The lawfulness of the supply of emergency contraception under group protocols, as in the Manchester trials, was not accepted by all, although no one went so far as to mount a challenge in the courts. The general view was that what was being done was in the public interest and that if any action needed to be taken, it was to clarify the law, rather than to confirm or create legal barriers.
The law has now been clarified, as readers of last week's issue (see p219) will have noted. New Medicines Act amending orders effective throughout the United Kingdom from August 9 pave the way for the supply and administration of prescription-only medicines and pharmacy medicines by designated health care professionals under patient group directions. It will now be lawful to provide written instructions (ie, a patient group direction) for the supply or administration of medicines to groups of patients who might not be individually identified before presentation for treatment.
And as we report this week, further guidance has now been issued for England in the form of a health service circular (see p255). Thus the groundwork is now complete - at least so far as England is concerned - which is perhaps a good time to welcome the changes that have been made, and to commend the work done by Dr June Crown's team reviewing the prescribing, supply and administration of medicines, which, in its first report, prepared the way for these changes to be made (PJ, April 25, 1998, p581).
The guidelines do not specifically mention community pharmacies as suitable places for medicines to be supplied under group directions. Nor, for that matter, do they mention any other particular locality. However, pharmacists are mentioned in the amending orders and included in the list of qualified health professionals who will be able to make a supply. Furthermore, the NHS guidelines make clear that pharmacists will be playing a central role in the new process. In line with the Crown report and the amending orders made as a result of it, pharmacists will be involved in the preparation of patient group directions and a senior pharmacist will be one of the people required to sign off each PGD, once it has been developed.
So, with the first Crown report implemented - what about the second, on prescribing (PJ, March 13, 1999, p346)? The second report advocates the delineation of two types of prescriber: the "independent" prescriber would be responsible for the assessment of patients with undiagnosed conditions, while the "dependent" prescriber would be responsible for continuing care. The opportunities for pharmacy are considerable. We can only hope that the profession will be as content over the outcome of the second report as it is with the first.