News summary

Pharmacists who are struck from the Register may find that they are virtually unable ever to practise again even after the Royal Pharmaceutical Society's Statutory Committee decides that it safe to restore them to the register...[more]

Britain's longest established pro-life group is to ask the High Court to halt pharmacy sales of emergency hormonal contraception...[more]

The Asda supermarket chain relaunched its public relations campaign against resale price maintenance on April 23 with a claim that pharmaceutical companies have exploited the delayed court case to force up the prices of over-the-counter medicines by three-and-a-half times inflation in six months...[more]

The pharmaceutical industry is to be given advice on packaging and labelling in an attempt to reduce medical accidents where confusing labelling is a contributory factor...[more]

Prison inmates are not getting the best treatment because prison doctors are not being allowed to prescribe the best treatment, according to a British Medical Association report...[more]

Varying the prices of medicines from one country to another is a feasible way of ensuring that poor countries can afford the medicines they need...[more]

The international pharmaceutical industry has declared itself satisfied with a commitment by the South African government to respect patents and has withdrawn a legal challenge to legislation intended to push down the cost of anti-retroviral medicines...[more]

The Restrictive Practices Court is to hear the case against resale price maintenance on medicines, which restarted on April 25, entirely in camera...[more]

Hospital managers and senior pharmacists are expected to have completed assessment of their hospitals' provision of, or need for, medicines management, together with action plans for the correction of any deficiencies, by the end of April...[more]

Hussain Mulla, a pharmacist working at Leicester's Glenfield Hospital is one of three young scientists to have been awarded the Westminster Poster Prize at a recent reception at the House of Commons...[more]

The number of health authorities in England is to be cut from 99 to 30 under plans announced by the Secretary of State for Health Alan Milburn on April 25...[more]

Professionally fit pharmacists could be effectively barred from practice for life

Pharmacists who are struck from the Register may find that they are virtually unable ever to practise again even after the Royal Pharmaceutical Society's Statutory Committee decides that it safe to restore them to the register.

Powers to be given to health authorities under the Health and Social Care Bill to maintain registers of health professionals permitted to work for the National Health Service could be used to ensure that someone convicted of defrauding the NHS never works again for the NHS or anyone who provides NHS services.

This has been brought to light by Don Alderton, a pharmacist from Chester, who is concerned that the provision means that pharmacists and other health professionals might never be able to expunge their guilt.

Mr Alderton recently wrote about the matter to his local member of parliament, Christine Russell, who then took it up with Parliamentary Under-Secretary of State for Health, Lord Hunt.

Lord Hunt's reply to Ms Russell made it clear that Mr Alderton's concern that pharmacists faced triple-jeopardy should they offend in any way was not only justified, but that this was the intention.

Lord Hunt said that the intention was to give health authorities greater control over who provides NHS community pharmacy services because they currently had little control over individuals who actually provide services, especially where they are employed by pharmacy owners.

“We think this puts health authorities in an unsatisfactory position,” he said.

Specifically, Lord Hunt said that there was nothing health authorities could do to prevent pharmacists who had been convicted of fraud from continuing to work pending a Statutory Committee hearing or after restoration to the pharmaceutical register. The new provision would mean that health authorities could suspend or exclude fraudulent pharmacists or those who were dangerous to patients or whose criminal or professional record meant that they were not suitable to provide NHS services. Excluded pharmacists would have a right of appeal to the Family Health Services Appeal Authority.

Referring to how the lists would work, the minister explained that health authorities would hold separate lists, but that inclusion on one English authority list would allow work in any other health authority in England. Welsh arrangements would be separate.

Mr Alderton told The Journal: “I think that the minister's reply raises more questions than it answers, because it would appear that the Society's authority over professional matters is in danger of being sidelined throughout the whole of the disciplinary process.”

Sue Sharpe, director of professional standards at the Royal Pharmaceutical Society commented: “We will be very interested to see whether the sanctions available reflect those given to our new disciplinary body under our revised proposals (PJ, April 14, p502) and whether there will be scope for anomalies, such as example when a person may be considered professionally fit for practice, but still not be eligible for readmission to an NHS practising list.”

Mrs Sharpe added that there were a number of questions about how the proposals would impact the Society's regulatory functions and the pharmacy manpower market.

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Court attempt to halt EHC sales

Britain's longest established pro-life group is to ask the High Court to halt pharmacy sales of emergency hormonal contraception.

The Society for the Protection of Unborn Children (SPUC) has applied for an oral hearing before a High Court judge to seek permission to bring a judicial review of the P classification of levonorgestrel.

