The Official College of Pharmacists of Madrid (COFM) faces this Sunday elections at a key moment for the sector. The network of pharmacies, one of the most capillary of the health system, faces the challenge of expanding its care role, integrating better with the rest of the levels of care and responding to new social demands, from the aging of the population to care in rural areas. In this scenario, Manuel Martínez del Peral seeks to revalidate his mandate after four years in which, as he defends in this talk with Demócrata, the College has strengthened its structure and has promoted new services. Now, the challenge is to consolidate these advances and position the pharmacy as an increasingly active player within the health system.
Question: This Sunday you are running in the COFM elections with the purpose of renewing your mandate. It is a key moment for the pharmaceutical sector. Why do you consider that you should remain in charge? Are you optimistic?
Answer: Voting has been going on for two weeks now because we have opened the College so that it can be done in advance, people are very happy and I think it is positive. I am always optimistic, but now especially. We arrived four years ago with a transformative project for the College to go from a somewhat antiquated institution to one of the 21st century, with normal business management methods to have the greatest effectiveness and efficiency and be as transparent as possible.
In that sense, we made a strategic transformation plan 2022/2025 that we have fulfilled, so the Madrid community and especially Health have had before them a College that knows where it is going, has its objectives and is loyal.
With this strategic plan we did two things. An internal transformation to provide more quality services to the pharmacist, more visibility to the figure of the pharmacist in society and above all, expand their activity as a healthcare professional within the sector.
It is there where, after the initial effort to implement the Law of the Community of Madrid in 2022, we are awaiting a regulatory development that has to be very fine.
We are awaiting a regulatory development that has to be very fine
We have also opened the work of the pharmacist in Madrid, with public health programs through intervention in screenings such as colon cancer (Prevecolon), and for the first time in a remunerated way. We have also opened a project with the Ministry of Presidency and Health regarding pharmaceutical services in rural areas, linked to a project of the Community of Madrid called Pueblos con Vida. All, reflected with scientific evidence.
Likewise, we are working on another project in Collado Villalba together with social services to follow up on people who have unwanted loneliness. These people usually go to pharmacies weekly and we want, through medication control, to see if they are taking it well, etc.
Finally, one of the great objectives of this legislature is to develop a collaborative dispensing project between hospital pharmacy and community pharmacy. We must bring that hospital medication closer to local pharmacies, decongesting hospital services -which are very saturated- and bring the medication closer to the patient's home.
One of the great objectives of this legislature is to develop a collaborative dispensing project between hospital pharmacy and community pharmacy
Q: We will delve deeper into each of these points you have mentioned, but for now, I see you have a very clear roadmap. You already know the position and have experience, in this regard, what milestones do you think support your continuity?
R: I would highlight the institutional reorganization at the institutional level of the College. We are well situated at an institutional level in relation to the General Council, with the rest of professional Colleges, with the distribution employers' association and most distributors, and with the Madrid Administration.
We are loyal and we contribute solution proposals to all problems. We are proactive, understanding that decisions are not always easy in Healthcare and that the best thing is to advance jointly.
We have transformed the cost structure and right now we have an impressive robustness, even returning more than 6.5 million in fees to the members. We are efficient and effective.
Q: How do you intend to empower pharmacies to take on more functions? Which, from what you say, is a priority.
R: Of course it is. It is clear that all developments also depend on regulations with the autonomous communities, etc. and four years is little. Many of the projects have 6-8 months. That is why our candidacy motto is Consolidate to continue growing, because we are still in that phase, with many expectations that need to be consolidated.
For example, the College supports pharmacies with the creation of a position called dynamizers, who go directly to help the pharmacist to undertake that activity. Once we advance in that professionalization of services, we can go demonstrating how good the presence of the pharmacist is.
There are very concrete examples in the project Pueblos con Vida. In Madrid, below 2,500 inhabitants there are 70 towns, 50 have a pharmacy office and only two, health centers. What is the citizen's healthcare access point? The pharmacy. We do not want to take away anyone's competencies, we believe there should be care continuity. There is a tool about to be released that connects pharmacies with primary care. It is vital because we prevent the patient from going from one place to another to solve their problems.
Q: How do you assess the pharmaceutical situation in the Community of Madrid? Is this closeness you mention one of its strengths?
R: It is one of the great strengths of the system. The pandemic unfortunately proved us right. Everyone had a healthcare access point less than 250 meters from their homes. In the Community of Madrid there are seven million inhabitants and only 1,600 people do not have a pharmacy in their place of residence.
The network of pharmacies, that proximity, is the great strength that we have. And I link this with the regulatory development that we were commenting on, which has four aspects, two of them vital. The first, home pharmaceutical care, which does not mean that there is a home delivery service. It is not a delivery, it is for people who have a significant and structural problem of lack of mobility. This care must be provided in the basic health zone, where one lives or in the bordering one. There is capacity to choose pharmacies, but it must be a proximity service. We cannot cross medicines through Madrid with motorcycle companies.
The second part is that pharmaceutical care must be done by the pharmacist himself or someone from the pharmacy, intermediaries are prohibited.
We cannot cross medicines through Madrid with motorcycle companies.
Q: You have mentioned, and several times, the small pharmacies or those in rural areas. How to boost them? What aid should be provided for that proximity to exist?
R: In Pueblos con Vida there are two types of aid. A structural one of 5,000 euros annually for expenses, because the rural pharmacy in many cases is very small. But this is by no means the objective, because we don't want to be subsidized all day long. We want services to be generated that we can provide to work and continue living.
