The Pharmaceutical Journal
Vol 277 No 7428 p636
25 November 2006

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· Section 60 Order (2)
· Supermarket pharmacy
· Patient safety
· Controlled drugs (2)
· Drug misuse
· The profession
· The Council (2)
· The Society
· Community pharmacy

Letters to the Editor

Controlled drugs

Dubious practice of doctor dispensing

From Mr N. Cameron, MRPharmS

As a proprietor pharmacist from New Zealand, I found returning to practise in the UK after 30 years an eye opener. This time I was working in a rural area surrounded by dispensing doctors.

There was much lip service being paid to the legacy of Harold Shipman. Many of the changes are desirable but I am astounded that the dubious practice of doctor dispensing was not one of them.

I spoke to a dispenser who formerly worked for a doctor. The practices mentioned were interesting and customer comments about being given bottles of drugs by the dispenser unchecked were surprising, but common.

My own employer, a large multiple, was aware of this practice and also of the poaching of patients from within the one-mile radius, but declined any action, for fear of rocking the boat.

The only positive side of doctor dispensing was that they paid their dispensers better and tended to use a pragmatically limited range of drugs.

If there is another Harold Shipman lurking within the British medical establishment, he will be able to go about his activities with total confidence if he is a dispensing doctor.

Neville Cameron
Coromandel, New Zealand

Frequency should be specified

From Dr I. ab I. Davies, MRPharmS

While referring to the Royal Pharmaceutical Society’s “Medicines, ethics and practice” guide on a matter involving Controlled Drugs and the Shipman episode, I was amazed to find, under section “g” of the paragraph “Prescriptions for Controlled Drugs” (July 2006, pp26–27), the statement “specify the dose to be taken (NB: The Home Office has expressed the view that a dose ‘as directed’ or ‘when required’ is not acceptable, but ‘one to be taken as directed/when required’ is acceptable)”. This would leave the door wide open to any potential Shipman who could prescribe 200mg MST Continus tablets: sig “one to be taken as directed”, with oral directions to the patient to take one every 15 to 20 minutes if in pain.

It is time this vague direction was altered to require the dose and the frequency or time interval between doses of Schedule 2 CDs to be specified. Any alteration in dose or frequency should be recorded both on the label of the preparation and in the patient’s records.
 
Iolo Davies
Ballygowan, County Down

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