“Pharmacies could be better used to reduce pressure on the NHS”

Celebrating half a century of existence with a renewed image, the National Association of Pharmacies (ANF) launches this Monday, the 21st, the campaign under the motto "life passes through the pharmacy", seeking to highlight and demonstrate that its main asset - proximity to the community and its support in the various stages of their lives - can be used to reduce pressure on health centers and hospitals.

For example, by expanding the range of situations in which a pharmacist can recommend medications without a prescription, such as mild urinary tract infections and oropharyngeal tract infections. "We believe it's appropriate to open this discussion and would welcome the possibility of the Portuguese Medical Association and the Portuguese Pharmacists Association, in collaboration with entities from the Ministry of Health, discussing these matters," argues Ema Paulino, president of the ANF, in an interview with Jornal Económico (JE).

The official emphasizes that pharmacists do not want to "usurp functions" but emphasizes that these professionals, during their training, "acquire a series of skills that allow them to assess certain situations and recommend certain treatments." However, there are other ways to help the NHS, namely in monitoring chronic patients and in sharing data between pharmacists and doctors, and vice versa, explains Ema Paulino.

The National Pharmacy Association is celebrating its half-century anniversary and wants to mark it with a change of identity. What image do you want to project at the start of the new 50 years?

Our starting point was the need to re-evaluate our collaboration, taking advantage of the 50 years, the strategic alignment within the organization, and the needs of society and the National Health Service, which are constantly evolving and require an adaptation of the value proposition. And, simultaneously and consequently, the value proposition that ANF offers to its member pharmacies.

And what came out of this reflection?

As a result, we identified the trust and proximity that pharmacies have with the population as our main values and differentiating criteria, and, through the qualifications of their teams, the ability to provide a supportive service at various stages of people's lives. The new brand seeks to reflect the presence of pharmacies throughout people's lives and how, in collaboration with other entities, healthcare professionals, and healthcare institutions, we can provide a more integrated and complementary care process to improve the population's quality of life. This is what the rebranding reflects, on the one hand, making its image more modern; on the other, it indicates our desire to constantly evolve and our willingness to be part of healthcare solutions and to capitalize on our main asset: our proximity to our community.

Pharmacies continue to be a kind of safe haven for many. Is your goal to include them more in the NHS solution?

Precisely. The main goal is to work on integration and complementarity. This is a particularly opportune moment for this, as we are moving toward a single population health record that can, ultimately, benefit from recording the interventions of the various healthcare professionals with whom the patient interacts, including healthcare professionals working in community pharmacies. This will result in a more efficient system that avoids wasteful duplication of procedures, but above all, promotes better monitoring of people's needs.

Today, we see an increase in the population's average life expectancy, but the Portuguese end up living with chronic diseases for several years. To maintain monitoring, it is necessary to involve various healthcare professionals who can make a positive contribution to chronic diseases. Pharmacists are undoubtedly one of these professionals, as many of these diseases require pharmacological treatment. Pharmacies are frequently visited, with extended hours and evenly distributed throughout the country. Better use of the network could be made to reduce pressure on health centers and hospitals.

An example of this complementarity to reduce pressure on the NHS is the possibility of pharmacists being able to prescribe medication in cases of minor illness, which the Portuguese Medical Association criticized?

We don't want to usurp functions that aren't ours. Diagnostic and prescription solutions are indeed medical skills, and this has a reason related to the training process. But pharmacists, during their training process, also acquire a series of skills that allow them to assess certain situations and recommend certain treatments. There are a hundred minor situations, from coughs to fevers, which are already, essentially, recommended by pharmacies without the need for a prescription. What we're saying is that, given international evidence that has already covered this path, there are certain situations that can be more easily detected in pharmacies, for example, through a protocol that could be developed between the Portuguese Medical Association and the Portuguese Pharmacists Association to expand the number of minor situations to which pharmacists could respond immediately.

For example?

For example, uncomplicated urinary tract infections, oropharyngeal tract infections, and respiratory infections, for which rapid tests are already available in pharmacies. A protocol could be drawn up that initially indicates that the pharmacist may dispense a medication that would be duly recorded in the clinical record and communicated to the attending physician. The situation would then be monitored to determine whether or not it is resolved. These are examples of situations that already exist in other countries, using this collaborative model and have yielded positive results.

And here, what stage are we at in this process?

We believe it is appropriate to open this discussion and would welcome the possibility of the Order of Physicians and the Order of Pharmacists, in collaboration with entities within the Ministry of Health, discussing these matters.

Pharmacy shortages have been in the news recently. Is this a worsening problem, or has it simply been more publicized?

