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The Society
Letters to the Editor
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Prescribing
Poor standard of FP10(HP) completion
From Mr N. Baumber, FRPharmS
There was a howl of agreement at our most recent local pharmaceutical
committee meeting when one of our members mentioned the low standard of
prescribing by hospital doctors on FP10(HP) forms arriving in community
pharmacies.
Dosages, strengths and quantities are omitted regularly, resulting in
telephone calls to clarify nearly every prescription and even what the
name of the prescriber might be. It takes an age to contact a doctor who
has left a clinic, needs paging, works irregular days or is a locum. This
also inconveniences the patient.
Sending back a prescription to be amended is fraught with difficulty.
It may never be seen again. Some doctors refuse to accept that their wishes
are impossible and will not reissue prescriptions so that they will be
accepted for payment by the Prescription Pricing Authority.
I have been tempted on
several occasions recently to ring my local hospital pharmacy to see whether
a little in-house training could be organised, but the problem must go
right back to the core of how schools of medicine train their students
in the art of prescribing. If doctors only want to diagnose and not be
bothered by the practicalities of prescribing, their standard of communication
has be addressed.
In putting pen to paper, I remembered my attempt, when computer printed
FP10s were invented, to interest the Department of Health and the Pharmaceutical
Services Negotiating Committee in a landscape style of prescription form.
One of its merits was that it was sectioned across the page to remind
hand-writing prescribers about the importance of completing form, strength,
dosage and quantity. Perhaps it might fit the Government’s clinical
governance agenda to insist that when FP10(HP) forms are revised they
are trialed as landscape prescriptions to improve standards?
Noel Baumber
Grantham, Lincolnshire
Judge products on their merits
From Mr P. Breame, MRPharmS
I firmly believe that patent extensions do not benefit patients and,
being responsible for the prescribing budget within my primary care trust,
I am concerned at the cost implications of these extensions. I understand
the concerns of the companies that will lose the benefits of their money-spinners,
but patents run for more than enough time to recoup costs and much, much
more. The prevention or delay of entry of generic products into the market
can have a significant effect on the prescribing budget of a PCT, particularly
where that product is a proton pump inhibitor or a statin; the extra money
being spent on extended patent products is unavailable for use in other
areas.
In many cases, but not all, the marketing of isomers or enantiomers is
nothing more than a ploy to extend patents by another means, particularly
where the original product is discontinued before the end of its patent
life. As a prescribing adviser I would not recommend that the “new”
product is significantly better, and in many cases that evidence can be
somewhat thin.
There are, however, some useful products. One of these is Diamicron 30mg
MR. I am not a great exponent of modified-release products and prescribing
indicators do not favour their use, but there is a case for their limited
use. Diamicron 30mg MR provides benefits in that a lower dose of drug
is being used to provide the same glycaemic control, and that control
is more effective over a 24-hour period. To achieve the same or better
control with a much reduced dose of drug must be something better than
a marketing ploy. What is more, the product is not replacing any existing
product; it provides a means of controlling glycaemia in patients where
control is difficult with existing products. The small additional cost
is probably worthwhile in order to provide a better quality of life for
these patients. The same cannot necessarily be said for all recently launched
products.
Let us not cloud the issue, but judge every product on its merits.
Paul Breame
Prescribing Manager, Tendring Primary Care Trust, Essex
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