The Pharmaceutical Journal Vol 265 No 7104 p41
July 8, 2000 News

NPA board

Opposition to age restriction for pharmacy sale of levonorgestrel

The National Pharmaceutical Association's board of management has expressed concern that the proposed reclassification of levonorgestrel 0.75mg from prescription only medicine (POM) to a pharmacy (P) medicine status will not allow supply to women aged under 16 years. It is also concerned that reclassification will result in an inequitable two-tier emergency hormonal contraception (EHC) service. In its response to the Medicines Control Agency's proposal (PJ, May 27, p788), the NPA board supported the basic reclassification proposal, but was concerned that limiting supply to those aged 16 years and above would work against a stated objective of increasing accessibility. Board members believed that levonorgestrel should be dealt with under the same criteria as other medicines, rather than be subject to moral judgments in line with the legal age of consent. The response pointed out that, in the health action zone pilot schemes where pharmacists were supplying EHC, the group protocols did not restrict supply to women aged 16 and above. Supply was in accordance with Gillick competence principles, where decisions to supply were based on the ability of the client to understand the treatment being offered and upon their having sufficient discretion to be able to make a wise choice in their best interests. If the proposal was implemented as written, pharmacists supplying to those under 16 years would commit a criminal offence. A due diligence defence was needed to protect pharmacists from becoming criminally liable for an offence arising from care based on misleading information provided by clients. The board also had concerns that the cost of EHC as a pharmacy medicine would significantly reduce overall access to emergency contraception. A key strand of the Department of Health's National Health Service strategy was equity of access. If EHC was available free from other providers, it was inequitable for it to be available only on payment from pharmacies. The board suggested that there should be a mechanism allowing free pharmacy supply of EHC and urged that a recommendation be made in favour of making this possible.

Sale of EHC to clients aged under 16 years would be a criminal offence

Pharmacy's voice The need to create a stronger voice for community pharmacy was emphasised by the NPA board. While not supporting a merger between the NPA and the Pharmaceutical Services Negotiating Committee (PJ, June 24, p938), members agreed that strong and effective representation was needed in view of the unprecedented number of major issues facing pharmacy. Community pharmacy was more likely to get its message across if speaking with one voice, and the NPA's door was always open to forging links with other community pharmacy organisations.
The importance of presenting a cohesive community pharmacy stance had been demonstrated by the concerted action taken by pharmacy contractors in the Isle of Wight following a health authority decision to discontinue payment for monitored dosage services and the disposal of unwanted medicines (PJ, June 24, p939). Unanimity among contractors was crucial.

NHS modernisation consultation With the PSNC and the Company Chemists Association, the NPA had called for the NHS modernisation plans to include policies that built on the accessibility of the community pharmacy network as part of the primary care team. In a joint response to the Government's consultation paper, the organisations highlighted the role community pharmacy could play on three key fronts - ensuring ready access to community-based health care solutions, better use of medicines and encouraging self-care.
Together, the organisations proposed that a national medicines management service, together with community pharmacy-led repeat dispensing services, would help to ensure the appropriate and cost-effective use of medicines.
A pharmacy prescribing role and formal involvement in managing minor ailments would ease the pressure on GP surgery workloads, reduce waiting times and free time for GPs to treat more serious illness.
To discourage unnecessary GP visits for patients exempt from prescription charges, the response called for NHS prescribing by pharmacists of some non-prescription medicines. The organisations stressed the importance of electronic data interchange to ensure the best pharmaceutical care.

P-to-GSL proposals The NPA board opposed moves by the MCA to add famotidine and heparinoid (for external use) to the general sale list Order and to increase the pack sizes of bisacodyl for GSL sale (PJ, May 20, p745). The response said that H2 antagonists were not suitable for long term or repeated use without monitoring. They could mask the symptoms of early gastric cancers. Sale solely from pharmacies meant that pharmacists could assess when sale was safe and appropriate. The response pointed out that, although the soft tissue injuries that heparinoid was used for were not serious, the presence of bruising without apparent injury might indicate an underlying blood disorder resulting from an adverse drug reaction or other cause. It also recommended that packs of more than 10 bisacodyl tablets should remain pharmacy medicines. Non-pharmacy sale of larger packs could exacerbate the problem of misuse of laxatives.