The Pharmaceutical Journal
Vol 268 No 7203 p871-872
22 June 2002

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  Prescribing
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Letters to the Editor

Prescribing

Concern is for patient safety

From Mr R. Gillespie, MRPharmS, on behalf of the NHS Argyll and Clyde Area Pharmaceutical Committee

I write in reply to George Bell's letter (PJ, 8 June, p802). The article to which Mr Bell refers (PJ, 4 May, p607) included selected extracts from a submission by the area pharmaceutical committee of NHS Argyll and Clyde on the proposals to switch the status of certain drugs from POM to P.

The views expressed in the submission were the collective thoughts of a committee and this explains the use of the word "we". It is unfortunate that the article conveyed the impression that the comments came solely from myself.

Our only concern is for the safety of patients. The committee believes that drugs should be prescribed only by practitioners who are competent in their use, irrespective of their professional background.

We fully support the moves to widen the scope for different professional groups to prescribe but consider that this should be done only in conjunction with appropriate training.

The reclassification of the listed drugs, such as ACE inhibitors, from POM to P would permit their prescription and sale by community pharmacists. Although pharmacists may look forward to the day when they would be in a position to execute such prescribing decisions, the view of the committee was that this cannot be achieved without appropriate training. In addition, it could not be done without relevant monitoring, access to patients' medical records and in isolation from other members of the health care team.

We also commented that few patients would be likely to purchase such drugs because of their cost. The committee therefore concluded that it would be more appropriate to use the considered introduction of specific legislation rather than using the mechanism of POM to P.

The legislation to which Mr Bell makes reference permits nurses who have successfully completed the extended nurse prescribers course to prescribe all P medicines. We believe that the present training course would not equip nurses to prescribe safely those drugs included in the proposed list and therefore consider that it is appropriate to include the implications for nurse prescribing in the debate of POM to P.

I would certainly take issue over Mr Bell's questioning of pharmacists' skills in respect to diagnosis. Community pharmacists, for example, successfully perform this task many times a day and it is disappointing that he fails to recognise this core skill.

As pharmacists we would expect (and were invited) to contribute to the debate of prescribing and availability of medicines. We are well aware of the potential for harm and have a responsibility to express our views on a change in the use of drugs which could affect patient safety.

Robert Gillespie
Area Pharmaceutical Committee,
NHS Argyll & Clyde

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