Hospital Pharmacist
Vol 10 No 8 p323
September 2003

Review of circulars and official publications
by Alex Bower, MRPharmS

The Department of Health issued “A vision for pharmacy in the new NHS” in July 2003. This sets out the Chief Pharmaceutical Officer for England’s ten key roles for pharmacy as:

• To provide convenient access to prescription and other medicines
• To advise patients and other health professionals on the safe and effective use of medicines
• To be a point of first contact with healthcare services for people in the community
• To provide medicines services, especially for people with enduring illness
• To promote patient safety by preventing, detecting and reporting adverse drug reactions and medication errors
• To contribute to seamless and safe medicines management throughout the patient journey
• To support patients as partners in medicines-taking
• To prescribe medicines and monitor clinical outcomes
• To be a public health resource and provide health promotion, health improvement and harm reduction services
• To promote value for money in the use of medicines and to reduce wastage

With regard to hospital pharmacy, it is noted that best practice is characterised by optimal use of staff, skill mix, robotics and information technology, since these aspects enable pharmacists to devote the bulk of their time to direct patient care. This needs to be underpinned by efficient systems for the procurement and supply of medicines. The development of specialised clinical roles, active engagement with improving patient safety, implementation of clinical guidelines/NICE guidance and managing the economics of hospital prescribing receive specific mention.

A second edition of a hospital medicines management framework, which provides a self-assessment tool, will be issued later this year. Fourth wave bids for the national medicines management programme will be broadened to encompass proposals that will make improvements across the primary/secondary care interface on aspects such as self-administration of medicines, using patients’ own drugs, dispensing for discharge and better communications about medicines. Joint working to help older people with their medication management when they are discharged from hospitals is also cited as a favourable development. The need to develop robotics, specialist clinical pharmacy services and supplementary prescribing are also noted.

The document provides a clear indication of the way forward and available support. In terms of implementation, the document notes that the DoH supports the Royal Pharmaceutical Society in its intentions that technicians will be registered with effect from January 2007 with voluntary registration from 2005.

Early implementation sites will be used to test out and refine the application of the job evaluation scheme, announced previously in "Agenda for change", to hospital pharmacy. Hospital pharmacists will wish to ensure that they are aware of the developments and focus their efforts accordingly.

“Roles and structures of prescribing committees” was issued by the Welsh assembly as WHC (2003) 73 on 2 July 2003.This contains the recommendations of the All Wales Medicines Strategy Group on the key principles, roles and membership of prescribing committees following the reorganisation of the NHS in April 2003. The circular records the key roles of prescribing committees and the main principles that should guide their work. The circular recommends that the following prescribing groups be available:

• Local health board (LHB) prescribing advisory groups
• Trust prescribing advisory groups
• LHB/trust prescribing advisory groups partnership medicines and therapeutics committees
• All Wales Medicines Strategy Group

These seem effectively to be “rebadging” groups that existed before April 2003, such as the then local health group prescribing committees and health authority or area prescribing committees.

The circular is useful in confirming the sort of arrangements that need to be continued. It is interesting to note that, following the demise of health authorities, the view remains that there is a need for a medicines management group that coordinates work across primary and secondary care sectors within local health economies. Appendix 1 to the circular outlines the proposed membership and the key areas of remit of such a group. These include defining the place of new drugs in therapy and disseminating information to stakeholders, encouraging the development of joint formularies, advising on implications of policies, such as national service frameworks and NICE guidance, and developing a common strategy for shared care prescribing. Hospital pharmacists outside Wales will be interested to consider how these views could apply to their local situation.

“A pharmacy service for prisoners” was issued by the DoH and HM prison service in June 2003, and is available as a PDF file (490K). The report applies to England, but indicates that the Welsh Assembly are to consider adapting it for use in Wales.

Funding responsibility for prison health services was transferred to the DoH in April 2003. This will be devolved to primary care trusts in April 2006. The report sets out 30 recommendations aimed at bringing prison pharmacy services up to NHS standards and developing more patient-focused, primary care based pharmacy services to prisoners.

New pharmacy leadership roles are to be established to implement the report. The report notes that about 10 per cent of the 137 prisons in England and Wales receive supplies from a NHS acute trust hospital but there is little direct reference elsewhere to potential hospital pharmacy involvement. There are, however, many aspects mentioned in the report to which hospital pharmacy skills should be transferable.

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

Mr Bower is a consultant pharmacist