concerns that a company whose tobacco products harm the public may later profit from providing a treatment, but also creates an ethical dilemma for healthcare professionals.

“We strongly urge the government to oppose this takeover to protect the public and healthcare professionals.”

SEPTEMBER 2021

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NEWS ANALYSIS

Legal Cannabis

UK’s legal cannabis market surges on Covid demand In recent months, community pharmacy teams have seen a massive increase in requests for cannabis-related products from members of the public…

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ritain’s legal cannabis market has boomed during the coronavirus pandemic to become the second biggest after the United States, as consumers rushed to alleviate Covid-linked symptoms, industry experts say.

Cannabidiol or CBD, which is most commonly sold as oil at high street retailers, including an increasing number of pharmacies, is one of the active ingredients of nonpsychoactive cannabis.

CBD is touted as have relaxing and antiinflammatory properties, but experts argue the market has long suffered from questions about its efficacy and a lack of regulation.

Food Standards Agency (FSA) now regulates the sector and its marketing, after the European Union classified CBD as food in 2019.

Such products will generate sales of £690 million ($856 million, 811 million euros) in 2021, according to the Association for the Cannabinoid Industry (ACI).

That was almost a third higher than the UK trade group’s pre-pandemic 2019 projection.

‘Pandemic increased demand’ “The pandemic increased CBD demand because there obviously were stress, sleep problems, anxiety, these kind of risks,” said ACI co-founder Steve Moore.

Britain has experienced a “quiet cannabis revolution” that has transformed it into “the world’s second largest consumer cannabinoids market”, ACI said.

Such products are stripped of psychoactive tetrahydrocannabinol or THC molecules, which are found in recreational cannabis that remains illegal in Britain.

The NHS warns there is “no guarantee” that products claiming to be medical cannabis and sold in health stores as food supplements, such as CBD oil, are of “good quality or provide any health benefits”.

The National Pharmacy Association has maintained that selling CBD in pharmacies doesn’t give the products extra legitimacy.

“It’s for each pharmacist to decide

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whether its suitable to stock a CBD product or not, but in terms of the safety and efficacy of it more research is required.”

The UK allows the sale of hemp products that can be made only from the cannabis plant’s fibres or seeds, but not the buds.

Aside from Covid, such products have also experienced strong demand from Britons seeking to ease pain from chronic illnesses such as severe arthritis.

‘No definitive evidence’ Versus Arthritis charity recommends patients contemplating CBD should consult their doctor beforehand, and also wants more work done to understand its impact.

Faced with booming sales, professor Sagnik Bhattacharyya, who researches psychotic and substance abuse disorders at King’s College London, says clinical trials are needed.

“CBD products available over the counter from many shops or online may not contain what it says on the tin,” Bhattacharyya told the AFP news agency, adding they can include potentially harmful substances.

“Most importantly, there is no definitive evidence as yet that CBD would work for any of the myriad health conditions which it is supposed to benefit, except for certain types of epilepsy.”

Despite those concerns, Joe Oliver, head of British-based cannabidiol firm LDN CBD, says his products help those with chronic illness. The company launched in 2018 to tap into the new market, and is seeking a new round of financing to fund expansion.

“From testimonials and feedback we have found that this benefits those who are dealing with the effects of traumatic experiences, chronic illness and in highstress environments,” he said.

“I’ve seen thousands of people’s lives changed. So that’s a lot better than nothing.”

‘Open up valuable market’ Britain’s CBD industry is currently forced to import oil from Europe and the United States.

Under UK drugs law, it is not possible for British companies to produce CBD because they are compelled to destroy the CBD-rich flower or bud of the hemp plant.

That has sparked an outcry from the farming community, which argues that profits could be boosted massively if they

were allowed to use all of the plant.

“It is hard to comprehend, especially in a post-Brexit era, why it is legal to import CBD into the UK, yet British businesses are not permitted to produce CBD commercially,” said Louise Motala, who runs Bridge Farm in eastern England.

“We have real expertise in cultivation and extraction in this country,” she added in a report published by drug reform group Volteface.

“A change in policy to open up this valuable market and allow production will enable UK businesses to make the most of this global opportunity.”

It’s long been thought that Britain could emerge as a global leader in the research and development of cannabis extract products. But for that to happen there is an urgent need to make changes to the current regulations. As legislation develops and more opportunities for businesses in the sector arise, the industry will only continue to expand.

However, at the moment CBD is sold in a plethora of formulations accompanied with a wide variety of medicinal claims or therapeutic benefits. It’s illegal to print any health claims on the products and anyone doing so will be in violation of guidelines set by the MHRA. “Companies that make these claims are either blatantly ignoring these guidelines or are in ignorant bliss of their existence,” says Bill Griffin, managing director of LXR Direct, a UK-based CBD oil supplier.

Neither of these scenarios give a good impression of an honest brand operating in the nutraceutical space. An honest approach for brands is to be clear on how much CBD is included in the product, he adds.

There needs to be a clearly marked batch number on the product and access to a certificate of analysis (CoA) from a reputable laboratory (for example Eurofins) which relates to that batch number. The percentage of CBD and quantity, usually in mg, needs to be displayed on the packaging. A valid CoA would back this information up.

Griffin says further: “Until sufficient research has been undertaken for the MHRA to allow medicinal claims we’re in the unfortunate scenario of customers preforming their own research and experiments on whether CBD can help them.

“Thankfully, we do know that in small quantities, FSA RDA is 70mg per day, CBD is not toxic so there are not many risks associated with consumers trying CBD to see if they gain therapeutic relief.

“Should they do find a benefit then they should be able to choose a CBD brand that is honest with what their products contain. The only way to do this is though clearly marked batch numbers and CoAs and not through slick marketing campaigns.”

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GSK Consumer selects Sigma in a reduced wholesale agreement.

From 1st October, Sigma will be one of 4 wholesalers supplying GSK Consumer products to your pharmacy Place your orders with the only shortline GSK Consumer partner wholesaler on 0800 358 4427

SPECIAL REPORT Pharmacy Funding

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Pharmacists in despair after funding freeze Although the Treasury’s ‘flat rejection’ for an uplift to the annual global sum disappointed many, sector lauded PSNC for some hard-earned concessions and new services…

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he government’s recent decision to keep the funding for the community pharmacy contractual framework (CPCF) unchanged for the third year in a row has dashed hopes of many in the industry. It also announced some positive initiatives that would open up new remuneration opportunities for pharmacists, but the efforts are not seen as enough to support the sector.

Therefore, the declaration of the terms of the third year triggered a mixed response from pharmacy’s representative bodies.

The August 23rd announcement comprises extension of Transitional Payments by another year; expansion of New Medicine Service (NMS) with the cap increased from 0.5 per cent to 1 per cent of monthly prescription volume and an additional catch-up NMS for patients who missed out during Covid-19.

The positive initiatives include introduction of two new advanced services: smoking cessation and hypertension case-finding, the latter of which will receive funding from outside the global sum to incentivise pharmacies to meet targets.

Despite these positives, the Treasury’s “flat refusal” to the Pharmaceutical Services Negotiating Committee’s (PSNC) persistent appeals for an uplift to the £2.592 billion annual global sum disappointed all.

The PSNC’s outgoing chief Simon Dukes said contractors should feel “aggrieved” that the Treasury declined to improve funding, especially after pharmacy’s hard work during the Covid-19 pandemic.

The government’s “insistence that we remain at £2.592bn for a further year will bring financial tensions as we move through the autumn and the Covid-19 advance repayments start to bite”, he added.

In June, PSNC accepted a deal from the government on pharmacy’s Covid-19 costs, as per which the sector will have to pay back the £370 million advance funding, and pharmacies had until August 15 to submit claims for Covidrelated costs.

“We continue to press for recognition of the financial pressures that community pharmacy is under and, as the pandemic slowly recedes, underline to the government how much worse things could be right now, were it not for the performance of our sector,” Dukes said.

Royal Pharmaceutical Society in England chair Thorrun Govind said while there were “positive steps” towards creating clinical roles with inclusion of blood pressure diagnosis, pharmacists “will understandably be demoralised” by the

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‘Flat funding, increased workload’

Julian Mount, managing director, Alliance Healthcare said: “Pharmacies in England continue to service their local communities against a back-drop of flat funding and Treasury’s refusal to increase increased pressures. core funding.

“Against a backdrop of havShe called for a recogniing to submit claims for their extion of the role pharmacists tra Covid-19 costs, getting ready have played during the for a potential record-breaking pandemic, as well as clarity flu vaccination programme, on funding for independent continued work-force pressures prescriber training, and and increasing inflationary cost, lauded the expansion of the going backwards in real terms NMS – a supportive move for for funding will be extremely pharmacists. challenging and the future viThorrun added: “We ability of the pharmacy network know that community has already been highlighted pharmacy can play a key role many times.” in helping manage increasMount pledged to continue ing demand on the NHS, but Simon Dukes: Contractors should feel efforts to “highlight the imporcollaboration and support for ‘aggrieved’ tant role community pharmacies implementation will be key to play in the fabric of the NHS primary care team.” making new services a success.”

Andrew Lane, chair of the National PharLeyla Hannbeck, chief executive of the Asmacy Association welcomed “the introduction sociation of Independent Multiple Pharmacies (AIMp), highlighted that with rising of costs “this and expansion of a number of clinical services” but expressed the pharmacy negotiator’s is yet another decrease in funding so let’s please “request to Treasury to resolve the long-term call it that”.

She added that AIMp has raised concerns with funding crisis facing pharmacies in England” was overlooked.

NHS England and NHS Improvement (NHSEI) He highlighted a commissioned report from about the lack of a level playing field for comErnst and Young (EY) that showed the precarimunity pharmacy “as GPs get funding to recruit ous situation facing pharmacies in the country. pharmacists to GP practices and this has signifiThe report depicted a funding gap of half a bilcantly impacted on community pharmacy”. lion pounds and stated that nearly three-quarters of family-owned pharmacies in England could be Jeremy Meader, managing director at PHOENIX forced to shut down by 2024.

Lane said: “Simply put, these new funding Medical Supplies Limited, said: “It’s unfathomarrangements do not address the fact that 72 perable that the government has widely acknowledged the importance of community pharmacy in cent of pharmacies in England are forecast to be delivering improved health outcomes, yet refuses loss-making within four years, as the EY report has highlighted.” to recognise this through increased investment.

The Company Chemists’ Association said the “The new hypertension service is welcome, pharmacy funding settlement “contains encouryet it is the tip of the iceberg in terms of what agement and concern”. pharmacy can offer as a local, valued healthcare While welcoming many of the service hub preventing ill health from arising in the first developments, Malcolm Harrison, chief execuinstance and providing the professional support tive of the CCA, said: “The refusal to increase which those with chronic conditions need.” the funding available for pharmacies to deliver He added that the PSNC team faced a stiff NHS services is compounded by the fact that any challenge while negotiating the funding increase efficiency gains promised as part of the five-year demand, and despite “warm words from senior deal have not yet materialised. politicians” it met with “a flat rejection” from the “We fully support PSNCs commitment to Treasury. pursue an uplift to the global sum as we see out Calling it an extremely disappointing decithe current five-year deal.” sion, Meader pointed towards countless surveys Despite being demoralised by the outcome, that have shown people want, need and value. many in the industry are looking forward to He, however, reassured that PHOENIX negotiations for the remaining two years of the remains committed to support members in maxifive-year settlement. mising their remuneration opportunities.

‘Unfathomable’ decision

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Michelle Riddalls

GUEST COLUMN

Supporting self care in pharmacy Michelle Riddalls supports the introduction of appropriate access to patients’ records and the right to refer to other healthcare professionals…

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he Covid-19 pandemic has shone a spotlight into every corner of our health system.

