• Welsh call for medicines management
• US faces pharmacist shortage
• Prescription charge to rise to £6.10
• BNF 41 available
• College launches prescribing faculty
• Government and wholesalers must support pharmacy
• P switch proposed for prochlorperazine

Welsh call for medicines management

Medicines management pilots for Wales have been called for in a report which has been accepted by the Welsh Assembly's Health and Social Services Committee. In essence, the document, which was produced by the committee's Prescribing Practices Task and Finish Group, is a Welsh strategy for pharmacy and prescribing.

The report has been welcomed by the Royal Pharmaceutical Society's Welsh Executive. Its chairman (Mr Colin Ranshaw) said on March 20: “Implementation of the report's recommendations will bring early benefits to patient care, through pilots for repeat dispensing by community pharmacists, use of patients' own medication while in hospital and electronic links to enable communication between GP surgeries, community pharmacies and National Health Service trusts.”

Sections of the report on dispensing in the community and in hospitals both call for medicines management to be introduced. So far as community pharmacy is concerned, it says that there should be pilots of a shift of the basis of remuneration from the number of items dispensed to a medicines management approach in order to cut unnecessary prescribing and dispensing. In hospitals, chief pharmacists should be given responsibility for establishing effective medicines management systems, along with the resources to do so.

The report calls for significant changes to the way the professions involved with prescribing and supplying medicines work together. It says that if patients are to be at the heart of the NHS, then demarcation lines between pharmacy and GP services, and between primary and secondary care must be eradicated.

Sections that consider the patient's position say that all dispensing contractors, be they pharmacies or GP practices, should offer the same standard of professionalism. Pharmacy consultations should offer the same level of confidentiality as is expected throughout the NHS and more use should be made of pharmacists' knowledge, ideally, working from the same premises as the rest of the primary care team.

The task and finish group also calls for health authorities and local health groups and trusts to find a way of implementing patient pack dispensing and for repeat prescribing to be put on a basis of three- or six-monthly prescriptions which are dispensed in monthly instalments. It says that the use of patient packs in hospitals would allow dispensing to be automated and the redeployment of pharmacy staff to ward-based duties.

Much of the report deals with training and accreditation for professional staff. For example, it says that nursing and pharmacy staff involved with ward medication systems should be trained and required to demonstrate requisite knowledge and skills. There should also be training and accreditation systems for safe drug administration and medicine-related duties. Doctors are not seen as exempt from these requirements, with the report calling for training and accreditation for prescribing, and for all doctors, pharmacists and nurse practitioners to regard accredited continuing professional development programmes in therapeutics as essential to practise.

The full report can be downloaded from PJ Online.

It is a 510K PDF file that requires Acrobat Reader 4 or later. Click below for the latest version.

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US faces pharmacist shortage

A shortage of pharmacists has emerged in the United States over the past two years. A study carried out by the Health Resources and Services Administration of the US Department of Health and Human Services blames the shortage on both rapidly increasing demand for pharmacists and constraints on increasing the pharmacist supply.

A major reason for growing demand is a sharp increase in dispensing. Between 1992 and 1999, the number of prescriptions dispensed in community pharmacy rose from 1.9bn to 2.8bn annually. The average pharmacist's personal workload rose from 17,400 to 22,900 prescriptions a year.

One effect of the shortage is job stress and poor working conditions. Pharmacists have less time for counselling patients and the potential for fatigue-related errors is increased by longer working hours and reduced flexibility in scheduling.

On the supply side, the number of active pharmacists is expected to grow by only 28,500 over the current decade — 800 less than in the past decade. Pharmacy school applications are falling and saw a 33 per cent drop between 1994 and 1999. Another constraint is a growing emphasis on DPharm degrees, which lengthen education.

The report is available on the internet.

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Prescription charge to rise to £6.10

The National Health Service prescription charge is to rise 10p to £6.10 per item in England and Scotland on April 1. The cost of prescription prepayment certificates will increase from £31.40 to £31.90 for four months and from £86.20 to £87.60 for 12 months.

At 1.67 per cent, this year's increase is the lowest rate of increase for over 20 years.

Prescription charges are expected to raise some £414m for the NHS in England and £45m in Scotland in 2001-02.

A freeze on prescription charges in Wales was announced by the Welsh Finance Minister (Mrs Edwina Hart) on October 19, 2000. She also said that everyone in Wales under 25 years of age would be exempt from prescription charges from April 1, 2001.

The Royal Pharmaceutical Society has called for a review of the prescription charge system.

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BNF 41 available

The 41st edition of the British National Formulary has been published. It contains details of changes to malaria prophylaxis recommendations and recent guidance issued by the National Institute for Clinical Excellence. In recognition of the fact that many over-the-counter preparations contain zinc, which notably affects the absorption of tetracycline and quinolone antibacterials, two warning labels have been updated. Mr Gerry Gallagher (editorial assistant, BNF, e-mail ggallagher@bnf.rpsgb.org.uk) commented: “I am sure many PJ readers will want to order new adhesive labels and/or amend their computer labelling systems — I would be very happy to provide any background information.” Pharmacists are asked to keep copies of the 40th edition for collection by the Pharmaid scheme in November.

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Pharmaid is an annual collection of recent editions of the British National Formulary. These are then sent by Book Aid International to Commonwealth developing countries for use by health professionals.

Pharmaid is organised by the Commonwealth Pharmaceutical Association. The CPA says: “The need for recently outdated BNFs in the developing world, particularly for training, is desperate. Our local representatives will ensure that the books go where there is most need. This is the most practical way that British health professionals can make a real difference to the quality of therapeutic care in developing countries.”

