The same, only different

NHS England has set a target for the uptake of biosimilars. In order to save £200-300m p.a the aim is that at least 90% of new patients will be prescribed the best value biological medicine within 3 months of launch of a biosimilar medicine, and at least 80% of existing patients within 12 months, or sooner if possible. That is a fairly challenging target for many health economies.

The difficulty that immediately springs to mind is that the users of the originator drug may have no real incentive to switch. They’re happy with what they’ve got. They’re reimbursed for what they use, so they have no financial incentive. And from the quality point of view, they know the characteristics of the treatment they’re using, whereas there may be a little question mark in their minds as to whether the new product will prove to be as satisfactory in practice as it has apparently been in clinical trials.

So how does the commissioner encourage change? One or two commissioners may decide simply to tell providers what they expect them to do, or to use financial penalties if they do not switch promptly. However, there may be good clinical or service reasons why an abrupt change is unwise.

This is just one of the questions we will be addressing at our Biosimilars conference on 1st November. You’ve never had an opportunity like this to discuss the introduction of biosimilars with all stakeholders present. We’re working with UKCPA, the British Oncology Pharmacy Association (BOPA) and Rheumatology Pharmacists UK to make this a day to remember. Come and be part of it.

Agenda and booking at


Sometimes the story behind a poem or article gives it extra point. I was musing on this recently when I read a short biography of W E Henley, whose poems I vaguely remember being instructed to read at school.

If the name is familiar, that is probably because he was the author of the poem Invictus, which inspired Nelson Mandela among others, and which contains at least three well-known quotations. My primary school’s motto was Invicta, which may have been why we were encouraged to read Mr Henley’s work.

The sentiment behind Invictus is more striking – and more painful – when you know something of his life. Henley suffered as a teenager from tuberculosis, which entered his bone and caused the amputation of one of his legs when he was just 19. The surgeon wanted to remove the other foot too, but Henley refused and his foot was saved by Joseph Lister, no less. Henley spent three years in hospital during this treatment, where he wrote a volume of poems, including Invictus.

Robert Louis Stevenson was a friend and later wrote that he based the character of Long John Silver on Henley, a testimony to Henley’s refusal to allow his disability to restrict him or to seek pity for it.

Henley married and had a daughter. Sadly she died at the age of 5, but J M Barrie immortalized her when he created the character of Wendy in Peter Pan. Eventually Henley succumbed to tuberculosis at the age of 53.

The next series of the PM Academy will be looking at resilience, the ability to keep going regardless, which is, perhaps, the reason why Henley is in my mind, because Invictus expresses exactly that note of being able to cope whatever is thrown at you.

Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeoning of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find me, unafraid.

It matters not how strait the gate,
How charged with punishments the scroll,
I am the master of my fate:
I am the captain of my soul.

Guest blog – locum governance

From time to time we offer our pages to partners. Here Seán Webb of Locate a Locum discusses the importance of ensuring compliance.

In such a highly regulated industry, where lives are on the line, compliance is key to both pharmacists and hiring managers. We’ve recently seen stories of fake doctors working within the NHS, putting institutional reputations and lives at risk.

Pharmacy owners, hiring managers and locum coordinators place a huge degree of trust in the agencies that they use to fill shifts, but where does the responsibility lie for ensuring that workers hold the required documentation and have amassed the desired experience? Is the agency model transparent enough?

Locate a Locum’s robust compliance methods have ensured transparency, thus changing the traditional recruitment model.

We do not let anyone register on our booking platform unless we can first verify the GPhC or PSNI/PSI number that the individual has claimed to own. This process has ensured that only registered pharmacists can access our booking platform and only then can they begin to build a profile that is visible to employers. That’s a very important factor to us, we empower employers to view the profile of those whom apply for shifts within their pharmacy.

After we approve someone’s account, we then embark upon a CPD-focused, document gathering exercise to prove that said pharmacists hold the qualifications they claim to have. Depending on the hiring pharmacy, they require a variety of specific qualifications. Some insist that pharmacists have their Dementia Friend Training certificate, others insist that locums have their Repeat Dispensing accreditations. We require all pharmacists to have an up-to-date DBS or police check before we allow them to work through us.

As pharmacists build their profile, they store documentation within their accounts so that their experience is as transparent as possible for hiring managers to see. By doing so, we give power to the hiring pharmacy and locum coordinator to decide on who to hire.

The final bit, and most recently developed piece of our technology with regards to compliance, is our new facial and document recognition software. Before any pharmacist can apply for their first shift, they will take a photograph of their documentation, using their web cam or telephone camera. They then take a photograph/selfie and our technology can verify the identity of the locum, in correlation with the proof of identity that they have provided.

The result of our checking processes and the technology that we have invested tens of thousands of pounds in, is that the hiring manager can choose the pharmacist of their choosing with the certainty that they are who they say that they are, and that they carry the necessary qualifications and experience. Locate a Locum’s compliance checks and pharmacy empowerment means that the best pharmacists gain work.

Our booking platform and its built-in compliance features mean that hiring managers are booking pharmacists directly in less than one minute, without the added cost and time created by traditional agencies.

Interested? Find out more at

If you think education is expensive, try ignorance

The news that Health Education England is to shed 315 full-time equivalent posts in order to reduce its running costs by 30% is not a surprise, but must raise questions about the future education and training of NHS staff.

Nobody seriously thinks that a four year university course can ever provide all the information anyone will need for a successful career in pharmacy; and while the recent proposals for revalidation from the General Pharmaceutical Council perhaps represent a more practical approach than GPhC has hitherto taken, it does not concern itself with who – if anyone – is going to provide the training that pharmacists and technicians realise they need. That is not GPhC’s business. Registrants will just have to sort something out.

