Practice Committee
A recent meeting of the Society’s Practice Committee focused
on independent prescribing. The Society’s Council has debated
the options for independent prescribing and will incorporate its
views in the final response to the consultation. Sue Kilby, head
of practice at the Society, said that there will be a series of
safeguards in place and that both the Code of Ethics and the clinical
governance framework will be reviewed. In addition, guidance will
be produced to cover the ethics of prescribing, evidence-based
practice, communication with other members of the health care team,
confidentiality and record keeping. |
Pharmacists should be able to prescribe independently from
a full formulary, according to responses to the Medicines and Healthcare
products Regulatory
Agency and Department
of Health’s UK-wide consultation on proposals
to introduce independent prescribing by pharmacists (PJ, 5 March 2005,
p257).
The Royal Pharmaceutical Society, the Company Chemists Association, the
National Pharmaceutical Association and the Pharma-ceutical Services Negotiating
Committee have all supported the proposal that pharmacists should be able
to prescribe from a full formulary and for any condition, but they also
all agree that pharmacists should only be able to prescribe within their
individual areas of competence.
“There is a clear need for independent prescribing to move on,” Colette
McCreedy, director of pharmacy practice at the NPA, says. The NPA believes
that independent prescribing is an issue that affects the whole of the
pharmacy profession and in its response it consulted with the Guild of
Healthcare Pharmacists, although the organisations will issue separate
responses.
In progressing into independent prescribing, pharmacists should, Ms McCreedy
believes, learn from the frustrations and lost opportunities nurses have
encountered with prescribing rights.
For instance, a restricted formulary is likely not to include some important
products and would be unable to keep pace with constantly changing clinical
guidelines. This could lead to pharmacist prescribers being unable to prescribe
according to latest guidelines because of delays in products being added
to the formulary and so cause inconsistencies between independent pharmacist
and GP prescribing.
In addition to the problems arising from trying to use a limited formulary,
the likely struggles involved in trying to expand the formulary also need
to be considered, Nigel Simmons, non-medical prescribing lead (Cambridgeshire),
warns. “Stepwise expansion through formularies or lists of medical
conditions, which require parliamentary time to be amended, is no longer
appropriate,” he argues.
Limiting the medicines that pharmacists can prescribe might also severely
curtail the benefits that independent prescribing might be able to bring
patients, such as filling the gap in out-of-hours services, providing full
medication reviews and prescribing medicines not available on the NHS.
The current out-of-hours gap is causing patients to put pressure on pharmacists
to supply prescription drugs without a prescription, Steve Dunn, managing
director of AAH Pharmaceuticals, says. “The only logical solution
is,” he believes, “for pharmacists to become fully qualified
to prescribe.”
Limiting the medicines that a pharmacist undertaking a medication review
can prescribe would also limit the usefulness of these reviews to patients,
since a pharmacist might be able to make changes to some, but not all,
of a patient’s medicines for some, but not all, of their conditions.
Independent prescribing could also allow pharmacists to prescribe privately.
For instance, pharmacists could prescribe prescription only medicines that
are not available on the NHS (for example, malaria prophylaxis or influenza
vaccines for patients not at risk). “This will improve access and
choice for the public and convenience for those who do not have time or
do not want to visit an NHS service for whatever reason,” Georgina
Craig, head of communications and partnership development at the CCA, points
out. It would also benefit the NHS, by decreasing use of NHS GPs’ or
nurses’ appointments times. But, if the formulary that pharmacists
could use were restricted, this might also not be possible.
In addition to the broad consensus that
restricting the medicines pharmacists can prescribe would limit the benefits
of independent prescribing, respondents also agree that pharmacists’ prescribing
should be limited to their area of practice.
This competence would be established at the time of training, but will
also, the CCA argues, be necessary to ensure competence on an ongoing basis.
The CCA proposes that competence is ensured by accompanying the expansion
of non-medical prescribing with the establishment of multiprofessional
peer review systems and joint continuing professional development initiatives. “Such
external revalidation would form an essential part of the necessary controls
that superintendent pharmacists will put in place as independent prescribing
develops in community pharmacy,” Colin Baldwin, chief executive of
the CCA says.
Any competency training scheme would also need to cover the whole of the
UK, the NPA argues, to overcome the potential difficulties of pharmacists
being able to prescribe independently in some primary care organisation
areas, but not in others. But the amount of training required will vary
for different prescribing roles. For instance, the training to prescribe
for a minor ailments scheme would be limited to the issues around its administration,
but for prescribing of prescription-only medicines, considerable extra
training will be needed, the NPA argues.
The necessary extent of this training has led the Cambridgeshire Steering
Group, in its response to the consultation, to recommend that a hybrid
approach is taken, allowing formularies to be limited by conditions or
clinical settings. Mr Simmons believes that pharmacists will need considerable
additional training before they can accurately diagnose most conditions
and that this will, therefore, initially limit how much benefit pharmacists
prescribing independently can bring to patients.
The NPA, however, compares the situation of deferred diagnostic competency
to that of GPs prescribing independently after a consultant has made a
diagnosis. It argues that there is no reason why the possibility should
not be pursued of pharmacists prescribing independently after the GP has
made a diagnosis. In fact, medicines legislation that recognises the competency-based
nature of independent prescribing would still allow primary care organisations
the option of implementing protocol-based and formulary-based prescribing
at local level, the NPA says.
It may be some time, however, before all these considerations of formularies
and competence are reflected in changes pharmacists will see — the
responses to the consultation will first be considered by the Committee
on Safety of Medicines later this summer, the committee will then need
to make recommendations to ministers before legislation can begin to be
drafted. |
The
Pharmaceutical Journal