From equipment procurement to clinical trials, the many cogs that drive the healthcare wheel have come under intense scrutiny.

So how has pharmacy fared, after 16 months at the forefront of the pandemic response? Have perceptions shifted among individuals and policymakers?

It’s a question close to our hearts at PAGB, the consumer healthcare association, where we have long advocated an enhanced role for pharmacists in recognition of their training and expertise.

And it’s a question we set out to explore in our latest survey on self care and attitudes to accessing healthcare services.

In the two weeks to 3 June 2021, we asked more than 2,000 people about the self-treatable health conditions they’d experienced in the previous 12 months and what they’d done to alleviate their symptoms or tackle the problem.

The first of our pharmacy-related findings will surprise no-one in the business: almost half of our respondents (47 per cent) told us they’d turned to a pharmacy for advice or medication, up from 37 per cent in our 2020 survey.

That’s almost certainly due at least in part to the continuing accessibility of pharmacists during the Covid-19 pandemic.

There were undoubtedly people who would have preferred to see a GP about a health problem that is generally self-treatable, and who might have been offered a GP consultation in ‘normal’ times, but who were not able to do so during the pandemic and chose a pharmacy visit as their alternative.

Of course, there were also people with more serious conditions who should have seen a GP but were deterred by the circumstances of lockdown – their situation is

clearly very different but lies similarly at the heart of the debate about self care and the best use of resources.

So what can we do to encourage people in future to use their pharmacy as a positive first choice for a self-treatable condition, rather than regarding it as a ‘next-best’ or even a ‘not-worth-it’ option?

It’s a question we need to address to help protect NHS resources such as GP appointments and A&E slots for those who need them most, as well as to reap the benefits for everyone of more widespread self care – which include better health outcomes and a reduction in health inequalities.

Some potential answers lie in the responses our survey participants gave when we asked why they felt as they did about pharmacy.

Those who said they hadn’t visited a pharmacy at all gave various reasons for their choice, some of which have become frustratingly familiar since PAGB’s first major survey of this kind in 2016.

They include: ‘pharmacists aren’t as qualified as GPs or hospital staff’ (13 per cent); ‘I cannot get to my local pharmacy’ (6 per cent); and ‘prescription medicine is better and/or stronger’ (6 per cent).

There is no easy way to overcome some of these negative perceptions, although PAGB will continue to press for measures that heighten public awareness of pharmacists’ training and expertise as well as their general accessibility. PSNC figures show that almost nine out of ten people in England live within a 20-minute walk of a community pharmacy, rising to 99 per cent in areas of highest deprivation.

In addition, one of our priorities is to support and encourage the appropriate reclassification of medicines from prescription-only to over-the-counter status. This has the benefit not only of offering greater flexibility and choice to individuals but of utilising the skills and training of pharmacists to maximum effect.

But arguably the greatest scope for effective change lies in the responses to our question: ‘What would make you more likely to ask your local pharmacist for advice?’

Top of the list is ‘more privacy in the pharmacy’ (44 per cent), which suggests it would be helpful to highlight the availability of consulting rooms that are now available in many pharmacies.

That’s followed by telephone access (32 per cent) – an admittedly difficult ‘ask’, logistically-speaking, but one that’s worth bearing in mind when services are shaped in future.

Then come two potential innovations that we believe deserve urgent consideration by policymakers.

Firstly, almost a third of people (31 per cent) said they would be more likely to visit a pharmacy if the pharmacist could refer them to another healthcare professional, such as a GP or a physiotherapist, where that was deemed necessary.

As a positive development for pharmacy, referral rights make perfect sense. If you could walk into your community pharmacy knowing you would come out with expert advice, an effective over-the-counter product or an appointment for medical help elsewhere, it becomes a much more appealing – and efficient – first choice.

It’s also a logical complement to the existing Community Pharmacist Consultation Service, which allows GP surgeries and NHS111 to refer individuals directly to pharmacists if that’s judged the best option for those with self-treatable health conditions.

We hope to see an expansion of this scheme before too long and we were very pleased to see the high level of enthusiasm among our survey respondents for the CPCS - 69 per cent support the idea of GP surgeries referring people to a pharmacist for a selftreatable condition.

Secondly, a quarter of our respondents said they would be more likely to opt for a pharmacy visit if the pharmacist could update as well as read individuals’ medical records.

Allowing pharmacists to record the advice they have given, and to base that advice on the most up-to-date medical history of the person in front of them, is another step that seems to us not only desirable but eminently possible.

We very much hope that the level of support in our survey for broadening pharmacy access to medical records and for pharmacists’ right to refer to other healthcare professionals will help drive these issues up the agenda, particularly at a time when the government is looking to integrate different parts of the health system more fully through its new Health and Care Bill and its recentlypublished Data Strategy.

All of our survey results will form part of PAGB’s ongoing campaign for the creation and implementation of a national self care strategy, built around the introduction of universal self care education and a greater role for pharmacists who have made such a vital contribution to our national Covid-19 response.

Michelle Riddalls is the chief executive of PAGB, the consumer healthcare association.

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PHARMACY BUSINESS CONFERENCE 2021

Creating a sustainable future In his fourth and final article, Michael Holden, conference chair, reflects on the topics and speakers we have arranged for you at our sixth annual conference…

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hy have we chosen innovation and integration as the theme of our conference? The simple answer is that this is what our biggest customer, the NHS, want from us and the rest of the health system. Just read the Health and Care White Paper launched in February, now backed by a new Health and Care Bill currently going through parliament.

The more complex answer is based on the evolving needs of our other customers, our patients, our profession and our wider workforce.

They are looking for something different, something better.

Our response to the Covid-19 pandemic has been, and still is outstanding. However, whilst demonstrating agility, it has to some extent that has moved us back to a focus on medicines supply, which, although critical to healthcare, is not enough to sustain pharmacy financially nor professionally.

Digital healthcare and technology are now moving at such a pace, some of it driven by the needs of the pandemic and some by rapidly changing expectations of commissioners and consumers of health services.

The future of health is local, but is pharmacy ready, willing and able to step into the local ring?

The conference The sixth annual Pharmacy Business Conference will together community pharmacists, owners and stakeholders to explore how to create a sustainable future through integration and innovation to meet the evolving needs of the health systems. This year we are holding our conference over two evenings utilising an online platform to improve accessibility and keep you safe.

21st September – Integration In our first session, you will hear from Dr Nikita Kanani, Medical Director for Primary Care (yes, we are part of primary care) on what

the NHS wants from community pharmacy within an integrated health and care system.

We will also hear from Anne Joshua, Head of Pharmacy Integration at NHS England, on our important clinical role in medicines optimisation and patient safety.

This will be followed by James Wood, the recently appointed Director of Contractor and LPC Support at PSNC. We anticipate James will give some insights on how the future of local and national representation and support might shape up plus some reflections on what local integration means for community pharmacy.

To put their perspectives on the benefits of local integration, we will hear from a Pharmacy PCN Lead and community pharmacy contractor, Jignesh Patel and a PCN Clinical Director, Dr Farzana Hussain, on how they have worked together in North East London to make healthcare better for their local population.

Our evening concludes with a panel consisting of Anne Joshua, James Wood plus Shilpa Shah, CEO of Kent LPC, who is doing excellent work to upskill and integrate community pharmacy in her area. They will reflect on the key elements of the session and delegate questions.

23rd September – Innovation None of the above will happen if we don’t

change what we do, why we do it and how we do it – this is the true essence of innovation. Some of this will be driven by pure determination and fresh thinking, some by embracing technology and digital healthcare.

Our opening speaker will provide some insights into why and how digital healthcare can make things better for the NHS, for pharmacy and for individuals. We will then hear from two independent pharmacy owners, Faheem Ahmed and Amish Patel, on how they have innovated in their pharmacy services and another, Ali Sparkes, who has fully embraced digital technology to improve her business and outcomes for her population.

The conference ends with a pharmacy stakeholder panel consisting of Simon Dukes, current but soon to leave his role as CEO of PSNC, and senior representatives from the three major pharmacy wholesalers and support organisations. Hear we want to hear their views on the future of community pharmacy and we want to hear your questions to them on the night.

Please ensure that you are there at both sessions to hear, participate and learn. I for one am really looking forward to them.

Michael Holden is chair of Pharmacy Business Conference and an associate director at Pharmacy Complete.

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INNOVATION HUB Faheem Ahmed

Forget cash flow. Content is king!

Award-winning pharmacist Faheem Ahmed explains what contractors who wish to set up a clinic need to do to position their business in a competitive market...

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o it begins. You have gotten this far and decide to set up a clinic. You’re excited and can see the future. But then, your competitors choose to do the same with one difference; they deliver cheaper services!

Marketing is your solution.

Anything you do can be copied and done better than you or I could – just look at the pharmacy sector and around you in the world.

In other words, if you set up an aesthetics clinic, then soon enough, someone will copy you. And the same can be said about any service you decide to set up – examples of which include delivery of prescriptions, administration of travel vaccinations, Covid testing, blood testing services, weight loss services, online or face-to-face consultations, etc.

And such is the irony that as I write this article I have just gone through this exact situation.

Recently at Ahmeys clinic, we rolled out Covid testing, and six months later, a Covid testing clinic appears in the town center. This clinic was also offering testing but at a lower price – when I say lower, I mean close to cost price!

Now, many years ago, I would have panicked – but not anymore – just keep reading, and you will soon never be fazed by a similar situation either.

Marketing is not advertising. That’s right.

Similarly, nor is advertising marketing.

On the other hand, marketing is the act of demonstrating value to your target audience.

For now, you can think of marketing as (1) how you position your brand, (2) how you communicate this to your target audience, and (3) how your audience connects or feels about your brand.

Apple’s marketing For example, when I think of laptops, MacBook comes to mind, and when I think of mobiles, Apple products like the iPhone spring

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up. However, I also know Dell and Samsung are equally qualified to manufacture these products.

So then, why does Apple come to my mind?

I mean, their products are set at a higher price point, and I am sure other products have similar features, if not better ones, then why Apple?

My dear reader, the answer lies in how Apple communicates to its audience and makes them feel, and this is marketing.

Indeed, with Apple, I feel I have a connection with the brand beyond a simple transactional relationship. When I buy their products, I think class, integrity, seamless integration between products, high quality, prestige, and all this amounts to enough value that it’s worth exchanging my hard-earned money even though there are alternatives.

However, this is not to say Apple products are better than those of Dell or other brands.

But Apple, the brand, develops a unique relationship with its audience. As a result, the company can cultivate higher-order feelings such as trust and loyalty, so you do not hesitate to buy again and again, regardless of the price you pay each time.

You might be wondering how do they do this?

Well, sorry to be repetitive, but the answer is marketing. In Apple’s case, they don’t get themselves into price wars; instead, they focus on their unique value proposition- and that is, their products are beautiful that work straight from the box. This is something you can’t just build overnight.

Brian Tracy, Author of The Psychology of Selling, says ‘people buy with emotion and justify with logic’ – and once you understand how to tap into emotions and create feelings, you won’t need to worry about what others are doing.

Positioning This is in your hands. First, I’d suggest you look at your company’s mission statement.

Remember that a mission statement is a summary of why your organization exits and outlines your organization’s purpose.

For example, our mission at Ahmeys is to improve the quality of human life by helping everyone on this planet unlock their optimal health and well-being.

Okay, so I bet you’re thinking, ‘that sounds great, Faheem, but what does it have to do with positioning my clinic?’

Well, once you know your mission statement, you should understand the message you need to communicate with your audience and then devise a plan to demonstrate this.

So, let’s continue using my clinic as an example. We know the mission statement and from here, what we need to understand is that to achieve this, we would need our brand to inspire and instill trust in all those who come into contact with it.

