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Lords reject bid to stop emergency contraception sales
from pharmacies
The House of Lords has rejected an attempt by some of its members to
overturn the Prescription Only Medicines (Human Use) Amendment (No 3)
Order 2000 and so prevent the sale of Levonelle (levonorgestrel) from
pharmacies for emergency contraception.
Peers rejected the proposal by 177 votes to 95 on January 29.
Launching her attack on the order, Baroness Young said that what she opposed
was not the principle that pharmacists should be able to supply a wider
range of medicines, but that the change in the law would encourage unprotected
sexual intercourse and promiscuity. Nevertheless, she was concerned that
girls below the age of consent were able to obtain Levonelle and that
pharmacists could sell it with no knowledge of their medical history.
Baroness Young also argued that the introduction of the Order had bypassed
normal Parliamentary scrutiny because it was brought into force less than
40 days after being introduced to Parliament.
Supporting Lady Young, Earl Howe said that some pharmacists were alarmed
at what they were being asked to do. He said that the Royal Pharmaceutical
Society’s list of questions that should be asked of potential purchasers
was itself long enough to question the wisdom of what was supposed to
happen. He did not see how a brief interview could satisfy a pharmacist
that a supply would be safe. The Society’s guidelines did not cover all
the risks outlined in Levonelle’s information leaflet. This meant that
patients were entirely dependent on an individual pharmacist’s ethical
and professional standards. Women would gravitate to pharmacies where
there was the least hassle and that was where trouble was likely to begin.
Referring to allegations made against pharmacists in the Daily Mail,
Earl Howe said: “While the Royal Pharmaceutical Society, without doubt,
approached this whole issue in a completely responsible and professional
way, the same cannot necessarily be said of all its members.”
Support for the Order was led by Baroness Gould of Potternewton, who is
president of the Family Planning Association. She said that it was predominantly
mature women in stable relationships who sought emergency contraception
and not wild, immature, young women. Emergency contraception needed to
be taken as soon as possible after unprotected sexual intercourse and
its availability from pharmacies had many advantages which should not
be lost. She added that the Committee on Safety of Medicines and the Medicines
Commission had gone through the proper procedures and had advised that
levonorgestrel was safe and effective.
Lord Rea (a retired general medical practitioner) said that one reason
emergency contraception had been little used by teenagers was that they
were reluctant to see a GP who knew them. Pharmacists would be able to
give good advice based on their protocols.
Lord Hunt (Parliamentary Under-Secretary of State for Health) told the
House that he did not share Earl Howe’s concerns. The pharmacy profession
had considerable experience in the move of medicines from prescription
control to pharmacy sale. Pharmacists were ideally placed to provide advice
on regular methods of contraception and local family planning services
to help women avoid the use of emergency contraception in the future.
“Furthermore, I am satisfied that the overall rigorous approach to regulation
within the pharmacy profession will ensure that sufficient safeguards
are put in place,” the Minister said.
Also opposing the call, Lord Carlile of Berriew described the Royal Pharmaceutical
Society as an extremely responsible body and regulator of the profession
which would enforce professional standards concerning the supply of emergency
contraception.
The full House of Lords debate, along with details of how peers voted,
is available on the internet at www.parliament.the-stationery-office.co.uk/pa/ld/ldhansrd.htm.
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High score for Bradford teaching
The quality of teaching in pharmacy and pharmacology at the Bradford
school of pharmacy has been given a score of 23 out of a possible 24 marks
by the Quality Assurance Agency for Higher Education (QAA). The score
is in line with the other schools of pharmacy which have been assessed
so far, all of which have scored between 22 and 24 marks (PJ, March
4, 2000, p355).
The only one of the six assessment criteria for which the school did not
receive full marks was that of quality management and enhancement. The
agency said that there was room for improvement in areas related to the
setting of examinations, assessing staff performance and self-assessment
by students.
The school of pharmacy has also been awarded an internal award for excellence
by the University of Bradford for its work on the Investors in People
quality standard.
