Hospital Pharmacist
Vol 9 No 5 p152
May 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The Medicines Control Agency (MCA) issued MLX 284, entitled "Proposals for supplementary prescribing by nurses and pharmacists and proposed amendments to the Prescription Only Medicines (Human Use) Order 1997" on 16 April.

This is a consultative document which applies to England, Scotland, Wales and Northern Ireland. Supplementary prescribing is defined as "a voluntary partnership between the responsible independent prescriber and a supplementary prescriber, to implement an agreed patient-specific clinical management plan with the patient's agreement, particularly but not only, in relation to prescribing for a specific non-acute medical condition or health need affecting the patient." It is seen as likely to be of most benefit to patients with non-acute conditions (eg, asthma, diabetes, conditions related to mental health) or defined health needs (eg, anticoagulation treatment, hormone replacement therapy, prophylaxis against coronary heart disease). The aim is to introduce the changes "during 2002 and early 2003."

An annex attached to the letter, which is available here, is to be used for responses, which should be provided by 9 July. This is a crucial document for the pharmacy profession. Hospital pharmacists are advised to read the letter, and those who wish to comment should do so through the means provided.

"Frequently asked questions and further information relating to HSC [health service circular] 2001/022" was issued by the Department of Health on 4 April. The document provides clarification on some issues arising from the national guidance on the safe administration of intrathecal chemotherapy, published in November 2001. For example, it clarifies the confusion between the advice in the guidance and that contained in the associated checklist by confirming that vincristine should be diluted to a maximum concentration of 0.1mg per ml and a minimum volume of 10ml. This document is essential reading for all those involved with intrathecal chemotherapy.

"Delivering the NHS Plan" was issued by the Department of Health in April. This announces the plan to increase health spending to 9.4 per cent of gross domestic product by 2008, so that health spending will attain the levels obtainable in the rest of the European Union. This rise in spending will involve an average annual increase of 7.5 per cent above inflation over the five financial years between 2003/4 and 2007/8.

There will be a focus on reducing waiting times to three months for outpatients and six months for inpatients by 2005. The main improvements will be in the treatments for cancer, coronary heart disease, mental health and older people. About 750 primary care one-stop centres will be established, along with additional diagnostic and treatment centres. There will also be extensions to intermediate, home and residential care. Councils will be charged by local hospitals for the costs they incur in keeping older people in hospital unnecessarily. There will also be matching charges on hospitals for re-admission costs to ensure that patients are not discharged too soon.

It will be essential for hospital pharmacists to become involved in the early planning stages of new developments to ensure that pharmaceutical services are delivered to meet the new requirements as these are introduced. The document can be accessed here.

"NHS Scotland: Guidance on regional planning for health care services" was issued by the Scottish Executive on 1 March. It relates to the planning and delivery of health care services which need to be provided across an area covered by more than one NHS board. The circular notes that the system whereby NHS boards come together as regional planning groups (that is, covering North, South-East and West of Scotland) has been effective in planning and developing services, and they should continue to be the main vehicle for developing and strengthening regional planning. The circular notes that health care planning operates at different population levels for different aspects of service provision and crosses all organisational levels. Regional boundaries for services that are best planned and delivered above the NHS board level may differ for each service, and some NHS boards may operate in more than one regional grouping. An appendix attached to the circular sets out the indicative planning populations for specialist services, which range from 1–20 million (and which therefore need to be planned in conjunction with UK colleagues) dependent on the specialist service concerned.

The following Technology Appraisal documents, which apply to England and Wales, have been issued recently by the National Institute for Clinical Excellence:

• Guidance on the use of trastuzumab for the treatment of advanced breast cancer (Number 34).
• Guidance on the use of etanercept for the treatment of juvenile idiopathic arthritis (Number 35).
• Guidance on the use of etanercept and infliximab for the treatment of rheumatoid arthritis (Number 36).
• Guidance on the use of rituximab for recurrent or refractory Stage III or IV follicular non-Hodgkin's lymphoma (Number 37).
• Inhaler devices for routine treatment of chronic asthma in older children aged 5–15 years (Number 38).
• Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation (Number 39).

"Getting ahead of the curve: a strategy for combating infectious diseases (including other aspects of health protection)" is the title of a Department of Health publication that was issued on 10 January. The document, which applies to England, outlines past and current threats from infectious diseases. A plan of action is proposed for the potential global threat. Hospital pharmacists are advised to read the document, which is available here.

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