Hospital Pharmacist
Vol 9 No 4 p115
April 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The Department of Health (DoH) published "Modernising the NHS supply chain — a strategic review" as issue 106 of the Chief Executive bulletin in February.

The review covers England only and will be carried out by the NHS Logistics Authority. A review team will visit 27 organisations in England in an information-gathering exercise and will be consulting widely with NHS bodies as well as drawing on expertise from the commercial and private sectors. A first phase report was due to be submitted to the Department of Health.

Those requiring further information, or who feel that they can contribute or otherwise be of assistance with the review, are advised to contact the project manager, Michael Wood, (tel 01773 724260, e-mail (michael.wood@logistics.nhs.uk). Hospital pharmacists involved in drug contracting and procurement may want to find out if the review has any potential implications for these services.

The DoH issued "Extending independent nurse prescribing within the NHS in England — a guide for implementation" in March. The guide contains comprehensive information on the administrative and procedural steps that are needed to enable nurses and midwives to prescribe, and provides information on good practice.

More than 2,000 nurses are currently able to prescribe from the "Nurse prescribers' formulary". Prescribing rights are to be widened to a "Nurse Prescribers' Extended Formulary" which includes all general sale list and pharmacy medicines (except those containing Controlled Drugs) along with a range of prescription only medicines.

Central funding is being provided to train about 10,000 nurses between 2001 and 2004. In addition, steps will be taken to permit supplementary prescribing by nurses, particularly for patients with chronic conditions such as asthma, diabetes, heart disease or mental illness. The programme of education involves 25 taught days in a university and 12 days learning in practice. The latter will involve a designated supervising medical practitioner providing the student with supervision, support and opportunities to develop competence in practice. From April, nurse prescription forms will be annotated as either "district nurse/health visitor prescriber" or "extended formulary nurse prescriber". Pharmacists should ensure that they only dispense items relevant to the formulary concerned.

The Scottish Executive issued a letter (ref SEEHD/CNO/[2002]1) from the Chief Nursing Officer on 5 February entitled "Identifying and prioritising nurses, midwives and health visitors to undertake extended nurse prescribing in Scotland: further information". This attaches a framework to assist directors of nursing in identifying and prioritising those who will participate in the first wave of training for the extension of nurse prescribing. Funding will be allocated at a rate of £700 per person identified. Higher education institution course fees are expected to be around £350. The letter also attaches a list of the prescription only medicines that will be prescribable.

The DoH is seeking views on "National Service Framework for diabetes: standards" to inform the delivery strategy that will be published in the summer. The consultation exercise covers performance indicators, practice-based registers and service models for the following:

• Empowering people with diabetes
• Clinical care of adults with diabetes
• Clinical care of children and young adults with diabetes
• Care of people with diabetes on admission to hospital
• Pregnancy and diabetes
• Detection and management of long-term complications

Hospital pharmacists with an interest in diabetes who wish to submit their comment before the deadline of 26 April should access this website.

"NHS performance indicators national figures: February 2002" was recently issued by the DoH. Indicators are included on the prescribing of antibacterial drugs, generic prescribing rates and the prescribing of ulcer healing drugs. The prescribing of antibacterials and generics has improved, but not so with ulcer-healing drugs.

The National Institute for Clinical Excellence issued "Guidance on the use of irinotecan, oxaliplatin and raltitrexed for the treatment of advanced colorectal cancer" in March (Technology Appraisal Guidance Number 33). Neither irinotecan or oxaliplatin (in combination with 5-fluorouracil and folinic acid) nor raltitrexed are recommended for routine first line therapy for advanced colorectal cancer. Patients and their consultants may wish to continue on current therapy until they consider it appropriate to stop. Oxaliplatin in combination with 5-fluorouracil and folinic acid is to be considered for use as first line therapy in situations where metastases confined to the liver may become resectable following treatment. Irinotecan monotherapy is recommended for patients who have failed an established fluorouracil-containing regimen.

On 13 February, the Scottish Executive issued NHS HDL(2002)8 entitled "Health board allocations for 2002–3: application of funding earmarked to support implementation of 'The right medicine — a strategy for pharmaceutical care in Scotland'." The strategy document was reviewed in the March HP. The more recent communication announces that the outcome of a recent generic drugs discount survey will deliver savings on the drug bill. A sum of £4m from these savings is to be made available to implement the strategy. The letter lists suggested topics to be covered by the funding and requires chief executives of NHS boards and trusts to submit spending plans in April. The provision of earmarked funding to implement the strategy will be welcome by pharmacists.

Mr Bower is assistant director of strategic development at Wakefield Health Authority