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The Pharmaceutical Journal Vol 264 No 7097 p766-767
May 20, 2000 The Society

Branch representatives' meeting

Branch representatives support emergency hormonal contraception from pharmacies

On this and the following two pages we report on some of the motions discussed by branch representatives at their meeting on May 11.
See also:
Call for permanent BPSA office at Lambeth headquarters
Call for reconsideration of Council election canvassing
Conference success?
No support for electoral college for Society's presidential elections
Representatives want UCAS style scheme for preregistration placements
Branches want their role reviewed
Pros and cons of STV discussed
Representatives want Society's public relations assessed for performance
Representatives want earlier Council response to BRM motions

Branch representatives want pharmacists to be able to provide emergency hormonal contraception. Mr CHARLES BUTLER moved, on behalf of the Reading branch, that "pharmacists should be able to provide emergency oral contraception, within an appropriate shared care protocol, which would include suitable family planning advice".
Mr Butler said that the motion could provide a defining moment for the profession. It could produce a vehicle for the development of a raft of patient-centred services, underpinned by supply of medicine. Despite the fact that some pharmacists objected to EHC on religious or moral grounds, he felt confident that they would wish to fulfil their professional obligations to patients by referring them on to colleagues. He said there was ample evidence that EHC prevented the misery and public health consequences of unwanted pregnancies, including those caused by the failure of other contraceptive methods. Longer opening hours of pharmacies, plus the fact that appointments were not required, together with the increasing number of premises with private counselling areas, all contributed to making community pharmacies a good choice to provide this service. Pharmacists would need a small amount of additional training in counselling and family planning issues, but there was no reason why any self-respecting pharmacist should be afraid to provide EHC within an appropriate shared care protocol, together with suitable family planning advice.
Seconding the motion, Mrs FRANCESCA SHEARCROFT (Reading) said that, in putting forward the motion, the branch was voicing the wishes of many, including the All-Party Pharmacy Group in Parliament and the British Medical Association's general practitioner Committee. Correspondence in The Pharmaceutical Journal suggested that a majority of pharmacists wished to provide the service. Nurses had already increased the number of services they could offer, and pharmacists should follow suit.

Charles Butler
Charles Butler: a defining moment for the profession

The PRESIDENT (Mrs Christine Glover), by way of update, said that the Council had just reaffirmed that it was in the public interest to improve access to emergency hormonal contraception through community pharmacists. The Council wanted to see measures in place to ensure that such a service would be available free of charge through community pharmacists to women who could not afford to pay for it.
Mr MARK DONAGHY (Bradford) spoke against the motion. He said EHC was a controversial form of medicine, and that the term "emergency contraception" was a misnomer. In the age of concordance, medicines should not be misdescribed. The provision of EHC by pharmacists would not solve the problems of unwanted pregnancy. He pointed out that under the 1967 Abortion Act other health care professionals had protection against discrimination in employment which pharmacists did not. He urged the meeting to vote against the motion.
Mrs JANET MAYNARD (Exeter), speaking against the motion, said that while she was in favour of pharmacists prescribing in many areas, and did not object to the prescription of morning-after pills, she did not feel a shop environment was the appropriate place in which to do it. Private consultation areas were essential, and in a busy pharmacy it would be difficult for pharmacists to spare the time needed to provide a good service.
Dr NICOLA GRAY (Harrow and Hillingdon) said that an EHC service was already being offered in Manchester. Pharmacists had no obligation to supply the medicine but had the ability to refer back into primary care teams under a shared care protocol. She found the motion a well-thought out one, and urged the meeting to support it.
Mr BUTLER, in summing up, pointed out that members of the Reading branch understood when they put the motion together that a significant number of pharmacists would not wish to participate in the provision of this kind of service on grounds of religion or conscientious objection. Additional employment safeguards could be included in the Code of Ethics, which was being studied in depth currently. He agreed that many pharmacies could not offer private consultation areas at the moment, but said that as pharmacies were refitted and renovated, this would come about. Facilities had to change to keep pace with changing practice.
The motion was carried.