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Superdrug defends internet EHC sales
The general manager of Superdrug’s internet pharmacy site, Superdrug.com,
(Mr Barry Simner) told The Journal on January 30 that he believed
that the sale of emergency hormonal contraception over the internet met
a need from customers.
Mr Simner said that EHC sales had started through the internet on January
19 without adverse comment. Superdrug had a robust protocol for such sales
and an audit trail of sales. Those asking for the product were called
back by one of the company’s pharmacists to discuss their situation. Customers
could collect the product from Superdrug pharmacies or, if they lived
within the M25 motorway area, they could have the product delivered by
courier for an additional fee of £7.50.
A Superdrug press release was received by the media on January 26 and,
later that day, the service was suspended following discussions with the
Royal Pharmaceutical Society. Mr Simner said that it would remain suspended
until discussions had been satisfactorily completed.
Superdrug’s service was criticised several times in the House of Lords
debate on January 29. For example, Baroness Walmsley said: “I also welcome
the fact that Superdrug has shelved the idea of selling the product over
the internet. The safeguards and advice available through this method
are just not good enough.”
Mr Simner said that he had had a constructive discussion with Lord Hunt
(Parliamentary Under-Secretary of State for Health) before the debate.
Lord Hunt said during the debate that supply via the internet was legal.
The issue was whether, in making such supplies, companies followed the
minimum standards laid down by the Society.
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Be on your guard, Society warns
The Royal Pharmaceutical Society’s director of public affairs (Ms Beverley
Parkin) has warned pharmacists not to be caught out by sections of the
media which might try to detect and expose any shortfall in professional
standards.
Following the decision of the House of Lords to support the pharmacy classification
of emergency contraception, Ms Parkin told The Journal: “There
has been a huge vote of confidence in the profession from Parliamentarians.
Pharmacists must now be aware that they will be under considerable scrutiny
from sections of the media which will inevitably be trying to find the
profession wanting.”
Outlining the effort the Society had put into supporting EHC over the
past two weeks, Ms Parkin said that members of the House of Commons and
50 peers had been sent a briefing document before their respective debates
on the matter. Many had also been briefed in person. In addition, the
Society had circulated an open letter issued in conjunction with the Royal
College of General Practitioners, the British Medical Association’s general
practitioners’ committee and the Royal College of Nursing.
There had also been significant liaison between the Society, family planning
organisations and others.
The Society’s President (Mrs Christine Glover) added: “Pharmacists will
be delighted with the outcome of the Lords vote. Peers have confirmed
the Government’s confidence in the ability of pharmacists to safely and
effectively supply EHC as a pharmacy medicine. Pharmacists now have the
opportunity to demonstrate that they are more than able and willing to
rise to the challenge of providing this service appropriately. I am confident
that the profession will deliver a responsible, professional service.
We believe that this service is in the public interest and, as part of
a national strategy to reduce unwanted pregnancy and abortion, will work
for the benefit of society. Our view is supported by the other health
professions and by organisations representing public health and family
planning.”
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Levonelle launched
Levonelle was launched to the press and public as a pharmacy medicine
at a press conference on January 30.
Mr Peter Curphey, who chaired a Royal Pharmaceutical Society advisory
group which drew up standards for the pharmacy supply of Levonelle, said
that pharmacy’s contribution to contraception and sexual health should
not be seen as an emergency only walk-in, walk-out service.
He said that supply via the internet was premature, but that there was
no straightforward evidence against it.
Responding to a question about how the Society would ensure best practice
in the sale of Levonelle, Mr Curphey said that professional bodies did
not exist to beat people about the head when they got things wrong, they
were there to ensure consistency and high standards. Referring to journalistic
investigations, he said: “We are in a position where we are vulnerable
to that sort of inquiry. We have no problem with journalists who expose
bad practice.”
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IPMI sends out survey
The Institute of Pharmacy Management International has sent out questionnaires
for its 11th annual survey of pharmacy personnel, recruitment and salaries.
