NHS trusts (hospitals) — pharmacist prescribers < Influencers contents | Print this page Increasing pharmacist prescribing levels Nurse and pharmacist prescribing are big issues for the industry in 2004/05. A couple of documents on pharmacist prescribing from the National Prescribing Centre should therefore be of interest to NHS influencers. One is a competency framework for supplementary pharmacist prescribers and is similar to the one produced for nurse prescribers a few of years ago. There are a couple of comments of particular interest like ‘abiding by the NHS code of conduct when working with the pharmaceutical industry’. The other document is a more general one, which complements that on the DoH website on the implementation of supplementary prescribing. There is some useful material here, particularly concerning the clinical management plan (CMP). CMPs, one might predict, are likely to be the ‘way in’ for many companies for both nurse and pharmacist prescribing. Some companies have already prepared patient group direction (PGDs) (eg, GSK and Zyban for smoking cessation). Similarly, some kind of toolkit by therapy area/class/product might be helpful from marketing departments for use by both sales and NHS influencers. See www.npc.co.uk. Note too that pharmacists are increasingly getting involved in PGDs. For example a new PGD to allow pharmacists to prescribe anti-obesity drugs has been launched. See www.groupprotocols.org.uk. And according to a report in Hospital Pharmacist, the DoH is setting plans that will allow pharmacists to prescribe controlled drugs and unlicensed medicines. Gul Root, principal pharmaceutical officer at the Department, made public comment on this vis-a-vis oncology and palliative care last year. Consultation by the MHRA on this for supplementary nurse prescribers closed at the end of March 2004. From October 2003, pharmacists qualified as supplementary prescribers are now able to prescribe Schedule 4 controlled drugs like diazepam in specific conditions like palliative care. PGDs will also be extended to include most other Schedule 4 drugs, including diamorphine in cardiac pain. And DoH press release 2003/0369 outlined new measures to ensure that patients needing emergency treatment get speedier care with the launch of some 18 PGDs. While most are for traditional ER stuff, note the launch of a national PGD template plus some interesting and useful material on PGDs — eg, a helpful Q&A section. Pharmacists also seem to becoming increasingly involved in NHS Direct. Since it started in 1998, NHS Direct has become one of the world's largest providers of telephone-based healthcare advice. Research has shown that almost 6 per cent of callers seek advice about medicines and approximately 40 per cent of responses include advice about medicines. As a result of this identified need a community pharmacy project was set up and this is being rolled out across all NHS Direct sites. One wonders how close companies are to the ongoing development of NHS Direct and its algorithms and the clinical assessment tools used to issue advice on medicines in a company’s main therapeutic areas. There is a natural affinity between nurses and pharmacists and implicitly the need for both groups of healthcare professionals to develop closer links with more joint working. Possibly companies could get more involved in strengthening ties here? The UK Psychiatric
Pharmacy Group (UKPPG) and the College of Mental Health Pharmacists
(CMHP) have published a Joint
position statement on specialist pharmacist supplementary prescribing
in mental health and learning disabilities. Basically,
as long as competence can be assured, this is just fine and will
have an important contribution to improvements in patient care. Pharmacy in Practice carried some interesting content on GPs’ and patients’ attitudes to pharmacists as prescribers last year — some GPs think it’s a conflict of interest and some patients are suspicious that they are not seeing a doctor. Some barriers remain then! It may be some time before doctors or patients will unquestioningly accept pharmacists as members of the primary healthcare team. But one author said, 'Prescribing is the future — we are the experts on drugs, so let us take control. Better again to be the experts than the people who simply stick labels on boxes'. It is worth repeating that with the new pharmacist contract, extended roles for pharmacy technicians, LPS, pharmacist prescribing, this previous 'NHS backwater' appears to be moving quite quickly now… It may well be worthwhile for companies to get more involved the British pharmaceutical conference (BPC). At the 2003 meeting, NHS influencers would have heard health minister Rosie Winterton make several important announcements, summarised in DoH press release 2003/0344. These included the new dispensing pilots, the medicines management framework but also another PCT wave of the medicines management collaborative; more monies to support the training of pharmacy technicians and assistants and an evaluation published of the three pilot schemes for ETP. With pharmacists going to be a lot more important from 2004 onwards, note this year’s dates for your diary. See www.rpsgb.org.uk. Prescription charges Prescription charges went up £6.40 in April 2004, raising an extra £462m for the NHS in England — although 85 per cent of all prescriptions are free to exempt groups. The Citizen’s Advice Bureau commissioned MORI earlier in the year and found that as many as 750,000 patients go without medication because they cannot afford to get their prescriptions dispensed. But the National Assembly for Wales is moving charges in the other direction. Currently at £6 per item they fall to £3 in October 2004 and Wales plans to scrap prescription charges altogether by 2007 although there are fears that this will send GP workloads up by around 20 per cent. Organisations like the think tank the Social Market Foundation (SMF) still say that a fundamental review of the whole system is required as some folk need free prescriptions (eg, asthmatics) whilst many older people can now afford to pay. A fairer prescription for NHS charges from the SMF suggests that the current system of prescription charges is a ‘dog’s breakfast’ and a much more rational system is needed. In essence the report argues that anybody who can pay, should pay and the SMF goes for a sliding scale co-payment system which reflects the cost or efficacy of what is being prescribed (as in much of Europe). They suggest setting up four bands for medicines:
In 2003 the National Consumer Council published a report claiming that escalating prescription charges were eroding the principle of free treatment. Further
information >
|