POM to P Switches, self care and the pharmacist Helen Darracott Proprietary Association of Great Britain

Government wants more self care and OTC medicines Health policy NHS Direct Support for switches New contracts for GPs and pharmacists People are encouraged to take control of their health Improved access to medicines Reduce pressure on GPs and NHS

Some self care statistics Over-the-counter medicines sales total £2 billion a year in Britain Two thirds of internet users have researched health issues online Sales of consumer health magazines have grown at around 20% per year in the last decade There are 1m people in England who each are providing over 50 hours unpaid care per week 50% of prescribed medicines are not used after purchase Self-treatable disorders account for nearly 40% of GP time

MHRA Target 50 switches by 2007

Switches have been happening for 25 years 1983Ibuprofen, Loperamide 1987Hydrocortisone 1991NRT 1995Fluconazole 2001EHC 2004Omeprazole, Simvastatin 2005Cloramphenicol

The OTC medicines market has changed Self Diagnosis/ Self management Longtermuse Doctor diagnosis and management Headache, colds and flu, indigestion constipation, diarrhoea, athletes foot, cuts, cold sores, allergy Minor arthritic pain, cystitis, insomnia, IBS, thrush, eczema, EHC Smoking cessation, allergy prevention, indigestion prevention, baldness prevention, cholesterol control, prevention of heart attack Migraine, erectile dysfunction Asthma, diabetes, oral contraception and HRT peptic ulcer, arthritis skin disorders Minor self limiting conditions Recurrent conditions Long term maintenance/ prevention

Making a success of a new switch Not all switches are successful. Some key factors: Bring a distinct new benefit to consumer Clear positioning in treatment category Market exclusivity Health professional support Advertising and trade marketing Ongoing product development

Not all switches are successful immediately After 23 years Nurofen is now the analgesic brand leader Imodium displaced kaolin and morphine NRT has taken 14 years to reach 7.4 million packs a year IBS sales are now 0.9 million packs a year

We aren’t going to see an explosion of switches Chloramphenicol eye drops(80%) Co-dydramol tablets(87%) Topical antibiotics(94%) Trimethoprim tablets(66%) Triptan for migraine(61%) Little support for asthma, hypertension, HRT GP List Bayliss and Rutter 2004

Changes in community pharmacy that will support POM to P New Contract from April 2005 More Consultation areas Records of some OTC sales Six local health campaigns

The OTC Consumer 2005 They prefer not to treat They use OTCs if the illness is more than minor and they can’t just wait for it to go away If it is really bad they go to the doctor Fewer consult a pharmacist, most still see doctor as first port of call –Half the population have consulted a doctor about minor ailment within past year –Little difference between social groups

OTCs are bad for you Interfere with natural healing process Risk of side effects overdose Regular use Immunity e.g. antibiotics Risk of dependency addiction Mask potentially Serious problems Hinders slowdown recovery Important to minimise consumption

What do confident consumers think about OTC medicines? Analgesics and cough/cold define the market –80% of consumers use them –More understanding of the market –30% generic/own label penetration People tend to go for the brand they know Satisfaction rates with the brand are high – over 80% are repeat purchases Price is an issue for some consumers Convenience is important

Healthcare Commission GP Survey 2004 – 250,000 patients Waiting times have improved except where person wants to see a specific GP Only 3% did not have confidence and trust in their GP Only 2% felt the doctor did not listen Three quarters had enough time to discuss their problems and got answers and explanations that they understood But 22% had put off seeing GP because of inconvenient hours

Is this where pharmacist prescribing fits in ? Needs to be wide range of drugs to meet the needs of secondary care Training and accreditation will decide timing Funding comes from PCT budgets Local variation, pharmacist, not pharmacy Care of patients will need to be shared with GP GP will have to help transfer patients to pharmacist It will not replace POM to P in suitable cases

Self Care Continuum Pure Self Care Individual responsibility Pure Medical Care ‘abdicated responsibility’ Self- managed ailments C o n t i n u u m o f s e l f c a r e Daily choices Lifestyle And prevention Minor ailments Assisted management Major Trauma Compulsory Psychiatric Care Chronic conditions Shared care Acute conditions 2005 Pharmacist and Nurse prescribing