The survey is aimed at the largest multiple pharmacy groups, but contributions
from smaller groups or single independent pharmacies are welcomed in order
to give the survey a broader perspective. Copies of the questionnaire
can be obtained from Workforce Survey, Green Pharmacy Consultants, Silver
Birches, Cuttinglye Road, Crawley Down, West Sussex RH10 4LR (fax 01342
715312) and should be returned by February 23.
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Standards set for cancer services
Standards for hospital pharmacy departments involved with the provision
of chemotherapy have been set by the Department of Health.
The standards are laid down in section 6 of a manual of cancer services
standards, which was launched by the Secretary of State for Health (Mr
Alan Milburn) on January 18. One of their principal objectives is to ensure
that chemotherapy prescribing is overseen by appropriate specialists,
including pharmacists.
Four out of seven standards concerning pharmaceutical aspects of chemotherapy
services are categorised as level 1* standards, which means that they
should be considered a top priority for implementation. One such priority,
which covers two of the standards, is the designation of named pharmacists
as having specific responsibilities stated in their job descriptions giving
them overall responsibility for pharmaceutical services to named wards,
ward areas or out-patient facilities. The others are the creation of a
group of designated pharmacists to deal with pharmaceutical issues arising
from the chemotherapy standards for each cancer network and the presence
of at least one designated pharmacist from each pharmacy dealing with
chemotherapy on these groups. The document defines a cancer network as
the commissioners (health authorities, primary care groups and trusts),
providers (primary and community care providers and hospitals), the voluntary
sector and local authorities responsible for cancer services to populations
from 1m to 2m people. The other standards for pharmaceutical aspects of
chemotherapy cover: the inspection of preparation units by Medicines Control
Agency inspectors, if they are licensed units, or by regional quality
controllers in the case of unlicensed units; the inclusion of designated
pharmacists on drug and therapeutics committees; and the frequency of
meetings of the designated pharmacists’ groups.
Further standards require all cytotoxic prescriptions to be checked and
signed by pharmacists.
The wide ranging document also includes standards for the administration
of chemotherapy - a matter which has been in the news recently as a result
of the inappropriate spinal injection of vincristine at the Queen’s Medical
Centre, Nottingham.
The standards say that chemotherapy is usually administered during normal
working hours by trained chemotherapy nurses. If treatment is to be administered
by medical staff, it should only be after they have undertaken supervised
training and have administered treatment under the direct supervision
of a trained nurse, the manual says.
The manual can be found on the internet at www.doh.gov.uk/cancer.
Letter, p149
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Princess Royal opens “Square” theatre
The Princess Royal, who is chancellor of the University of London, visited
the School of Pharmacy on January 24 to open a new lecture theatre.
The new facility, converted from the school’s assembly hall, provides
an additional 300 sq m of teaching space with state-of-the-art audio visual
facilities on the ground floor and a further 300 sq m of research and
study space on a newly constructed mezzanine floor. The ground floor teaching
space includes retractable seating which compresses and folds against
one wall so that it can be used either as one large lecture theatre, seating
170, or as three seminar rooms.
The new lecture theatre is called the Maplethorpe Theatre, after Cyril
Maple-thorpe, who graduated from the “Square” in 1922 and was President
of the Pharmaceutical Society from 1963 to 1965. Mr Maplethorpe later
became a founding member of the School of Pharmacy’s council and, together
with Mr F. W. Adams, had a profound influence on pharmaceutical education
in Britain.
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Pharmacists give Welsh evidence
Four pharmacists gave evidence to the Welsh Assembly’s audit committee
on January 25. They were
- Mr Phil Parry (chairman, Welsh Central Pharmaceutical Committee)
- Mr Christopher Martin (vice-chairman, WCPC)
- Mrs Erica Barrie (secretary, Welsh Executive of the Royal Pharmaceutical
Society)
- Miss Ann Lewis (Secretary and Registrar, Royal Pharmaceutical Society)
The committee is considering a report from the auditor general for Wales
on maximising income from prescription charges (PJ, December 23/30,
2000, p904).
