Community pharmacy
CPD
Medication review
Schizophrenia
NHS Web
Special general meeting
The Journal

CPD

Should be part of normal working week

From Mr J. Brocklebank, MRPharmS

Having just resigned from a multiple after 26 years' service, I wholeheartedly agree with the sentiments expressed by Julia Wood (PJ, February 17, p224).

My point in writing is to encourage the membership to write to the Health Act Working Party with comments on competence-based practising rights. Ms Wood makes a valid point with regard to further education being carried out in our own time.

We need to make sure that the working party recommends that any statutory training is funded in order that the membership can obtain relevant training as part of the normal working week.

In my own circumstances, I work a 46-hour week split into four 11.5-hour shifts with no breaks. After returning home at 9pm I am in no fit state to update myself on anything and I feel that I need my days off to recover.

Why does reading The Journal not count for anything? I spend a minimum of half an hour per week reading it and making notes that are useful to me. This is 26 hours per year, which is nearly four days' study.

Jonathan Brocklebank
Stone, Staffordshire

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Medication review

A solution for primary care?

From Miss B. R. Dean, MRPharmS, and Miss A. Jacklin, MRPharmS

Hospital pharmacists often identify patients who have been admitted to hospital on suboptimal or inappropriate medication. Quite understandably, hospital doctors are often unwilling to change treatment that has been initiated in primary care unless it is directly related to the condition for which the patient has been admitted. Although there have been numerous successful trials of pharmacist-led medication reviews in primary care,¹ current resources do not permit this to be standard practice. We are concerned that we do not currently have a mechanism for resolving many of the potential medication-related problems identified in secondary care.

We suggest that one solution would be for hospital pharmacists to write to general medical practitioners giving their recommendations regarding the patient's medication. Such a letter could suggest that the patient's medication is reviewed on their next visit to the surgery or at their next request for a repeat prescription. In line with recommendations of the NHS plan, a copy of the letter would be given to the patient so that they can raise the issue at their next consultation. A copy would also be given for the patient to take to their community pharmacist.

We have been unable to find any literature describing a service of this type, but wondered if anyone was already doing this in practice and would be delighted to hear from pharmacists who are doing so. Such pharmacists are asked to contact Bryony Dean, Pharmacy Department, Hammersmith Hospital, London W12 OHS (e-mail bdean@hhnt.org).

Bryony Dean
Principal Pharmacist, Clinical Services

Ann Jacklin
Chief Pharmacist, Hammersmith Hospitals NHS Trust, London W12

Reference
1. Granas AG, Bates I. The effect of pharmaceutical review of repeat prescriptions in general practice. Int J Pharm Pract 1997;7:264-75.

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Schizophrenia

Replacement of thioridazine

From Mrs P. E. Bradshaw, MRPharmS

Thioridazine (Melleril) has now been restricted by the Committee on Safety of Mecicines to the second-line treatment of schizophrenia by a consultant psychiatrist only, owing to the risk of cardiotoxicity (PJ, December 16, 2000, p877). Thioridazine, haloperidol, chlorpromazine and other neuroleptics have traditionally been used for many years to quieten elderly people in care with behavioural problems and dementia. Newer antipsychotics such as risperidone and olanzapine are also used.

Many research papers have shown that there is little evidence for these drugs' effectiveness against agitation and other behavioural problems in patients in care or with dementia. Indeed research has shown that withdrawal of these drugs has not increased challenging behaviour or affected the clinical management of patients.^1,2 In the United States it is now illegal to use this class of drugs in nursing homes except for severe disturbances, such as schizophrenia. The side effects of the antipsychotics, which are common, can cause distress to patients and relatives and include drowsiness, leading to difficulties in eating and drinking, worsening confusion and behaviour, increased memory loss and incontinence. Other effects can be dizziness, parkinsonism, restlessness and involuntary movements.

The British National Formulary advises that they should only be used in the short term to quieten disturbed patients, that side effects occur frequently in the elderly and that treatment of such patients should be carefully and regularly reviewed. It adds that serious consideration should be given before prescribing antipyschotics to those over 70 years of age.

Those pharmacists who have an input into prescribing for the elderly might like to consider whether it is in the best interests of the patient taking thioridazine that they be transferred to another antipsychotic or whether gradual withdrawal of inappropriate  neuroleptics over a period of weeks might be considered?

Pamela Bradshaw
Derby

References
1. Thapa PB, Meador KJ, Gideon P, Fought RL Ray WA.  J Am Geriatr Soc 1994;42:280-6.
2. Tuthill J .1988. Care Concern 1988;(Sep/Oct):10-12.

