The Pharmaceutical Journal
Vol 276 No 7384 p72
21 January 2006

This article
Reprint   Photocopy

PDF 45K, Acrobat Reader

· Vitamin D and Cancer
· Animals in testing
· Out-of-hours services
· Medicines use reviews
· Prescribing
· NEL LPC
· Pharmacy workforce
· Overseas pharmacists
· Statutory Committee

Letters to the Editor

Prescribing

Can nurses prescribe diazepam 5mg/5ml oral solutions?

From Dr R. J. Schmidt, MRPharmS

The Pharmaceutical Services Negotiating Committee has recently reminded community pharmacists that diazepam oral solution 5mg/5ml is a blacklisted item. We may suppose that increasing numbers of prescriptions for this item are being submitted for reimbursement. Indeed, I can imagine why this might be occurring given an increasing population of elderly patients, the requirements of the Disability Discrimination Act and the principles of clinical concordance. Since liquid preparations of diazepam 2mg/5ml for oral administration are not blacklisted, why is a 5mg/5ml solution treated differently?

Currently, neither a generic nor a branded version of the 2mg/5ml solution seems to be available in the community, so the item has to be ordered from a specials manufacturer. Typically, an invoice in excess of £30 to £40 follows. I understand that the Prescription Pricing Authority has been reimbursing pharmacies at the Drug Tariff price (currently £1.75 for 100ml). Perhaps not surprisingly, some GPs are reportedly now writing prescriptions for 3mg/5ml in order to ensure that the prescription is reimbursible as a special item. This is an unwelcome development from the point of view of the global sum from which pharmacies are paid.

Further, I am not sure that the assertion made by the PSNC regarding whether diazepam 5mg/5ml oral solution can be prescribed on an NHS prescription is entirely correct. Extended formulary nurse prescribers are allowed to prescribe oral, parenteral and rectal formulations of diazepam. Careful reading of Parts XVIIB(i) and XVIIB(ii) of the Drug Tariff (the nurse prescribers formularies, both of which I understand to be “white lists”) reveals that items in the blacklist, ie, in Schedule 1 of the NHS (General Medical Services Contracts) (Prescription of Drugs etc) Regulations 2004, are included only by proxy through the use of the phrase “currently prescribable by GPs”, and then only in respect of the prescribing of GSL and P medicines by extended formulary nurse prescribers.

This interpretation is based on my belief that the blacklist does not in fact apply to nurse prescribers. In turn, this is based on my belief that nurse prescribing is not covered by general medical services contracts, and hinges on whether or not community nurse prescribing contracts make reference to the blacklist. So, unless a different interpretation is necessary because of what is written in GMS contracts and CNP contracts (which I have not had the benefit of reading), it would seem that the PPA cannot refuse to reimburse an extended formulary nurse prescriber’s prescription for diazepam 5mg/5ml oral solution.

Richard Schmidt
Barnoldswick, Lancashire

LINDSAY McCLURE, head of information services, Pharmaceutical Services Negotiating Committee, replies: Paragraph 5 of the Pharmacists’ Terms of Service, as set out in the NHS (Pharmaceutical Services) Regulations 2005 requires a pharmacist to dispense with reasonable promptness any ordered drug, other than a “scheduled drug”, and any drug listed in Schedule 2 to the Prescription of Drugs Regulations signed by a prescriber and including the reference “SLS”. A “scheduled drug” is a drug or other substance specified in Schedule 1 to the National Health Service (General Medical Services Contracts) (Prescription of Drugs etc) Regulations 2004 (which is commonly known as the “blacklist”). This list is reproduced in Part XVIIIA of the Drug Tariff. As the provisions in the Pharmacists’ Terms of Service and the Drug Tariff do not differentiate between different classes of prescriber, an NHS prescription for a “blacklisted” item cannot be dispensed by a pharmacist, irrespective of who has written the prescription.

Diazepam 2mg/5ml is currently listed in Part VIII of the Drug Tariff with the reimbursement price based on the list price of Sandoz Diazepam Syrup. There are currently supply problems with this particular product and there are no alternative licensed products available.

If pharmacists are unable to obtain this product, the prescription should be referred to the prescriber so that he or she has the opportunity to prescribe an alternative licensed product and/or is aware of the changes in liability caused by an unlicensed product being given to the patient. If the prescriber believes that the product should be specially manufactured, the prescription should be amended to specify the specials manufacturer within the product description.

If the prescriber has stated the name of the specials manufacturer, the Prescription Pricing Authority will pay based on the endorsed invoice price for the specially manufactured product rather than the Drug Tariff price. The costs of drugs dispensed are charged back to local primary care trust unified budgets by the PPA rather than the global sum.

Guidance on dealing with shortages of Part VIII products is available from the PSNC National Prescription Research Centre (tel 020 8441 8427).

Send your letter to The Editor

Previous Topic (Medicines use reviews)

Next Topic (NEL LPC)