Healthcare: The new prescribers

As patients gain power over their own medicine, healthcare PROs face a fresh challenge, finds Mark Johnson.

In the eyes of the patient, it used to be that doctors were godlike creatures holding power over life and death. This power has been gradually eroding over the past 20 years and things are about to take an even bigger swing in that direction.

The Government has a vision of patients becoming experts on their own health and is radically altering the way they interact with the NHS. Patients suffering a range of common illnesses will increasingly be expected to manage their conditions through the advice of a pharmacist and with less reliance on their GP.

In this era, pharmacists are set to become the 'new prescribers', empowered to offer ever more medical advice, conduct more tests, such as for high blood pressure, and prescribe more powerful drugs as 'partners in the NHS family' alongside Primary Care Trusts. All of this poses not only a fresh set of challenges but major opportunities for healthcare PROs, whose role will be to support the education process and to guide stakeholders through it.

From POM to OTC

One of the most important roles communications will play in this period of radical change is in the reclassification of medicines. The number of drugs that have switched from prescription-only medicine (POM) status to over the counter (OTC) has gradually increased in the last decade.

However, 2005 is set to be a watershed year.

Dr John Blenkinsopp, an independent consultant to the pharmaceutical industry who is also involved in the Government's policy of switching from POM, says that 2005 - when the UK will hold the presidency of the European Union - will be vital to the speed of progress of switching status in this country.

'The Government is looking for opportunities where it can safely increase access to medicines. It wants to be seen as a leader in Europe,' says Blenkinsopp.

Government announcements since last year have indicated interest in increasing patient access to drugs in areas such as asthma, skin conditions, chronic migraine and infections.

Pharmaceutical companies, community pharmacists, doctors and the general public will all be affected by these changes, but the path from POM to OTC reclassification has, in the past, proved one strewn with communications hurdles.

The switch of Johnson & Johnson MSD's anti-cholesterol drug, or statin, Zocor Heart-Pro from POM to OTC in July created an outcry from interest groups. Claims were made that as 1.8 million people were already on statins, the switch was merely an NHS cost-saving initiative.

The Consumers' Association also had reservations, describing the move as tantamount to treating the public as guinea pigs, while the Royal College of GPs raised concerns that pharmacists would be under pressure to assess risk of cardiovascular disease and that poorer people - those most commonly affected by heart disease - would be least able to afford to pay for treatment.

Chime-owned Ozone PR worked for J&J MSD on the switch of Zocor. Ozone PR managing director Paul Jarman says that although Zocor was far from being the first POM to switch to OTC in the UK, it had one vital difference that added to the comms challenges it faced.

'With the new wave of switches, it required a pharmacy algorithm - a set pharmacy consultation process - that delved into the patient's health background: age, sex and lifestyle,' says Jarman. 'None of the others required that.' He points out that the PR programme for Zocor had to cover all stakeholders, including patients and pharmacists. But due to the new requirements placed upon pharmacists as a result of the switch, Zocor attracted unusual levels of criticism.

Making the switch

Jarman says communications around the switch followed a timetable that will be replicated with other POM to OTC switches. 'Over the 12-month period we have four phases,' says Jarman. 'During the initial consultation period for the switch, groups will talk to the press as they are able to criticise the application. Then, the Committee on Safety of Medicines considers the switch application, and news can leak out from that. Then the Medicines and Healthcare Products Regulatory Agency (MHRA) approves the licence before you go on to launch it. But before the licence is granted you are not allowed to market the product, so you have to deal with all stakeholder comment in the channels open to you.'

But the messages the Zocor campaign aimed to communicate were not in themselves new, he explains: 'The campaign was about getting consumers to recognise whether or not they were in a risk group. Our PR focused not on cholesterol but risk and the overall benefits of the product.

We needed the public to realise they have a one in seven chance of a heart attack in the next ten years, which would compromise their lifestyle and that of their family, but that they could reduce that risk by 30 per cent by going to see a chemist and taking Zocor if appropriate.'

Next year, one of the biggest communications opportunities to arise out of this area will come in the form of patient user leaflets, believes Red Door Communications managing director Catherine Warne. The leaflets will need to go beyond a 'plain English' test, but will be thoroughly tested for user-friendliness to ensure that patients understand how to take the drugs and how to avoid misuse.

Warne, who has worked on several POM to OTC reclassifications in the past, says one of the chief aims of a communications strategy around a switch is to ensure all stakeholders are informed.

'You must take all the stakeholders along with you,' says Warne. 'If, for example, GPs are unsure of the reasons behind the switch, there will be problems. Therefore you have to ensure all stakeholders are kept up to speed on the rationale of the switch to OTC.'

Consultation consequences

A further issue that could stimulate more POM to OTC reclassifications, and consequently a further boon to PR agencies with expertise in the field, is the possibility that the MHRA could extend exclusivity of products to pharmaceutical companies from the current 90 days.

This extension would allow manufacturers the opportunity to enjoy what amounts to almost a patent protection for longer.

Blenkinsopp says: 'If the consultation goes through - and it is almost certain it will - then as long as a pharmaceutical company brings new data to the table, the MHRA could grant exclusivity for up to a year.

'This could stimulate even more POM to OTC switching. There are a lot of POM to OTC switches in train. This could make them even more attractive,' he adds.

The next few months will be a crucial stage in the development of what is expected to be a major market for communications agencies affiliated to the healthcare industry over the next few years as more drugs switch from POM to OTC.

ZOCOR HEART-PRO

Coronary heart disease is the leading cause of death in adults in the UK. Up until July, cholesterol-lowering statins were only prescribed by doctors to patients at high risk of cardiac disease, potentially saving 7,000 lives a year.

But after experts on the Committee on the Safety of Medicines advised the Government that one statin, Zocor Heart-Pro (simvastatin), should be available without prescription in a 10mg dose across the UK, the drug was made available at pharmacies.

The pharmacies within the 1,400 Boots stores in the UK were able to stock and offer the anti-cholesterol drug over the counter for the first time, which meant a great deal of comms activity was needed to raise awareness of issues.

But as a Boots spokesperson points out: 'POM to OTC switches are quite common within the pharmacy arena and pharmacists are already familiar with the drug and its benefits.' As Zocor is not exclusive to Boots, the company undertook no direct-to-consumer communications but instead focused on raising awareness externally of the danger of high cholesterol.

The main communication objective therefore was to give pharmacists a clear understanding of the new licence for simvastatin, so they would be fully aware of suitability and protocol.

As an extra service, Boots also introduced pharmacy cholesterol testing to raise awareness of the wider lifestyle changes people can make to reduce their cholesterol in a campaign that featured rugby hero Jonny Wilkinson.

Strict pharmacy guidelines and protocol had to be adhered to in offering this type of service. In order to fully train pharmacists, on both the statin and cholesterol testing, regional events were held across the country and training packs and videos were sent to all stores.

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