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NHS Web

Issues to address

From Mrs C. A. Farrow, MRPharmS

It was with interest that I read the article on excluding pharmacists from the proposal to give all National Health Service clinical staff internet and intranet access to online information services(PJ, February 17, p206).

How does the Government expect pharmacists to meet the agenda within the "pharmacy strategy" in regards to medicines management services or pharmaceutical care without having access to patient health records?

Why are we not being afforded the status of clinical staff as we are clearly seen this way within the pharmacy strategy?

Is the Government really serious about the contribution pharmacists have to make towards individual patient care and the rational use of medicines? Surely these are issues we must insist on being addressed before we can make inroads into the national agenda.

Carol Farrow
Norwich

Exclusion

From Mr C. J. Partridge, MRPharmS

It is with dismay, frustration and regret that I note the exclusion of pharmacists from plans to give all National Health Service clinical staff internet and intranet access to online information services by the end of next year (PJ, February 17, p206).

As a hospital pharmacist, I am amazed that clinical pharmacists could be excluded from a definition of "all NHS clinical staff" that already includes doctors, nurses and specialists. Furthermore, the integral role of hospital pharmacists in the roll-out of electronic health records and electronic prescribing as part of the "Information for health" White Paper's plans will be jeopardised by this exclusion.

I would encourage hospital colleagues to write to Alan Milburn and Gisela Stuart to demand that pharmacists are included in the electronic future that the NHS is about to embrace, and that their clinical status is recognised.

Carl Partridge
Chief Pharmacist, Queen Elizabeth Hospital, Birmingham

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Special General Meeting

Incredible!

From Mr D. J. Coleman, FRPharmS

Are we not incredible? Can we really be dragooned into a special general meeting?

The meeting is being called apparently to pass a "no confidence" motion in the members of the Council of the Royal Pharmaceutical Society "for offering a non-pharmacist the post of editor of The Pharmaceutical Journal" (PJ, February 24, p239).

The proposer says, however, that even if the motion is passed he does not want the Council to resign; neither does he know what should happen to the editor (who would have, I hope, a contract with the Society). So what is the purpose of the meeting?

The proposer says that he is away for three weeks from March 29 and that the meeting must be on a Sunday afternoon. I imagine it would be very difficult to arrange such a meeting on or before March 25 because staff and the Council would also have to rearrange their timetables, a venue would have to be booked and notices sent out. Members attending would also have to make arrangements in advance and even if the venue was in a central location such as Birmingham's National Exhibition Centre, many members would have to make overnight arrangements, train services on a Sunday being what they are. So the SGM is being called for at the end of April or the beginning of May, when we are told a general election campaign will be in progress, and just before our own annual general meeting.

What, I ask again, is the purpose of the SGM? What gain do we get for the considerable disruption and cost to the Society and its members?

Perhaps the AGM should consider a motion that an SGM can only be called at the request of say, 1,000 members or even of at least 2 per cent of the membership rather than just 30 as at present.

David Coleman
North Walsham, Norfolk

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The Journal

Answers, please!

From Mr J. D. Khan, MRPharmS

It is with great interest that I have been following events leading up to the appointment of the new editor of The Pharmaceutical Journal. I agree with Bruce Rhodes (PJ, February 24, p249) and with the two requests submitted for a special general meeting over the PJ editor post.

In the Royal Pharmaceutical Society's usual secretive "closed doors" approach, a non-pharmacists editor has been appointed. This raises serious questions about Council activities and decisions and hence calls for a vote of no confidence are not unexpected. There are three issues that need consideration: the notion of a non-pharmacist editor, the interview and selection of that editor and the selection of the editorial advisory board.

First, I do not feel that it is imperative that the editor is a pharmacist; the concern must surely be whether the person appointed is the best candidate in terms of ability and experience, whether a pharmacist was considered at all and, if so, under what criteria was he or she unsuitable. Was the new editor preselected and was there a bias to select a non-pharmacist so that the editor would not question Council thinking in the same way that the previous editor did? Why was the acting editor not considered after his sterling performance since the untimely departure of Douglas Simpson? The focus here is on the mechanics of the appointment.

Secondly, how many applications were received and how many candidates were interviewed? What were the critera used to select the editor? I find it hard to comprehend that nationally a suitable pharmacist could not be found. Or was it the case that no effort was made to look?

