The Royal Pharmaceutical Society is to look into the advantages and disadvantages of creating a "P+" category of medicinal products for which there would be stricter supply conditions than those that currently applied to pharmacy (P) medicines. That decision was made by the Law and Ethics Committee on March 7, when four of the Council's committees met.
The committee noted that the change could be facilitated under existing legislation, since Section 58 of the Medicines Act 1968 allowed ministers to grant exemption for certain prescription-only medicines to be sold or supplied without prescription subject to compliance with specified conditions. A product could be exempted from POM control subject to conditions such as personal supply only by a pharmacist who, after interviewing the person for whom the product was intended, was of the professional opinion that it was appropriate for that person to take.
Other possible conditions of non-prescription supply might include record keeping, the provision of information to the patient's general medical practitioner and follow-up monitoring.
The Law and Ethics Committee agreed to support the supply by pharmacists of citric acid and water for injections to street drug misusers in the context of programmes for harm minimisation.
The committee proposed that the President should write to the Government's cabinet co-ordinator (Ms Mo Mowlam), who had overall responsibility for drug misusers, to advocate a national approach to harm minimisation programmes.
The committee noted that current Council policy was that citric acid and similar products should not be sold for the purpose of assisting the use of illicit drugs. This was in line with Home Office advice that sale or supply would be illegal under Section 9A of the Misuse of Drugs Act 1971.
However, on the understanding that Section 9 had never been intended to restrict products such as citric acid, the procurator fiscal for the Glasgow and Strathkelvin area had advised the Greater Glasgow health board that no action was envisaged against pharmacists who supplied citric acid, etc, in the interest of harm limitation as part of a recognised needle and syringe exchange scheme. It was hoped that similar assurances would be issued by the offices of other procurator-fiscals in due course.
The committee confirmed that the Society should make clear to pharmacists in the Glasgow area that it would support their professional decision to supply citric acid in appropriate circumstances.
It was reported to the Law and Ethics Committee that the Society had sought legal advice on possible changes to the Society's practices in disclosure of information about pharmacists. The Director of Professional Standards (Mrs Sue Sharpe) explained that the Society's practices needed revision in the changing context of health service provision and accountabilities, and in particular the duty imposed on health authorities to ensure quality of care.
The Education Committee agreed a number of measures designed to improve the process for the accreditation of pharmacy degrees.
One of the main decisions was that the leader of a degree accreditation visiting party need not in future be the chairman of the Education Committee. This decision would reduce the workload of the chairman and allow the chairman to remain detached when chairing discussions about the reports of accreditation visits. It would also open the role to other "senior pharmacists" with appropriate capabilities and experience for the role.
The selection of candidate leaders would involve consultation between the President, the Education Committee chairman and the chairman of the UK Committee of Heads of Schools of Pharmacy to select pharmacists with appropriate capabilities and experience. The leadership of any specific visiting party would need the approval of both the Officers and the Education Committee.
It was also agreed that each visiting party should comprise one pharmacist each from community, hospital and industrial pharmacy, two heads of schools of pharmacy and a secretary.
Other decisions included amendments to the requirements for the school's submitted documentation, with the leader and secretary being given joint responsibility for deciding whether the documentation met the Society's specification.
The committee's decisions were made on the recommendation of a working group set up to carry out a rapid review of current procedures. Once the new system of the Quality Assurance Agency for Higher Education had emerged, a more fundamental review would be carried out, taking into account the QAA system which was for a different, but related, purpose to the Society's degree accreditation.
The Education Committee resolved that the health declaration required from a United Kingdom pharmacy graduate as part of an application for registration should in future be supplemented by a declaration by the applicant's preregistration tutor. The tutor's statement would appear on the final tutor declaration rather than on the current health declaration signed by the graduate and his or her medical practitioner. The tutor would be asked to sign a declaration that he or she had not observed any mental or physical ill health problems that might compromise the trainee's ability to discharge properly the duties and responsibilities of a pharmacist. In cases where there had been a recent change of tutor, the Secretary and Registrar would be asked to accept a declaration by the pharmacy superintendent that no mental or physical ill health problems had come to his or her attention.
The Practice Committee noted that there was a need to resolve confusion over the terms used to describe systems for supporting decision making in health care. Terms in use included algorithms, guidelines, protocols and clinical decision support systems (CDSSs). The committee felt that the systems most likely to be of use to pharmacists were decision support systems that allowed users to bring in their own knowledge and experience. An appropriate system could also facilitate data collection and audit.
The committee reached that conclusion after a demonstration of NHS Direct by a nurse supervisor at the South London NHS Direct site (Ms Hilary Crozier). She explained that the nurses at the site received training on pharmacy issues and dealing with queries on medicines. They had access to a drug information back-up service. The site used the TAS clinical decision support system, which did not include formal referrals to community pharmacy, although the nurses did advise callers to visit a pharmacy in some cases.
The Practice Committee welcomed news that progress had been made towards connecting community pharmacies to NHSnet.
The head of the Society's information management and technology policy unit (Mr Ian Shepherd) reported that, following a meeting between senior personnel from the National Health Service Executive and the information authority, the NHSE had expressed a positive view on progressing the project initiation document produced for electronic data exchange in England and Wales. The document had been prepared by the Society and an external consultant.
