It is 21 years since the first issue of Pharmacy Magazine appeared. Here is a look at what was making the headlines in community pharmacy back in 1995 and the key events that have shaped the sector since then.

Starting in 1995…

The final quarter of 1995 may have witnessed the launch of Pharmacy Magazine but was otherwise uneventful in the great scheme of things, but with some hint of the events that would define the profession in years to come.

In October, the UniChem convention visited Marrakech. It will be remembered more for the spectacular number of delegates who succumbed to food poisoning rather than the quality of the conference sessions. Wholesaler conventions were big things back then, with multimillion pound budgets, 400+ delegates and a generous dollop of industry sponsorship.

The Royal Pharmaceutical Society belatedly woke up to the fact that it had a professional leadership role alongside its statutory regulatory one – it was responsible for both back then – and launched ‘Pharmacy in a New Age’, a process intended to provide the profession with a blueprint for its future development. PIANA, as it was known, was a surprisingly successful exercise and set a direction of travel for pharmacy that is still being followed today.

Asda boss Archie Norman was rattling his sabre over Resale Price Maintenance (RPM), cutting prices on vitamin supplements covered by the scheme. Medicines were one of only two categories of goods (the other being books) exempted from the Resale Prices Act, which meant the same price was charged in all pharmacies. Independents viewed RPM as vital to protecting their OTC business from the pricecutting tactics of supermarkets and the larger multiples.

After years of acrimony, peace was starting to break out between pharmacists and dispensing doctors, due in no small part to indications from the Government that it had seen enough. The DHSS in Northern Ireland laid down a marker by issuing new guidance on rural dispensing, which extended to 5km the distance patients had to live from a pharmacy before their GP could dispense for them.

The Institute of Pharmacy Management published the results of a survey of independent pharmacies on the NHS contract. Over half of contractors rated PSNC as ineffectual, a whopping 93 per cent said remuneration was unsatisfactory and 85 per cent were dissatisfied with their terms of service. This smouldering discontent would lead to the introduction of a ‘new contract’ a decade later.

Mandatory training for medicines counter staff was being rolled out. The RPSGB had decreed that new counter staff must be taking an accredited course by July 1996. ‘Experienced assistants’ could opt to sit a 30-minute MCQ paper with 55 questions instead of taking the course.

The march of the multiples was well underway. End-of-year figures showed Moss, Tesco and Boots were pipped in the pharmacy acquisition table by upstart Superdrug, which was making good on its promise to be operating 40 pharmacies by the end of the year.

Roll on 1996…

The year 1996 started with something of a bang. In January the Consumers’ Association magazine Which? published a damning report suggesting that incorrect medicines or advice were given in nearly half the pharmacies visited by its covert shoppers. It is a topic Which? has revisited several times since.

UniChem offered £547m for Lloyds Chemists, a figure topped by Gehe a month later with a bid of £584m. The whole affair was referred to the Monopolies and Mergers Commission, where it spent months under scrutiny before Gehe was declared the winner in 1997.

Other notable events in 1996 included the NPA’s 75th anniversary, and later in the year the unexpected death of its larger-than-life director Tim Astill. In a story that would run and run, the OFT decided to refer RPM to the courts, and the DH announced plans to pilot instalment prescriptions and repeat dispensing.

People making headlines included David Sharpe, who stood down as PSNC chairman and became the front man for the Community Pharmacy Action Group (CPAG), heading the PR drive in support of RPM (that’s him under the hammer, above). Pharmacy systems guru Simon Driver (now a big cheese at Cegedim) told pharmacists at the Vantage Convention: “If you held onto your cars the way you hang onto your computer systems, you would all be driving Morris Minor Travellers.”

Fast forward to 2000...

The beginning of the year found everyone breathing a sigh of relief that the millennium bug had not destroyed their computer software.

In a pilot scheme, 16 pharmacies in Manchester, Salford and Trafford Health Action Zone started providing emergency contraception under a ‘group protocol’ and Boots the Chemist announced it was piloting an online shopping service on its website. Although the RPSGB had just issued Standard 19, its first guideline for the online supply of medicines, Boots played it safe and stuck to baby and beauty lines.

LloydsPharmacy went one step further, with parent company Gehe ruling out a move into online pharmacy services. Chief executive Michael Ward opined: “The pharmacy process should be a face-to-face consultation with customers that adds value.” Allcures, which started trading the following month, had no such scruples, and claimed to be the UK’s first full service online pharmacy.

In 1999, inspired no doubt by the white heat of the IT revolution, the Government had decided that scripts should be transferred electronically from GP surgery to community pharmacy by 2002. With hindsight this timeframe was touching in its naivety, but pharmacists were starting to be briefed on how the system might work. One option mooted was the advance issue of a prescription to a nominated pharmacy…. As infants across the nation can often be heard asking, “are we nearly there yet?”

