Hospital Pharmacist
Vol 9 No 7 p210
July/August 2002

Review of circulars and official publications
by Alex Bower, MRPharmS

The Welsh Office issued "Medication supply to hospital patients" on 17 June as WHC(2002)71. This heralds a major redesign of the medication supply system through the use of patients' own drugs in hospitals. The circular recommends that medicines brought in by patients should be assessed for suitability, and that individual medicine lockers should be used at the patient's bedside for storage purposes.

The circular also states that original packs that have been prelabelled for discharge should be dispensed if additional supplies are required. Trust boards are required to review pharmacy staffing levels and make funding available to facilitate the introduction of these supply arrangements. The use of patients' own drugs requires a significant change, but it is highly desirable in the interest of seamless care.

The circular does not refer to funding issues but these will obviously have to be addressed. GP prescribing costs will increase at the expense of hospital costs, especially since drugs are commonly supplied to hospitals at discounted prices. The time commitment required to bring about such a change should not be underestimated, since it will involve gaining support from a wide range of stakeholders. This is why it is heartening to note the recognition given to the potential impact on pharmacy staff time, as well as the need to provide resources for the new supply arrangements. The circular also provides guidance on other issues. These are:

Prescribing at the primary/secondary/tertiary care interface Hospital outpatients should only receive a supply of medicines from hospital when there is an urgent clinical need or where it is not possible to transfer information in time for a GP to prescribe. Consultants should, wherever appropriate, recommend a class of drug to be prescribed by the GP rather than a specific drug or brand. Patients discharged from accident and emergency units should receive a maximum of 5–7 days supply as original packs or prepacks.

Use of manufacturers' original packs ("patient packs") Hospital pharmacies are asked to use original packs as standard practice and as a means of ensuring compliance with European Directive 2001/83/EC which requires that all dispensed medicines be supplied with a patient information leaflet. It is claimed that the use of original packs will result in financial savings, and the transfer of funds from primary to secondary care is advocated to facilitate the process.

Prescribing of original packs in primary care Local health boards will be required to facilitate the move towards original pack dispensing in primary care. Further guidance on this aspect is to be provided by the All Wales Medicines Strategy Group.

Although hospital pharmacists outside Wales will be familiar with general trends towards implementing the areas indicated, they will no doubt be impressed by the clear, official lead that has been given by this Welsh document. Guidance on the estimated cost implications of using patients' own drugs would be particularly helpful.

"Pre and post appointment checks for all persons working in the NHS in England" was issued as HSC 2002/008 on 30 May. The circular identifies good practice relating to the checks required before an NHS body appoints a person as an employee or volunteer or engages them by hiring their services. The circular states that failure by an employee to provide accurate and truthful information at the time of their application must be considered as a disciplinary matter that can lead to dismissal. The checks that must be carried out are detailed in an attachment to the circular. Hospital pharmacy staff responsible for recruitment will need to ensure that the essential and mandatory checking requirements are now being met.

"National Service Framework for older people, supporting implementation. Intermediate care: moving forward" was issued in June by the Department of Health. This applies to England. Intermediate care aims to prevent unnecessary hospital admissions and facilitate timely discharge. The document recognises the progress made to establish these services over the past two years but adds impetus to their further development. Intermediate care has primarily been focused on treatment and rehabilitation related to physical problems, but the document indicates that it is not the intention to exclude people with mental health problems from such arrangements. The potential for intermediate care in the latter group of patients is found in Appendix 5 to the document, while the importance of specialist medical assessment for older people is referred to in Appendix 7. Hospital pharmacists will readily identify a potentially significant contribution that can be made to the development of intermediate care through improved medication management processes. Many will already have developed, or be in the process of developing, suitable schemes. The document does, however, provide another opportunity for local discussion about pharmacy services for the elderly and a particular opportunity to consider how services to those with mental health problems can be developed.

It may well be worthwhile having a discussion with those responsible for intermediate care locally, since pharmacy developments are likely to contribute directly towards their aims. The document can be found here at www.doh.gov.uk/intermediatecare/icmovingforward.htm

"Funding arrangements for specialised and other pan-regional hospital services" was issued as HDL(2002)39 by the Scottish Office on 14 May. A specialised service is one where the population used for planning purposes is significantly greater than that of a single, average sized NHS board, and for which a critical mass is required to optimise clinical outcomes, clinical effectiveness and equity of access for all patients. Hospital pharmacy managers may need to liaise with their finance departments to ensure that funding arrangements are in place for drugs included as part of a service level agreement for a specialised service.

The following Technology Appraisal documents have been issued recently by the National Institute for Clinical Excellence:

• Guidance on the use of infliximab for Crohn's disease (Number 40)

• Guidance on the use of human growth hormone (somatropin) in children with growth failure (Number 42)

• Guidance on the use of newer (atypical) antipsychotic drugs for the treatment of schizophrenia (Number 43)

  * PDF files on PJ Online require Acrobat Reader 4 or later.

Mr Bower is a consultant pharmacist