There are, of course, plenty of one day courses – we run some ourselves under the PM Academy banner – but perhaps part of the great success of CLIP in Scotland has been that participants have seen a structure for their training that makes achieving their educational goals much easier than having to compile a basket of offerings. As we roll CLIP out to Ireland (don’t worry, Wales and England, you’re next!) we’ve learned from the Scottish experience and we’ll do it even better.

We’re committed to making our educational opportunities as useful as we can. When you book one of our events you can be sure that we will do everything possible to make it so, and your feedback really helps, because we use that to tweak it for future events.

One of the key features of our partnerships with various bodies is to provide top class education. Their reputation is your guarantee of quality. We are confident that they would not want to be associated with anything that was inadequate.

And we must not forget our peer-reviewed journals. Their independent editor ensures that everything is done in the right way.

While other bodies are contracting Pharmacy Management is going from strength to strength. We must be doing something right!

Making things clear

There is a recognised procedure that lawyers follow when they are trying to work out what a law means.

They begin by looking at the plain English meaning of the law. Thus, if a law refers to a car, it does not include a bus or a van. They will try to construe the law so as to cause the fewest possible conflicts with another law. There are a number of legal maxims that relate to this, but wrapping up the process is the question “What mischief was being addressed?”

There is a logic behind this. It is that Parliament means what it says (hence the plain language rule), that it does not contradict itself (hence the conflicts rule) and that what it does has a purpose (the mischief rule). It is assumed that Parliament would not waste its time discussing something that has no purpose, so if you find out what Parliament was trying to put right, you can construe the law on the assumption that it did, in fact, put the mischief right. Thus if, for example, the preamble to an Act of Parliament says that it is a law to prevent the sale of football boots on Thursdays, you try to read the law in a way that would achieve that. In my particular daft example, the law does not seem to intend to prevent the leasing of football boots (if anyone does such a thing).

We have attempted this explanation because it is clear that some people are confused by the policy on management of Potential Conflicts of Interest promulgated by NHS England and are interpreting it in a way that was never intended. It does not say that all contact with outside agencies or companies is naughty or to be avoided; it says that all contacts involving transfers of value have to be reported so that managers can evaluate whether there is anything improper about them. It is unfortunate to say the least that the press seem to think that there is something wrong about a leading doctor accepting research funding, or a pharmaceutical adviser being paid for their time in offering advice where that interaction has been properly declared. Declarations of conflicts of interest are made so that they can be managed properly, and managing these, like managing risk, is not best achieved by eradicating it. Nobody would suggest managing risk to a child by locking him in his bedroom for eighteen years, yet some people think that the NHS is trying to avoid potential conflicts of interest by forbidding all contact.

Because Pharmacy Management works with both industry and the NHS (not to mention having to work with each national health system in the devolved administrations) we spend a lot of time on promoting transparency. Unfortunately the systems operated by the pharmaceutical industry and the NHS do not dovetail perfectly – there are occasions when the industry has to disclose something that the NHS professionals are not obliged to report, and vice versa – and in our view the disclosure systems do not always distinguish clearly enough between a transfer that could be diverted and one that cannot.
Let us explain that a bit further. If I receive a £10,000 grant for some research there needs to be some system whereby I can prove I spent it on appropriate things because there is a risk that I might not. If I receive the same sum by way of having my fees paid to attend a university course I have undoubtedly benefitted but there was no way that I could have used the money in any other way.

The funding model that Pharmacy Management uses for its events is well-tested and we consult widely within the NHS to ensure that it meets current expectations of probity and transparency. For example, in 2015 we introduced our Transparency Certificates. These are produced for each event to show who has funded Pharmacy Management’s provision. This matters because the attendees do not receive funding directly from any particular company and therefore, on the face of it, there would be no need to make a declaration of potential conflict of interest. However, the training they receive at these events undoubtedly has a value and they might feel uncomfortable if they said nothing at all about it. Following the mischief rule, if the purpose of the NHS policy is to ensure that governance managers can ensure that nothing untoward has taken place, giving them the Transparency Certificate meets the purpose of the policy even though, on a strict reading of the policy, there may have been no requirement to make a declaration.

That value is hard to calculate for large events, because no two delegates may have followed the same programme during the day, but we will calculate one for those events where every delegate follows the same timetable during the day. This goes beyond the requirements of the NHS in allowing people to say “I attended this meeting and my place was worth £66 which was contributed to by these four companies.” There is nothing wrong or embarrassing about making such a declaration – you received training without charge to the NHS and without creating any potential obligation to those who indirectly funded it. It will probably have cost less than comparable training directly purchased; and it comes with our guarantee that we will defend the probity of the process on your behalf if questions should be asked. Any governance manager who wants to know how a meeting was run can contact our Chairman or our Chief Executive Officer and will receive a prompt and personal reply. That’s a promise.

Not only that – we distinguish clearly between the promotional and non-promotional parts of our events (the Academy and CLIP have no promotional element at any time). There are specified exhibition areas and times and no promotional activity takes place elsewhere. The Chairman of the meeting has to certify that in his or her report.

We are proud to have been in the forefront of promoting transparency. We intend over the next few months to take more steps to safeguard our reputation and, most importantly, yours. If you have any suggestions or concerns we would be delighted to hear of them so that we can ensure that you have the greatest protection possible against scurrilous accusations.

Let us add one more thing. We do not believe that our partner organisations (whom you can see listed on our website) would have anything to do with us if they were not convinced that we conduct our business in a proper and transparent way.