John Smeaton, SPUC's national director, said on April 23: “We expect the hearing to take place very soon, possibly next week. We shall set out our case, which centres on the undeniable fact that the morning-after pill can cause the death of a newly conceived human being by preventing his or her implantation in the womb. Thus the morning-after pill can cause an early abortion, and should be subject to the controls set out in the 1967 Abortion Act.

“We believe that the supply of the morning-after pill under this new regime constitutes a criminal offence under the Offences Against the Person Act 1861. The 1861 Act prohibited the supply of 'any poison or other noxious thing ... with intent to procure the miscarriage of any woman, whether she be or be not with child'.

“Parliament must be presumed not to have intended to facilitate any criminal act when it passed the statutory instrument to reclassify Levonelle-2, and we therefore contend that the Secretary of State exceeded his powers when he made the Order last year which reclassified Levonelle-2.”

The SPUC argues that it is not accurate to describe EHC as a contraceptive because it can cause the death of a newly conceived embryo.

The argument that stands against the SPUC position is that abortion cannot take place until implantation has occurred and that EHC acts to prevent implantation and is, therefore, not abortifacient.

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Asda campaigns against RPM again

The Asda supermarket chain relaunched its public relations campaign against resale price maintenance on April 23 with a claim that pharmaceutical companies have exploited the delayed court case to force up the prices of over-the-counter medicines by three-and-a-half times inflation in six months.

Asda backed its claim with a list of example price increase and says that more are planned for the future.

“Our latest research shows that that drug companies simply cannot be trusted to set prices in the best interests of shoppers,” said Asda's health and beauty director, Jeremy Cross.

Before the RPM case began last year, Asda made a series of price cuts on various branded medicines and was forced to return prices to RPM levels by threats of legal action by their manufacturers.

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CSM to advise on medicines labelling

The pharmaceutical industry is to be given advice on packaging and labelling in an attempt to reduce medical accidents where confusing labelling is a contributory factor.

A Committee on Safety of Medicines expert group, to be chaired by Dr Rob Calvert (consultant in prescribing and pharmacy practice, East Riding and Hull Health Authority) is to draw up the advice with a remit to report to Ministers by July.

Andrea Patel, a hospital pharmacist who won the Guild of Healthcare Pharmacists' Pharmacia & Upjohn Award for 1999, identified similarities in packaging and similar sounding names for medicines as a source of mistakes (PJ, November 18, 2000, p744).

She says that dispensing errors caused by ambiguities in packaging are commonplace but are accepted as something pharmacists have to live with. After surveying 33 hospitals, the most frequent sources of error she found were different strengths of the same medicine being in indistinguishable boxes and different medicines with similar names made by the same manufacturer.

In the past, both the Royal Pharmaceutical Society and the MCA have opposed devices to reduce confusion, such as colour-coding, arguing that they would make people liable to rely on the coding, rather than read labels carefully.

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Prisoners denied best treatment, says BMA

Prison inmates are not getting the best treatment because prison doctors are not being allowed to prescribe the best treatment, according to a British Medical Association report.

The report, “Prison medicine: a crisis waiting to break”, says that doctors are pressurised by prison governors to compromise their clinical judgment in the interests of efficiency and economy. These are interpreted to mean cutting corners and prescribing cheaper medicines rather than the most appropriate ones and not referring to hospitals because of the cost of guarding prisoners, the BMA says.

Prison doctors say that they have been prevented from prescribing the most effective migraine treatments and that prisoners who suffer repeated migraine attacks can go on to develop depression and mental illness.

The report says: “Trust between doctor and patient suffers when less effective medication to that available in the community is prescribed.”

It adds that prison doctors feel that they have been excluded from processes for developing prescribing protocols which balance prisoners' needs for proper treatment with economy.

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Call for differential pricing to help poorer countries pay for medicines

Varying the prices of medicines from one country to another is a feasible way of ensuring that poor countries can afford the medicines they need. That is a conclusion from a three-day workshop held by the World Health Organization and the World Trade Organization before Easter.

WHO director-general Dr Gro Harlem Brundtland said the meeting had been constructive and helpful.

“We heard from the experts that much lower prices can be achieved for the poorest countries,” she said. “Equally important is strengthening health systems, and, for the poorest countries, securing additional international financing.”

“Intellectual property rights stimulate development of new medicines, but must be implemented in an impartial way that safeguards public health. We also need to ensure that there are additional incentives for the development of the drugs needed to address the health problems of people in poor countries,” Dr Brundtland said.

