Hospital Pharmacist
Vol 10 No 6 p240
June 2003

Review of circulars and official publications
by Alex Bower, MRPharmS

Patient group directions (PGDs) have recently been issued by the Department of Health. PGDs allow staff other than doctors to give specific medicines to groups of patients in certain situations (for example, where mass casualties are expected) without individual prescriptions having to be written. PGDs have been developed for use in the event of chemical or biological agents being released into the environment, such as during a terrorist attack. The drugs currently covered by PGDs are:

• Atropine

• Pralidoxime mesylate

• Obidoxime chloride

• Dicobalt edetate

• Glucose injection 50%

• Potassium iodate

• Ciprofloxacin

• Doxycycline

A training strategy for staff who are to administer the drugs is being developed.

Improving health in Scotland: the challenge was issued recently by the Scottish Executive and is available here. The focus of the document is on "healthy living" with the challenge being to boost physical, social and mental health among the Scottish population.

The first phase will address tobacco and alcohol consumption, fruit and vegetable intake, physical activity levels and obesity within the four theme areas of early years, teenage transition, workplace and communities. Future phases are to address mental health and wellbeing, the health of the homeless and sexual health.

It is recognised that progress is dependent on multi-agency working, including the National Health Service, local government, voluntary agencies and the private sector, and that links need to be strengthened between policy areas such as education, social justice, environment, employment and sport. To facilitate this, a director of health improvement has been appointed to lead a new directorate within the Scottish Office.

There is little that is new in the document regarding the determinants of health and the multi-agency dimension needed to achieve success. What is new, however, is the clear determination and drive to develop a co-ordinated approach to make progress. Senior hospital pharmacists might wish to strategically assess the potential role of the profession in promoting healthy living and become involved in the early stages as structures and processes are developed.

Guidance on commissioning arrangements for specialised services, is now available as a PDF file (60K). Primary care trusts are the primary commissioners of health care services for their local populations but the expectation is that they will act collaboratively when commissioning specialised services.

Specialised services are defined in a certain way. They are provided in relatively few specialist centres to catchment populations of more than a million people covering more than a single PCT.

There tend to be two main groupings of specialised services — those with planning populations of 1-2 million, with around 20- 30 specialist centres in the country, and those with planning populations of between 3-6 million, with around 8-15 specialist centres in the country. Examples of each type of specialised service are given in the paper, for example, liver, cancer and neurosurgery services are of the first type, and cleft lip and palate, spinal injury, gender dysphoria services are of the second type.

The work of commissioning specialised services is generally undertaken by regional and/or local specialised commissioning groups. The document notes that stakeholders, which include health care providers, need to be involved in the commissioning process. The guidance suggests that commissioning groups should ensure that service specifications encompass National Institute of Clinical Excellence recommendations.

There is no specific mention of drugs but hospital pharmacists will be aware that drugs can represent a significant component in the costs of delivering specialised services. Hospital pharmacists in trusts that provide specialised services may wish to ensure that there is appropriate pharmaceutical input into commissioning arrangements to ensure that the drug issues are suitably addressed.

Reforming the NHS complaints procedure: patient focus and public involvement, a draft for consultation was issued recently by the Scottish Executive. The deadline for responses will now have passed but the document provides an early opportunity to review complaints procedures. The comments do not specifically relate to pharmacy but there are some common messages which will be relevant to the profession in all parts of Britain, not just Scotland.

According to the document, complainants are often unhappy with the procedural aspects of complaints systems. For example, they think that resolving a complaint takes too long, or are dissatisfied with the outcome. Interestingly, most staff consider that complaints are handled well. Other causes of dissatisfaction among complainants include unhelpful, aggressive or arrogant attitudes of staff.

My own experience from being involved with complaints supports these views – it is often a "high handed" attitude of a member of staff that leads to a complainant taking matters as far as they can. The report recommends that all staff be adequately trained in dealing with complaints as part of induction procedures.

If any of this sounds familiar, then it may be a good idea to use this as an opportunity to review the camplaints procedures in hospital pharmacies, to ensure that they are appropriate. Better still, pharmacists could review procedures to ensure that complaints do not arise in the first place.

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

Mr Bower is a consultant pharmacist