Primary Care Pharmacy September 2000 Vol 1 No 4 p92

Leading article

The NHS national plan

While pharmacists in the rest of the UK await plans for the NHS locally, the plan for England gives us some insight into opportunities for pharmacists who wish to expand their role in primary care. Many community pharmacists are trying to develop their professional role but feel constrained by a remunerative system that is based largely on the dispensing process. I hope that the plan will give those community pharmacists who wish to, the opportunity to move the profession forward in primary care.

NICE proton pump inhibitor guidance

After many months of waiting, the National Institute for Clinical Excellence (NICE) finally published its guidance on proton pump inhibitor (PPI) prescribing in July (see p98). Does it tell us anything new? It urges the review of existing patients and estimates potential savings that could be realised as a result. However, it fails to reinforce the essential points necessary to achieve successful outcomes of: fewer patients requiring treatment doses or long-term repeat prescriptions for PPIs; increased quality of life for many patients and release of money for reinvestment in other therapeutic areas). Many pharmacists in primary care groups, local health care commissions and local health groups are being asked to help practices put the guidance into operation. My personal experience, in a dedicated upper gastrointestinal review clinic, is that many patients who have been taking PPIs, even for a few weeks, are likely to have some degree of acid rebound when the medication is discontinued. The solution? All new patients should be informed of this possibility prior to commencing short treatment courses of PPIs and should be encouraged to persevere with treatment for at least four weeks before returning to their general practitioners. Similarly, patients whose treatment is being reduced to maintenance doses or is being discontinued also need reassurance and encouragement. The whole health care team involved in the patient’s care needs to give consistent advice and not succumb to patient pressure to restart treatment early. Make sure you include this within your management strategy and success rates will be improved.

Royal Pharmaceutical Society steering group for primary care

A new group has been established by the Council of the Royal Pharmaceutical Society to represent pharmacists working in the primary care sector who undertake activities outside of community pharmacies. Following the first meeting, the chairman, Richard Seal, explains the background to the group and its aims and objectives for the next 12 months (see p117). I think this will be a useful forum for primary care pharmacists in all capacities to interface with the Society and the Council. Regular updates on progress and developments will be reported in future editions of Primary Care Pharmacy.

Sheena Macgregor
Editor