Pharmacist prescribing in mental health
By C. Feetam, MSc, MRPharmS and G. Newton, BSc, MRPharmS, MCMHP
|
The United Kingdom Psychiatric Pharmacy Group and
the College of Mental Health Pharmacists have published a joint position
statement on supplementary prescribing. In this article, two of the
authors outline the key points |
Ms Feetam is part-time
course tutor for the psychiatric pharmacy and therapeutics distance
learning programmes at Aston University, chief pharmacist, North
Birmingham, and the immediate past-chair of the UKPPG.
Mr
Newton is the medicines
information pharmacist at Mossley Hill Hospital, Mersey Care NHS
Trust, Liverpool, and chairman of the UKPPG
|
Legislation is now in place to allow suitably trained pharmacists
to act as supplementary prescribers. The opportunities that supplementary
prescribing offer in mental health and learning disabilities are vast
but they also pose risks. It is a particular characteristic of mental
health pharmacy services that many staff are employed through service
level agreements with managers on both sides of the contract. These managers
may not clearly understand the opportunities and risks that pharmacists
are exposed to. It was against this background that a joint position
statement was drawn up by a working party of national representatives
from both the United Kingdom Psychiatric Pharmacy Group (UKPPG) and the
College of Mental Health Pharmacists (CMHP) to highlight the impact of
supplementary prescribing and its relevance to mental health
pharmacy.
Panel 1: Executive summary of the UKPPG and
the CMHP joint position statement
· Specialist mental health pharmacists
are pharmacists practising in mental health. They will have a special
interest in mental health
and ideally a postgraduate qualification in the
speciality
· Specialist mental health pharmacists will, as supplementary prescribers,
contribute to improvements in patient care
· The competence of specialist mental health pharmacist supplementary
prescribers must be assured in the area of mental health as well
as in prescribing practice. This will ideally be undertaken by nationally
recognised organisations using appropriate accreditation
schemes
· Specialist mental health pharmacist supplementary prescribers will
work autonomously and take full responsibility for their actions
· The specialist mental health pharmacist supplementary prescriber
will prescribe
medicines according to an agreed clinical management plan that has
been developed and agreed with an appropriate independent prescriber
· It is recommended that the employing trust, or equivalent organisation,
consider the resource implications before allowing suitable specialist
mental health pharmacists to become supplementary prescribers
· It is recommended that the employing trust, or equivalent organisation,
must draw up and implement appropriate policies and procedures to
ensure a safe working
framework within which both the independent and supplementary prescribers
will work
· It is recommended that training schemes be developed, on a local
and/or regional level, to facilitate the ongoing development of future
specialist mental health pharmacist
supplementary prescribers
· Independent pharmacist prescribers may develop in the future. Competent
specialist
mental health pharmacist supplementary prescribers will be in an
ideal position to take on this role |
The aim of the statement is to describe a framework and to provide guidance
for specialist mental health pharmacists, their managers or employers
and trusts.
These aims will support the provision of the best pharmaceutical care
for people with mental health needs and allow pharmacists to work in
a safe and supported environment. They are complementary to the basic
premise of supplementary prescribing which states that it must improve
patient care. It is further anticipated that the position statement will: · Aid the development of policies and procedures for supplementary
prescribing in a mental health trust before implementation
· Outline the necessary competence of pharmacists who may wish to become
supplementary prescribers
· Encourage the recruitment and
retention of pharmacists in the mental health field
· Support business and capacity planning in relation to supplementary
prescribing
The joint position statement from the UKPPG and the CMHP provides a
broad framework within which pharmacists working in psychiatry and learning
disabilities may act as supplementary prescribers.
Competence The most significant recommendation is to encourage trust managers to
consider the competence of those who are to take on supplementary prescribing
roles. One method of demonstrating such competence is membership of CMHP
(denoted by the letters MCMHP). The statement recognises that there are
likely to be other suitable qualifications, but currently this seems
the most appropriate standard for assuring specialist pharmacist competence
in mental health. Both a general clinical diploma and a master of pharmacy
degree, which includes the supplementary prescribing component, are considered
inadequate alone. Neither qualification confers the degree of
practical experience, competence and confidence in mental health that
CMHP membership would assure. Such qualifications, particularly clinical
diplomas, are however, an appropriate and valuable means of professional
development before specialist accreditation.
The Department of Health suggested during the consultation process that
therapeutics training should not be considered as part of the training
requirement for supplementary prescribing. However, following recommendations
from the Royal Pharmaceutical Society in the outline curriculum, many
establishments offering supplementary prescribing
courses are delivering therapeutics as a substantial part of their training
programme. Despite this contradiction, the mental health component proposed
for such courses is so superficial, if it is taught at all, that it would
be unsafe to suggest that such an approach is adequate alone.
The statement clearly highlights a broad range of policies and procedures
that should be clarified before we would advise that specialist mental
health pharmacists
set about training as supplementary
prescribers.
Staffing issues Some authorities see supplementary prescribing as a solution to immediate
staffing problems, and a way of getting leave and discharge prescriptions
written. Such roles are routine, clerical and administrative and can
readily be managed within a local framework, without the need for a change
in primary legislation or the lengthy period of training required to
become a supplementary prescriber.
There is concern around remuneration, particularly in the context of
Agenda for Change and the lack of recognition of these developments within
the English implementation guide for supplementary prescribing (currently
the guides for Scotland, Wales and Northern Ireland are awaited).
There is also the need to consider resource implications. Adequately
resourced and protected support services and workforce or capacity planning
are required. While supplementary prescribing has been proposed as a
solution to medical staff shortages and the reduction in junior medical
staff hours it does not recognise the current manpower shortages in pharmacy,
especially within secondary care mental health services.
Sufficient appropriately trained specialist mental health pharmacist
supplementary prescribers must be assured for the future.
Local or regional training Local or regional training programmes that facilitate formal accreditation
should be developed. Such programmes would be best organised with the
involvement of practitioners and higher education establishments. Such
an approach has obvious ramifications for how pharmacy staff and specialist
mental health supplementary (and ultimately independent) prescribers
work as part of the clinical team. Although it is not the intention of
the joint position statement to dictate boundaries of models of care,
various scenarios where supplementary prescribing could occur are described.
Examples include lithium or clozapine out-patient clinics, or a case
load of patients with schizophrenia or other similar chronic conditions.
The joint position statement on specialist pharmacist supplementary prescribing
in mental health and learning disabilities was published and circulated
in September 2003, just before the UKPPG annual conference.
The full text of the position statement may be downloaded as a PDF file
(460K, Acrobat Reader).
A full
report on the 2003 UKPPG conference, where the issue of pharmacist
supplementary prescribing was debated, is available here |
Hospital
Pharmacist