APPENDIX 10
Memorandum by Proprietary Association
of Great Britain (PH 17)
The Proprietary Association of Great Britain
(PAGB) is the national trade association, which represents manufacturers
of over-the-counter medicines and food supplements. We represent
more than 98 per cent of the branded OTC medicines market in the
UK and the vast majority of the branded food supplements sector.
We regularly conduct attitudinal and behavioural research among
consumers and doctors which has helped provide an understanding
of the extent of ill-health, particularly of minor ailments, in
the community and how people deal with them. The research also
demonstrates the value of education in helping people manage chronic,
recurring conditions within a long-term public health strategy.
We have already stressed to Government the need
to look at what people do about their minor ailments to get a
clear picture of what they may be expected to do about improving
their health and taking preventive measures. We appreciate the
opportunity to give our views to the Health Select Committee on
this topic.
These views are based on our research (1), which
suggests that:
— 96 million GP consultations a year
are for minor ailments (which people could manage for themselves);
— these result in 63 million prescriptions
a year (14 per cent of total NHS prescriptions in 1997);
— half the prescriptions written are
for ailments suffered by people who pay the prescription charge,
which is often three times the cost of an OTC product;
— if just 25 per cent of these consultations
were translated into self-care/medication activities it would
free up 135 hours for every GP and £380 million a year. (Although
we do acknowledge that not all these consultations are just about
the treatment of minor ailments, it is an illustration of the
potential);
— while our research shows that people's
first response often is self-care or self-medication, 10 per cent
of ailments are referred to the GP;
— the research also shows that 65 per
cent of these consultations result in a prescription and 17 per
cent with advice to wait and return if the symptoms worsen. These
data suggest that the patient might be seeking reassurance rather
than treatment;
— further research (2) shows that most
of these consultations are indeed for reassurance that the symptoms
are simple and not masking serious disease. The doctor's reassurance
rather than a prescription would have been sufficient;
— a qualitative survey among GPs (3)
however, reveals that they feel the unique doctor-patient relationship
must be preserved and a prescription is a tangible manifestation
of this; and
— further research among GPs and their
patients (4) shows that while GPs are cautious, almost reticent,
to make OTC recommendations, the majority of their patients said
GPs should ask about prior OTC use. The study also revealed patients
saying that GPs should make OTC recommendations and if they did
the patients said they would act on this advice and very few said
they would be upset by this behaviour.
These data show that there is a culture of dependency
upon the GP, which is being fuelled by the profession, as there
is little to help them break the cycle and encourage greater self-reliance
by their patients.
The reason we believe a consideration of these
factors is fundamental to public health strategies is that it
shows the degree to which we need to move the population towards
independent action before they can truly embrace the actions needed
for the promotion of public health. These would include understanding
the need for and application of prevention strategies, improving
health in general and changing environmental factors, which lead
to poor health.
TESTING IN
A HEALTH
ACTION ZONE—A
CASE STUDY
Working with Tyne and Wear Health Action Zone,
we have been trying to construct a study involving PCG/Ts, pharmacies,
NHS Direct and a walk in centre with the objective of testing
the hypothesis that empowering patients to do more for themselves
in the treatment of minor ailments will help to change the culture
of dependency.
The project was first discussed in January 1999
and a working group set up consisting of people from the three
health authorities in Tyne and Wear and members of PAGB. Funding
was approved for the project in the autumn of 1999 but the path
of the project changed and an amended description had to be resubmitted
to guarantee funding since the start of the project had passed
the financial year from which funding had initially been secured.
Additionally, the performance measures for HAZs had been changed,
which contributed to the delay in implementation.
The revised project plan was submitted in May
2000 and funding once more secured.
We believe this project serves as a case study
for the problems that can arise when timing cannot be controlled
and monies must be pitched and re-pitched.
The organisational arrangements are important
to get right if real progress is to be made in testing ways in
which public health programmes can be developed.
DELIVERING PUBLIC
HEALTH
Understanding what is meant by public health
is the key to its communication, in the first instance, to the
public. It is not a term understood by the majority of the population
and has different definitions depending on which discipline of
the health professions is consulted. The first objective of the
Minister for Public Health and the Director of Public Health must
be to engage in definitions and ensure consistency of understanding,
which must then be communicated, to the public. Once achieved
there needs to be a period of public consultation.
The structure of PCG/Ts lends itself to tailoring
this consultation at a very local level. PCG/Ts can identify vulnerable
groups and those who would benefit from a change in health behaviour
thereby allowing a direct communication with them around the benefits
of introducing public health strategies. PCG/Ts can also do this
by involving local authorities, social services and education
services to look very specifically at the fundamental factors
influencing the state of that population, namely environment,
transport, care at home, employment and education.
Education is a key factor in effecting a change
in behaviour but it must be delivered in a way that allows for
action. A problem solving approach works and our research suggests
that the public want to be treated as adults, do not want to be
patronised and want to be given information upon which they act.
CONCLUSION
There needs to be strong leadership at the centre
and this must firstly be provided by the Minister for Public Health
and the Director, which can then serve to motivate activities
on a local level.
We believe that if the target is to improve
public health in England (and we limit our comments to England)
there needs to be a level of public communication, which is missing
from the arena currently.
There is also little evidence of cross-departmental
working, whether at local or national levels.
Budgets must be clarified and until this is
done it will be difficult for cross-departmental working to be
realised.
Information, education and consultation lie
at the heart of a strategy, which is by definition long term.
As such, the education must begin in schools so that the skills
needed to empower future generations towards independent action
can be introduced.
We believe that the research we have carried
out provides a very important guide to what is necessary to bring
about long term social change and would welcome being involved
in the debate on how this can be achieved.
We would like to make the research available
to the Committee so that it can inform the enquiry and would be
willing to talk to members of the Committee on our comments, views
and thoughts. Please contact Ms Gopa Mitra, MBE, on 020 7421 9315
or e-mail: gopa.mitra@pagb.co.uk.
NOTES:
1. BMRB Everyday Healthcare Study of Self-medication
in Great Britain, October 1997.
2. The HPI Research Group OTC Medicines
and Consumers, May 1994.
3. McMaster Cawte Associates OTC recommendation
by GPs, April 1994.
4. Bradley C P, Riaz A, Tobias R S, Kenkre
J E and Dassu D. Patient attitudes to over-the-counter drugs and
possible professional responses to self-medication. Family
Practice 1998; 15:44-50.
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