PSNC chairman Wally Dove proposed that pharmacists could offer flu vaccinations after a mini flu epidemic stretched GP resources. He also had a go at the DH over its “frustrating intransigence” on the switching of prescriptions to the paid bundle if no exemption was completed. Pharmacy contractors were losing £9-10m a year, he said. Fifteen years later they are losing £899 per pharmacy per year, according to PSNC’s new script analysis tool, Check34.

In February Dr Harold Shipman was found guilty of mass murder at Preston Crown Court. Subsequent public inquiries led to a raft of regulatory changes. March saw the ‘peppermint water’ case come to court. An infant had died after being prescribed Alderhey peppermint water mixture. Concentrated chloroform water had been used in the dispensing instead of chloroform water double strength. This tragedy effectively saw the end of extemporaneous dispensing in community pharmacy – secundem artem finally consigned to the history books.

In March 2000, exactly two years after Dr June Crown’s ‘Review on the Prescribing, Supply and Administration of Medicines’ was published – a mere twinkling of the bureaucratic eye – the DH announced legislation was on the way to allow pharmacists to prescribe.

In April every contractor in England got a letter from health minister Lord Hunt. Pharmacies were about to be sandbagged as a consequence of a dust-up between the Government and the generics industry over drug prices. Exit Category D from the Drug Tariff and (eventually) enter Category M and NCSO endorsements.

Elsewhere, a pharmacist called Sandra Gidley announced she was standing as the Lib Dem candidate in the Romsey by-election. The Lib Dems might not be the force they were, but Sandra is still around somewhere, isn’t she?

On a more sombre note, obituary notices appeared in the pharmacy press for Anne Anstice, the editorial director at Communications International Group (right), who had launched Pharmacy Magazine five years earlier. She dies prematurely, having been diagnosed with cancer six months previously.

After five years, the OFT’s referral of RPM to the Restrictive Practices Court had still not been heard. The changing retail landscape and CPAG’s delaying tactics meant the case, scheduled to go to court in April, was further delayed. It would not be heard until 2001 but the outcome would be the demise of RPM.

In September Lord Hunt was making headlines again at the BPC. Hold the front page: the DH actually had a plan for community pharmacy! ‘Pharmacy in the Future’ was billed as the most radical overhaul of pharmacy services since the control of entry regulations were introduced in 1987.

For the first time local pharmacy services free from the “restrictions of the rigid national remuneration system” were on the agenda. Individual named pharmacists may hold contracts alongside pharmacy owners, said the minister. I wonder what happened to that one?

Tucked away in the small print was a ministerial “expectation” that the RPSGB would “link continuing registration with demonstrated professional development”. More ominously for the Society, he also advised that within the year the Government would be consulting on legislation to modernise the Society’s disciplinary procedures. From such insignificant beginnings the General Pharmaceutical Council (GPhC) would emerge 10 years later.

As an aside, and for proper historians only: 100 years earlier, in September 1900, a new fluid beef product called Oxo was launched into chemists only, at a bargain price of 10d for a 2oz bottle. Like much else, now only found in supermarkets…

Skip to 2005…

“It is satisfying to reflect on how far the profession has developed in the past 12 months,” raved the editorial in one pharmacy title in a December 2005 issue (not Pharmacy Magazine, surely?). PSNC, the perennial target of blame when things aren’t going too well, topped a poll of “organisations that had done the most for pharmacy in 2005”. Was this the year pharmacists actually thought their glass might be half full?

The Big Event of 2005 was the introduction of new contractual frameworks across the nation on April 1. The details had been hammered out and voted on in 2004, with over 90 per cent of contractors in England and Wales coming out in favour. The Scots not only voted in support of their new contract but agreed a novel two-year funding deal into the bargain.

In other news… Remember Distalgesic (coproxamol)? After being handed out like Smarties for years, it was deemed too toxic for Joe Public and withdrawn from dispensary shelves in February. Department of Health statistics showed that multiples (companies with more than five branches) represented over half of all pharmacies, compared to a third a decade earlier. In a move that was to sour its relationship with the sector for some time, GSK introduced a new discount structure for products that faced competition from generics and parallel imports.

Ghislaine Brant, the pharmacist who had the misfortune to supply mass murderer Harold Shipman with his CDs, appeared before the Statutory Committee facing seven charges of misconduct. The chairman called a halt to the case after a month, saying there was no case to answer.

The RPSGB, having got itself tied up in knots over a new Charter in 2004, faced further uncertainty as the Foster Review widened the Government’s investigation into the role and function of a number of professional regulators.

In May the second ETP implementation site in England went live in Croydon. NHS Connecting for Health faced a mounting tide of criticism for its lacklustre implementation programme as the year unfolded. Bragging rights in this area clearly lay north of the border in Scotland.

Also in May, Phoenix emerged as the buyer of Numark, but the bigger business news story came in October when Alliance UniChem and Boots announced plans for a £7bn merger. The deal was sweetened for Boots shareholders with £1.7bn from the sale of the manufacturing operation, Boots Healthcare International.

In December Dr Keith Ridge was appointed chief pharmacist at the DH following the retirement of Jim Smith. He was charged with raising the profession’s profile. In another inspired appointment, model Jerry Hall was unveiled as Bayer’s global ambassador for erectile dysfunction, charged with raising… yes, well, let’s move on….