What I mean is if you run an ad on Facebook with the headline: ‘We want to unlock your potential’, personally, I would laugh and ask, ‘’who gave you the right, and why should I trust you?’’

So how do we get our audience to trust

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our brand with aspects of their health and well-being? Well, if you thought the solution was marketing, then you were only 50 per cent right. The complete solution is content marketing (more about this later).

My point is you need to focus on positioning your brand/clinic as a product where people can find helpful information, advice, insights, resources, and inspiration – by the way, this is all content – to improve the quality of their lives.

Content marketing The term is commonly used by Joe Pulizzi.

Joe is the founder of Content Marketing Institution and explains, ‘content marketing is the marketing and business process for creating and distributing valuable and compelling content to attract, acquire, and engage a clearly defined and understood target audience—with the objective of driving profitable customer action.’

If the definition is confusing, consider content marketing as (1) creating valuable information, i.e., content that your audience is passionate about – so they pay attention to you; (2) Then expressing this content in an article, video, webinar, podcast, or info-graphic; and (3) Finally, distributing this content through a channel which may be your website and/or social media, radio, TV, etc., to reach your audience.

Before we go any further, I want you to understand two key messages: Firstly, customers or people generally don’t care about you, your products, or your services. They care about themselves.

And secondly, people are bombarded with ads and content – which now they can just choose to ignore. So to get their attention, you need to become a leading informational expert delivering value through compelling content within your field, or you won’t stand out, let alone generating sales.

Where to start Start by reading. Yes. Pick up books and start reading. One of my biggest regrets as a business owner and pharmacist was that I stopped educating myself; so don’t make that mistake!

I could recommend plenty of authors and books to get you started and I will do in future articles. But, for now, I would recommend reading Epic Content Marketing by Joe Pulizzi.

Alongside reading the book, I would suggest you undertake an audit and evaluation of the current content you produce and the channels of distribution you use. Just ask yourself, ‘what message am I communicating and on whose platform?’

If you want to know a good place to start, just visit your website because it will have content, and it’s also a channel where you distribute your content.

Build your platform A couple of years ago, my Facebook account was blocked. Two years on, I was then blocked from YouTube and LinkedIn (albeit for a short while but blocked nonetheless). I sat down one day and realized I am making a huge mistake.

In essence, I am building my real estate on borrowed land and can be dictated to at any given time.

Therefore, I no longer focus on building my audience on social media platforms like Facebook, Instagram, LinkedIn, or YouTube because, technically, I do not own those channels. As such, at any point, the terms and conditions of these platforms can change, or even worse, the platforms could go bust, and I’d have lost my audience – remember Myspace or Bebo?

If you’re with me so far, I hope you’re wondering, ‘what platform should we focus on and which one can I own?’; well, that would be your own website!

The promised land Oh yes, the website is the promised land. This is your land; you can own this, and here is where you need to build your audience. Here is where you want all your subscribers and followers, and this is where you should spend your time and energy.

Imagine your website having 1000’s of paid customers every month in addition to your website ranking number one on Google for specific search terms! Can you also imagine being paid by others to market on your site?

If you can’t, you need to start believing it is possible; if you are willing to put the work in that is.

Content is king Forget cash flow. Content is king!

But, before you start to produce content, please answer the following: (1) who is your content for? – to answer this, keep your audience in mind so you can plan and develop content that they would value; (2) what resources do you have at your disposal – currently do you have a dedicated team of writers and videographers who can support you with content creation and the editing process; and (3) why are you creating content? – think about your content mission and goals because this will impact what, where, and how often you publish and how you prioritise, organise and categorise your content creation efforts.

Let’s discuss this concept of content goals in more depth for a moment.

Your content goals I’m a big fan of setting goals.

However, before you set your goals, make sure you do your market research. It is essential to know what people are searching for on the web; you can use tools like MOZ or SEMrush to help with keyword research.

Assuming you have done some research, now you need to set a clear content marketing goal. There are many choices, such as monetising new or existing customers (in sales speech, we call these leads) or building a community.

However, I’d suggest you start with the following goal: building an audience base.

To explain further, building an audience is not just about gathering an email list. It runs a lot deeper. Essentially, you need to develop a relationship with your prospective or existing customers beyond a shallow transactional relationship – think about the Apple example I gave earlier – such that you create a community of advocates and brand promoters.

Moreover, building your audience will lead to increased satisfaction and loyalty towards your brand.

Now I know by no means is the above an easy feat, but if you discipline yourself and develop grit, as Angela Duckworth, author of Grit: Why passion and resilience are the secrets to success, explains in her book, you can achieve your goals.

Things to consider Writing content is not difficult. In actual fact, if you have a basic understanding of English, as Ann Handley, author of Everybody writes, puts it; ‘you can write!’

However, I don’t just want you to write. I want you to create content that fulfills its purpose. For example, you set up a clinic whose main objective is to generate sales by through private consultations. Therefore, you need to create content that encourages your audience to do exactly that; book a consultation.

To achieve the above, you need to consider the following: (1) how will you stand out from the crowd? – think about what unmet need you can address with the content you intend to create? What gaps exist?; (2) call to action – what do you want your readers to do? Do you want them to sign up for a service or buy a particular product; and (3) audience outcome – think about what you want your audience to gain from your content. Will it be live a better life in some way? Get a better job or learn a new skill? By doing this, you will understand the purpose of your content from the audience’s point of view.

Final thoughts If you want your clinic to stand out, then produce ridiculously good content for your audience. That content could be expressed in blog posts, videos, podcasts, and webinars, but remember to focus on publishing on your owned channels, leverage unowned channels like social media, stay consistent and then watch your audience grow.

Try copying that!

Faheem Ahmed, winner of the Pharmacy Business Innovation Award 2020, owns Ahmeys Pharmacy in Oxford and MEDLRN. SEPTEMBER 2021

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Mike Hewitson

VIEWPOINT

Hub & Spoke – why independents need it now Mike Hewitson argues that independents should no longer waste time debating over a centralised hub and spoke dispensing model…

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ndependent pharmacy owners and staff have been under relentless pressure for the last 18 months. With prescription volumes strong, despite the growth of online pharmacies it is easy to feel overwhelmed by the number of things that need to be done.

If your staff are anything like mine, they have been incredible, but we do not want to burn them out either.

In 2021, independents were called upon to take part in the roll-out of the Covid vaccination programme, but many were not able to grasp the opportunity because they found it impossible to get on top of the day-today dispensing workload.

Some still are.

It has been a brilliant example of why we urgently need to bring forward centralised hub and spoke dispensing for independent community pharmacy.

The necessary primary legislation achieved Royal Assent back in February and we’re now in the midst of industry and public consultations. This consultation will be essential in determining how the regulations should be updated so that independents can use this technology.

The debate is no longer ‘should’ Hub & Spoke dispensing happen, as we have moved on to ‘how’ Hub & Spoke dispensing will happen. There is a lot to consider to ensure that we have a vibrant market of potential Hubs, not just a stale choice of a handful of very large operators.

Further consultations are planned for the autumn which will allow patients and the public to have their say on important issues such as consent and transparency – watch this space.

If I had hub and spoke dispensing switched on right now, I would not be worried about burning my staff out, because I could take a lot of the mundane pressure off their shoulders.

This would allow them to focus their time and energy on the patients with the greatest needs.

With the launch of the Discharge

Medication Review service in February, pharmacies must now think about how they handle patients after they are discharged from hospital, to help them get the most from their medicines and avoid unnecessary readmissions.

We have just seen the announcement of new hypertension and smoking cessation services which will launch from pharmacies later this year. It is vital that we embrace these opportunities, not just for the much needed revenue, but also to reinforce the importance and opportunity that community pharmacy offers commissioners.

Opting out of these services is not an option in the long term.

The five-year contractual settlement sets out explicitly that the NHS wants to reduce the cost of dispensing, focusing more resource on clinical services.

This is hardly news to most contractors, but I see the development of an efficient, automated hub solution as an essential enabler to help us transform services from where we are today to a different future.

Freeing the pharmacist to have more capacity to deliver services will help us to embrace not just NHS commissioned services, but also private services. Having just completed my training as an Independent Prescriber I already have a number of private services lined up, for which there is both a need and high patient demand.

‘Freeing up capacity’ doesn’t have to mean reducing staffing levels, but it might mean that we can start chasing new business, for example patients in other areas who have been badly let down by other providers during the pandemic.

Our plan is to go all out for growth by offering the best levels of service that we can, innovating in not only what we do, but also the way we do it.

Technological and clinical innovation is essential or else independents will get left behind. Larger organisations are too slow

to adapt, being small means that you can be agile to local developments which will be increasingly important with the development of Integrated Care Systems, which will be responsible in future for pharmacy service commissioning.

Our problem as independents will be showing scalable solutions to local problems, but we can only do that if we are doing something other than checking prescriptions.

All of the innovation in community pharmacy comes from the independent sector, and I am confident that we will be able to evolve to meet the changing demands of the NHS and patients, but we cannot continue to play the same game of chasing procurement margin and item volume alone.

When I speak to other independents about Hub & Spoke some can become concerned over the risk to their dispensing volume by sharing information with their competitors or their wholesalers, and I think these are largely legitimate concerns.

But it doesn’t have to be that way. I am working to ensure that independents have a solution which improves their margins and safeguards their data but still delivers marketleading automation and efficiency.

I’m looking forward to sharing more information in the coming months, but whatever your thoughts on this subject I would urge you to keep an open mind and spend some time thinking about what your service is going to look like in the future, because if you don’t nobody else will.

When I think about the huge quantum leaps that have happened since the start of COVID, it is clear that the patient want and expect more from healthcare, whether it is the GP e-consult or video consultations through to Deliveroo style deliveries we cannot afford to stand still or our customers will have moved on.

The best pharmacies are already transforming themselves to become fit for the future. While online providers can dispense a prescription, they find it more difficult to give the face-to-face clinical care that many patients want and need.

This is how independents will secure their future, and soon hub and spoke dispensing will be there to help me make it happen.

Mike Hewitson owns the Beaminster Pharmacy in Dorset and is a non-executive director of HubRx. SEPTEMBER 2021

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SPOTLIGHT Technology

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Changing the game A

Tariq Muhammad discusses how community pharmacy can defend itself against the potential onslaught of Amazon...

recent study published by consultancy firm, Simon-Kucher & Partners, revealed that 41 per cent of UK customers are ready to use Amazon Pharmacy when it becomes available. The study also found that just 24 per cent of customers would continue using bricks and mortar pharmacies and only 9 per cent said they would use a different online pharmacy.

If these figures are to be believed, they present a depressing outlook for community pharmacy.

It would appear no one is safe from the Amazon juggernaut that seems to bulldoze anything in its path, including even those online businesses that have modelled themselves in Amazon’s image.

In many ways, the news of Amazon coming into pharmacy is no longer a surprise. If anything, I’m surprised they haven’t already launched. However, each time we hear this it does allow us to reflect on the current state of pharmacy and what we need to consider in order to survive.

The pharmacy game I greatly admire the services that pharmacies provide and the lengths that pharmacists go to help their patients. Whether you are a contractor, employee or locum, you will be able to recount almost daily stories where you did something that gave a positive experience for your patients. In the vast majority of cases, whatever you did, wherever you did it, chances are you did it for free.

Beyond the individual stories, pharmacy businesses have used this approach to model their services. Whether it is providing medication in blister packs, home delivery, consultations and advice, it is all available free of charge.

Underlying all these efforts

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is the desire to grow prescription volume. Pharmacies compete with each other on customer experience in return for securing dispensing income. If one offers original packs, another will offer MDS. If one offers MAR charts, another will offer ‘coloured’ MAR charts. If one is offering next day delivery, another will offer same day delivery. And if anyone is looking to charge, there will always be someone willing to offer the same thing for nothing.

