Jesus Aguilar Santamaria, president of the General Pharmaceutical Council of Spain (CGCOF) discusses the role of the council in the Spanish healthcare system, in addition to exploring the benefits of the recent digital changes to the sector and how these changes drive the Council to continue the improvement of the pharmacies in the country.
Can you please give an overview of the CGCOF and the role it plays in Spain’s healthcare system?
The CGCOF is the professional body in Spain representing 72,000 registered pharmacists at a national and international level, working in the field of pharmaceuticals, whether this is in a pharmacy, hospital, clinical laboratory or a distribution depot, among other activities, and gathers 52 provincial pharmacists’ chambers. Furthermore, there are eight regional councils at the regional level. In Spain, the health management is transferred down to the 17 different regions, and it is the regional health authorities who make the final decisions on issues such as reimbursement and pharmaceutical organization. We do collaborate with the regional government on specific projects, bringing more success to initiatives we implement in the Spanish healthcare system.
At an international level, the Council is a member of several different organizations, most notably the Federation of International Pharmacists, currently chaired by the former President of the General Pharmaceutical Council of Spain, securing a strong relationship between the council and the federation. In addition, we work with similar professional organizations in Latin America and have a close relationship with many different countries there, not only due to the cultural and linguistic similarities but because these countries look to Spain as a reference for their own healthcare system.
Looking more towards Europe, the Council is a member of the Pharmaceutical Group of the European Union, the umbrella organization representing the community pharmacists throughout Europe, where this year I have been designated to hold the Presidency of the organization. This organization represents the community pharmacy voice in Europe and aims at influencing political and legislative activities coming from the European Institutions.
What are the main incentives driven by the Council?
At a national level, we have advanced significantly Spain’s professional pharmaceutical services through the development of programs, a specific example being a collaboration with the universities and with the provincial chambers. The aim of this initiative is to build up evidence on the outcomes of pharmacy services and the savings that they can bring to the Spanish public healthcare. Some real-life evidence that we have received so far shows that the pharmacy sector has helped to decrease the number of emergency visits to hospitals by at least 50 percent, which is a very important result. In addition, we have helped to decrease the number of patients admitted to hospitals by more than 60 percent, contributing to savings of almost two billion euros.
The General Pharmaceutical Council of Spain has a strong relationship with all the key stakeholders in the healthcare sphere, and we collaborate closely with the whole supply chain, from the associations such as Farmaindustria, Fedifar, and AESEG to the very Ministry of Health, and even with the private companies and laboratories. This enables the Council to promote relevant initiatives and care projects in the healthcare sector, with great success! For example, we have been actively working to install the national verification system, where new serialisation technologies and information systems will be introduced into the medicines supply chain, and we have seen huge steps in the right direction, in order to comply with the European legislation and enhance the safety of the medicines supply channel in Spain.
Furthermore, the Council played an important role in developing the pharmaceutical services available in the public health system, demonstrating the value of the community pharmacists by conducting 60 percent of all health screenings at community pharmacies. Before our intervention, this target was not achieved, but now we see a successful amount of screenings for different diseases, such as colon cancer, HIV, and diabetes.
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What are the most pressing issues that your members are currently facing?
Due to Spain’s economic crisis, pharmacies contributed with savings of up to 40 percent to the healthcare system, through cuts in the prices of medicines and a reduction in the number of prescriptions. These two criteria combined mean that the margins of profit decrease, thus reducing the amount of money the pharmacy receives. Despite these incredible savings that the pharmacies contributed to, they now only represent 15 percent of the healthcare budget. A pressing issue for our members and the council as we feel there is a lack of recognition for the saving we help to achieve.
In addition, there has been a deviation of innovation away from the pharmacies, and these high-priced medicines are being disrupted exclusively through hospitals, as opposed to being available in the 22 000 community pharmacies we have in Spain. This is a problem, not only for the pharmacists but also for the patients whose easiness of access to innovative medicines is being compromised.
What have been the major changes in the healthcare sector in Spain?
The healthcare sector is a challenging environment, undergoing constant transformation. Recently, Farmaindustria has signed an agreement with the Ministry of Health to control the pharmaceutical expenditure. The Council has also been working towards a framework agreement with the Ministry of Health to develop the pharmaceutical profession.
One of the major advancement in Spain has been the digitalization of the healthcare sector, paving the way for the early implementation of electronic prescriptions. This has allowed pharmacists to be connected to health centers at a regional level. Taking this a step further, we have connected pharmacists at a national level enabling them to collaborate, through the collection and consolidation of data and processes, to offer more efficient services such as access by patients to pharmaceutical records or pharmaceutical care services. This data can be used as evidence of the health outcomes of the pharmaceutical services our pharmacies provide. In addition, this technology platform hosts an application called CISMED, which allows pharmacists to update information on their supplies of medicines, which is updated every day and reported to the authorities, giving real-time detection of any shortages and short supplies of medicines in the pharmacies.
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What would you highlight as your main achievement as the President of the General Council?
The strategic positioning of the Spanish pharmacy profession at an international level could be highlighted of my time as President of the Council. This achievement has resulted in our participation in “Marca España”, and it has been an honor to participate and collaborate with the government on this initiative to promote Spain’s excellence in the field of pharmacists’ services abroad. In addition, the Council has been given the honor of organizing the annual congress for the Federation of International Pharmacists in Sevilla, Spain in 2020. It is going to be hard work, but we are excited about this opportunity. In addition, I hold the Presidency of the Pharmaceutical Group of the European Union this year, and we are organizing the annual encounter of European Pharmacists in Málaga, in June.
Along these lines, a main achievement of the Council is its active engagement with the European institutions, with regards to the approval of the directive on a proportionality test for the regulation of professions, seeking to improve the transparency of how certain professions are regulated. We have gained special recognition for our participation in this important directive, having played a key role with our members of the European Parliament, and representatives in the Council, as well as mobilizing all the delegations at European level.
What would be your outlook for the future of the General Pharmaceutical Council of Spain?
I am passionate about the role that pharmacists play in the healthcare system and so I will continue to promote to society their efforts and contribution. The Council’s main strategic priorities for the future combine innovation with sustainability. We have a strong and expanding network of pharmacists in Spain who, before the creation of the technological network, worked independently. The Council has formed a collaboration of these individuals to form a coalition, with the help of the digitalization of the healthcare sector, in order to show the role of the pharmacist in providing healthcare services to the patients and contributing to the efficiency and sustainability of the health system.
