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Letters to the Editor
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Shipman inquiry
Pharmacists need to be full players in primary care team
From Ms C. F. Anderson, MRPharmS
The contention that Ghislaine Brant “had not fulfilled her professional
obligations to scrutinise the prescriptions to ensure they were appropriate
for the patient” (see PJ, 24 July, p103) leaves me feeling uncomfortable.
Until community pharmacists have access to patient records, how can we
possibly do this? And how many of us have had to dispense prescriptions
for, for example, benzodiazepines against our better judgement, knowing
that the prescriber had overruled (or could do) any concern of the pharmacist
regarding the appropriateness of the prescription?
I hope the Royal Pharmaceutical Society will support its members in efforts
to secure partnership in patient care, and the tragic events of Shipman
should be testament to the need for the pharmacist to be a full player
in the primary care team.
C. Anderson
Kilmarnock,
Ayrshire
Should be able to report GPs in confidence
From Mr C. Morris, MRPharmS
I read with interest the allegation that the pharmacist involved in
the Shipman inquiry has not fulfilled her professional obligations (PJ,
24 July, p103). I am interested in what she was supposed to have done
to fulfil her professional obligations.
A few years ago I worked in a pharmacy where a retired, but still registered,
GP was writing private prescriptions for temazepam for himself, his wife
and his daughter. They also seemed to be getting through the tablets
inordinately quickly.
I rang the General Medical Council to express my concerns and was told
that it could only work on a written complaint. Knowing the quality of
support GPs receive and the quality of support pharmacists receive, and
given that I had only been qualified a few years, I was not prepared
to put my name on paper. Having been qualified for longer now, I definitely
would not put my name on paper.
Perhaps legislation could be changed so that GPs could be reported in
confidence; a pharmacy I have just worked in receives regular monthly
prescriptions for one person for 500 temazepam tablets and for another
person for 800 Oramorph unit dose vials — the GP has been contacted
and says that both cases are fine!
Again I will say nothing as I do not believe I would be doing myself
any favours butting heads with a professional that actually receives
professional support from his profession.
Chris Morris
Newquay, Cornwall
Management coming out against its members?
From Mr C. R. Legg, MRPharmS
I feel bound to comment on the report in the PJ (24 July, p103) with
reference to a “dedicated pharmacist” whose conduct has been
called into question in the Shipman case. On what evidence or experience
did the chairman of the inquiry decide that the dispensing pharmacist
should be monitoring the doctor’s intention of use of the drug?
Am I wrong in thinking, after 40-odd years at the bench, that our terms
of service require us to dispense any legal prescription in as reasonable
time as possible?
As to the content, a prescription for a single 30mg ampoule of diamorphine,
or even a number of them, would hardly warrant a raised eyebrow in many
of the pharmacies I have worked in. Split packs or large quantities are
fairly common place, as many registers will testify. And how many pharmacies
flag up patients on the computer who have died, just in case their names
get used on prescriptions subsequently?
I suggest that even if the prescriptions had been questioned, Ghislaine
Brant would have got nowhere. I once became concerned by large quantities
of Controlled Drugs being prescribed by a drug dependence clinic, and
then split up and sold on to others in the car outside the pharmacy door.
When I expressed concern, the doctor said the large doses were part of
an experimental regimen. Not satisfied, I reported the matter to the
local drug squad officer, who suggested I went higher up. The Royal Pharmaceutical
Society proved to be of little help, so I then rang the appropriate person
at the Home Office. The eventual conclusion was that while the doctor
was registered to prescribe CDs there was nothing it could do about it.
I am amazed that Mandie Lavin, director of fitness to practise and legal
affairs, should be considering possible action to be taken in Mrs Brant’s
case — presumably against her. Is this just a case of the management
coming out against its members as a sop to some public pronouncement?
I would welcome some closer eyes on doctors’ prescribing of CDs,
and the pharmacy where I do most of my locum work already keeps running
balances of CD usage. I doubt that will stop another Shipman. If we are
now supposed to question the doctor’s prescribing habit, perhaps
the prescription form could be modified so the doctor could insert details
of patients’ conditions, for a reasonable fee of course.
Chris Legg
Sudbury,
Suffolk
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MANDIE LAVIN, director of fitness to practise and legal affairs,
Royal Pharmaceutical Society, replies:
As the Royal Pharmaceutical Society
is currently considering the content of the Shipman Inquiry report
it would be inappropriate for any comment to be made on the facts of
the
case about the named pharmacist. However, there are a number of issues
arising relating to a pharmacist’s professional responsibility
when dispensing medicines, which need clarification.
Professional accountability Pharmacists have a professional duty to
assess every prescription to determine its suitability for the patient.
A pharmacist who has concerns regarding a prescribed medicine must take
all reasonable steps to contact the prescriber to discuss the medicine
and must only dispense the medicine if satisfied that it will be safe
to use. It is not sufficient for a doctor to confirm that what is written
on the prescription is what he or she intended to prescribe and that
he or she will take full responsibility. The pharmacist must be satisfied
as to the product and dosage to be supplied and that it will not harm
the patient. If there is any doubt, the pharmacist may have no option
but to refuse to dispense the prescription and refer the patient back
to the doctor. In cases of uncertainty the pharmacist should make every
effort to contact the prescriber; if it is impossible to contact the
prescriber the pharmacist should use his or her professional judgement
and decide in all circumstances what course of action will be in the
best interest of the patient.
This was clearly outlined in a Law and Ethics Bulletin in The Pharmaceutical
Journal (PJ, 1 June 2002, p789).
Where a pharmacist is concerned about Controlled Drug prescribing by a doctor
and a report is made to the Society, the Society will report the doctor to
the General Medical Council with any supporting evidence. Sometimes the Society
inspectors, in conducting an investigation, will identify a doctor whose prescribing
patterns cause concern; a report is always made to the GMC.
Legislative powers The limitation of the current legislation was examined
during the Shipman Inquiry. The Society duty to act under the Medicines
Act legislation extends to the unlawful supply of prescription only
medicines, but the Society currently has no powers under the misuse
of drugs legislation. With regard to terms of service requirements it
is important that pharmacists recognise that terms of service do not
override professional responsibilities arising under the Code of Ethics.
Patient’s condition to be included on prescriptions The suggestion
that a prescription may in the future contain details of a patient’s
condition is a recommendation of the Shipman Inquiry. A patient’s
condition could be recorded if they consent to its inclusion on a prescription. |
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The
Pharmaceutical Journal