Professional pharmaceutical services have a dignified and adequate remuneration for the responsibility that it is. Because when we prepare a personalized dosage system, we prepare the medication, the pillboxes, and we assume the responsibility that it is taken well because a bad intake ends in a visit to the health center, in a hospitalization or a serious health problem.
We cannot ask for this to be done for free. We have to change the chip a bit. Pharmacies must become a point of health promotion and prevention. For example, Prevecolon started in January and 215,000 tests have already been distributed in the pharmacies of the Comunidad de Madrid, the same units in these two months as in the entire last year in the health centers of the Comunidad de Madrid.
Q: How is the relationship of the College with other autonomies? What synergies can be established and/or expanded?
R: Since we entered, Madrid has an absolute listening capacity. Many of the issues I have mentioned are from visits to rural pharmacies in Castilla y León. Right now we have a project that is being observed by all of Spain to see how it works. Home pharmaceutical care, remuneration of personalized dosing systems, that small towns that today are not cardioprotected are going to have a defibrillator on the facade of the pharmacy and we are going to start taking measurements of biometric parameters, such as blood pressure. What is missing there? That this blood pressure be communicated to the doctor through a secure channel. The Spanish Association of Arterial Hypertension is behind it and the College, a bit of a guarantor.
This type of projects are the ones that we then put in common in the Consejo General, which is the one that must champion and unify. It is true that a system with 17 communities and each one with a sensibility, is not simple.
Q: A more national matter. The Consejo de Ministros has pending approval in second reading the Preliminary Draft Law on Medicines Reform. What do you expect and how can it impact the pharmaceutical sector?
R: This law would consolidate the model, which is very positive because most countries have taken a more Anglo-Saxon drift. There is nothing more than going outside of Spain, that you don't enter pharmacies because many times there aren't any.
Then, the law in a certain part improves and gives more capacity for action to the pharmacist. We have to think that the pharmacist is the specialist in medication, and therefore, he has to have the capacity to change one medication for another very similar one, when there is a shortage, to change doses. Agreed, the pharmacist dispenses, never prescribes, but he has to have a certain scope of action, especially in the face of possible shortages.
That intervention in minor symptoms should also be addressed, which we often demand, because agility is gained to unblock the healthcare system with minor pathologies that have always been resolved in the pharmacy. We have to improve that laxity.
Its approval is pending, as you say, it seems it could be around summer; and then the parliamentary processing, where we will see if there is consensus to move forward.
Q: You speak of "shortages". Is there a real risk? How necessary is it to reinforce strategic autonomy? Especially in wartime situations, such as with the current war in Irán.
R: In the crisis of a few years ago we had a boom of shortages. We must learn that we cannot have this dependence, and even less so when the European pharmaceutical industry has been one of the most thriving in Europe. It is true that the feeling is that sometimes we are a little dependent on all raw materials from another part of the world, in which any war, like the current one, can affect you.
To reassure the population, 90% of shortages are solved with a pharmaceutical intervention. It is true that there is 10% of medicines that due to their characteristics, manufacturing etc., have more problems and we would have to go to the doctor to rethink that treatment.
As of today, we are better than a few years ago. We must not stop looking at the problem. It is also a problem that has been generated many times. There are very popular molecules that stop being supplied due to the price regulation policies we have. We are in an inflationary scenario in price and some medicines continue to fall. In the end, these medicines are replaced by others, but some end up disappearing because their manufacturing is not viable.
Q: In recent weeks there has been a controversy between pharmacists and veterinarians, due to the statements of the president of the Consejo General de Colegios de Farmacéuticos, Jesús Aguilar Santamaría, who accused veterinary practitioners of prescribing certain antibiotics for economic gain. What is your opinion?
R: In my opinion, it has been over-staged by one of the parties. In Europe, it is very clear that there is a policy for animal and human use medicines One Health. We all have to get a bit into that concept that health and the use of medicines affects the entire chain and we know for a fact that antibiotic resistances are going to be one of the big health problems of the coming years, so we have to intervene there.
The other point, is an issue that is indisputable in human health, which is that whoever prescribes does not dispense. This gives a security to all citizens that there is no conflict of interest. This is what is happening right now in veterinary medicine, but certainly in the Colegio de Madrid we believe that there are fields where we can reach agreements.
Before all this media show began, we proposed to the Consejería de Sanidad the creation of medicine depots in veterinary clinics, where the pharmacy should supply them and thus we would all keep track of what is being done. That was under study when it blew up with decree 666, which somewhat limited the separation and transfer of the medicine.
It happens to all of us, that you have a problem in emergencies, not with your animal, but with your child, and it seems very good to us that that same night they give us the dose and you don't have to go around looking for on-call pharmacies -even when they are for that-. But that transfer cannot be of a medication for the whole week, because then we break the security model and of prescription-dispensation separation.
It is here when it is said, from the other side, that there are two problems: that of supply and the speed of getting the medicine to remote areas. The Spanish Agency of Medicines has already said that, if there are authorized packages of two small ones, they must exist in the market. And when it is said that in small towns speed is difficult... if we have a distribution like that of Spain, which is the best in the world for human use ones, how is it not going to be for medicines for animal use?
Q: Finally, and going back a bit to the beginning, any message you would like to convey as a conclusion.
R: We are a candidacy that has fulfilled 90% of the program with which we presented ourselves and, now, we do it to consolidate and be able to continue growing in these projects. I believe it is a good dynamic for a candidate to propose a strategic plan and fulfill it.
The conversation concludes with the shared feeling of having addressed the most relevant points of the Madrid pharmaceutical situation and with the promise to resume the talk after the elections, which he faces with optimism. A certainty that rests on the conviction that the work of these years supports his candidacy.