Hospital Pharmacist
Vol 10 No 10 p421
November 2003

Review of circulars and official publications
by Alex Bower, MRPharmS

Issued in September by the Department of Health, “Medicines management in NHS hospitals” provides hospital pharmacists with an opportunity to ensure that their trust chief executive is aware of the key components of the service and any gaps that need to be filled before “value for money” audits are conducted next year.

The framework focuses on the clinical and cost-effectiveness aspects of medicines management and notes that issues concerning the safe and secure handling of drugs are contained within a separate controls assurance standard. The framework is a self assessment tool which must be completed by chief pharmacists in England and agreed with medical directors and chief executives and returned to strategic health authorities (SHAs) by 1 December. SHAs should establish review groups led by directors of performance management to analyse the information received and ensure local remedial arrangements are in place. The review groups should include medical, public health, finance and pharmaceutical input. This is the first time SHAs have been required to undertake such a task since their inception in April 2002 and it will be interesting to observe how they discharge the function. The framework requires responses under the following headings:

• Senior management involvement
• Information, finance and business planning
• Medicines policy
• Procurement of medicines
• Designing services around patients
• Influencing prescribers and training
• Managing risk

Some of the standards relate to issues at the interface between primary and secondary care (ie, section C “Medicines policy”, standards 11–15; and section E “Designing services around patients”, standards 24 and 25). This provides an opportunity for discussions with primary care trust prescribing advisers, aimed at gaining a greater understanding of the specific topics and agreement on where change should be made and what this should be in advance of a return being made to the SHA. This would also be preferable to hospital pharmacists submitting a return and then discovering that PCT colleagues did not agree with the position.

The framework is a useful document that will provide a helpful stimulus to chief pharmacists to ensure that their medicines management arrangements are operating effectively. The opportunity should be taken to identify any resource requirements to deliver the required standards.

“Updated national guidance on the safe administration of intrathecal chemotherapy” was issued on 2 October by the DoH as HSC 2003/010. The document notes that 23 incidents have occurred around the world in which vincristine has been injected intrathecally. Half of these cases were in England. The updated guidance, which replaces HSC 2001/022, must be implemented by the end of November. SHAs are required to ensure that the updated guidance is enforced by the date indicated. There is no guidance provided to SHAs on the way that they should assure themselves that the guidance is being followed, but the summary in section 18 provides a useful checklist of actions and could be used for self -audit which is then reported to the SHA.

Hospital pharmacists should generally be familiar with the requirements of the previous circular but should take the opportunity to ensure that current practice is in line with recommendations. Particular attention should be paid to annex A since this sets out the changes from previous guidance. One key aspect is that the trust chief executive should identify a single “designated lead” to oversee compliance with the guidance: some might turn to trust chief pharmacists to fulfil this role. Procedures are set out for NHS organisations that do not provide an intrathecal chemotherapy service. Where this is exceptionally required, discussion should take place with an NHS organisation that routinely carries out intrathecal chemotherapy and someone should attend to supervise where possible. The SHA should be informed. This requirement may initially appear bizarre but it will provide an opportunity to monitor the frequency at which the need arises.

“Key recommendations on the regulation of herbal practitioners in the UK” was issued in September by the Herbal Medicine Regulatory Working Group. The report had been commissioned, among others, by the DoH.

Currently, the majority of herbal medicines on the UK market are sold and supplied as unlicensed products. The report notes that the Medicines Act 1968 exempts herbal medicines from licensing if they are made up on the premises from which they are supplied and prescribed after a one-to-one consultation. They can also be sold over the counter provided that no written claims of efficacy are made. There are no standards of quality control for unlicensed herbal medicines. Section H of the report contain recommendations which are aimed at providing a stricter regulation of herbal products. The report does not make subsequent actions clear but the introduction indicates that the intention is to inform a wider consultation by the Government regarding future regulatory mechanisms. Hospital pharmacists who are aware of the potential potency and safety issues concerning herbal medicines will no doubt lend their support to the move to stricter controls.

“Medicines, pharmacy and industry division: electronic transmission of prescriptions (ETP): evaluation study” was issued by the DoH in September. It is available as a PDF file (50K). The report is particularly relevant to primary care, but hospital pharmacists may be interested to note the potential development of ETP and consider how this might lead to better communications between primary and secondary care about the drugs that patients were prescribed prior to admission.

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

Mr Bower is a consultant pharmacist