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PSNC secures Health Bill change
The position of existing pharmacy contractors will have to be considered
before any local pharmaceutical services (LPS) pilot is established, following
amendments to the Health and Social Care Bill made after pressure from
the Pharmaceutical Services Negotiating Committee.
In a statement issued on February 5, Mr Wally Dove (chairman, PSNC) said:
"This is an important victory for us. In our meetings with Lord Hunt
(Parliamentary Under-Secretary of State for Health) and his civil servants
since the Bill was published, we have been stressing our concern that
the introduction of LPS contracts could have a damaging effect on existing
pharmacy services, especially where those new LPS services are provided
by people other than pharmacy contractors. We do not want that damage
to happen, the public does not want it to happen, and I am pleased to
see that the Government does not either.
"Lord Hunt listened carefully to our arguments and has acted on them.
We are grateful to him and his civil servants, and to John Denham, the
Minister who took the amendment through the Commons committee which is
examining the Bill.
"The Government has been determined to push this Bill through quickly
and has resisted nearly all attempts to amend it. That makes our success
all the more notable.
"Contractors can feel more confident now about the future than they
might have done when the Bill was first published, and the public are
more likely to avoid the risk of disruption to existing services on which
they rely. I think that is good news all round."
As originally drafted the Bill did not require health authorities to take
into account the effect LPS could have on existing pharmaceutical services.
An amendment to schedule 2 was tabled during the standing committee's
review of the Bill on February 1 by the Minister of State for Health (Mr
John Denham) and approved without a vote.
The Government has also come under pressure to amend Clause 59 of the
Bill. This clause would restrict the processing of patient information,
however it was recorded and regardless of whether individuals could be
identified.
Mr Denham indicated on February 2 that the Government saw one of the aims
of Clause 59 as stopping sales of anonymised patient information to the
pharmaceutical industry for marketing purposes.
In 1999, the Department of Health took legal action to ban the sale of
such information by Source Informatics Ltd, saying that it would breach
patient confidentiality, but the ban was overturned on appeal (PJ,
January 1, 2000, p5).
Mr Denham said: "The aim of such marketing was to drive up the costs
of drugs prescribed on the National Health Service and, if successful,
would lead to a waste of resources.
"We do not believe that it is right that companies should make money
out of patients' information in this way. The aim of the Bill is to stop
this, not to ban independent reports as some commentators had suggested."
It had been suggested in the press that the clause would stop investigations
into the state of the NHS by all but Government approved investigators.
Mr Denham said that the Government would be taking into consideration
concerns raised by professional bodies that restrictions on the use of
patient information would affect the maintenance of cancer registries
and other medical databases.
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Separate pharmacy prescribing decision for Scotland
Prescribing rights for pharmacists in Scotland will be introduced separately
from prescribing rights for pharmacists in England and Wales.
That became clear during a debate on the Health and Social Care Bill in
the Scottish Parliament on January 17.
Mr Malcolm Chisholm (Deputy Minister for Health and Social Care) said
that the Bill proposed enabling powers in respect of the authorising of
new groups of prescribers under the Medicines Act 1968, which was a reserved
power for the Scottish Parliament. The proposed enabling amendments provided
the legal framework for such a change and amendment of the National Health
Service (Scotland) Act 1978 would enable Scottish ministers to give newly
authorised prescribers NHS prescribing rights in Scotland.
Although the Medicines Act 1968 and the National Health Service (Scotland)
Act 1978 were being amended in parallel so that the changes were available
for implementation throughout the United Kingdom, it was for the Scottish
Executive to decide whether, and to what extent, that legislation should
be enacted in Scotland. Important considerations were patient safety,
continuity of care, avoiding fragmentation of services and safeguarding
patient choice and convenience.
Before any new NHS prescribers were designated, Ministers would have to
be satisfied that there was clinical need, that new prescribers were properly
trained and that their skills could be kept up to date. Health care professions
that might be considered for prescribing rights include pharmacy, chiropody
and physiotherapy.
"With all those safeguards in place, I believe that extending the
right to prescribe will help to break down the divisions between health
professions and will play an important role in the introduction of more
flexible team working across the whole of the UK," Mr Chisholm said.
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Society lobbies MPs over Health Bill
The Royal Pharmaceutical Society has lobbied the Members of Parliament
who are considering the Health and Social Care Bill in its committee stage
(PJ, January 27, p102).
The Society expressed concern about the effects which the Bill might have
on employment of pharmacy locums, the existing provision of pharmaceutical
services and the use of patient information.
In a briefing paper sent to MPs, the Society said that it foresaw a number
of practical difficulties with health authorities maintaining lists of
pharmacists who might provide services in their areas, particularly with
regard to locums. The Society noted that there was a national shortfall
in the pharmacist workforce in primary and secondary care, exacerbated
by the fallow year this year following the move to four-year degree courses.
