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Pharmacists on the current supplementary prescribing courses will qualify early in 2004
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Supplementary prescribing provides opportunities that any pharmacist
who works with patients can grasp. It is not confined to one particular
health setting or one or two therapeutic areas. Enormous variety exists
in the models that the pharmacists who are currently on supplementary
prescribing courses plan to pursue. As more and more pharmacists become
supplementary prescribers, and confidence in this new role increases,
the number of models looks set to grow.
The models of supplementary prescribing can be roughly divided between
the
following four health settings: community pharmacy, hospital, general
practice surgeries and the primary/secondary care interface. One exception
to this is the prison service, where several pharmacists expect to be
prescribing next year.
“Supplementary prescribing offers great potential for our profession,” says
Nuttan Tanna, lead for primary care and community pharmacy, London region
supplementary prescribing support team. In particular, she stresses the
opportunity for supplementary prescribing to be used in the more advanced
medication services that will be introduced as part of the new community
pharmacy contract next year. “Every pharmacist should explore the
new opportunities.”
Different settings
Within a doctor’s surgery has perhaps been thought of as the most
popular place for pharmacists to prescribe. This has the specific advantage
of allowing access to patients’ records, which, until the IT catches
up, is more difficult for community pharmacists. As expected, many pharmacists
are opting for clinic work within GP practices. Therapeutic areas in
which pharmacists are planning to prescribe at clinics in surgeries include
cardiovascular disease, diabetes, gastrointestinal disease and osteoporosis.
One pharmacist who provides a prime example of this is Fiona Reid. She
is based at Newbyres Medical Group Surgery in Gorebridge, Midlothian.
For a number of years, Mrs Reid has run a hypertension clinic at the
surgery and has recently added another clinic for patients with heart
failure. Within the clinics she undertakes all the medicines management
required but has always required the GPs to sign prescriptions for her;
becoming a supplementary prescriber will change this.
In Croydon Primary Care Trust, four pharmacists working in GP practices
expect to become supplementary prescribers. Three are employed by the
PCT. All will prescribe in chronic disease management clinics focusing
on the PCT priority areas of cardiovascular disease, diabetes, respiratory
disease, mental health, musculoskeletal
conditions and gastrointestinal disorders. Which of these areas is selected
will depend on the individual GP practice’s needs.
Hospital pharmacy is another setting where supplementary prescribing
is expected to be taken up quickly. This is largely in recognition of
the fact that hospital pharmacists benefit from easier access to patients’ medical
records and closer working with other health professionals than community
pharmacists tend to enjoy.
At Southampton University Hospitals NHS Trust, four pharmacists are training
to become supplementary prescribers. Two are specifically interested
in parenteral nutrition, one in parenteral nutrition and therapeutic
drug monitoring, and one in HIV treatment. Another hospital pharmacist
in Croydon will also become a supplementary prescriber in HIV treatment.
Meanwhile, Gillian Jardine is set to become a supplementary prescriber
in an anticoagulation clinic at Ayr Hospital. She has been running anticoagulant
clinics for some time and has been setting doses for patients under a
local agreement. Becoming a supplementary prescriber will mean that this
arrangement can be formalised legally.
At Falkirk and District Royal Infirmary, Joanne Low will become a supplementary
prescriber in an oncology clinic. She will conduct reviews when patients
come to the hospital for chemotherapy for breast cancer, lung cancer
and lymphoma. Other therapeutic areas in which hospital pharmacists plan
to become supplementary prescribers include renal disease, rheumatology
and transplant medicine, and in intensive care.
In some ways, community pharmacists have faced a greater battle to become
supplementary prescribers. Not having access to patients’ medical
records has not helped. Some pharmacists have also had to consider whether
or not their premises are suitable to carry out the patient consultations
in supplementary prescribing. However, many community pharmacists have
overcome these obstacles and the number looks set to grow, particularly
in Scotland where Scottish Executive funding to train 100 community pharmacists
to become supplementary prescribers was announced in October.
One pharmacist already in training is John McAnaw, a community pharmacist
in Fife. He will use supplementary prescribing as part of the coronary
heart disease pharmaceutical care service he runs. Patients are assessed
in the pharmacy and he develops a care plan which is transferred to the
GP. Mr McAnaw accesses patients’ medical notes at the GP surgery.
Supplementary prescribing will be added so that the he can manage the
patients’ medicines.
Maurice Hickey will be prescribing at his community pharmacy in Forres,
Morayshire, for patients with asthma and chronic obstructive pulmonary
disease. He also plans to set up a pharmacist-led pain management clinic.
Emily Kennedy, a pharmacist for Boots the Chemists in Dumfries, and the
independent prescriber with whom she is working will develop clinical
management plans for patients with a number of different conditions to
see where supplementary prescribing will be most successful. These will
include asthma, contraception, hormone replacement therapy, thyroid conditions,
diabetes and recurrent urinary tract infection.
Helping patients to stop taking antidepressants is another area in which
at least one community pharmacist plans to use supplementary prescribing.
Some primary care trusts have developed an integrated approach to the
implementation of supplementary prescribing. For example, in Harrow PCT,
the initial phase of supplementary prescribing will involve pharmacists
working within care of the elderly wards in hospital. An infrastructure
is being developed so that community pharmacists and practice-based pharmacists
can add supplementary prescribing to the structured medication reviews
that they currently carry out for older people. This area — care
of older people –— means that a wide variety of drugs could
be included in clinical management plans and prescribed by supplementary
prescribers. |