Seamless care

Four other motions relating to pharmacy practice were debated by the meeting. The first of these was successfully proposed by Miss SUZANNE JOHNSTON on behalf of the Dudley and Stourbridge branch. Mrs Johnston moved that the Royal Pharmaceutical Society "proceeds with all due speed to promote the seamless pharmaceutical care which patients deserve". She said that seamless care between hospital and community pharmacists had been discussed for many years. The reality was that very little progress had been made. Guidelines and best practice should be vigorously promoted nationally. The Royal Pharmaceutical Society, the British Medical Association, the National Pharmaceutical Association, the Pharmaceutical Services Negotiating Committee and the Department of Health had to agree on the principle of seamless care. There had to be a will to make it a reality. In each area the local branch, local pharmaceutical committee, primary care groups, health authority and each community and hospital pharmacist would need to work towards this concept. She noted that the Council had responded in detail and favourably to the motion.
Ms JUDITH HESSLEWOOD (Dudley and Stourbridge) seconded the motion.
There being no comments on the motion, it was put to the vote and carried.

Suzanne Johnston
Suzanne Johnston: little progress towards seamless care

Financial regognition

A motion from the Sefton branch called on the Society to "make approaches to the Departments of Health to recognise both financially and formally the advice and care given by community pharmacists".
Proposing the motion, Mr ALAN WOODCOCK said that his branch wanted the Society to be more proactive with the Department of Health as regarded the future development of pharmacy. The usual negotiating mechanisms seemed to have come to a halt because of the Government's indifferent and autocratic approach. The Society should press for the practice allowance to be increased to enable pharmacists to take on more staff to free them for their increasing responsibilities in areas such as NHS Direct.
Mrs VALERIE WELLS (Sefton) seconded the motion.
The motion was carried.

Patient packs

A motion put jointly by the Brighton branch and the East Metropolitan branch and amended slightly by the meeting, successfully proposed that "it is the opinion of this meeting that the Council must exert such pressure as they are able on the relevant authorities to design patient packs to aid concordance and safety".
Mr ANTHONY PUGH (Brighton) in proposing the motion, said that the end user should be able easily to identify the medicine and gain access to it. Package design should involve practising pharmacists, aware of the pitfalls which could cause confusion to customers.
Seconding the motion, Mr ALLAN ASHER (East Metropolitan) said the whole issue of patient packs gave an ideal opportunity to the authorities to produce a good, workable system which had not been taken. The Department of Health and the Medicines Commission should ensure that packs were dispensed in multiples of seven or 28 for ease of prescribing, and common sense should be introduced into the marketing of medicine packs.
The amended motion was carried.

Whole packs

The meeting supported the Dorset branch's call for the Society to "make representations to the relevant bodies aimed at allowing pharmacists to dispense medicines in numbers of whole packs".
Mr PETER THOMAS, in proposing the motion, pointed out that patient packs should not be cut, because it was both unprofessional and potentially hazardous to patients. It might make it impossible to identify the expiry date or the strength of tablets, and there was an increased chance of dispensing errors.
Leaflets might not always be available, in direct contravention of the EC Directive, with possible consequences in an overdose situation.
Mr STAN WHEATLEY (Dorset) seconded the motion.
Mr ALLAN ASHER (East Metropolitan) suggested an amendment, that in place of the word "allowing" the word "requiring" should be substituted, and that the word "Council" should replace "Society".
The PRESIDENT said that pharmacists could not be "required" to do such a thing.
Mr ROGER ODD (head of professional and scientific support, Royal Pharmaceutical Society) explained that there was a legal problem in cases where the doctor prescribed a certain amount and wanted a certain amount. Not to allow pharmacists to do so in specific cases would put them in an impossible situation. He said the word "allowing" should be retained, although the sentiments behind the motion were appreciated.
Mr MEL SMITH (Hull) observed that dispensing doctors prescribed whole packs, and he felt pharmacists should press to alter the law so that doctors would have to prescribe in complete packs.
The amended motion was carried.