The population of locums was increasingly mobile. Provision needed to
be made for health authorities to share information in such a way that
did not create barriers to pharmacist recruitment.
The Society added that criteria for exclusions from any of these lists
would need to be in line with new regulatory powers the Society was working
towards.
On local pharmaceutical services (LPS), the Society said that it wanted
to see strong strategic and management input by pharmacists into their
planning and implementation. The Society was concerned to see that the
introduction of LPS pilots did not prejudice existing pharmacies, particularly
in remote or disadvantaged communities.
On control of patient information (Clause 59 of the Bill), the Society
wanted to ensure that any new provisions were flexible enough to take
account of the patient information captured on pharmacy patient medication
record systems, which it felt could be of use in public health strategies.
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Pharmacist prescribing in Wales by 2004
Pharmacists in Wales could be prescribing under the National Health
Service by 2004 under the National Assembly's NHS plan unveiled on February
2.
The Welsh plan is entitled "Improving health in Wales — a plan
for the NHS with its partners". In the section headed pharmacy [pages
11 and 12], it says that implementating the Crown report on prescribing
by 2004 "should provide patients with more convenient and efficient
access to medicines. As a consequence, it will dramatically increase the
number of professionals who can write prescriptions and take responsibility
for their administration and effectiveness."
It adds that the aims for future pharmacy services are better access for
service users, better use of medicines, redesigning services around patients,
and ensuring high quality services.
The five areas highlighted by the Royal Pharmaceutical Society as a result
of the Pharmacy in a New Age process — management of prescribed drugs,
management of long-term conditions, management of common ailments, promotion
and support of healthy lifestyles, and the provision of advice and support
to other professionals — are all "areas needing to be developed".
The plan says that pharmacists will "review the current boundaries
of their responsibilities and expertise and then change their working
practices to ensure that services provided put patients at the very centre
of health care delivery".
There are real opportunities to develop more responsive, flexible and
integrated pharmacy services in community and primary care, the plan says.
The Assembly's health and social services committee has established a
task and finish group to consider options to improve the prescribing of
drugs, the provision of pharmaceutical services and the supply of pharmaceuticals
in Wales. The group will report in March when the Assembly will consider
and, where appropriate, implement its recommendations. The plan is available
on the Assembly's website (www.wales.gov.uk/polinfo/health/health_e.htm).
Other proposals included in the Welsh NHS plan are:
- Abolition of health authorities by 2003, with the National Assembly
taking control of health through a health and wellbeing partnership
council
- Representation on local health groups extended to include local government
members
- Keeping community health councils
- Freeze on prescription charges and free prescriptions for those under
25 years
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BMA report calls for honest rationing in health care
A British Medical Association report has called for an open, honest
approach to rationing health care.
The report, which took a year to produce, sees little potential in alternative
funding mechanisms which, it argues, could be more costly to run and would
not provide the equal access that the public values so highly. Instead
it argues that a more open and honest approach to rationing is needed.
The report says that increased resources alone, although an essential
precondition to improving services, can never be a complete solution.
The chairman of the steering group which oversaw the production of the
report (Dr Ian Bogle) said: "We have looked at other methods of funding
health care, but these can never resolve the rationing dilemma. Whatever
funding method we adopt and however much money we spend on health care,
we will always reach a point at which the cost of treatment begins to
outweigh the benefits. We have to accept the prospect of treatments being
excluded from the National Health Service if we want to maintain a universal
service — one which is available to everyone and essentially free
at the point of use."
The report says that the concept of the NHS as a comprehensive service
may have outlived its usefulness and that it will be increasingly commonplace
to see treatments excluded from the NHS if they are judged to be of limited
clinical effectiveness. An informed public needs to be brought into these
discussions about the cost-effectiveness of treatment and the appropriate
use of public funds.
The report's findings are based on opinion polls, written evidence and
surveys of recent research. It looks at what the public wants from the
health care system and explores different approaches to funding it.
Dr Bogle added: "The report is not advocating a two-tier service.
The Government and the public must decide how much money they are prepared
to put into the NHS, and this will dictate the service that can be offered.
But if people as individuals are not satisfied with this, we cannot and
should not stop them going to the private sector. Although we see an expanded
role for the private sector, we do not see tax relief on private medical
insurance or other fiscal incentives as a particularly efficient way of
spending public money."
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Boots denies job cuts
The Boots Co Plc has denied media reports that it is planning to cut
more than 1,000 jobs, mainly from Boots the Chemists. Mr Francis Thomas
(group media relations manager, Boots) told The Journal on February
6 that despite a report in the Financial Times on February 5 this
was "simply not the case". Mr Thomas added that Boots had no
plans to demerge either Boots Healthcare International (its non-prescription
medicines business) or Halfords.