Further information is available from
Mrs Betty Falconbridge at the Royal Pharmaceutical Society
Tel 020 7735 9141 ext 281
e-mail bfalconbridge@rpsgb.org.uk

College launches prescribing faculty

The first step towards restructuring the activities of the College of Pharmacy Practice — the launch of the faculty of prescribing and medicines management, its first faculty — was announced on March 15.

Any UK-registered pharmacist is eligible to be an associate of the faculty, provided the pharmacist can demonstrate an interest in the relevant specialty. Progression to full (practitioner) member will require completion of the College Portfolio consistent with criteria specified by the faculty board.

The faculty will recruit the initial wave of members by June, 2001. Nominations for membership of the faculty board will be put forward at the end of that month, with voting for the board taking place in July. An action plan and recommendations for competencies will be circulated to members in September. The college hopes to have 200 members in the faculty within the first year. There is to be a supplementary annual subscription of £10 for faculty membership, as well as the normal college fee of £47.

The launch brought together a number of different professional groups in support of the initiative, which aims to foster the knowledge base, tools and skills required for practitioners in the health service. Professor Bryan Veitch (chairman of the college's governors) explained that patients, the profession, the public and the makers of policy would benefit from the faculty's existence.

The launch platform was shared by Dr Jim Smith (chief pharmaceutical officer, Department of Health), as well as representatives of the Pharmaceutical Advisers Group, the Scottish Prescribing Advisers Association, the Primary Care Pharmacists Association, the Primary and Community Care Pharmacy Network and the National Prescribing Centre.

“Skills, knowledge and continuing professional development are central to the modern National Health Service and clinical governance,” said Dr Smith. The delivery of medicines management services, local pharmacy services, and pharmacist prescribing will be seen in the next three years, and the profession can ensure that delivery with the help of the faculty. “I strongly support the initiative,” he said.

Although the groups involved at the launch were closely associated with primary care, the faculty would embrace the needs and interests of other pharmacists with an interest in medicines management and pharmaceutical care.

Professor Veitch also explained that the faculty was to be a “first among equals” and that the college had established a generic template following discussion with both small and large specialist groups. The aim was to launch another faculty later this year and then possibly two more in 2001. The UK Medicines Information Pharmacists Group, the UK Radiopharmacy Group and the Neonatal and Paediatric Pharmacists Groups have had discussions with the college.

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Government and wholesalers must support pharmacy

The existing network of community pharmacies must continue to be supported by the Government and pharmaceutical wholesalers in order to reap long-term rewards, Mr Kirit Patel (chairman, Day Lewis Plc) told the British Association of Pharmaceutical Wholesalers' dinner in London on March 19.

Mr Patel said that, despite the pharmacy plan, there were no signs of the Government investing in the pharmacy network at present. Community pharmacy contractors were required to support the National Health Service through their stockholdings and premises. With threats to resale price maintenance and NHS margins where was the revenue to invest in delivering the pharmacy plan going to come from?

Community pharmacies were part of a chain that linked the Government, as the NHS, through pharmaceutical companies and wholesalers to patients. If the Government wished to protect patients then it had to help preserve the chain.

Pharmaceutical wholesalers had traditionally supported information technology developments in pharmacy. Mr Patel said that he wanted to see the contract for electronic transfer of prescriptions awarded to the Transcript consortium of major wholesalers. In turn, the consortium would need to help pharmacy on to higher ground by investing in IT for pharmacies.

Mr Stephen Simms (chairman, BAPW) said that consolidation in the United Kingdom wholesaling market appeared to be heading towards a conclusion. The main European markets would be dominated by Alliance Unichem, Gehe and Phoenix, with vertically integrated chains of pharmacies where that was permitted. However, at present, there were major differences between the European and American distribution models, although these might be reconciled in time leading to global companies.

Mr Simms expressed concern about manufacturers bypassing full-line wholesalers to make supplies to pharmacies either directly or via short-line wholesalers. Full-line wholesalers were being left with a huge tail of slow-moving unprofitable lines making up almost 70 per cent of their stock. The Government would be concerned if full-line wholesalers were unable to subsidise the supply of these lines.

Mr Andy McKeon (head of medicines, pharmacy and industry, Department of Health) said that the Department would be concerned about such a development, but he was unwilling to speculate about what the Government might do. Government intervention could be seen as a double-edged sword by those who asked for it.

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P switch proposed for prochlorperazine

The Medicines Control Agency has proposed that prochlorperazine maleate should be reclassified as a pharmacy medicine for use in the prophylaxis and treatment of nausea and vomiting in migraine.

Consultation letter MLX 271 (available on the MCA website) says that the Committee on Safety of Medicines advises that it is safe to allow the sale of packs of eight 3mg buccal tablets without prescription in adults with previously diagnosed migraine. Also proposed are: the reclassification or extension of authorised indications of a number of antifungal products — fenticonazole nitrate for thrush, fluconazole for penile thrush, terbinafine hydrochloride 1 per cent spray (30ml pack) for athlete's foot, jock itch and ringworm and miconazole nitrate with 1 per cent hydrocortisone acetate for athlete's foot and candidal intertrigo; the sale of clobetasone butyrate 0.05 per cent cream (15g pack) for short-term treatment of patches of eczema and dermatitis (including atopic eczema and primary irritant and allergic dermatitis) in adults and children aged 12 years and over; stannous fluoride at a maximum strength of 0.4 per cent in dental gels; and the return to prescription control of adrenaline eye-drops for the treatment of glaucoma.

Subject to comments received and Ministerial approval, the MCA intends to implement the changes in June.

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