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Book website
A website dealing in books for academics and professionals has been
launched (www.profbooks.com). The
site has been established by Mr Simon Boisseau, formerly a marketing executive
for the Pharmaceutical Press.
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Aristolochia ban to be permanent
A temporary ban on the inclusion in herbal medicines of aristolochia
species and ingredients that can be confused with aristolochia species
(PJ, January 29, 2000, p171)
is to be made permanent on July 1 after a consultation exercise.
Aristolochia species are considered to pose a serious risk to public health
because aristolochic acids are mutagenic, carcinogenic and cause kidney
damage. The ban on other species is necessary because a number of plants
have similar common or Pin Yin names, or because Chinese herbal tradition
allows the interchange of plants with similar medicinal properties.
The ingredients affected are all aristolochia species, along with Akebia
quinata, A trifoliata, Clematis armandii, C montana,
Cocculus laurifoliu, C orbiculatus, C trilobus and
Stephania tetrandra and their extracts. In addition, Chinese herbs
described as Mu Tong or Fangji are banned, along with their extracts.
Comments on the proposed ban can be sent to Miss Joy Gay, Medicines Control
Agency, Room 16/133, Market Towers, 1 Nine Elms Lane, London SW8 5NQ until
March 16.
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More primary care awards available
A new award for postdoctoral researchers in primary care has been announced
by the Department of Health, in conjunction with PPP Healthcare medical
trust.
The new award is aimed at supporting outstanding individuals who have
completed research training resulting in a doctorate degree. The award,
for three years (or four years pro-rata part-time), is intended to consolidate
research experience and prepare them to become independent research leaders
through training and mentoring.
The Department is also inviting applications for the third round of its
primary care researcher development and primary care career scientist
awards. The researcher awards are intended to identify and fast track
individuals through customised training programmes. They are postdoctoral
awards for three years. The scientist awards are intended to unblock the
career pathways of high-calibre individuals who are at the stage of developing
their own programmes of research. The awards are made to individuals for
five years. All of the awards cover salary, tuition, a contribution towards
research costs and a conference allowance.
Application forms for the awards are available from Mrs Linda Robinson,
Research School of Medicine, University of Leeds, 24 Hyde Terrace, Leeds
LS2 9LN (tel 0113 233 6668) or from the Department’s website (www.doh.gov.uk/research).
The closing date for applications is March 26.
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Indian earthquake appeal
Pharmacists who would like to make immediate donations to help those
affected by the recent earthquake in Gujarat, India, can contact charities
recommended by Mr Kirit Patel and Mr Hemant Patel (members of the Royal
Pharmaceutical Society’s Council).
The Anoopam Mission is supplying food, water and clothing through its
mission in India. It can be contacted at
Brahmajyoti
The Lea
Western Avenue
Denham
Uxbridge UB9 4NA
Tel 01895 832709
Donations can be made directly to Lloyds TSB (sort code 30-98-91) account
028858602 (Gujarat earthquake relief fund). The Federation of Patidar
Associations has opened a FPA Gujarat relief fund. It can be contacted
at
Patidar House
22 London Road
Wembley HA9 7EX
Ttel 020 8795 1648
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NPA Board report: NPA instructs solicitors over Daily
Mail allegations
The National Pharmaceutical Association’s solicitor has written to the
Daily Mail about what the NPA board regards as a misleading and
inaccurate article on emergency hormonal contraception (see PJ,
January 13, p40). The decision
to instruct the solicitor was taken at the NPA board’s January meeting.
The newspaper article claimed that many pharmacists were flouting EHC
guidelines by supplying to a girl under 16 years of age. The claim was
repeated in a further article (PJ, January 27, p101).
The first article named six pharmacies and failed to appreciate the difference
between supply under patient group direction (PGD) as opposed to over-the-counter
supply, despite the newspaper having been made aware of the difference
prior to publication. All of the pharmacies investigated by the Daily
Mail were participants in the Lambeth, Southwark and Lewisham health
authority EHC PGD pilot, had complied with the PGD and were NPA members.