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First Royal Pharmaceutical Society in Scotland LHCC
practice award
The first Royal Pharmaceutical Society in Scotland local health care
co-operative practice award was won by Miss Sheila Tennant for a poster
presented at the Society's LHCC conference on January 14. Co-authors with
Miss Tennant were Mrs Elizabeth McGovern and Mrs Carolyn Mackay.
The poster described an audit of medicines returned to pharmacies in the
Anniesland, Bearsden and Milngavie LHCC. All 10 pharmacies in the LHCC
area were involved in the study, which made use of a modified Royal Pharmaceutical
Society audit template on drug wastage. They identified wastage, extrapolated
across the Greater Glasgow health board area, of close to £500,000
a year.
A runners-up award went to Mrs Kim Munro and Mrs Lesley Thomson of the
Central Aberdeenshire LHCC's prescribing group. Their poster described
the development of a disease-based acute electronic formulary based on
a local joint formulary, incorporating national and local guidelines.
Gehe UK has offered to support the award in future.
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Integrated services should be developed locally rather
than at LHCC level
An integrated approach to the delivery of health care should be developed
at a more community-based, local level than at that of local health care
co-operatives, the Royal Pharmaceutical Society in Scotland's LHCC conference
was told on January 14.
Mr Michael Sawyer (head of social work, Fife council) said that Fife had
five LHCCs, but over 20 communities. The strength of pharmacy was that
it was at the heart of these communities, he said.
Fife pharmacists had carried out pilot projects looking at medication
in nursing and residential homes. Collaborative working between the home
staff, general medical practitioners and pharmacists had reduced medicines
use. This had made a great difference to the quality of care. Consideration
was now being given to extending this service to home care.
People could not stay in professional silos, he said. Joint teams were
needed, which should, with the support and help of LHCCs, be split down
below LHCC level.
Mrs Grace Christie (clinical lead nurse, Forth Valley LHCC) said that
pharmacists should be recognised as part of the primary care team. Nurse
prescribing, if extended, would need the support of pharmacists, especially
in an educational role. Pharmacists could help in nursing formulary development,
particularly at locality level. Health needs and care were now so complex
that joint planning was essential.
Dr Marion Storrie (clinical director, Midlothian LHCC), who described
herself as a pharmacist groupie, said that LHCCs needed pharmacists' skills,
both pharmacological and with people. Pharmacists were articulate and
were good at communicating with patients. However, there were still difficulties
within community pharmacy where some pharmacists did not want to take
on extended roles. Pharmacy, as a profession, should do this and undertake
the accreditation that went with it.
The view that pharmacists should be recognised as primary care team members
was supported by Mr Brian Smyth (general manager, Dundee LHCC). Multidisciplinary
and multi-agency groups supported all the LHCC's major clinical objectives
(coronary heart disease, cancer, mental health, community care, chronic
obstructive pulmonary disease, children and young persons, prescribing
and quality). Areas in which pharmacists could make a difference included
quality and cost-effectiveness, drug wastage, hospital discharge, repeat
prescribing, minor ailments, health education and promotion, mental health
in primary care, chronic disease management, prescribing, medication review,
acute services review, community resource centres and primary care centres.
However, he felt that a number of barriers needed to be overcome. The
pharmacy contract was archaic and there should be personal medical services
type schemes. A modern service needed modern legislation, he said.
He took the view that community pharmacy premises were another barrier,
as were out-of-hours arrangements. It was also necessary to establish
how practice pharmacists and community pharmacists should work together
and for pharmacists' involvement in LHCCs to be adequately resourced.
Presenting a management perspective, Mr David Bolton (director of primary
care and community services development, Lothian Primary Care NHS trust)
said that pharmacists needed to influence and develop best practice. Pharmacists
were well placed to translate policy development at a local level. Community
pharmacists needed to be engaged in this as much as possible. Pharmacists
who were involved in LHCCs were usually employed by trusts. This was a
good start, but was it the way forward. Trials to engage community pharmacy
were needed.
The final speaker, Mr Bill Scott (chief pharmaceutical officer, Scottish
Executive Health Department) said that the rebirth of the National Health
Service in Scotland was about virtual primary care teams and not bricks
and mortar. Pharmacy's role in Scotland was being extended, but so too
was the use of pharmacy premises and facilities.
A move away from an antiquated system of remuneration was needed. —
Contributed.
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EHC in the media spotlight again
Community pharmacists supplying emergency hormonal contraception came
under fire in a report on ITV's Tonight with Trevor McDonald programme
on February 1.
The programme showed covert video recordings of a 15-year-old girl buying
Levonelle as a pharmacy medicine and obtaining it from pharmacies operating
under a patient group direction (PGD) in the Manchester, Salford and Trafford
health action zone (MSL HAZ).
Pharmacists who sold the product were criticised for not seeking documentary
proof of the under-age girl's claim to be 16 years old, despite her insistence
that she was 16 when questioned.
