A balance must be struck
It cannot be denied that the Controlled Drug legislation is out of date; it has hardly been revised in 30 years. And any system that made it possible for a doctor to murder over 200 patients can only be described as flawed. The problem facing the Government now, as it decides how — or even whether — to implement the proposals put forward by the Shipman Inquiry (p109), is how to strike an appropriate balance between the public safeguards that are needed and a system that works. Some
of the inquiry’s proposals could lead to an over-complicated,
over-bureaucratic system. Others could threaten patient confidentiality
and, as always, there is a cost issue.
Although some of the proposals will mean more work for pharmacists, there
is plenty of good news. Not least is the proposed allowance of discretion
over technical defects on prescriptions. Pharmacists waste far too much
time chasing doctors to get small details on prescriptions changed when
the intention of the prescriber is perfectly clear. The Shipman Inquiry
sensibly proposes that pharmacists should be allowed to decide whether
or not to dispense such a prescription without fear of prosecution.
Other proposals could put more pressure on pharmacists’ time. Proposed
changes to Controlled Drug registers, including requirements to record
the name of the person to whom the drug is supplied and the name of the
pharmacist making the supply, and to keep a running balance, are just
a few examples.
The proposed introduction of different coloured prescriptions could raise
some eyebrows, particularly over how patients might feel about their
medicine being identifiable by the colour of the prescription. But this
would be solved by electronic transmission of prescriptions: no one would
see the prescription then. In fact, technology could answer many of the
problems — the inquiry recommends the introduction of electronic
Controlled Drug registers and that pharmacists should have access to
the electronic, central NHS Care Record.
None of this will come cheaply, and the Government will need to consider
how any changes it implements will be funded. Setting up the proposed
new Controlled Drug inspectorate that will inspect pharmacies and doctors
will be a massive undertaking in itself. And pharmacists must be adequately
remunerated for any new systems or procedures they have to introduce.
The Government must provide extra resources so that money is not diverted
away from current patient care. But spending thousands, or even millions,
trying to prevent future Shipmans and making Controlled Drug regulations
too bureaucratic to be workable will only alienate health professionals
and probably the public. After all, it needs to be remembered that Harold
Shipman was a deviant and determined individual and even the inquiry
admitted that no system can ever be foolproof.
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