News

• Scotland to pilot ETP
• One in 30 hospital admissions leads to disability or death
• Call for changes to Controlled Drug recording
• Self-audit modules available to Glasgow pharmacists
• Clinical governance survey finds lack of funding
• Pharmacy damaged in ram raid
• NPA board: Concerns raised over electronic signatures
• US Hammer Award for MCA
• Legal obstacles to pharmacist prescribing to go soon
• MPs visit Boots

Scotland to pilot ETP

The electronic transmission of prescriptions from prescribers to pharmacies and on to Common Services Agency pricing centres in Scotland is to be piloted in the Ayrshire and Arran primary care trust in the spring.

The Scottish Health Minister (Ms Susan Deacon) said on March 1 that the system to be tested would provide a better service for both patients and health professionals.

Patients, she said, would particularly benefit from not having to visit their GPs every time they wanted repeat prescriptions. Instead, they would just need to pick up medicines from pharmacies. The benefit for professionals would be better communications between GPs and pharmacists to sort out queries and improved medicines management. She added that after evaluation it was intended that a similar scheme should be rolled out across Scotland.

The announcement has been welcomed by the Royal Pharmaceutical Society.

The Society's Scottish vice-chairman (Mr David Thomson) said: “Pharmacists strongly support exploiting technology to enable health professions to work closer together in improving access to, and the efficiency of, services. We look forward to seeing the pharmacist being a full stakeholder in NHSnet able to interact fully with patients and their GPs. ETP will allow for an ongoing review of patients' therapy by their pharmacists and will result in less wastage of medicines. The commitment the Minister has made to ensure that pharmacy is a core provider of services, working with GPs and other health professions, will ensure patients get a better service from the National Health Service in Scotland.”

One in 30 hospital admissions leads to disability or death

A retrospective pilot study has found that 10 per cent of hospital patients suffer adverse events leading to injury (BMJ, March 3, p517). A third of the errors led to at least moderate disability or death and half of them were preventable.

The authors conclude that adverse events are a serious problem for the National Health Service and cost at least £1bn a year.

A Department of Health spokesman said: “This new study tells us what we already know — that the number of medical errors is far too high. We are currently setting up a compulsory national reporting system for errors in the NHS.”

Call for changes to Controlled Drug recording

The chief medical officer's inquiry into the circumstances that allowed the Manchester GP Harold Shipman to get away with murdering many of his patients undetected called for a review of the way in which Controlled Drug dispensing is recorded in pharmacies. But a question mark has been put over whether or not changes would make any difference.

Part of the report, available here, concentrates on Shipman's CD prescribing and pharmacy records. It concludes that there are deficiencies in the current systems for monitoring CD prescribing. Among these is the fact that pharmacy CD registers do not show the batch numbers of medicines obtained and supplied.

The report says that this means that it is not possible to follow the trail of CDs, in this case ampoules of diamorphine, from their purchase by pharmacies to their administration to patients or destruction if unused.

“The routine recording of batch numbers would provide the basis for a more satisfactory audit trail for prescribing of controlled injectable drugs and consideration should be given to promoting such a policy,” the report says.

Mr Stephen Axon (general secretary, Pharmaceutical Services Negotiating Committee) commented: “I cannot see that this would actually solve anything. The only thing it would show is excessive prescribing, but the records would reveal that already. What is important is a record of the medicine having been taken.”

Mr Axon added that pharmacists would expect to be paid for any additional record keeping that might be required.

Self-audit modules available to Glasgow pharmacists

A register of self-audit modules has been circulated to all community pharmacists in Glasgow under the Greater Glasgow Pharmacy Audit Programme.

The register, called “Quality in practice”, lists modules which focus on areas of professional activity such as dispensing, counselling, advice to residential homes, supervised methadone provision, domiciliary oxygen, health promotion, needle and syringe exchange, and information for locums.

The modules are intended for use by pharmacists for practice review, induction of new staff, staff training and service improvement. Each is set out in a consistent format with a specification of the quality standards next to space to record results, action and target dates.

