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Letters to the Editor
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Emergency supply
Salbutamol should be a P medicine
From Mr P. D. Burgess, MRPharmS
I appreciate the opportunity to sell sumatriptan and amorolfine and
consider that to be progress. Please include salbutamol now.
Unlike Rupert Peskett (PJ, 22 July, p104) I have not come across anyone
wanting a supply of salbutamol because they have not been using their
preventive inhaler correctly. The closest I have seen to this was someone
who tried to get a supply twice because it was more convenient than taking
time off work to see his GP — but surely even that is a role pharmacy
could fill with a few checks built in.
In my experience the vast majority of the people requesting salbutamol
have had a genuine need — perhaps to replace a lost inhaler or
one that has run out unexpectedly early. Their requests have not been
in any form that could be construed as bullying. I do not think the legal
classification would alter anything there, as I can still refuse the
supply of Dulcolax, for example, when I consider it inappropriate. Although
I agree with most of what Neil
Heslop and Adam Todd say (PJ, 22 July,
p104) I believe that emergency supplies are supposed to be made to someone
who has been issued with the prescription-only medicine by a UK doctor
in the past, so visitors from overseas are denied supply under those
rules; a POM-to-P change would definitely benefit them.
Paul Burgess
Auckland,
New Zealand
Allow us our professional opinion
From Mr C. Morris, MRPharmS
Regarding emergency supplies, I would like to add my support to Rupert
Peskett’s letter (PJ, 22 July, p104) and, as another pharmacist
not prone to bullying, I applaud his sentiment. I am aware of a pharmacist
in our area who, when giving an emergency supply, would charge for the
drug and only give a refund if he received a prescription for the exact
amount of tablets, five days or calendar pack. If the patient returned
with a monthly prescription they would not get their money back. This
meant that they would have to approach their GP and tell them that they
had not ordered their prescription in time. Within a few months he received
no more requests for emergency supplies for late requests.
Neil Heslop and Adam
Todd (ibid, p104) in their letter that berates those
pharmacists who do not supply, say that “emergency” is open
to interpretation and urge us to view a pharmaceutical emergency as something
different from a medical emergency. Surely, in the above case, it is
better to have people ordering their prescriptions in time rather than
waiting to see if they can get an emergency supply. In this way the pharmacist
has almost removed pharmaceutical emergencies and therefore cut down
greatly on the chances of a medical emergency.
Another pharmacist, on taking over a pharmacy, said that no loans were
to be made and all emergency supplies must be paid for. Again, emergency
requests dropped substantially within a few months.
The authors raise three points, which they believe are incorrectly believed
to be true:
· That supplying would encourage patients to forget about going
to their GP and request “emergencies” on a regular basis.
The two pharmacies mentioned above may not prove this point but they
certainly prove the reverse, that if the person is put out a little,
the emergency requests dry up.
· That emergency supplies must not be done if the GP surgery is
open. Although this may or may not be true, if the patient’s medicine
is so important, what is wrong with getting them to explain to the surgery
why they have not ordered it?
· That the patient must have documentary evidence of their medicines.
I have always provided emergency supplies if I deem them to be emergencies,
if they are regular users of the pharmacy and have received regular repeat
prescriptions for the item they require. If the person is a holidaymaker
or from out of the area, how are we to uphold the Code of Ethics when
it says, “that treatment with the pharmacy only medicine requested
has, on a previous occasion, been prescribed” (paraphrased from “Medicines,
ethics and practice”) without written evidence? Perhaps telepathy
is part of the new pharmacy course.
I have never refused a supply for anything other than “sound legal,
ethical or clinical reasons” to quote their letter, yet I am guessing
that I am one of the pharmacists being berated by the authors. Perhaps
it is time that we all started acting like professionals, allowed our
colleagues the right to a professional opinion and stopped trying to
lecture to them, or force our own opinions or views on them.
Chris Morris
Newquay, Cornwall
Dilemmas with foreign customers not uncommon
From Mr J. E. Packham, MRPharmS
The new edition of “Medicines, ethics and practice” states
that “doctor” means a doctor registered in the UK with the
General Medical Council (p13).
Large numbers of international visitors present initially at the weekend
or on bank holidays requesting, eg, salbutamol. Often they are at the
end of their stay or on their way to the airport. If an asthmatic person
does not have his inhaler with him, then the anxiety engendered by its
absence, coupled with stresses of travelling, could precipitate an attack.
Frequently a British person is off on holiday abroad and has forgotten
to pick up a medicine they take regularly. No problem there, as they
are registered with a UK doctor. He or she may be travelling with a relative
returning home abroad and who also needs salbutamol. Are their needs
any different? Is professional judgement a defence against possible prosecution
for supplying a POM without a UK prescription? I often work unsocial
hours on the route to a major airport where these dilemmas are common.
John E. Packham
Ely, Cambridgeshire
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