The third question is who appoints the editorial advisory board. According to the past editor, this should be the role of the editor. With the existence of a pharmacist deputy editor, is there a need for an editorial board? Who are the people likely to sit on the board? A non-pharmacist, not knowing any different, might select Council members for their wisdom, and no doubt the same hierarchy who had a role in appointing the non-pharmacist editor would sit on this board. That must not happen, otherwise there could be a conflict of interest.

Considering the fact that the editor of the PJ is on the Society's payroll, which is indirectly funded by the membership, there is a need for answers to the above questions in the interest of accountability, transparency and corporate governance.

Why is the Council so docile on matters that are likely to have a huge impact on the membership? Big changes are needed in the way the Council conducts its business if the membership is to gain confidence in it. As for corporate governance, the only policy that the Council is implementing is to silence the vociferous and radical Council members who want to see true democracy and accountability to the membership. The only way to change this autocratic regime is to update and modernise the Society's Charter and Byelaws and to vote for those candidates who do support transparency and accountability to the membership and who are willing to be held on these promises.

J. D. Khan
Rochdale, Lancashire

Appointment process explained

From Miss A. M. Lewis, FRPharmS

In view of some of the recent correspondence in the pharmaceutical press about the appointment of the editor of The Pharmaceutical Journal, I believe that it would be useful to place on record the process that was followed.

In line with the Royal Pharmaceutical Society's current practice for senior appointments, the arrangements were made by me and involved Council representation. The recommendations of the appointment panel were brought to the Council for ratification.

In October, 2000, the Council had approved the recommendations of a brainstorming group on the way forward for The Journal. The editor's job description was amended to incorporate these recommendations, which provided for the appointment of an editorial board to work with the editor to devise a strategy for The Journal. Although never in doubt, the paragraph on editorial freedom was specifically expanded to indicate that the editor has designated authority from the Council to exercise editorial freedom. The overall duties of the editor were broadened to include not only communication with the membership but also communication with the wider world, a change that had been agreed with the previous editor.

Recruitment specialists were engaged. Recruitment was by way of open advertisement in The Pharmaceutical Journal, the Guardian media section, and Scrip as well as an executive search.

It was recognised that this was a high level appointment and that the recruitment field would be narrow, and this proved to be the case. At a meeting held with the recruitment specialists, recognising that the field would be potentially extremely narrow, it was discussed and agreed that non-pharmacist applicants should not be excluded from the recruitment process. This was agreed to on the basis that the ideal candidate would be a pharmacist, but that the top priority was that the best person available for this high-profile role should be appointed. I agreed to this on the basis that the final decision on this would be for the Council.

Applicants were selected according to the agreed brief, and were interviewed initially by the recruitment specialists. Long listed candidates were then interviewed on December 18, 2000, by a sifting panel chaired by the Vice-President.

The short-listed candidates resulting from the sift, which included pharmacists, were called for interview on January 22, when the interviewing panel comprised Mrs Christine Glover (President), Mr Marshall Davies (Vice-President), Mr Hemant Patel (Immediate Past President), and myself, together with two external experts, Professor Alison Blenkinsopp (professor of practice of pharmacy, department of medicines management, Keele university, and editor, International Journal of Pharmacy Practice) and Dr Alun Jones (chief executive, Institute of Physics, and formerly editor of Nature).

The President, as chairman of the panel, asked all the panel members to agree and confirm the recommendation. In the presence of an independent rapporteur, the members agreed that the decision on which candidate to recommend was unanimous. The panel's decision was recorded. There was no expression of dissent on the recommendation, so, since the panel had recorded a unanimous decision, no vote was taken.

The recommendation was brought to the Council at the February meeting. The Council considered the recommendation of the panel and gave its approval. The Council also considered the recruitment process and concerns about it expressed by staff. The Council was satisfied that the appointment process was appropriate and had followed current Society practice.

Ann M. Lewis
Secretary and Registrar, Royal Pharmaceutical Society

In response to Mr Khan's third query, I would like to reassure him and other Society members that I will be personally inviting individuals to join the editorial board. In addition to using my own pharmacy contacts and those of The Journal's staff, I hope to draw up a list by the end of March. This list will be sent to the Council for ratification and approval at its April meeting and will be published in The Journal shortly afterwards.

Council members will not be invited to join the board, and I will not be approaching them or the Society's Officers for suggested names. I expect the board will have two representatives from community pharmacy and one from the hospital sector. There will be a representative from Wales, one from Scotland, one from industry and one from academia. There will probably be one or two other members.

No doubt the membership will have many ideas of whom they would invite to join the editorial board, and I hope that they will be satisfied that when the names are published they are representative of the profession.—EDITOR.

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