In our pursuit to help patients and sustain our businesses through the prescriptions model, we have built an industry focused on supply and measured upon loss leader add-ons. This then creates the vulnerability against the likes of Amazon who with their deep pockets and technology are masters at playing this game. They can wrap an alternative customer experience around a supply service which could wipe out the entire pharmacy sector at a stroke.

The only way to compete with Amazon is not to play the game on Amazon’s terms. In fact, we need to play a different game all together.

Automate dispensing The greatest asset Amazon has is its technology and automation.

The greatest asset pharmacy has is its pharmacists. However, ever since time began, most pharmacists have been buried doing a process which can be done better by technology with little time to spend on front line services.

There is now an urgent need for pharmacists to get out of the dispensary and spend their time being pharmacists. We now have the technology, via systems such as Titan, to automate much of

Technological advancements in pharmacy are happening at a faster pace

the dispensing process and all but free the pharmacist from the dispensing process without compromising safety.

Frontline services

With pharmacists freed from the dispensary, we need to rapidly rebuild our front-line image. We have a wealth of services emerging which can keep pharmacists fully occupied all day. CPCS, DMS, NMS, vaccinations, prescribing and a range of private services are just some of the paid activities pharmacists can be involved in.

Aside from helping supplement income, the main purpose is to get pharmacists to become visible.

This is a PR exercise like no other. We need to give patients an experience that would be missed if it was then taken away.

Subscription models

I have long advocated the idea of a patient registration model for pharmacy. If pharmacies were paid ‘per capita’ as opposed to payment per item, I believe it would have driven different behaviours within the profession and we’d be in a different place today.

Although the government and our negotiators are unlikely to change the remuneration model any time soon, pharmacies could and should establish their own subscription models chargeable

to patients. Under a subscription model, it would be easier to offer a range of pharmacy services over and above the NHS contract for those willing and able to pay.

Subscription models are becoming the norm in many industries enabling customer loyalty without getting into a transactional value.

App experience

Of course, pharmacy needs the technology to connect the above services together. Patient Apps are needed that connect the pharmacist to the patient and help manage repeats, dispensing, services and collection of payments. Crucially, Patient Apps build loyalty and allow a new experience which are essential if we want to prevent the loss of patients to Amazon.

Right now, all the above may look daunting but much of the groundwork is already in place.

The technological advancements in pharmacy are happening at a faster pace now than any other time in our history. We just need to leverage the technology and redefine what pharmacy actually means beyond supply. If we do this, then it will be a game that Amazon would struggle to play, and one they certainly won’t win.

Tariq Muhammad is the CEO at Invatech Health.

SEPTEMBER 2021

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Technology

SPOTLIGHT

Face-to-face time T

Gary Paragpuri considers how the pandemic has both shifted our understanding and crystallised our appreciation of digital and in-person experiences…

hree years ago, with our company still very much in start-up mode, the Pharmaself24 medicine collection point was a relative unknown in the UK pharmacy market.

Despite the fact that my partner in the business, Ryszard Cygan, had been providing his patients with a 24/7 prescription collection service for a decade at his West Elloe Pharmacy, he remained one of only a handful of early adopters of this technology.

As a new player in the market, our goal was to build awareness of our company as well as the Pharmaself24 brand and the concept of automated medicine collection itself. We tackled this through a combination of digital and face-to-face marketing activities, aiming to demonstrate and demystify the technology, and show contractors firsthand how it can be used to help achieve their goals, whether that’s easing the workload on the pharmacy team, better positioning themselves to defend against competition from online providers, or supporting efforts to grow their share of the local prescription market.

Over the past 18 months, opportunities to meet at live events were sadly lost to the pandemic, but they are beginning to make a welcome return, bringing the UK pharmacy community together for the chance to discuss industry developments, discover new things and learn from each other – all things that can’t be fully replicated online.

They do so, however, in altered circumstances. In our

world alone, awareness of the benefits of the Pharmaself24 and automated medicine collection has grown significantly, and our install base has also grown, now incorporating independents, smaller groups and larger multiples right across the country.

Early adopters and pioneers are now established users, with the Pharmaself24 embedding itself ever deeper into their workflow, in some cases helped by the addition of a seamless twoway fully integrated link to their PMR system.

More widely, the digital shift experienced by society during the pandemic has seen rapid adoption of online virtual platforms as alternatives to the face-to-face meetings that were previously the default – a reminder that the world of technology moves at an increasingly rapid pace.

Indeed, consider the fact that it was just over a decade ago, in April 2010, when Apple’s Steve Jobs unveiled a new model of tablet computer at an event in San Francisco. Subject to much rumour and speculation at the time, the device was expected to be called the iTablet or iSlate and, for many, was seen as the realisation of a goal outlined

by Jobs back in 1983 “to put an incredibly great computer in a book that you can carry around with you”.

Before 2010, other tablets had achieved some commercial success (anyone remember the GRiDPad 1900?), but their share among households in the US stood at a lowly 3 per cent. With its super-smooth user experience and the backing of the equally

Technology moves at a rapid pace

slick Apple marketing machine, the iPad changed that almost overnight, shipping 3 million devices in its first 80 days. Within a year, tablet share had jumped to 10 per cent and continued on an upward trajectory to reach 64 per cent by 2017 as other device manufacturers tucked into Apple’s slipstream.

Compare and contrast that rate of adoption with other technologies that we might now consider commonplace. For example, the humble washing machine was present in 10 per cent of US households in 1930, but it was not until 1972 that the adoption rate hit 64 per cent.

Dishwashers weren’t present in 64 per cent of homes until as late as 2005. What the iPad achieved in six years took washing machines and dishwashers the best part of half a century.

Today, with consumers leading ever busier lives, the benefits offered by technology mean that rapid adoption of ‘new’ digital products and services happens almost in the blink of an eye, from the use of streaming TV services to the digital assistants that help manage our homes.

We might not be the next Netflix, but at Hub and Spoke Innovations we have seen firsthand how rapidly the effects

of technology can be felt. The learnings from our customers’ experiences, particularly over the course of the pandemic, are incredibly valuable to us, to our ‘family’ of Pharmaself24 customers and to our prospective customers, helping develop a better understanding of how our technology can continue to evolve and advance - in line with Google’s ‘launch and iterate’ philosophy.

In some cases, they detail truly transformational change, where 24/7 collection technology has been rapidly adopted and welcomed by patient communities and helped ease pressure on staff throughout such a difficult time. In all cases, they show the value of combining digitally-driven convenience and efficiency with ongoing face-toface engagement and interaction.

The same is true of our continued marketing efforts, with enforced digital-only activities now increasingly balanced by in-person engagement – valuable opportunities to break out from behind the screen and have realworld discussions about how the world of pharmacy might look different again three years from now.

Gary Paragpuri is CEO of Hub and Spoke Innovations.

SEPTEMBER 2021

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CLASSIFIED

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The vital role of the VMS category in im

626 £

+20.7% IN VALUE

MILLION

(+£107million)

Vitamin D SALES

Vitamin C SALES

+103%

+31%

As we head towards cold & flu season, people are

increasingly thinking about how they can best support their immune systems. This has become even more evident since the arrival of coronavirus and is reflected in the rising sales of VMS products with immune supporting nutrients.

So, how can pharmacies ensure their VMS category is meeting the immunity needs of their customers this winter?

STOCK THE RIGHT RANGE Start by ensuring you stock the right range of immunity focused products. The key nutrients to look out for include vitamin C, vitamin D and zinc. Whilst sales of vitamin C and D showed strong growth across 2020, they particularly soared during the winter months with vitamin C +40% and vitamin D +152% as consumers looked to support their immune systems .

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VITAMIN C Helps to protect cells and keep them healthy, maintaining healthy skin, blood vessels, bones and cartilage and helping with wound healing. Vitamin C cannot be stored by the body so is needed in the diet every day.

VITAMIN D Benefits are numerous but particularly regarding immune and bone health. The body creates vitamin D from direct sunlight on the skin, however we do not make enough all year round. Whilst it is found in a small number of foods, a good quality supplement (particularly between October and March when sunlight is limited) is often recommended to ensure requirements are met.

ZINC An essential trace mineral vital for many functions in the body including the normal development and function of immune cells and supporting the skin barrier, which protects against foreign invaders entering the body.

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Whilst diet and lifestyle should always be the first choice to obtain nutrients in today’s world this is not always easy to achieve and supplements can bridge the gap to optimal nutrition.

USE EMPLOYEE EXPERTISE Data shows many people enter the VMS category buying vitamin C and vitamin D products before expanding their repertoire. The willingness of VMS consumers to engage with new products offers an excellent opportunity for pharmacies to provide education and support. Having staff trained on specific products can increase their sales by up to 26%2 and will help consumers find the right product for their needs and in turn drive customer satisfaction and repeat purchase.

What’s more, 58% of VMS buyers prioritise quality3.

Pharmacies should therefore offer a range of more premium quality products, thus providing the opportunity for shoppers to trade up.

CREATE EFFECTIVE DISPLAYS Clear category merchandising, signposting and pointof-sale materials will ensure customers can find the products they want.

Making the fixture easy to navigate is a fundamental way to safeguard against missed sales. Group similar products together and double-face key sellers to help them to standout on-shelf. An excellent way to capture attention and encourage engagement is to create theatre with a secondary display.

SEPTEMBER 2021

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n immune support this winter

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V I TA M I N S A N D SUPPLEM ENTS

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• Helps muscle function • Supports immunity

Vitamin D3 is the more potent form of vitamin D compared to vitamin D2 and Solgar®’s vitamin D3 is one of the highest strength vitamin Ds available.

• Vegetarian, Kosher • Free from sugar, salt and starch

Ester-C® Plus Immune Complex • Comprehensive immune support formula • Includes gentle on the stomach Ester-C® • Immune supporting vitamin C, vitamins A, B6, B12 and D3 and zinc • Botanical ingredients elderberry & echinacea • Easy-to-swallow softgels

Maintain immune system function throughout the year with scientifically studied immune system supporting nutrients.

Exclusively formulated for Solgar®, Ester-C® is retained in white blood cells for up to twenty-four hours. Twice as long as standard ascorbic acid.

Ultibio Immune • Unique formula to balance and maintain the immune system • Immune supporting vitamin A, B12 and D3 • Two clinically studied live bacterial strains Lactobacillus plantarumHEAL9 and Lactobacillus paracasei8700:2 • Easy to swallow one-a-day capsule formula

A careful balance of gut microbes is critical for immune defences. To achieve a healthy gut we need a well-balanced and varied diet.

Bacterial strains also play an important role and multiple clinical studies indicate the efficacy of the two strains in Ultibio Immune to balance and maintain the immune system.

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Flavo-Zinc Lozenges • Potent antioxidant that is recommended by specialists • Supports healthy brain function • For healthy skin, hair and nails • Provides Zinc as Citrate and Gluconate

• Easy to take lozenge form Flavo-Zinc Lozenges provides premium quality zinc in a highly absorbable and easy to take lozenge form.

ABOUT SOLGAR® An award-winning range of over 350 nutritional supplements. Solgar® has over 70 years of commitment to quality, health & wellness and remains at the forefront of nutritional science.

We are proud to say that 98% of Solgar® consumers would recommend our brand.* For more details on opening an account or to place an order email enquiries4@solgar.com 1 Kantar 52wks to Feb 21. 2 Kantar 12wks to Feb 21. 3 The Nature’s Bounty Co. research. 4 Survey of 1000 VMS users in the UK in Dec 2020.

Food supplements should not be used instead of a varied balanced diet and a healthy lifestyle. Solgar® is a registered trademark. For business use only.

