Prescribing Pharmacists

[paul2008]

Hi

quick questions for pharmacist prescriber's supplementary or otherwise:

RPSGB guidance document on prescribing pharmacists say you should not dispense if you prescribe. So if you own a shop and are a supplementary prescriber from that premises how does it work. Do you always have to employ a locum or second pharmacist or send the patient to the multiple down the road?

In the current set up is there any incentive to prescribe inappropriately for example a product that you get more profit on or does the requirement to follow guidelines remove this conflict. if not how do you address this aspect of the decision process?

Regards

paul2008

[Jeff]

I'll be interested to see Tony Schofields reply - but he won't be on-line for a couple of days.

Jeff

[paul2008]

Any ideas about a prescribing pharmacist and dispensing robot? Ethical, legal? In the patients best interest?

[Tony Schofield]

Hi.

I have prescribed and dispensed methadone, subutex and palliative medications (buscopan, paracetamol etc) for opiate dependent patients in my pharmacy. I have checked it out with the Society's inspector and as long as my ACT (I have 3) has confirmed details with me the Society will not hang me.

I appreciate that this will not be to the taste of others but the whole idea of allowing nurses and pharmacists to prescribe was to improve access to medicines. I am not a jealous custodian of the "pharmacist final check" believing that dispensing doctors have been doing such things for decades and there is no evidence that patient safety has actually been compromised.

I feel I must point out here however that due to a change in my circumstances I now do employ another pharmacist so the process in my pharmacy would be that I prescribe and a pharmacist could, and does check the dispensing process. I don't feel ready to throw the baby out with the bath water just yet!

With regard to a robot......... a final check can of course be performed by an ACT. I am not yet convinced of the value of robots but by the time I retire I expect we will have at least one.

Pharmacist prescribers are under exactly the same pressures as any other prescriber to prescribe for profit. However, I would expect that if such a thing was proven the penalties would be high.

The times are changing and it will be interesting to see how pharmacists take up and discharge prescribing. Conflicts of interest are a serious issue that will need careful managing. Prescribing for drug addicts is not subject to much incentive to prescribe for profit and currently controlled drugs still require a clinical management plan so opportunities for abuse are limited.

[johnep]

It would be marvellous to have a prescriber for drug abusers adjacent to the pharmacy. Our prescribers see addicts late in the afternoon and then send them off to the pharmacy after closing, and of course not adding the words re missed dosages. Others will gleefully mix up mgms and mls on the same script, while occasionally they forget to sign and date, or get the year wrong.

I seem to cop it for most of these errors committed on a Friday and presented on a Saturday.
johnep

[Tony Schofield]

We are training two pharmacists to prescribe for drug addiction in their pharmacies. The pharmacies are on estates where there is no surgery. Once I have proved how well it can work I want to use these sites to manage long term illness.

The pharmacists will prescribe and dispense from their premises.

[johnep]

Well done Tony, will see you on Darzi day.
johnep

[Pharmanaut]

Originally Posted by Tony Schofield

We are training two pharmacists to prescribe for drug addiction in their pharmacies. The pharmacies are on estates where there is no surgery. Once I have proved how well it can work I want to use these sites to manage long term illness.

The pharmacists will prescribe and dispense from their premises.

Will they be using FP10MDA scripts? Just wondering about software support for printing them out correctly etc.
Regards
Toni

[paul2008]

Hi Tony,
I found your replies very helpful. I believe that there should be a clear distinction between prescriber and supplier basically because I know how difficult it is to recommend the best thing in the circumstances when something else will have a very similar effect but give a higher profit/reward/points. I was wondering how you handle this aspect of pharmacy prescribing.

I have heard of another pharmacist who is a supplementary prescriber and does a lot of methadone. If the prescribing is according to a clinical management plan does that mean that there is no need for a clinical check and that an accuracy check will suffice?

If you were an independent prescriber would this be different or could you be confident that you knew what you were doing and keep adequate records to cover yourself?


Regards,

Paul

[Tony Schofield]

Originally Posted by Pharmanaut

Will they be using FP10MDA scripts? Just wondering about software support for printing them out correctly etc.
Regards
Toni

Yes they will. Currently we use a software package called Scriptbase but it is pretty crude. We are trialling "Carenotes" which seems more sophisticated.