It's not just in our country. There's a global problem with drug shortages. A report by the European Union (EU) pharmacists' group recently published, indicating that, on average, a pharmacist spends at least 11 hours per week trying to find solutions to drug shortages. The European Commission has been working to identify ways to promote incentives for the establishment of pharmaceutical industries in the EU. There's a dependence on global supply chains and production that often takes place in other parts of the world. At the same time, there's been a discussion about what measures we can implement to mitigate the impact. If we can't prevent supply chain issues, there will always be shortages.

What can pharmacists do to ensure that stockouts do not impact the population?

What we've been promoting is giving pharmacists more scope to make substitutions within the same active ingredient, in terms of package size, dosage, and formulation. These measures, however, have already been legislated in Portugal but have yet to be implemented. We're informed that they will be implemented very soon.

What are the main medications that are often out of stock?

They vary greatly. I would say that, at the moment, we don't have any active substance for which there isn't an alternative solution. Typically, there are alternatives that can be easily implemented. The issue here is that changes often require another visit to the doctor. There are constraints on the time it takes for people to access a new prescription. We've been working with Infarmed on how we can streamline these processes; we can also provide pharmacies with more information about the expected timeframe for stockouts and when they're expected to return to the market.

Thus, we can now direct our recommendation. Very recently, in partnership with ANF, ADIFA, and Infarmed, a feature was implemented in the computer system that allows pharmacists to know, when placing an order with a supplier, whether they will receive it or if it is out of stock. And if it is out of stock, how long it is estimated to take until it will be replenished. These measures have been worked on between industry partners and Infarmed and are crucial for better addressing this international shortage and finding faster solutions for the population.

Are you concerned that tariffs could, ultimately, worsen medicine shortages in Europe?

Many drugs, especially generics but not limited to them, operate with very low margins. Applying tariffs on active ingredients or finished products can make these drugs unviable, leading to discontinuation of marketing and/or potential shortages in products used to replace those that are now discontinued. Pharmaceutical production depends on complex global production and supply chains. Applying tariffs can force changes in material suppliers, cause logistics delays, and increase costs at multiple stages—increasing the risk of shortages. On the other hand, if the US introduces tariffs, the EU may want to retaliate against American drugs, triggering a trade confrontation that would also affect the European market.

What has been the ANF's relationship with Health Minister Ana Paula Martins, who previously served as president of the Pharmaceutical Association? Is there a different level of sensitivity because of this?

Understandably, the Minister of Health delegated pharmaceutical matters to Secretary of State Ana Povo, who also oversees Infarmed. The entire pharmaceutical sector has been handled by the Secretary of State, not the minister.

Has the dialogue been good?

Yes, it's been positive, quite pragmatic in addressing the government's priorities. It's also been a constructive dialogue in exploring how pharmacy professionals can be part of the solutions. It's been a constructive dialogue, but very much guided by the objectives of the government and the Ministry of Health.

What problems would you like to see resolved in the short or medium term that directly affect the guardianship?

I think these would be more opportunities we'd like to explore, particularly because Portugal has a healthcare system with very good indicators, particularly in terms of average life expectancy, but we have problems related to morbidity: that is, people live fewer years with quality of life than some of our European counterparts. This has a lot to do with the burden of chronic disease in our country. Since these diseases are treated with medications dispensed in community pharmacies, we believe there should be formalized pharmaceutical monitoring. It may even be useful for physicians to have access to the results to make clinical decisions: whether to continue or change therapy, or even to identify people whose disease is not under control and who need to be referred to a doctor, before this lack of control results in a cardiovascular event that later requires hospitalization, or a visit to the emergency room that could have been avoided if the person had been monitored.

Nowadays, we have prescriptions that are valid for one year for people with chronic illnesses. Therefore, they can go a year without seeing a doctor again. During that period, they go to the pharmacy at least every two months to get their medications. This would be a great opportunity to check whether the medications are effective or if there's any situation that needs to be addressed by a doctor. We have some expectations, because it's something we've discussed with doctors themselves, who welcome this monitoring in pharmacies to keep diseases under control, avoiding unnecessary hospitalizations and deaths.

Are you referring to situations that are already carried out in pharmacies, such as measuring blood pressure?

Exactly. And that these measurements, the parameters, be agreed upon as to which are most relevant for the physician to monitor, and that they be entered into the clinical file itself so that professionals can have access.

Basically, a sharing of data between doctor and pharmacist and vice versa?

Yes. We operate as a multidisciplinary healthcare team.

Is the Government willing to move forward in this direction?

We have some hope that we can develop this area. The government's program mentions this possibility. On the one hand, using the pharmacy network to improve the population's health literacy; but also in monitoring people with chronic diseases.