Clinical governance survey finds lack of funding

The implementation of clinical governance in community pharmacy is being hindered by a lack of funding, according to a survey carried out by the Pharmaceutical Services Negotiating Committee. A survey of local pharmaceutical committees in England and Wales found that their main activities were the circulation of a clinical governance baseline questionnaire to pharmacy contractors and negotiations with health authorities over funding. Nearly a third of English LPCs had agreed a clinical governance lead pharmacist job description, mostly based on a model description drawn up by the PSNC and the Royal Pharmaceutical Society, whereas in Wales, local health group pharmacists are designated as clinical governance leads for pharmacy. Funding had been received in some health authority areas for circulating the questionnaire, for the lead pharmacist position and for meetings or training. The PSNC says that health authorities are responsible for implementing clinical governance in community pharmacy. The Government has promised £2m for this from April but its allocation is not yet clear.

Pharmacy damaged in ram raid

Ram-raiders attempting to steal an ATM cash machine from a pharmacy at Oakley, near Basingstoke, caused extensive damage to the premises after reversing a Mitsubishi Shogun through the front windows in the early hours of February 28.

Mr Rajiv Sarna, MRPharmS, the owner of R. K. Sarna Chemist, said that the incident had taken place at 3.24am. After reversing the car through the window, a tow rope had been tied around the cash machine and an attempt had been made to pull the machine off its base. When this failed, the thieves had taken some designer spectacle frames, sunglasses and reading glasses from an opticians business upstairs run by Mr Sarna's wife, and a few toiletry items from the front of the pharmacy.

The ram raid caused extensive damage to the front of the pharmacy, including the windows and doors. Inside, many shop fittings were pushed back into the middle of the front-of-shop area and shelves, mirrors and gondolas were broken. A fax machine and a blood pressure and weighing machine were damaged.

Mr Sarna said that he was alerted by the police in the early hours of the morning. He had arrived at the pharmacy expecting to see only broken glass and had been shocked by the scale of the damage. The damaged area had been boarded up and only emergency prescriptions were handled on February 28. Business returned to normal by March 2.

The cash machine had been on trial from TRM Ltd since September. Mr Sarna said that he had previously decided to end the trial and that the machine was due to have been removed the week after the raid.

The placing of cash machines in pharmacies is rare, according to the National Pharmaceutical Association. Mr Trefor Williams (head of business services, NPA) said that the NPA had had few enquiries about this service. He suggest that pharmacists could provide customers with cash back with purchases, arranged through credit card merchant handling companies, as an alternative service.

NPA board: Concerns raised over electronic signatures

The National Pharmaceutical Association's board of management has expressed reservations over the use of electronic signatures and possible prescription direction in trials of the electronic transfer of prescriptions from surgeries to pharmacies.

At its February meeting, the NPA board considered a National Health Service Executive consultation letter about a POM Order amendment that was necessary to allow ETP trials to go ahead in England later this year. The proposed amendment would allow designated prescribers to sign prescriptions digitally and to transfer them electronically to designated pharmacists.

Board members' concerns centred on the fact that digital signatures are electronic messages authenticated by the message recipient's computer, rather than digital representations of a handwritten signature. They felt that the proposed rules should ensure that the designated prescriber was the only person permitted to use the electronic signature. There was also concern that the proposed amendment could allow prescription direction when the key principles underpinning ETP, which had been agreed between the pharmaceutical and medical professions and the Department of Health, forbade direction of prescriptions to particular pharmacies.

Other matters considered at the meeting are reported below.

EHC The NPA is to write a second letter to the Daily Mail complaining about the newspaper's report on the emergency contraception service offered by Lambeth, Southwark and Lewisham health action zone pharmacists (PJ, February 3, p139). The Daily Mail's response to the original complaint had been that the article had been based on information received from the HAZ project manager. Board members were aware that, although the HAZ representative had originally led the newspaper to believe that pharmacists were not following the patient group direction exactly, this was wrong and the newspaper had been told before the article was printed. The Daily Mail had chosen not to correct or withdraw its report. Board members decided not to complain to the Broadcasting Standards Commission about a Tonight with Trevor McDonald programme on the same topic (PJ, February 10, p177), which they considered to be unbalanced. The item failed to mention pharmacies that had been filmed and which had performed well and concentrated only on the age-related parts of pharmacists' consultations with an underage girl who lied about her age.

Saline and the Drug Tariff A proposal to reclassify sodium chloride solution and irrigation solution as Drug Tariff appliances was opposed. Board members could not understand why saline irrigation fluids, which had always been classified as drugs, were to become appliances. What would happen to sterile water and liquid antiseptics, they wanted to know, and how would community pharmacists know which fluids were drugs and which were appliances? There was also concern that the dispensing fee for appliances was 85p compared to 97.5p for drugs.