AUGUST 2021

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SPOTLIGHTPain Management

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Acupuncture – a point in the right direction Paul Battersby discusses how recent NICE guidelines have improved acupuncture’s credibility as a viable treatment option for pain management…

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cupuncture has long been seen, incorrectly, as an alternative treatment for pain management, aligned to ‘sandals and candles’ rhetoric that bundles it together with far less scientifically-advanced approaches.

Take a recent article in The Telegraph, that reviews Dr Monty Lyman’s assertion that pain can be treated without medication. The article cites shocking statistics from Lyman’s book ‘The Painful Truth’, including that a third of UK adults suffer from chronic pain (pain that lasts 12 weeks or longer, despite treatment) with back pain being most common, as well as joint/muscular pain and

headaches.

Lyman’s arguments do not centre around acupuncture, but the article summarises: “Lyman even goes so far to recommend some forms of alternative medicine, like acupuncture and hypnotherapy…”.

While not overtly negative, the assertion is that acupuncture is a fringe treatment.

In reality, as the recent NICE guidelines update has highlighted, is it is viable treatment that is reducing chronic pain for millions, without the need for medication. Pharmacists will be aware that, following this guidelines revision, NHS registered physiotherapists may be approved to

administer the treatment.

How it works Physiotherapists use acupuncture treatment modality as an adjunct to reduce pain, and evidence has shown that acupuncture actively improves rates of healing and recovery, thereby enhancing treatment outcomes.

The modality works by utilising natural pain-relieving chemicals, such as endorphins, melatonin and serotonin, which are produced when acupuncture needles stimulate various physiological mechanisms within the central nervous system and in the local peripheral tissues.

Additionally, functional magnetic resonance imaging (MRI) studies have confirmed the effect on the pain pathway to the brain.

Data suggests that acupuncture triggers a sequence of events involving the release of endogenous opioid-like substances including encephalin, β-endorphin and noradrenalin.

With opioids being one of the strongest painkillers available for treatment, and one of the most

Chronic pain – a case study Chronic pain can be debilitating.

Even the simplest tasks that most of us take for granted like walking the dog or even getting to sleep can cause excessive pain. So, when Andy Morris was told he would have to be on painkillers for the rest of his life, he decided to do something about it, and by taking advice from his mother, has discovered the benefits of acupuncture.

Now 40, Andy from Wrexham, underwent spinal surgery in 1995 to treat Scoliosis, a condition where the spine twists and curves to the sides. He had a titanium plate fitted and was overjoyed to find the operation was a success and years of discomfort were at an end.

The reprieve lasted until 2017 when he had a fall at work and landed on his lower back, hitting a pyramid-shaped footstool. He was obliged to give up work and has since had a constant battle with

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chronic back pain that he rates as: “generally eleven out of ten.”

X-rays and ultrasounds show no signs of broken bones or any root cause of pain. Physio has helped, and his doctor prescribed medication to alleviate the pain.

He takes two different medications (Naproxen and Omeprazole) daily and additional paracetamol when the pain becomes too much.

“The initial course of physio did relieve the pain somewhat and meant I was able to go to the swimming, which also helped – but it was short-lived,” Andy explains. “I don’t want to be reliant on pain killers, but I don’t have a choice.”

A dog-owner who loves walking, Andy’s battle with chronic pain has had a big impact on his life. “Walks are generally not an option. My friends and family know when it’s at its worst because I become very moody and take it out on them,” he says.

Andy Morris

“The situation is made worse by the fact that lying down is especially painful, and so sleep becomes very difficult. I often wish I could sleep standing up.”

Since January of this year (2021), Andy has discovered a lifeline in the form of acupuncture.

His mother had been receiving treatment and recommended he give it a go. His doctor would not prescribe it, so he went private.

During treatment, he says, the pain almost disappears, and that

addictive, reducing dependency can lead to a more sustainable, consistent treatment plan.

Info for pharmacists Physiotherapists are the largest group of medical professionals practising acupuncture in the UK. Acupuncture Association of Chartered Physiotherapists (AACP) members have had full training as physiotherapists and all have clinical experience treating patients in a hospital setting and in private practice, before starting their acupuncture education.

Furthermore, after successful completion of the acupuncture course, the AACP ensures its members conduct regular continual professional development which enables the individual to be informed with the latest developments. Pharmacists can refer customers to a practitioner through the AACP online practitioner search tool.

Paul Battersby is chief executive officer and clinical advisor at the Acupuncture Association of Chartered Physiotherapists. relief lasts for a few weeks.

“While I am hopeful that the doctor will prescribe me another course of physiotherapy, my main wish is that acupuncture could be prescribed – and these recent NICE guidelines suggest it can. I have acupuncture when I can afford to, but that’s not enough to mean pain is not a big part of my life.

Without it, however, I would be in continuous pain.”

Andy says he was a bit nervous before his first acupuncture appointment as he just didn’t know what to expect: “Very quickly I was put at ease, and the results were instantaneous. After a total of four sessions, I’m convinced of its effectiveness as a treatment for chronic pain.

“After acupuncture sessions I can do what I want and it makes a fundamental difference to my life. I really appreciate the basics – walking the dog and sleeping properly. And it’s an option that might mean I don’t have to take medication for the rest of my life.”

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Pain Management

SPOTLIGHT

Managing pain in pharmacy Dr Rod Hughes suggests ways in which pharmacy teams can help patients suffering from inflammation of joints and surrounding tissues…

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rthritis is a chronic

condition that results in inflammation of the joints and surrounding tissues.

Osteoarthritis (OA) is the most common type of arthritis, with eight million people affected in the UK and the numbers are increasing at an alarming rate due to our ageing population.

Over 50 per cent of people over 50 have some form of OA. The condition is generally agerelated, with wear and tear of joint tissues causing lubricant cartilage lining in the joint to gradually wear away.

OA changes and the inflammation involved causes difficulty moving and considerable pain. Rheumatoid arthritis (RA) affects about 1 per cent of the population and can impact people of any age, including children, although it is most commonly starts in the 3rd or 4th decade of life.

RA is caused by the body’s immune system wrongly attacking healthy joints and can eventually cause joint damage if not treated early.

As the development of OA is largely a genetically inherited risk, patients need to understand what lifetime factors make arthritis more likely. Of these, weight is the most important.

Maintaining a healthy weight is important to reduce the load and protect weight-bearing joints such as the back, knees and hips.

OA can sometimes result from an untreated acute joint injury, so it is important to always stretch and warm up before exercise and allow injuries to heal properly so as not to cause long term damage.

Lifestyle changes Currently there is no cure for OA so treatment will often focus on the self-management and lifestyle changes that can lead to pain relief.

Ideally everyone with OA should have a tailored selfmanagement plan to encourage positive changes such as exercise, regular stretching, dietary changes, weight loss in some cases and trials of supplement use.

Enjoying a healthy balanced diet helps to keep your weight in check, reducing the strain on load bearing joints, whilst adding an anti-inflammatory supplement may help to calm the body’s immune response. Poor sleep has also been linked to inflammation, so good sleep hygiene can be recommended to promote a restful sleep.

As all arthritis involves inflammation, foods with antiinflammatory properties may be of benefit to calm the body’s immune response.

Ginger has been shown to have anti-inflammatory properties to reduce morning joint stiffness, an early indicator of OA, and has been shown to benefit symptoms of arthritis in the knee by relieving pain and improving mobility.

Oily fish and leafy green vegetables are also commonly considered to reduce inflammation and joint health. Vitamin C is important for the formation of collagen, a key component of protective joint cartilage, and is plentiful in lots of citrus fruits and vegetables, or available as a supplement.

Osteoarthritis is the most common type of arthritis

It is also important to stay well hydrated throughout the day, as water contributes to keeping your soft tissues (tendons and muscles) hydrated and moving smoothly.

It’s extremely important to encourage patients to keep as active as they can. Exercise helps to strengthen joints and their surrounding tissues, aiding pain and stiffness, and keeping supporting tissues strong and supple.

Even simple exercises like daily walking, gentle yoga classes and Pilates can all make a big difference. Any worries that the joints might ‘wear out’ quicker with exercise is untrue and strong muscles protect adjacent joints.

Community pharmacists are ideally placed to screen for OA and make treatment recommendations, as they are often consulted about the choice of over-the-counter analgesics to manage OA pain.

Supplementation There is some clinical evidence to support the efficacy of a small number of nutritional supplements, including rose-hip, for symptom relief in OA, rheumatoid arthritis and musculoskeletal pain. Some supplements such as glucosamine are widely used but have no evidence of effect to support their use.

Many people with painful

joint conditions feel they benefit from taking joint supplements – either instead of, or in addition to, their prescribed medications.

Taking a supplement at the earliest signs of joint pain or stiffness may well offer protection to safeguard the future of your joints.

Rose-hip extracts have a long history of medicinal use, with consistent and robust research having been undertaken on extracts from a specific species of rosehip called Rosa canina, which has been found to contain a potent anti-inflammatory galactolipid (or GOPO for short), with analgesic and antioxidative affects.

GOPO has been investigated in a number of well-designed studies involving people with both OA and RA. These studies found that daily supplementation of GOPO can rapidly reduce joint pain, stiffness and swelling, improve joint mobility and reduce the need for standard painkillers over several months. In one combined analysis of all GOPO studies, the researchers concluded that GOPO can be more effective than either paracetamol or glucosamine in the treatment of Osteoarthritis.

Dr Rod Hughes is a consultant rheumatologist.

SEPTEMBER 2021

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STOCKTAKE Products

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Avigan® 200mg tablets

Support for joint health

Dr. Reddy’s Laboratories can provide Avigan® (Favipiravir Tablets) as an unlicensed medicine under the ‘Specials’ Regulations for an unmet clinical need.

Product: Avigan® Active Ingredient: Favipiravir Dosage Form: Tablets Strength: 200 mg Pack size: 100 List Price: £612.00 Trade contact: Dr.Reddy’s :01482 389858 customerserviceuk@drreddys.com

Pharmacists have a key role when it comes to advising customers on options to support their long-term joint health. Newly launched, GOPO® Joint Health Plus Ginger is the first UK supplement to contain the unique combination of ginger extract and cultivated rose-hip, high in levels of GOPO®.

Longstanding Scandinavian research has established that rosehip may play a valuable role in the care of joints and joint tissues, with the galactolipid GOPO® having been studied in over 20 scientific trials.

Ginger is loaded with bioactive compounds that may help to support morning joint flexibility and good muscle function.

This new product is also rich in Vitamin C, essential for normal collagen formation, needed by the body for healthy bones and cartilage.

For more information visit the GOPO® Website: www.gopo.co.uk Or call GR Lanes Health: 01452 524012

Relief from constipation In many cases, digestive health issues can be combatted, with OTC products, stimulant laxatives, faecal softeners, and lactulose all having the desired effect. Natural stimulant laxatives, such as Senna, are more effective as they increase the wave-like muscle movements that push the contents of the GI tract forward and can work within 6-12 hours. Glycerin suppositories, as another option, can offer gentle relief from occasional constipation.

Care has developed a number of NPA-approved training modules which offer insight into a variety of conditions commonly encountered in pharmacy, with an ever-extensive workload, it’s important that pharmacy staff can quickly access resources to help them in their role. Care has developed “The Ultimate Guide to Care” mobile app where colleagues can complete learning modules and tests, supporting their CPD. Training modules can also be accessed online via (www.carehp.co.uk/ training).

Senna is available to consumers behind the counter with an RRP of £1.49. Pharmacies can buy direct from Thornton & Ross or via wholesale.

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Bamboo toothbrush for kids Aquafresh has combined its oral health expertise with the sharp rise in demand for sustainable products, to launch its new ‘Bamboo for Kids’ Toothbrush.