Specific criticism was levelled at an MSL HAZ pharmacist who provided
the girl with a pack of Schering PC4, when the PGD called for Levonelle.
He gave the girl a Levonelle instruction leaflet.
When the MSL HAZ pilot for supplying EHC under a protocol began (PJ,
January 8, 2000, p44),
it called for PC4 to be supplied, as that was the only EHC product at
the time. Levonelle-2 was substituted when it became available.
The programme reported that the pharmacist who supplied PC4 was subsequently
removed from the list of those authorised under the PGD.
Mrs Karen O'Brien (project manager, emergency contraception scheme, MSL
HAZ) told The Journal that she had concerns over the way the investigations
were carried out by the programme. For example, pharmacists selling Levonelle
as a pharmacy medicine had asked the girls their age but the girls had
lied. This was a problem because, even if pharmacists asked for proof
of age, girls could easily supply false identification. In addition, footage
of conversations between pharmacists and clients had been edited so that
the results did not reflect the nature of the whole consultations.
Mrs O'Brien had spoken to all the pharmacists involved. All pharmacists
had followed the protocol of the PGD except one, who had supplied PC4
instead of Levonelle. That case was being investigated, she said.
However, Mrs O'Brien said that it was particularly important to remember
that there were two routes of supply of EHC — through PGDs and as
a pharmacy medicine. It was important to reinforce the positives of both
schemes, she said. They were interchangeable, and pharmacists involved
in either needed to work together to make them successful. Pharmacists
who were not involved in a PGD should refer patients who could not afford
to purchase Levonelle to a pharmacist who was in a PGD, and patients who
could not be supplied Levonelle under a PGD should be referred to a pharmacist
from whom they could purchase it, she said.
The Royal Pharmaceutical Society's director of public affairs, Ms Beverley
Parkin, told The Journal that the Society was "very concerned
about the sensationalist approach to journalism".
The Society had issued a statement to the Tonight programme before
it was broadcast, which had not been used during the programme. The statement
had highlighted the Society's concerns that pharmacists were being deterred
from supplying the product legitimately to women who look young.
Ms Parkin added that pharmacists were trying hard to establish a professional
service in the interests of patients.
A spokeman for the Tonight with Trevor MacDonald programme told
The Journal on February 6: "What the programme sought to illustrate
was the incredible muddle at the point of sale of the morning-after pill.
We reflected that this is open to abuse and misunderstanding which the
British Medical Association agree with."
"We are not accusing all pharmacists — a point that we made
clear in the programme," he added.
Mr John D'Arcy (chief executive, National Pharmaceutical Association)
told The Journal: "It is inevitable that programmes will focus
on negative aspects rather than good ones."
Pharmacists had appeared to be slightly nervous with arrangements but
this was hardly surprising considering how new pharmacy supply was and
the recent negative publicity it had received.
The programme had highlighted the dilemma between pharmacy supply, which
was licensed for over-16s, and other types of supply, such as PGDs, where
professional discretion was possible, he said. Pharmacists in the programme
looked as if they were following a protocol but, because only small segments
were shown, the full content of the consultation was not known.
Mr D'Arcy added that the NPA recommended that pharmacists read and followed
the Society's guidance, completed available training packages on EHC and
ensured that all staff knew to refer all requests for EHC to the pharmacist.
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NPA publishes three resource packs
Three new resource packs have been produced by the National Pharmaceutical
Association for members and local pharmaceutical committee secretaries.
One, on the English NHS and pharmacy plans, is intended for use in discussions
with health authorities and primary care groups and trusts. Another, on
emergency hormonal contraception, summarises and analyses the policy background
to teenage pregnancy and health action zones. It lists lessons that have
been learnt from the first three schemes set up in England and key issues
for planning similar schemes. The third resource pack examines the need
for community pharmacy representatives on the primary care trust executive
committees.
All three packs are available from the NPA Professional Development Department,
Mallinson House, 38-42 St Peter's Street, St Albans, Hertfordshire AL1
3NP.
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NICE to look at cancer and heart drugs
Cancer treatments and thrombolytic drugs are among the topics that might
be looked at by the National Institute for Clinical Excellence in its
fifth-wave work programme. The proposed work programme was put out for
consultation by the Department of Health on February 2. The topics proposed
are:
- STI-571 (Glivec, Novartis) for chronic myeloid leukaemia
- Caelyx (liposome encapsulated doxyrubicin) for ovarian cancer
- Thrombolytics especially suitable for early initiation of treatment
in acute myocardial infarction
- Photodynamic therapy for age-related macular degeneration
- Surgical treatments for morbidly obese people
- Computerised cognitive behaviour therapy for depression and/or anxiety
- Hip resurfacing as an alternative to total hip replacement in younger
people
- Using ultrasonic locating devices for inserting central venous lines
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