Fast forward to 2010...

By the start of 2010, plans for the transition of regulatory powers from the RPSGB to the new General Pharmaceutical Council were well advanced. The handover was due to be completed in April but was threatened with delay after objections in the House of Lords to the draft Pharmacy Order 2010. The last president of the RPSGB , Steve Churton, had turned down the chance to become CEO of the fledgling professional leadership body and returned to Boots. Helen Gordon was appointed three months later.

The year kicked off with the heaviest snowfalls seen for 18 years and a DH consultation on generic substitution that could have seen pharmacists dispensing generics against scripts for branded products. While superficially attractive, pharmacy organisations predicted substantial difficulties and the idea was quickly kicked into the long grass.

As a trailer for the next episode in the long running EPS soap opera, Connecting for Health announced that EPS release 2 would be ready in the spring.

After years of swingeing Category M price cuts, improved funding was top of a pharmacy wish list that included more commissioning of local enhanced services, access to patient records and a stronger unified voice for the profession. In Northern Ireland contractors were set to lodge a claim for Category M compensation after the High Court judged the mechanism had been used unfairly.

Back in April 2009, pharmacists had been shocked when Elizabeth Lee received a suspended jail sentence for a dispensing error despite being found to bear no responsibility for a patient’s death. More than 12,000 pharmacists and 234 MPs signed petitions to change the law and decriminalise single dispensing errors. In March 2010 Mrs Lee said she would be appealing her conviction and in June her custodial sentence was quashed. Decriminalisation remains on the agenda…

The Office of Fair Trading, which has a track record of sticking its nose into matters of which it has limited understanding, proposed that PCTs should set dispensing fees locally. This genius idea came in an impact evaluation of the relaxation of the control of entry rules that had taken place in 2005, and which it had championed.

The ’relaxation’ had been exemption of 100-hour pharmacies from the regulations. The OFT noted that pharmacy numbers had risen by 9 per cent since then, and claimed it had produced savings of up to £20m a year. Contractors were more concerned about the threat the exemption posed to their businesses and the dilution of pharmacy funding than OFT spin.

The GPhC was sent back to the drawing board after its first effort to draw up new standards for pharmacy practice got a pretty universal thumbs down. Another consultation was launched. Later in the year 1,500 pharmacists failed to renew their registration – some 3 per cent of the register, pretty much the norm.

In April, regulations making pharmaceutical needs assessments mandatory came into force, with PCTs required to produce a document by February 2011. They would be used to inform the commissioning of new pharmaceutical services. PSNC was sceptical from the outset about the ability of PCTs to deliver.

NHS Prescription Services told pharmacists that they would have to separately sort specials and expensive items over £100 in a bid to reduce errors in pricing caused by its automated pricing system. The true scale of the problem was to unfold over the coming months and led to a major loss of confidence in the accuracy of reimbursement. By November, PSNC was telling contractors it was pursuing further compensation for errors made in the previous financial year.

The NPA parted company with chief executive John Turk, the second in short succession. It is a habit the association doesn’t seem to have completely shaken off since. And in May Sandra Gidley lost her Commons seat in the general election. Healthy living pharmacies and project lead Deborah Evans were in the news in June when six HLPs were accredited in Portsmouth PCT, a project that was to spark emulation across the country.

Meanwhile, new health secretary Andrew Lansley was explaining that PCTs would be abolished and GP consortia would take over commissioning. Cue yet another NHS reorganisation. Continuing professional development claimed its first victims, with five pharmacists referred to the RPSGB’s investigating committee for failing to meet standards.

After a quiet summer September opened with the announcement that contractors faced a £140m Category M clawback. The RPSGB went the way of the dodo as its regulatory role passed to the GPhC. Its epitaph was a report on its handling of disciplinary cases, which was variously described as “appalling” and “obscene”.

At the LPC conference in November, PSNC unveiled PharmaBase, a web-based service to help pharmacists record and invoice the enhanced services they provided. A good concept, it had a short and troubled life before it morphed into PharmOutcomes. A BBC investigation revealed that the cost of specials to the NHS in England had risen from £57m to £160.5m in four years and PSNC revealed it was in talks with the DH about introducing a tariff for some standardised specials.

The year ended with the publication of a Government white paper ‘Healthy Lives, Healthy People’, which highlighted pharmacy as a valuable and trusted public health resource. Pharmacy’s engagement with public health is still evolving, but the marker was put down. A lobbying group called Pharmacy Voice was set up by the NPA, AIMp and the CCA to provide pharmacy with a unified voice. Pharmacy minister Earl Howe welcomed the initiative, saying a coherent message from the sector would be “extremely helpful”. Ouch!

There are a hundred-and-one other events that have shaped community pharmacy over the past 21 years that have not featured in this ramble through the archives. But if you are looking for a CPD point to take from this, it is simply – look back and learn. The seeds from which future developments unfold are often planted years before. The trick is to spot the ones that will grow.