With almost six in 10 willing to change their purchasing habits to help reduce negative environmental impact1, this sustainable innovation will tap into the consumer shift towards more environmentallyfriendly products. The Aquafresh ‘Bamboo for Kids’ Toothbrush, available in two different colours, is the perfect solution for pharmacy teams wanting to offer their customers sustainable and efficient ways to maintain their dental health.

The sustainably-sourced bamboo toothbrush, is perfectly suited for children aged 6+ and is packaged in 100 per cent biodegradable and plastic free packaging. MSRP: £4 For further information please email: group.gsk-trade@cirkle.com

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TRAINING

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Childhood eczema Free CPD for pharmacy professionals

The Pharmacy Business has teamed up with the Pharmacy Academy to bring a new featured CPD in every issue. This month we’re focusing on childhood eczema, focusing on the symptoms and diagnosis, to assist pharmacy professionals in practice.

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czema (atopic dermatitis) affects up to 20% of children and refers to a group of conditions that cause skin to become itchy, inflamed and red (lighter skin) or brown, purple, grey or ashen (darker skin). Eczema can develop at any age; however, most cases emerge during early childhood, typically between 3 and 6 months of age.

Itch is the hallmark of eczema

People with eczema show a variety of signs and symptoms, including: Eczematous lesions and intense itch (pruritus) are the most common symptom and sign Itch is the hallmark feature: rashes that do not itch are unlikely to be eczema The skin damage that characterises eczema triggers inflammation in the stratum corneum, which contributes to itch. This leads to scratching, which releases more proinflammatory mediators further exacerbating eczema and xerosis.

Symptoms of eczema differ in skin colour

Eczema is more common in people of Asian and Black descent than White, the clinical presentation of eczema can differ depending on ethnic background, for example: Patients of African and Asian descent more commonly present with extensor dermatitis than flexural involvement Patients with darker skin types are at higher risk of postinflammatory dyspigmentation In Asian, Black Caribbean and Black African children, discoid (circular) or follicular (around hair follicles) patterns may be more common than in White children1

NICE guidance on diagnosis

NICE suggests diagnosing eczema when a child has at least three of the following signs and symptoms in addition to itch; Visible dermatitis involving skin creases (flexural dermatitis), such as the bends of the elbows or behind the knees Personal history of flexural dermatitis.

In children aged 18 months and younger a personal history of dermatitis on their cheeks, extensor areas or both Personal history of dry skin in the last 12 months Personal history of asthma or allergic rhinitis or, in children younger than 4 years of age, history of atopic disease in a first-degree relative Onset of signs and symptoms when the child was younger than 2 years of age.

This criterion does not apply to children aged 2-4 years of age2

Eczema treatment and management

Parents and carers should start treatment of flares as soon as signs and symptoms emerge. Treatment other than moisturisers should continue for about 48 hours after symptoms resolve to dampen the subclinical inflammation that can remain once acute symptoms resolve.

Moisturisers (commonly known as emollients) are the first-line therapy during acute flares and as maintenance therapy during remission and can also be used with, when necessary, other active treatments and can have steroid-sparing effects.

Dermatology 2018;27:340-357 2. NICE Atopic eczema in under 12s: Diagnosis and management Available at www.nice.org. uk/guidance/cg57/resources/atopic-eczemain-under-12sdiagnosis- and-managementpdf-975512529349 Accessed May 2021

The Pharmacy Academy provides free CPD which can be used towards your revalidation with the CPD module is for the use of pharmacy profession GeneralThis Pharmaceutical practitioners and other health professionals wh Councildental (GPhC).

Managing acute d dental services

Take this FREE CPD to benefit from: An age-by-age guide to how eczema presents JANUARY 2021



Understanding eczema pathophysiology

Being able to offer practical advice about eczema management and moisturiser use

Visit www.healthprofessionalacademy. co.uk/eczema-pb or scan this QR code to access this free CPD

REFERENCES: 1. Kaufman BP, Guttman-Yassky E and Alexis AF Atopic dermatitis in diverse racial and ethnic groups—Variations in epidemiology, genetics, clinical presentation and treatment Experimental

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In association with:

GUEST COLUMN Farina Jabbari

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Natural Healthcare Innovation Farina Jabbari, Global Head of Innovation and Strategic Portfolio Development at Nelsons, shares her thoughts on the future of natural healthcare innovation.

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atural healthcare has been given a huge opportunity over the last year. We have seen that consumer behaviours and attitudes are changing because of the pandemic and this is likely to continue in the coming years. Consumers are continuing to shift towards a proactive approach to their health and turning to natural healthcare products.

Key areas for growth include the importance of maintaining a healthy immune system, taking care of our mental and emotional well-being, ensuring quality sleep and generally wanting to feel good and have natural energy. At Nelsons, we have a range of products within both our current diverse portfolio but also as part of our future innovation pipeline.

Longer term, the importance of natural healthcare will only grow, as more and more people will continue the shift towards a proactive approach to their health and will prefer natural effective products that work in harmony with the body. Pharmacists should be aware of this and look to have a comprehensive natural healthcare offering for their customers.

It’s an exciting time for natural healthcare. The healthcare industry as a whole, including pharmacists, have a leading role to play in terms of understanding and rapidly responding to evolving consumer and customer needs.

Innovation is one of key building blocks here at

Nelsons. With a consumer centric approach to all our future innovation plans we have invested heavily into understanding what are the key consumer unmet needs within natural healthcare across a number of markets.

We are focused on developing naturally inspired products that consumers want with pace and agility. We emphasise effective, natural ingredient blends, sustainable packaging and ensuring suitability for those on a plant-based diet.

CBD is an example of an innovative ingredient that is on the rise and should be something pharmacists consider offering.

At Nelsons, we are assessing the use of CBD as a key ingredient as part of our future innovation plans, working with leading 3rd party suppliers in the sector and local regulatory authorities. In August, we launched our first cosmetic product with pure CBD isolate (proven and tested to contain 0% THC) and we expect that we will have more CBD innovation in the coming years.

Pharmacists should keep an eye on natural healthcare trends and new innovative ingredients, as it’s rising rapidly in popularity and awareness amongst consumers.

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Medical Cannabis/CBD

Demystifying medical cannabis Clinicians Mikael Sodergren (left) and Simon Erridge share key insights into accessibility, education and opportunities for community pharmacists…

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edical cannabis is a broad term used to refer to any medical products derived from, or related to, cannabis. In the medical field they are defined by the term cannabisbased medicinal products (CBMPs).

CBMPs were legalised for use on prescription in November 2018.

Synthetic cannabinoids, such as dronabinol, are defined separately and are subject to separate scheduling regulations.

There are a number of product formulations that can be defined as a CBMP, including whole cannabis flower – which can be vaporised, as well as capsules, oils, and sprays containing cannabinoids.

The main compounds in CBMPs are the cannabinoids cannabidiol (CBD) and tetrahydrocannabinol (THC), which have been investigated for their useful therapeutic properties.

CBMPs can be further defined as full spectrum, broad spectrum, or isolated compounds.

Full spectrum products are those which contain the full composition of cannabinoids from the specific strain of cannabis plant, in addition to flavonoids and terpenes which give a product a specific taste and smell profile.

In addition, the other cannabinoids, often referred to as minor cannabinoids, and other chemicals are purported to have their own pharmaceutical properties.

The collective action of these compounds to create an overall clinical response is often referred to by some as the ‘entourage effect,’ however its true existence is often debated.

Isolated compounds, or isolates as their often known, contain either isolated CBD or THC without

any other active pharmaceutical ingredients.

Currently, Sativex, Nabilone, and Epidyolex are currently the only licensed medical cannabis products in the UK. However, other products may also be initiated, off-license, in patients where first-line therapies have been unsuccessful by a clinician from the GMC specialist register. It is considered good practice to support initiation of therapy through a multi-disciplinary assessment.

Shared-care arrangements may transfer care to a non-specialist prescriber. However, as CBMPs are unlicensed and not available via the NHS this is not common practice.

Over-the-counter CBD CBD isolates defined as a CBMP are different from CBD oil available over the counter as all CBMPs are produced to EU Good Manufacturing Practices which ensures consistency in supply and quality. In contrast, CBD oil available on the high street is classified as a novel food and therefore does not have to meet the same stringent regulations regarding its manufacture and batch consistency.

CBD wellness products however have benefitted from the introduction of the Food Standards Agency’s requirement to meet the requirements set out in their decision to require a ’novel foods’ application to remain on the shelves of pharmacies around the country.

Prior to its introduction, a study by the Centre for Medicinal Cannabis found that 62 per cent of CBD products available over the counter, with some also containing detectable levels of THC. Whilst a repeat study has not been performed, these new regulations which are enforced by

Trading Standards will hopefully reduce the risk presented to consumers.

A reduction of risk is particularly important as more people in the UK turn to over-the-counter CBD products as information about its purposed effects becomes more prevalent in traditional and social media.

A recent white paper from the Association for the Cannabinoid Industry predicts the market for CBD products will reach £690 million in 2021. Those seeking treatment with CBD, THC, or any combination thereof for a diagnosed health condition, however, should be signposted towards specialist clinics, such as Sapphire Medical Clinics to ensure they only receive treatment when suitable, with the right medication and under clinician supervision.

Access Sapphire Medical Clinics was the first specialist medical cannabis clinic to be granted approval to operate in the UK by the Care Quality Commission (CQC), in 2019. It recently received the highest rating for a medical cannabis clinic from the CQC in their latest inspection which included ‘Outstanding’ in leadership.

The clinic offers a secondopinion service to evaluate patient suitability for medical cannabis treatment. Clinicians understand where medicinal cannabis may fit into the treatment pathway for each individual condition that patients may present with based on available clinical evidence and have been trained to prescribe safely.

CBMPs are unlicensed medicines and are not currently listed in the British National Formulary.

Clinicians typically lack education on these medicines and can be apprehensive about prescribing medicines that they have limited experience of.

Education All registered pharmacists can register for free to access CPD certified training on medical cannabis via the Sapphire Institute for Medical Cannabis Education (sapphirecannabiseducation.co.uk). You will

SPOTLIGHT

access pharmacology modules, online webinars and condition specific evidence for topics such as neurology and chronic pain.

Partnership In partnership with Sapphire Clinics, community pharmacies can now enter this growing market using a patient referral scheme. You can enter the medical cannabis market with confidence, deliver UK manufactured treatment at an affordable price and have specialists available for your patients. Partners are provided with training, professional support, and assets to ensure your pharmacy can identify the patients this scheme may be suitable for.

Dr Mikael Sodergren is Managing Director and Dr Simon Erridge is Head of Research and Access at Sapphire Medical Clinics.

When to consider

Below are some of the conditions where medical cannabis can be considered: Pain Conditions such as Chronic pain, Fibromyalgia, Neuropathic pain, and Cancer-Related Pain Psychiatric Conditions such as Anxiety, Insomnia, Depression and PTSD Neurological Conditions such as Epilepsy, Multiple Sclerosis and Autistic Spectrum Disorder Gastrointestinal such as Crohn’s Disease, Ulcerative Colitis and Irritable Bowel Syndrome (IBS) Cancer Related Conditions such as Anxiety, CINV, Appetite Loss and Palliative Care Rare and Unresponsive Skin Conditions such as Psoriasis, Pruritis and Acne

Contraindications

Medical cannabis products are currently not recommended for use in patients who are/have: Pregnancy/breast feeding Ongoing or active psychosis Unstable cardiovascular disease Allergic reactions to ingredients or excipients

Caution

When prescribing medical cannabis, health professionals should be cautious of: Children/adolescents Interacting medicines

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SPOTLIGHTMedical Cannabis/CBD

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Stocking and selling CBD T

Bill Griffi n offers his expert advice on what pharmacy contractors need to consider when procuring CBD oil for sale…

he UK CBD market is set to hit £690 million in sales this year according to recent market research undertaken by the Association for the Cannabinoid Industry. It’s a staggering feat given that a few years ago very few people were aware of this compound and the industry emerged in a legal grey area.

