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Letters to the Editor
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Non-medical prescribing
Partisan editorials serve no one, least of all new prescribers
From Mr A. R. Cox, MRPharmS, and Dr N. J. Langford, MRPharmS
We write to express our dismay at a Pharmaceutical Journal editorial (PJ, 13 May, p554) which, after condemning doctors’ prescribing
skills in general terms and calling the medical profession ignorant,
summarily dismissed a reasoned and well-balanced article about non-medical
prescribing by a respected publication: the Drug and Therapeutics
Bulletin.1
The editorial complained that it was unfair to extrapolate high rates
of adverse drug reactions to pharmacist prescribing, yet there is little
evidence to suggest that the rate of adverse reactions would be reduced
by this extension of prescribing. Pharmacists already play an important
clinical role in the supply of medicines. Most prescriptions in the UK
are dispensed by either hospital or community pharmacists. Yet, even
given this opportunity, significant and avoidable adverse reactions occur
as a result of these dispensed prescriptions.
The editorial also suggested that the important point that doctors should
know about pharmacists is “that pharmacists know much more about
medicines than most doctors”. However, this knowledge is only beneficial
if it can be applied with a good understanding of clinical therapeutics.
While we can hope that only “meticulous” pharmacists who
have the knowledge and confidence to prescribe will do so, there is no
evidence that the prescribing culture of pharmacists will be safer than
that of doctors. Indeed a cautious approach also carries risk. An act
of omission, through fear of causing harm, may have consequences as serious
as those of prescribing.
Pharmacists are human; they are just as prone to cognitive errors as
doctors and may even create innovative forms of prescribing error. We
already know that pharmacists make significant numbers of dispensing
errors,2 yet pharmacy has devoted relatively fewer resources into measuring
this problem compared with the efforts that the medical profession and
others have made to quantify prescribing errors.
We welcome the potential benefit for patients that non-medical prescribing
may bring. Indeed, we are both involved in educating and examining medical
students and health care professionals (such as pharmacists and nurses)
in prescribing and therapeutics. However, like the Drug and Therapeutics
Bulletin, we would suggest that it is important that there is close monitoring
of safety of non-medical prescribing and attempts to evaluate its benefit
for patients.
Pharmacists should prove their worth and then shout about it. Partisan
editorials creating undeliverable expectations of non-medical prescribing
and alienating other health care professionals at this early stage serve
no one, least of all the new prescribers on the block.
Anthony Cox
Teaching Fellow
School of Pharmacy
Aston University
Nigel Langford
Honorary Senior Lecturer
Birmingham Medical School
Birmingham University
References
1. Non-medical prescribing. Drug and Therapeutics Bulletin 2006;44:5
2. Cox AR, Marriott JF. Dealing with dispensing errors. Pharmaceutical
Journal 2000;264:724
Nursing leaves pharmacy trailing in its wake again
From Mr D. R. Evans, MRPharmS
Once again the Royal Pharmaceutical Society shoots its self in the foot
and hinders pharmacy practice.
Nurses who can prescribe from the extended nurse formulary are to be
allowed to prescribe any medicine within their competence even though
their initial training may have only covered general sale list and pharmacy
medicines if their qualification was obtained some years ago.
Pharmacists who are supplementary prescribers outside community pharmacy
cannot even initiate therapy for general sale list or pharmacy medicines
if they are not included in the clinical management plan.
The Society apparently does not trust pharmacists who already have prescribing
qualifications. Yet the nursing profession grabs the opportunity with
both hands and leaves the pharmacy profession trailing in its wake again.
How ludicrous is it that the Society has had to set up a multiprofessional
group to look into the competencies for independent prescribing when
we already have a supplementary prescribing syllabus?
What is good enough for nurses should apply to ourselves as pharmacists
as well.
How can other professions take us seriously if the Society continually
puts over-regulation and obstacles in the way of advancement?
David Evans
Ilkeston,
Derbyshire
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PETER WILSON, head of post-registration, Royal Pharmaceutical Society,
responds:
Pharmacist independent prescribing has been hard fought for
by the Society. We have been working towards this goal for over 10
years as this was one of the aims set out in “Pharmacy in a New Age”.
The announcement of the introduction of pharmacist independent prescribing
was heralded as a new era by the chief pharmaceutical officer of the
Department of Health.
However, it was greeted with concern
by the medical profession and with reservations by the Drug and Therapeutics Bulletin (see PJ,
13 May, p557).
Independent prescribing is significantly different from supplementary prescribing.
Supplementary prescribers are constrained to prescribe the medicines in a
clinical management plan agreed with the independent prescriber who has assessed
the
patient. Pharmacist independent prescribers will be able to prescribe any
medicine, except
Controlled Drugs, for any condition. The pharmacist will be solely responsible
for assessing the patient, making decisions on treatment for the patient’s
condition and, importantly, not missing a serious problem. These are big differences
from supplementary prescribing and it is important that pharmacists who complete
independent prescribing training programmes have the requisite skills and knowledge.
The curriculum for supplementary prescribing is the starting point for developing
the independent prescribing curriculum. Involving other professions in the
process of curriculum development ensures that we make informed
decisions, particularly about skills and knowledge that are core to other professions
but which pharmacists have not learnt at college or through pharmacy practice.
It is important that we get the curriculum for pharmacist independent prescribing
right both for the pharmacists who will go through the courses and to reassure
the public (and the other professions) that pharmacists will have the right
skills and knowledge to treat them.
We understand the frustrations of pharmacists who want to become independent
prescribers. The curriculum is being developed as quickly as we can. |
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The
Pharmaceutical Journal