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Letters to the Editor
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Shipman inquiry
“Professional responsibilities” need rewriting
From Ms H. D. Marsden, MRPharmS
The controversy over the Shipman Inquiry has highlighted faults in the “professional
responsibilities” laid down by the Royal Pharmaceutical Society.
The Society, which I understood was there to support pharmacists, instead
gives us professional duties that are impossible to uphold without psychic
powers. For example: “Pharmacists have a professional duty to assess
every prescription to determine its suitability for the patient.” How
can this be achieved without full access to all patients’ records?
All we have is the prescription, and, in many cases, no access to the
patient.
The dispensing fee buys approximately 60 to 90 seconds of our professional
time. To carry out this first point, we must:
· Contact the GP, get full copies of records, ascertain contraindications,
allergies, past history, etc
· Question the doctor on the indication for which he is prescribing the
medicine (patient confidentiality springs to mind here)
· Interview the patient (at his or her home if housebound) to find out
if he or she is taking any over-the-counter medicines, herbal remedies,
illicit drugs, excessive amounts of alcohol, etc
And this must take place with “reasonable promptness”. Imagine
the damage this sort of questioning to GPs on every single item would
produce.
“The pharmacist must be satisfied as to the product and dosage
supplied and that it will not harm the patient.” For this we also
need a full medical history, including allergies, renal and hepatic values.
We need to ensure the patient has no enzyme deficiencies, blood disorders,
genetic or ethnic factors that might affect the drug metabolism, and
do a full review of all medicines they are currently taking which they
may have obtained from other pharmacies.
I would recommend that these “professional responsibilities” be
rewritten by someone who works regularly in a busy community pharmacy
and based on what can be achieved in the 60 to 90 seconds per item that
we are reimbursed for, taking into account the lack of other patient
information we have at our disposal and the difficulties in contacting
GPs that we all experience, especially at weekends and out of hours.
Either that, or the dispensing fee has two noughts added and patients
expect to wait for a few hours while we make the necessary investigations.
Ghislaine Brant has my sympathies (PJ, 24 July, p103); I do not believe
there are many of us who would have questioned a GP we knew on whether
a prescription (correctly written and legal in every sense) for a single
ampoule of diamorphine for an elderly patient (unknown to us) was “suitable”.
As to this being repeated regularly over a period of years, I for one
would have assumed he has a high percentage of elderly patients or a
special interest in palliative or cardiac care (perhaps locuming for
a local hospice). How would we know any different?
Hazel Marsden
York
A dilemma about a doctor
From “Concerned Pharmacist”
Further to the letter about reporting GPs by Chris
Morris (PJ, 31 July,
p147) I, too, have a similar dilemma.
I have recently moved pharmacy and was presented with a private prescription
for 100 temazepam 20mg tablets written by a local doctor for himself.
The prescriber, who presented the prescription personally, was well known
to the staff. Upon entering the prescription in the register later that
day I was alarmed to find that a similar quantity had been dispensed
approximately monthly going back a number of years. A week later, I found
out that he is the substance misuse consultant at a local hospital. Even
though the POM register goes back many years this has not been picked
up by either the inspectors, the drug squad on their visits or by the
numerous pharmacists who have worked at this pharmacy over the years.
If I now report this do all the pharmacists and police officers who have
gone before me get reprimanded for “not fulfilling professional
obligations to scrutinise the prescriptions”? Who would make the
final decision about this prescriber’s actions if it were reported — would
it be the local substance misuse consultant?
Concerned Pharmacist
297/29
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SHONA COY, head of fitness to practise and advisory services, Royal
Pharmaceutical Society, replies:
Where a pharmacist has concerns about
the prescribing practices of a doctor, the appropriate body to consider
the facts of the case is the General Medical Council. It is for
the GMC to investigate the allegations and having considered the facts
of
the
case decide whether it constitutes misconduct and what action, if
any, is appropriate. A pharmacist who has concerns about the prescribing
practices
of a doctor may wish to contact the fitness to practise directorate
to discuss the matter further. |
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The
Pharmaceutical Journal