What is CBD CBD, an abbreviation of cannabidiol, is a compound found in the cannabis plant. Many, wrongly, say that it is non-psychoactive.

However, cannabidiol is mildly psychoactive, although its physiological effects are very different from those of THC (tetrahydrocannabinol), the constituent of cannabis that is responsible for the psychotropic mood-altering effects associated with its use as a recreational drug.

CBD is psychoactive in that it changes your perception and can give users a sense of wellbeing.

It’s the mild effects that allowed CBD to avoid scrutiny from the Home Office as they put together their list of 12 cannabinoids that are controlled under the Misuse of Drugs Act (MDA).

A list that includes variations of THC and CBN.

CBD legality CBD is not illegal but there was confusion for a while on whether it is fully legal to be used as a food supplement. In 2019 the European Food Safety Authority (EFSA) advised the European Commission that CBD in its extracted form (typically via CO2 extraction) was actually a novel food as it was not consumed en masse prior to novel food legislation coming into effect in May 1995.

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Campaigners argued that CBD had been consumed for centuries, as it is present in low quantities in hemp seeds and hemp oil. However, novel foods does not apply to these products and the EC stood fast.

Ironically, just before the UK left Europe the FSA were one of the few national food agencies to agree with EFSA and set guidelines for a regulated CBD industry based on novel foods applications for CBD. The novel foods application process is a safety evaluation of a new food, so the FSA has a clear ethical obligation to ensure this new food product is safe for human consumption.

Plethora of products The FSA set a deadline this year for all CBD products that were on the UK market before 13 February 2020 to submit their novel foods application to FSA by 31 March 2021 in order to be allowed to stay on sale.

This means all CBD products for sale in the UK must have submitted a novel foods application to the FSA. It is a retailer’s responsibility to ensure that any brand’s product that they sell has proof of their novel foods application to avoid the risk of trading standards removing them from the shelves.

Another aspect relating to CBD products that retailers should be aware of is that MHRA and ASA make it very clear that anyone promoting or selling CBD must not make any medicinal claims.

This includes publishing case studies, publishing user reviews that make medicinal claims and even sharing research papers investigating the medical properties of CBD.

Fig: Cannabinoids controlled under the MDA and subsequent regulations

In the field, this is far from the case. Brands and CBD specialist shops make many medicinal claims, in fact most online shops actually sort their products into categories such as sleep, anxiety, pain etc. Not only are they flouting the rules, they are actually structuring their whole operations around these claims.

As an owner of a CBD company, which is intent on abiding by the law, it’s frustrating to see the competition taking an unfair advantage this way.

Although CBD is popular, it’s difficult for brands to promote.

They are not allowed to mention the product benefits and in addition they are not able to advertise it on popular platforms such as Google, Facebook or Instagram.

Instead, they rely upon search engine optimisation which target key words people search for. Unscrupulous brands want the traffic of inquisitive consumers searching for phrases such as “CBD for sleep” or “CBD for pain relief”.

It seems the greed of making a sale trumps the ethicality of making medicinal claims that do not have sufficient research to be deemed official by MHRA. Unlike other food supplements such as many vitamins.

Can a brand that has this ethical ambiguity be trusted? One could wonder what other rules they are bending or circumnavigating. To build a trustworthy

brand LXR took the decision to focus our messaging around purity of product and full transparency.

Your checklist The following is what LXR do to ensure that we fully abide by the rules. You could use it as a checklist to see if the brands you deal with are on the level.

We stock four products, all were on sale in the UK prior to the FSA’s cutoff date of 13 February 2020, each one of these has a novel food application submitted by FSA’s deadline of 31 March 2021. We do not make any medicinal claims on our products, we do not share case studies, reviews that mention medicinal claims nor do we share research papers relating to CBD and health issues.

All our products are produced in our BRCGS-certified manufacturing facility in the UK. Each product has a clearly identified batch number, this is printed on the bottle and displayed on the product web page.

This batch number corresponds to a certificate of analysis (CoA) from a recognised 3rd party food safety analysis laboratory that is available to scrutinise on our website. We even display the CoA on the product information page of the current batch we are selling.

Bill Griffin is managing director of lxrdirect.com.

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Medical Cannabis/CBD

SPOTLIGHT

CBD is good for pharmacy Analyst Alexej Pikovsky sorts fact from fiction on market projections, consumer trends and future of the CBD industry...

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BD products are here to stay. The category is one of the fastest growing self-care sectors in the UK and it’s set to be the single biggest driver of the health and wellness space over the next 10 years.

Industry projections In 2020, the global cannabidiol (CBD) market was valued at USD 2.8 billion and is set to continue this impressive trajectory at a compound annual growth rate of 20.1 per cent until 2028. Some estimates show even larger CAGR projections of 40.4 per cent CAGR between 2020 and 2025, and project the value of the global CBD market to reach USD 5.3 billion by 2025.

The US is still the largest market for CBD products and will probably continue to lead in product innovation and development. However, the UK and Europe is now following suit.

Although the CBD industry in the UK and across Europe is still only in its early stages, it is already displaying huge opportunities for growth. Europe is already the second largest market after North America and Germany is set to be the largest European market for medical cannabis.

Consumer trends and product landscape Customer research from the very latest data analysis we have just reviewed over the last few months, shows that the main over the counter reasons for purchasing CBD products are pain, sleep problems, and anxiety.

In fact in a research poll we

ran recently with CBD users, the top four reasons for using CBD were: Self-perceived anxiety (42.6 per cent) Sleep problems (42.5 per cent) Stress (37 per cent) General health and wellbeing, including pain (37 per cent) In those aged 55+, 42 per cent were using CBD specifically for arthritic/joint pain.

And the good news is that repeat purchase is high because customers see benefits. Good news for pharmacy!

Hence, the CBD category is not a passing fad and has been around a lot longer than most people are probably aware. As a result, there are many self-care market opportunities for pharmacies across the CBD sector.

Other CBD market growth areas are predicted across edibles and drinks as well as cosmetics. We are also starting to witness great progress on the pharmaceutical side in regard to CBD, and I am excited to see the industry progress in this direction.

It will help to legitimise CBD as a natural compound with true medicinal potential in all sorts of areas, including arthritis, skin conditions and pain and nausea caused by chemo or radiation therapy. Studies are ongoing and more research is needed, but as the industry grows, greater investment is being allocated to this sector, which it deserves.

Being ahead of the market Providing customers with a

CBD category is not a passing fad

range of trustworthy and effective CBD products, without THC is essential for those pharmacy owners wanting to expand their CBD market offering over the counter.

However, it is not an easy category for both shoppers and business owners to navigate and provide the best-in-class product range choices.

We provide a wholesale channel at Alphagreen to pharmacy and here we can guide and support pharmacy owners to grow their own businesses. We include access to an Intelligence channel, the most comprehensive CBD intelligence tool on the market.

The business intelligence system incorporates a database of more than 3,000 CBD products and combines data from multiple sources including website traffic, product reviews, social listening, and Google search analytics. In short, it provides retailers with all the knowledge they need to be powerful and successful in the flourishing CBD, health, and wellness sector.

What we hope to see in 10 years We should be optimistic about the UK CBD marketplace, despite CBD having moved to a Novel Food status and the emergence of a more regulated market headed by the FSA, with brands now starting to be officially approved as they go through the authorisation process.

CBD will continue to thrive and new CBD product development is set to explode from current market players. Consumer education and ensuring product safety, coupled with product innovation with a difference is set to shape the CBD market future coupled with shoppers wanting to understand what to look out for when buying CBD products.

And it is here that pharmacy is well poised to educate, advise and help shoppers when it comes to CBD and any purchasing guidance.

Alexej Pikovsky is CEO and cofounder of Alphagreen.

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CLASSIFIED

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Oral-B Genius X Limited Edition Electric Toothbrush Rose Gold - Powered By Braun

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Charles Russell Speechlys

LAW

Practical completion takeaways PATRICIA

C

NATHAN -AMISSAH

Patricia Nathan-Amissah and Georgina Bernard provide an overview of practical completion which can have a number of important consequences under construction contracts…

onstruction works are a big financial commitment for pharmacies. The fit-out works for the pharmacy could be a part of a base build constructed by a developer. Alternatively, pharmacists may prefer to engage their own contractor to carry out the internal fit-out works under a separate building contract once the base build has completed.

Practical completion is a key part of the construction process. Although there is no statutory definition of practical completion, it represents the completion of construction works and signifies when the new development can be occupied and put to use.

Many of the standard forms of building contract, such as one of the Joint Contracts Tribunal (JCT) suite of contracts, do not have a contractual definition of practical completion. This can be the subject of debate between parties as the pharmacy will only want to take possession of the works when they are completed to the required standard, whereas the contractor will be keen for practical completion to be certified as soon as possible to minimise any liability for liquidated damages (LDs) for late completion.

It is a good idea to consider taking legal advice to amend standard forms of building contract; for example, to include a definition of practical completion.

LDs LDs are fixed rate damages payable by the contractor for each week or day of delay from the contractual completion date until the actual date of practical completion. The rate should be set by the pharmacy (if it is the employer under the building contract), with the help of its advisers, to provide adequate compensation in the event of delayed completion.

Completion The intended date for completion is specified in the building contract, and represents the date by which the contractor employed under the contract has undertaken to complete the works. This date is subject to any extensions of time for completion which are usually on limited grounds called ‘Relevant Events’.

Understandably, the pharmacy may want to decide for itself when practical completion has been achieved. However, the standard JCT contracts provide for a contract administrator or employer’s

agent to be appointed by the pharmacy to perform certain roles under the building contract, including certifying practical completion. The certifier is usually a construction professional and must act independently and fairly between the parties using their professional judgement. A pharmacy can opt for this role to be carried in-house but it this would require some technical knowledge and a detailed understanding of the building contract terms.

Inspections The contract administrator is responsible for checking whether the works have achieved practical completion in accordance with the contract documents and other statutory/regulatory requirements.

It can be useful to amend the building contract to require the contractor to give advance notice of the anticipated date of practical completion, so the parties can meet and share any views with the contract administrator.

This is the time for the pharmacy and its technical advisers to check for any incomplete or defective work which the contractor needs to rectify. The contractor will be motivated to comply due to the potential liability it could incur for LDs and the release of half the retention monies on practical completion. The building contract can be amended to include specific conditions that must be satisfied before practical completion is certified; for example, compliance with licence or planning requirements or the successful application for approval to use the premises as a pharmacy.

Where a pharmacy is constructed as part of a larger health care facility, ‘partial possession’ might be granted. In such cases the developer will obtain possession of the pharmacy unit from the main contractor and practical completion of that unit is deemed to have occurred, even though the rest of the development has not yet been completed.

The contract administrator certifies practical completion by preparing, dating and issuing the practical completion certificate. The date of practical completion is not the date of the certificate itself, but the date specified in the certificate. The date specified in this certificate may also be binding under a lease agreement with a landlord.

Implications and effects Certifying practical completion has a number of implications:

GEORGINA

BERNARD

The contractor’s liability to pay any LDs for late completion will cease to accrue. The pharmacy does not have to exercise its right to deduct LDs: there may be good commercial reasons to delay or forgo the deduction of LDs against a contractor that is struggling to complete.

Upon practical completion, it is likely that the pharmacy is contractually required to pay the contractor 50% of the retention monies previously withheld from interim payments. The remaining balance of the retention is paid following expiry of the rectification period (see below), once the contract administrator has certified that any defects have been made good. Retention provides financial security for the pharmacy against the possibility that the contractor will fail to rectify any outstanding defects.