The solicitor’s letter clarified the legal position on supply of EHC,
making clear the distinction between PGD as opposed to OTC supply. It
pointed out the NPA’s concern about the serious nature of the inaccurate
and misleading impression conveyed by the article and made it clear that
pharmacists had not broken any rules nor flouted any guidelines. The letter
sought an apology and correction and said that the pharmacies referred
to in the article reserved their rights to take further action.
Board members also decided that the NPA chief executive (Mr John D’Arcy)
should write to all NPA members to emphasise the need to handle requests
for EHC with extra diligence and sensitivity. The letter would remind
members that they should be fully conversant with the Royal Pharmaceutical
Society’s guidance on EHC and should have completed the recently published
centres for pharmacy postgraduate education training pack. Members would
also be reminded of the NPA/Schering Health Care training pack for medicine
counter assistants. The NPA would develop a patient information leaflet
for use by pharmacists who did not wish to provide emergency contraception.
Other matters considered at the NPA board’s January meeting are reported
below.
Nicotine replacement A robust argument against a proposal
to make products for nicotine replacement therapy general sale list medicines
would be sent to the Medicines Control Agency. Board members were concerned
that no advice would be available to smokers who purchased NRT outside
pharmacies and that this would make failure to stop smoking more likely.
The Government’s proposal to make NRT prescribable on the NHS was welcomed.
However, board members felt that allowing items to be repeatedly prescribed
was neither cost-effective, nor in the patient’s best interests. They
suggested that NRT practice guidelines should be developed for all health
care professionals and that pharmacists should be allowed to prescribe
the products.
Veterinary dispensing It was felt that pharmacists were
ideally placed to take a more active role in the supply of veterinary
medicines. However, pharmacists were frustrated because very few veterinary
prescriptions were written and products could not be easily obtained from
manufacturers or wholesalers. It was hoped that due regard would be given
to pharmacy’s role by a Veterinary Medicines Directorate review group.
GSL additions Responding to a Medicines Control Agency proposal
to classify a number of products as GSL (PJ, December 9, 2000,
p845), the NPA had
argued that the public was best served if all non-prescription medicines
were restricted to pharmacy sale.
Health and Social Care Bill It was recognised that most
of the pharmacy-related provisions in the Health and Social Care Bill
were to allow implementation of the National Health Service pharmacy plan.
It was decided to ask that implementing legislation should have regard
to the importance of the pharmacy network. Clause 59 of the Bill, which
proposes controls over patient information, gave the NPA board particular
concerns. It was agreed to would insist powers taken under the Bill should
not stop pharmacists using anonymised patient data to improve the efficiency
of their pharmacy businesses.
e-Pharmacy indemnity To encourage a clicks-and-mortar approach
to e-pharmacy, it was decided to offer professional indemnity for e-pharmacy
services only where they were incidental to a United Kingdom-based bricks-and-mortar
pharmacy business and represented no more than 10 per cent of turnover
for pharmacies with turnovers up to £2.5m per set of premises. Cover above
these limits would be at the NPA board’s discretion. Compliance with the
Royal Pharmaceutical Society’s interim standards for internet pharmacy
would be required.
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Domiciliary service survey planned
The Mental Health Foundation (MHF) is calling for evidence on community
pharmacy home visiting services for people with dementia and their carers.
The inquiry is part of a new MHF programme to evaluate community support
for people with early dementia.
An MHF statement on January 24 said: “Although some pharmacists do make
home visits, it is usually through good will, rather than because of any
specific local policy. With the National Health Service pharmacy plan
providing a framework for community pharmacists to become more actively
involved in care, it is time to make home visiting pharmacy available
for those people who would find it particularly helpful and to provide
pharmacists with the training and resources they need.”
Details from Jayne Lingard, Mental Health Foundation, 20/21 Cornwall Terrace,
London NW1 4QL (e-mail jlingard@mhf.org.uk).
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