Out-of-hours services A model for a community pharmacy-led out-of-hours pharmaceutical service which met the requirements of a Department of Health out-of-hours review was approved (PJ, November 18, 2000, p745). Meeting demands for new pharmaceutical services in primary care would help to provide a secure future for community pharmacists. Nevertheless, there were concerns about the likely demand for out-of-hours pharmaceutical services and how the model would be funded. There was also a question-mark over whether or not out-of-hours pharmacies should sell over-the-counter medicines.

Meeting with Lord Hunt The NPA chairman (Mr Ben Zatland) and chief executive (Mr John D'Arcy) had met Lord Hunt (Parliamentary Under-Secretary of State for Health) on February 19. They stressed the importance of the pharmacy network as a means of securing access to pharmaceutical services. Responding to concerns expressed by Lord Hunt about recent publicity about the availability of EHC from pharmacies, they said that most of the coverage had been misleading. The opportunity was taken to say that many pharmacists were uncomfortable with the 16 year age limit associated with OTC EHC, given that PGD supplies were based upon competence to comprehend rather than age. There was no logical or clinical need for this age restriction.

US Hammer Award for MCA

The Medicines Control Agency has received the United States vice-president's Hammer Award in recognition of collaborative work to reduce bureaucracy and saved money.

The award was presented to the MCA's medicines testing team for its contribution to the development of technical data on active constituents and toxins in herbal products, which is helping with the identification of the sources of counterfeit medicines and the enhancement of consumer protection. The MCA's work has achieved savings by avoiding duplication of effort in the US and the United Kingdom.

MCA staff named on the award are Dr Gordon Munro (head of inspection and enforcement), Dr Ged Lee (group manager for laboratories and licensing), Mr Andy Charvill (analytical assessor) and Dr Roger Alexander (head of good laboratory practice). The head of the Royal Pharmaceutical Society's Edinburgh-based medicines testing laboratory (Dr Alistair Davidson) is also named on the award.

The Hammer Award was introduced by the previous US vice-president (Mr Al Gore) to recognise steps taken by government agencies to work together to reduce bureaucracy and save money. It was introduced after it was realised that it cost the US government $400 to buy a $6 hammer.

Legal obstacles to pharmacist prescribing to go soon

Once the Health and Social Care Bill becomes law, there will be no legal obstacles to pharmacists prescribing as independent or as supplementary prescribers. This was the consensus at a meeting organised by the All-Party Pharmacy Group under the chairmanship of Dr Howard Stoate, MP, held on March 6 to discuss “Prescribing by pharmacists: what, when and how?”

The limiting factor to prescribing by pharmacists will be what individual responsibility they will be prepared to take, depending on their skills, training, confidence and what formal access they will have to patient records. There were many issues to iron out — ranging from defining the width of pharmacy prescribing, the level of diagnosis and assessment involved, even to what a supplementary prescription would look like — but the principle was accepted.

Mr Andy McKeon (head of medicine, pharmacy and industry, Department of Health) pointed out that pharmacist prescribing embraced hospital pharmacist prescribing as well as community pharmacist prescribing. The crucial issue of what form pharmacist prescribing might take would depend on trust between the doctor pharmacist and the patient.

There was also agreement that the wider acceptance of pharmacy prescribing should not take the 14 years that it has taken nurse prescribing to become established. Dr June Crown, leader of the Royal Pharmaceutical Society's pharmacy prescribing task force, said that pharmacist prescribing had moved far enough forward without the need for expensive pilot studies.

Strong support for prescribing by pharmacists came from Dr John Chisholm (chairman of the British Medical Association's general practitioners committee) who said that in time: “I would like to see that every pharmacy is a prescribing pharmacy.” But GPs were concerned that they would be held responsible for others' prescribing, he added. He also supported the comment that the development of pharmacist prescribing should be regarded as a desirable development in its own right, and not as a way to address GP manpower problems.

Mr Noel Dixon and Mr John Hall, community pharmacists from Tyne and Wear, described their own experience in organising and running an anticoagulation monitoring clinic for 300 patients. Mr Dixon said that patients were 100 per cent confident that the pharmacists were qualified to provide the service.

MPs visit Boots

Members of the All-Party Pharmacy Group, including Dr Howard Stoate, MP, (chairman, APPG), Mr Mark Todd, MP, (secretary) and Mr David Heath, MP, (treasurer), accompanied by Mrs Christine Glover (President, Royal Pharmaceutical Society) visited Boots the Chemists's refurbished branch at High Street Kensington, London, last week.