Pharmacists Claim Policy Space on Europe's Healthcare Checkerboard

Time was-and not so long ago-that the people who make medicines dominated the healthcare policy-making scene in Europe. Sure, doctors and nurses and hospitals and other constituencies had their lobbies, but they were small and of limited ambition. The European Union had virtually no legislation on any health-related topic-except on medicines. And the big battles, such as they were, consisted largely of big drug firms and their associations facing up to a highly-fragmented bunch of national authorities over safety, quality, efficacy, and-above all-pricing.

The inter-connected world has changed all that. Not just the technical advances in communications (although they should not be underestimated), but the growing recognition, often arising out of tighter competition for funding, that all aspects of the healthcare system are related, and cannot sensibly be viewed in isolation from one another. So no longer were the discussions about drug pricing conducted just between manufacturers and the insurance systems that paid for their products. They spilled over into broader reflections on whether hospital spending was too high, or prosthetics had become too expensive, or the workforce needed different training, or prevention should be given greater priority, and dozens of other debates with dozens of other players and payers.

The just-published annual report for 2015 of the European grouping of community pharmacists, PGEU, is an eloquent example of the trend. Pharmacists have traditionally had what can most charitably be described as a respectable role in European policymaking-in other words, polite but insignificant. But one technical advance in this interconnected world has given them new prominence in the last five years, as one of the partners in a sector-wide coalition to stop falsified medicines reaching patients. They have new prominence in a new European system, created jointly with drugmakers and wholesalers and parallel traders, that will provide on-line identity-checks on each individual medicine from factory to pharmacy.

PGEU flaunts this position ostentatiously in its annual report. It will, it says, be working hard in the coming years "supporting all member organizations as we assert our right to participate as equal partners with the other stakeholders in the establishment of the national medicines verification systems." And there's more. With the setting up of the European Medicines Verification Organization, "pharmacists’ position as an equal partner in the project is reinforced by our holding of the first presidency of the EMVO."

Their determination to exert new influence is not limited to identity checks on medicines. The pharmacists' grouping also reports on how a European Pharmacists’ Professional Forum that it has just established "will assist PGEU to demonstrate the importance of community pharmacists’ vital role in improving patients’ health outcomes and will further strengthen our efforts to ensure that our current and potential future contribution to health care is properly recognized when European policy is developed and when legislation is being drafted."

And the potential opportunities from the seismic shifts now taking place in overall health policy have not escaped pharmacists' attention as another field where they can benefit from raising their profile.

"The prevalence of chronic diseases is increasing and will continue to grow. As a result, existing health systems are under unprecedented pressure due to the increasing demand for care. The old ways of treating illness will not suffice in the future," PGEU comments, accurately reflecting much current thinking in Europe and beyond. Seizing the moment, it goes on: "There is an appetite to see pharmacy expand its role, to innovate and to find new ways to support patients…and we are perfectly placed to support efficient health care systems by targeted services which promote better health at every stage in patients’ lives."

Pharmacists are newly ambitious. But they are not dumb. They also observe, as they reach out across Europe in a bid for new territories, that "there will be barriers to overcome, including reassuring other professions that pharmacists are not a threat to them, and convincing payers that investment in pharmacy services pays a dividend in reduced long-term health care costs. " The acknowledgement they make here of the competitive nature of the European policy-making scene demonstrates again just how much things are changing on the Old Continent.

And the pharmacists' coup de grace in their wish-list is an astute recognition that nothing will ever be the same again as Europe's health systems evolve-above all with a shift from measuring inputs to measuring outputs. "As the focus of pharmacy practice moves from medicines to patients and from inputs to outcomes, PGEU must facilitate the exchange of ideas and experiences so that each of us and our patients can benefit from the successes," it says.

Here in what history often referred to as the "cockpit of Europe," new factors influencing healthcare and its provision are leading to significant realignments-and no one, not even the most advanced drug research center, can any longer afford to be complacent about any guaranteed places in the sun or remain aloof from and dismissive of the impact of change.