The rectification period begins. This is the period following practical completion during which the contract administrator can instruct the contractor to remedy defects, shrinkages and faults in the works.

The rectification period typically lasts for 6-12 months after practical completion. The building contract should include provisions setting out the terms on which the contractor will have access to carry out rectification works once the pharmacy is in use. This can be tricky to manage, especially where access is required through a doctor’s surgery or a larger health care facility.

Responsibility for securing and insuring the property will pass from the contractor to the developer/pharmacy. The developer or pharmacy (as appropriate) should therefore put their building and content insurers on notice as soon as practical completion takes place.

Pharmacies should give careful consideration to their requirements for practical completion (and take proper advice) to ensure the building contract adequately specifies these.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances. This article was written by Patricia NathanAmissah (Associate) and Georgina Bernard (Trainee Solicitor). For more information, please contact Patricia on +44 (0)1483 252638 or at patricia.nathan-amissah@crsblaw.com.

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FINANCE Umesh Modi & Vinku Shah

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Boosting OTC sales Umesh Modi and Vinku Shah remind contractors how vital it is to increase sale of over-the-counter products amid changing consumer attitudes and behaviours…

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ommunity pharmacies have been under increasing financial pressure during the height of the Covid-19 pandemic but were given a lifeline when the government announced a £370 million advance to help ease cashflow problems. This relief was short-lived and from October 2021 through to March 2022, the advance payments will have to be repaid in six equal instalments and as a result, many pharmacies will worry about the effects on their cash flow again.

One way of mitigating the cashflow from the repayment is to boost the over-the counter (OTC) trade which will generate more cash in the business. Below we discuss some of the ways in which this can be achieved.

Customer service Ensure your staff are well trained to provide excellent customer service and make a point to ask the customers if there is anything that the business could do to improve their shopping experience. This will help identify areas of weakness and provided you take on board the comments and implement changes, it should help increase the OTC sales and build customer loyalty in the process.

Everyone loves a personal touch when it comes to services, and you should make it a point to know your customers. Customers with an established relationship or personal connection with the business are more likely to return on an ongoing basis and therefore every effort should be made to educate the staff to engage with the repeat customers e.g., greeting them by name, build relationships, assist them with their shopping needs, etc. This will also help the staff to upsell (see further below).

You could create customer loyalty programs, offer discounts that could be used in future or even free giveaways to attract more customers.

This will ensure a secure customer base and at the same time guarantee sales increase.

Shop floor You should analyse your shop floor lay out and identify areas where there is more footfall for example tills may have more traffic and therefore you should attempt to display more popular products nearby. Alternatively, rotate products to see which products generate more sales in the aisles or near the counters. Supermarkets have been known to display more expensive

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line items at eye level whereas own brand or cheaper alternatives are either above or below these shelves.

and if these are not selling in your pharmacy, you may be better of minimising stocks on that line or discontinuing it and spending on stock that moves and generates cash flow.

Shop window An attractive shop front will always attract custom. You do not need to have a shop window that competes with the likes of a multiple, but you could remodel it so that it is fresh and pleasing to the eye. Other options are to have a chalkboard with witty messages each day and displaying offers of the day to boost sales. Also ensure that your shop windows are cleaned regularly.

Promotions

Use of services

Sales promotions do not need to be around Christmas and Easter holidays only to boost sales. You can have these all year round or monthly promotions for example Stoptober which is usually in October and aimed to help people quit smoking could help you boost sales on smoking cessation products. You could develop your own sales promotions to run during a particular period.

Upselling

Having a good professional looking website is key to attracting new custom. Potential new customers tend to look at the website and read reviews before walking into any establishment.

It is important that you read the reviews and address any critical reviews in a positive way to enhance your pharmacy’s image in the public eye. This will create a sense of assurance for new customers.

Product display

Displaying complementary products together is one way to increase sales e.g., if daytime cold relief OTC medication is next to night-time cold relief, customers will most likely pick both up.

Other examples may be bandages and antiseptic sprays, antihistamines and boxes of tissues, etc.

Review the services that you offer to customers, and you could also sell various products linked to services you offer e.g., selling chewing gum or mints to those who you provide a stop smoking service. Offering health assessments may help you identify services and products that will benefit your customers’ long-term needs which will in turn help to secure long term sales.

When your customers trust your staff and their knowledge of the products you sell, it becomes easier to upsell products. Certain drugs are known to cause drug induced nutritional deficiencies and knowledgeable staff will be able to recommend health supplements to the customers. Give customers a choice of three different brands of supplements with three different prices and they will most likely pick the middle priced one.

Sales analysis

If you use a point-of-sale (POS) system, you should be able to generate various reports which could help analyse your product sales. Analysis of POS data could highlight what products are the highest selling, or times of the day, week or month when sales peak so you could enhance sales by adopting various strategies mentioned.

Competition

It is important to know who your nearest competitors are and what they offer in terms of products. This will require some research, but the information will be useful in terms of helping you offer better products at competitive prices in order to attract more custom. You could offer different products through identification of gaps in the market for example if your nearest competitor is stocking up on baby care products

Online presence

Covid-19 jabs If your pharmacy is offering Covid-19 jabs, then you will have a number of new customers walking in. If you can employ various strategies mentioned above, there is potential to convert the new walk ins into loyal customers. The government plans to give Covid-19 booster jabs from September and you should grab this opportunity to increasing your customer base. This would be an added bonus to the income from the Covid-19 vaccinations.

If you have managed to boost your OTC sales, the next step would then be to look at reducing costs in order to improve profitability further. This is a continuous process and pharmacy business owners should regularly keep track of their sales and product mix as consumer needs are ever changing.

This article is based on current practice and is for guidance only. Specific professional advice should be taken before acting on matters mentioned here. Umesh Modi BA ACA is a Chartered Accountant and Tax Advisor, and a partner at Silver Levene LLP. He can be contacted on 020 7383 3200 or umesh.modi@ silverlevene.co.uk. Vinku Shah FCCA is a Chartered Certified Accountant and Manager at Silver Levene LLP. He can be contacted on 020 7383 3200 or vinku.shah@ silverlevene.co.uk.

SEPTEMBER 2021

PB Umesh Modi1.indd 32

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REALITY CHECK Christian Rebholz & Graham Tatham

www.pharmacy.biz

Independents must adapt Expanding on the results from a recent survey, Christian Rebholz (left) and Graham Tatham give their expert opinion on how bricks-andmortar pharmacies can face off stiff competition from Amazon…

A

recent study, conducted by strategy consulting firm Simon-Kucher & Partners, has found that the Amazon Pharmacy launch would have wider implications on the UK pharmaceutical market. In November 2020, Amazon launched its online pharmacy service in the US and now, armed with its approved UK trademark, Amazon Pharmacy prepares its journey across the pond.

Meanwhile, British bricks-and-mortar pharmacies prepare for the worst. With its convenient free-of-charge delivery for Prime customers, and cheap over-the-counter medicines, the threat that many consumers will switch to Amazon is undeniable.

Room for hope While this casts a shadow over businesses already struggling to compete against chains and online services, a recent study shows that there is still room for hope.

Originally aimed at manufacturers, the representative study, entitled ‘Effects of Amazon Pharmacy on the UK pharmaceutical market’, revealed that Amazon Pharmacy would not be able to meet the needs of every customer.

In fact, many consumers stated that they would rather continue buying from other channels, including traditional bricks-andmortar pharmacies. So, while there are grounds for anxiety, local pharmacies should adapt by drawing on their strengths.

Huge market Why should local pharmacies be worried? The anxiety around the renowned disrupter entering the pharmaceutical market is justified.

The UK pharmaceutical market is worth billions a year, with lucrative growth possibilities.

It is, therefore, not surprising that Amazon is looking to extract its potential in this sector.

Moreover, having asked 1,000 UK consumers about whether they would buy from Amazon Pharmacy, the results show that the company has every right to be confident in its success. 41 percent of current Amazon customers said that they would switch – among Amazon Prime users this figure increased to almost 50 percent.

Another worrying number for existing players, is that even 10 percent of people who are

34

not currently Amazon customers would consider purchasing from Amazon Pharmacy. Meaning that Amazon Pharmacy could directly gain 20.5 million potential customers, putting it among the top online pharmacies in the UK. There are two main reasons for its potential popularity. The first can be attributed to past consumer experience. Amazon is a well-known online retailer, providing a fast, affordable, and reliable service across a whole host of sectors. With that level of brand awareness and reputation, it is no wonder that so many consumers are willing to make the change.

The second reason comes down to price and convenience. As stated above, Amazon is able to deliver items within hours, free of charge – especially to its Prime users.

Basic care While we are on the subject of price, it is important to highlight the wider implications Amazon Pharmacy could have on all UK stakeholders in the market.

If Amazon’s US strategy is to be taken as any basis, the online pharmacy will sell both wellknown OTC medication, and its own brand. The “basic care” range includes standard drugs at low prices, which, if in circulation, will put pressure on UK manufacturers.

The survey results showed that consumers are largely motivated by price. It is, then, quite likely that “basic care” will become a bestselling brand.

So, manufacturers will need to be clear about their future strategy.

Although selling products on Amazon can help businesses reach a wider consumer base, there is the danger of becoming dependent on a formidable competitor. It is best to build consumer relationships, understanding how to reach customers directly, as well as knowing what discerns you from the competition.

Personal touch While Amazon Pharmacy promises a convenient and cheap service, where it lacks is precisely in the areas local pharmacies thrive. Among those who would not buy from Amazon, our survey showed that many value the personal touch and expert knowledge that independents offer.

Actually, 41 percent think that a purely online

Online pharmacy can’t meet needs of every customer

experience, like Amazon Pharmacy, would lack the consultation and personal healthcare services they feel reassured by. While 31 percent distrust Amazon’s medical expertise. It is no surprise, therefore, that 27 percent of respondents stated that they would remain loyal to their current pharmacies.

Saying that, the key to retaining loyalty will be to listen to customers, doubling down on value-add services, and trust-building activities.

Independent pharmacies are an important and trusted part of the healthcare value-chain – especially, when it comes to patients who have complex, often polypharmacy needs.

Taking this into account, as well as the concern around Amazon’s general use of data, the results of this study should serve as an opportunity for self-reflection and improvement. Elevating and emphasizing the personal, confidential, and expert aspects that the conglomerate lacks.

Customers loyal to local pharmacies today already have many alternatives on the high street, as well as online. So, independents should really question who, why, and what is being bought through the pharmacy. Focusing on areas of differentiation that a low-touch, conveniencefirst, e-Commerce solution cannot provide.

Listen to patients As detailed above, independents – and manufacturers – should strengthen and highlight their value propositions.

These are enterprises which have continued to receive business even when faced with large chains, such as Boots and Superdrug. Everything that has set them apart from those powerful competitors will also set them apart from Amazon Pharmacy when it launches.

The important thing is to listen and adapt to patient/customer needs, while continuing to deliver the expertise and personal touch that consumers value.

Christian Rebholz is a partner and consumer health expert at Simon-Kucher & Partners.

Graham Tatham is a partner at Simon-Kucher’s London office.

SEPTEMBER 2021

PB Reality Check1.indd 34

8/26/2021 4:01:36 PM

NEW DATE! Due to on-going issues around the Coronavirus pandemic and large in-door gatherings, we have decided to postpone the 2021 Pharmacy Business Awards which were scheduled for 29th September 2021 to 3rd February 2022. The awards dinner will be held in central London where we expect a senior Government minister to our celebrations to recognise the very best of community pharmacy.

We look forward to welcoming you to the 21st edition of the Pharmacy Business Awards on Thursday 3 February 2022.

For further information please contact tanuja.parekh@amg.biz www.pharmacybusinessawards.co.uk

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8/25/2021 10:57:38 AM

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