The committee congratulated Mr Shepherd on his work.
The Practice Committee welcomed a draft document setting out guidance for pharmacists on the protection and security of electronically held information. It was agreed that a revised draft should be prepared for approval by the Council before publication in ‘Medicines, ethics and practice'.
The committee noted that data protection requirements were changing frequently and that the guidance would need to be reviewed and updated regularly.
Working with the industry
The Practice Committee agreed that guidance should be prepared for non-industrial pharmacists on working with the pharmaceutical industry.
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BrieflyDegree approved The Education Committee resolved that the MPharm degree of Cardiff university should be accredited for a further period of five years. Public open meeting The Science Committee noted that the Society's second public open meeting would be on complementary medicine. It was reported that the presentations made at the open meeting on rationing in the National Health Service had been of high quality, but that the level of attendance by members of the public had been disappointing. OST Foresight Healthcare The Society's chief scientist (Professor Tony Moffat) reported that he had attended the first two meetings of a public and patients task force set up as part of the programme of the Office of Science and Technology's Foresight health care panel. At the second meeting he had presented a paper on "Key drivers for pharmaceutical care in the next 20 years". Almost all the task force members had agreed that pharmacists had an important role to play in health care, arising from developments in genomics, diagnostics and information technology. |
The Practice Committee approved a draft document setting out a constitution and rules for the Society's Steering Group for Primary Care Pharmacy.
The document set out the group's main purposes as being: to foster the special interest of pharmacists in the primary care sector; to provide a source of specialist knowledge and expertise in primary care pharmacy; to represent the views of primary care pharmacists to the Society; and to advise the Society, through its Policy Support Unit, of any need for policy development or review of policy relevant to primary care pharmacy.
The group would initially be established for a 12-month period, during which time it would produce a proposal on future group structure within primary care pharmacy, including specific proposals on ways of working with the Community Pharmacists Group, the Hospital Pharmacists Group and the Society's headquarters in general.
The group would comprise one member of the Society's Council and one nominee each from the Community Pharmacists Group, the Hospital Pharmacists Group, the Primary Care Pharmacists Association, the Primary and Community Care Pharmacy Network, the Prescribing Support Pharmacists Group, the Pharmaceutical Advisers Group and the UK Clinical Pharmacy Association primary care practice group, along with one member of the Society's staff in an advisory capacity.
The Practice Committee agreed that the Society should advise the Medicines Control Agency that it was content with the proposals set out in an MCA consultation letter (MLX259) for an exemption from prescription-only medicine control for terbinafine for external use and an extension of the POM exemption for topical ibuprofen. The Society would support the MCA's proposal that terbinafine should continue to be monitored for any indication of the emergence of resistance. The committee also agreed that the Society should advise against any further relaxation of control on terbinafine.
The committee noted that the consultation letter listed a number of substances proposed for addition to the POM Order after having initially been categorised as POM by means of provisions in their marketing authorisations. It was agreed that the Society should propose that one of them, ranitidine bismuth citrate, should be considered for early reclassification for pharmacy sale.
The Science Committee welcomed the proposals set out in the National Science Strategy Bill, which had been introduced into the House of Commons by the chairman of the Parliamentary and Scientific Committee (Dr Ian Gibson, MP) as a Private Members' Bill in November, 1999.
Although the Bill would not proceed during the current Parliamentary session, the committee welcomed its aim of raising a wider awareness of the importance of science. The Bill proposed the establishment of a National Science Strategy Council, which in exercising its functions would consult a list of organisations, including the Society.
The committee noted that Dr Gibson had visited the Society and been briefed on its activities in the field of pharmaceutical science.
The Science Committee approved a programme of work proposed by the working party on complementary medicine, which included the drafting of fact sheets on herbal remedies, homoeopathy and homoeopathic medicines. Other topics to be addressed included traditional Chinese medicine and aromatherapy.
The committee also received a short report of a recent meeting with representatives of trade associations concerned with nutrition, health foods and herbal preparations. The meeting had shown a good degree of concurrence of views on the requirements for safety and quality of products, including information that should be provided to the public about herbal preparations.
The committee agreed to investigate appropriate means of providing good quality information on complementary medicines to the public. It was also agreed that the Society should continue to strive to make the public more aware of the dangers in the use of some herbal products and the potential for interactions. The Society's forthcoming promotion of the pharmacist as the "scientist in the high street" could help in this process.
It was reported to the Science Committee that the Society had prepared a response for submission to the House of Commons Science and Technology Select Committee inquiry on "Causes, prevention and treatment of cancer".
The response outlined opportunities for improving current outcomes, pointing out that, with the ageing of populations world-wide, prevention and treatment would become an increasingly vital element in overall health care provision. Informed national policies and robust partnerships would be needed if the United Kingdom was to play a full part.
The response added that the Society would be happy to contribute further if required and to support the implementation of the inquiry's conclusions as and when appropriate.
Branch observers The following observers from the Society's branches attended the meetings of Council committees on March 7: Miss E. L. James (representative of the Society's Somerset County branch; Mr A. Tebby (representative of the Society's Powys branch; and Mr R. J. A. Riley (treasurer of the Society's West Midlands region).