According to Adrian Otten, director of the WTO's intellectual property division, although participants approached the issues from different points of view, there was broad recognition that differential pricing could play an important role in ensuring access to existing medicines at affordable prices, particularly in the poorest countries, while the patent system would be allowed to continue to play its role in providing incentives for research and development.

Differential pricing has already been achieved for commodities such as vaccines, contraceptives and condoms through a combination of high-volume purchasing, reliable and adequate financing, advocacy, corporate responsibility and market forces. The challenge now is to find ways to expand this to life-saving medicines. Workshop participants accept that there is no single formula to achieve this.

Differential pricing would allow companies that make patented medicines drugs to recover most of the costs of research and development in richer markets and at the same time to sell or license production at lower prices in lower-income countries. Critical to the success of this would be methods of preventing lower priced medicines from finding their way into rich country markets.

Even when prices fall there is still no guarantee that poor communities can afford them. This is particularly true for HIV/AIDS drugs. Although costs are coming down to $500 per patient per year, this remains beyond the reach of many countries whose total health expenditure is less than $10 to $20 per head per year.

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Industry satisfied with South African settlement

The international pharmaceutical industry has declared itself satisfied with a commitment by the South African government to respect patents and has withdrawn a legal challenge to legislation intended to push down the cost of anti-retroviral medicines.

The Pharmaceutical Manufacturers Association of South Africa withdrew its action following an undertaking by the SA government to respect the international Trade Related Intellectual Property Rights Agreement (TRIPS). The association was challenging a provision in legislation which would have allowed the government to order compulsory licences for patented medicines with no right of appeal. According to GlaxoSmithKline, the SA government has confirmed that there will be consultation with the industry on regulations to implement the law.

The World Health Organization has declared itself satisfied with the settlement. It says that it should now be possible for all in South Africa to invest their energy in implementing the National Drug Policy and Medicines Act 1997, including generic substitution, greater competition in procurement of medicines, improved medicines quality and rational use.

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RPM case in camera

The Restrictive Practices Court is to hear the case against resale price maintenance on medicines, which restarted on April 25, entirely in camera.

David Sharpe, chairman of the Community Pharmacy Action Group, said that Mr Justice Buckley, who is hearing the case, ruled that the entire case should be heard behind closed doors because the amount of confidential evidence meant that the court would otherwise be constantly opening and closing to the public.

Opening submissions from those defending RPM are to be heard on April 30 and May 1 with the following two days given over to the Office of Fair Trading's submissions against the continuance of RPM. Closing submissions are timetabled to be heard from June 7.

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Appraisal of medicines management performance is under way

Hospital managers and senior pharmacists are expected to have completed assessment of their hospitals' provision of, or need for, medicines management, together with action plans for the correction of any deficiencies, by the end of April.

National Health Service hospital trusts have been completing 10-page self-assessment forms which ask them to rate their performance in such areas as management awareness of the need, budgeting, medicines policies and procurement, influencing prescribers and interaction between primary and secondary care.

The next stage in the process, which will culminate in an Audit Commission investigation, is for NHS Executive regional offices to assess individual trusts' action plans and to organise regional seminars to share good practice.

The Audit Commission is expected to start a value for money audit of prescribing and medicines management in hospitals in November.

Original paper, p585

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Pharmacist wins Westminster award

Hussain Mulla, a pharmacist working at Leicester's Glenfield Hospital is one of three young scientists to have been awarded the Westminster Poster Prize at a recent reception at the House of Commons.

Mr Mulla's poster “Chemists and pharmacists stick together like drugs to plastic” addressed how life saving extracorporeal membrane oxygenation circuits used to support patients with severe lung failure can affect the delivery of drugs.

It explained how many active ingredients can become adsorbed onto the plastic components, thus reducing the available dose.

Mr Mulla is senior clinical pharmacist in critical care medicine and a part-time PhD student at the University Hospitals of Leicester–De Montfort University Centre for Pharmacy Practice Research and De Montfort's Department of Chemistry.

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Health authorities to be cut from 99 to 30

The number of health authorities in England is to be cut from 99 to 30 under plans announced by the Secretary of State for Health Alan Milburn on April 25.

Under the scheme, the eight regional offices of the National Health Service Executive are expected to close, with the 30 health authorities taking strategic responsibility for the NHS and being the bridge between services and the Department of Health. The best performing NHS management teams are to be invited to bid to run the new strategic health authorities.

The NHS Executive, too, will disappear, to be replaced by Departmental regional directors of health and social care.

“The balance of power in the NHS will shift decisively in favour of patients,” Mr Milburn said. “This can only happen if the centre of gravity in the health service moves from Whitehall to the NHS front-line.”

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