From Dr D. J. Temple, FRPharmS, and others
SIR,—We welcome your initiative in publishing the article from Professor
Chapman (PJ, October 21, p615),
which provides his clear view of the implications of the NHS plan for pharmacy
presented by Lord Hunt to the British Pharmaceutical Conference this September.
Like your correspondents Goodyer et al (PJ, October 28, p650),
we are surprised at the lack of discussion within your journal.
We have two points to make. First, nowhere in Chapman’s article does it
make it clear that what is being discussed is an NHS plan for England only.
Scotland and Wales are developing separate plans for primary care, which may
well reflect some points made in the English plan, but will inevitably include
some differences. In fact, in Wales, there has been a series of consultation
meetings, both on a multidisciplinary basis at local level and uniprofessionally
at national level. The pharmacy specific consultation was held in Cardiff in
conjunction with the annual educational weekend in mid October.
The second point relates to the use of technicians in community pharmacy. In
two places in the article, Chapman uses the term “final check” in
relation to the pharmacist’s actions in regard to an item otherwise assembled
by a technician. We would of course concur with the concept that the “ultimate”
check on the safety and appropriateness of a medicine remains the pharmacist’s.
However, we feel that Chapman’s choice of words implies that the time for
this check is at the end of the process, immediately before the medicine is
given to the patient. “Final check” was a term developed through debate
within pharmacy a decade ago, but is not strictly a requirement of the Medicines
Act, which calls for supervision of dispensing by a pharmacist. Current practice,
particularly in the hospital sector, increasingly accommodates the concept of
technicians exercising autonomy in physically dispensing items with no direct
input from a pharmacist within defined standard operating procedures.
The Welsh Centre for Postgraduate Pharmaceutical Education has been involved
in developing a system in the Welsh hospitals of “accredited checking technicians”,
whereby qualified technicians, after suitable training and testing of competence,
are allowed to check the technical aspects of the dispensing process performed
by colleagues. After such checking, items may be issued to patients, provided
that a clinical check of the prescription, considering issues of appropriateness
and safety, has been performed by a pharmacist after the prescription has been
written. This clinical check will often not take place in the pharmacy, as it
will be a key element of the ward work of a clinical pharmacist. Such schemes
are also in place in other areas and we have been asked to help establish a
similar scheme in hospitals in Northern Ireland.
Of specific interest to the pharmacy plan is an extension of this scheme to
some community pharmacies in South Wales, at the request of the pharmacists
themselves. Our interpretation of the Medicines Act has been accepted by the
Royal Pharmaccutical Society’s professional standards directorate and the
National Pharmaceutical Association has accepted that the pharmacist establishing
such a scheme, with technicians working within strict protocols and procedures,
will be covered under the normal chemist defence liability insurance. The first
cohort of technicians are due to sit their competence test in November. It should
be pointed out that although the pharmacist in such a scheme need not perform
a “final check” in terms of timing of their intervention, they must
be present within the pharmacy premises at all times when dispensing services
are provided to the public in order to satisfy the requirements of the Medicines
Act.
David Temple
Guy Thompson
Lesley Morgan
Welsh Centre for Postgraduate Pharmaceutical Education,
Cardiff University