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]

Re: Prescribing Pharmacists

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

Jeff

[paul2008]

Re: Prescribing Pharmacists

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

[Tony Schofield]

Re: Prescribing Pharmacists

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]

Re: Prescribing Pharmacists

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]

Re: Prescribing Pharmacists

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]

Re: Prescribing Pharmacists

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

[Pharmanaut]

Re: Prescribing Pharmacists

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]

Re: Prescribing Pharmacists

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]

Re: Prescribing Pharmacists

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.

[Tony Schofield]

Re: Prescribing Pharmacists

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

Hi Paul.

It is exciting stuff and I expect to upset a lot of people along the way!!

However the NHS review of 1997 had the premise to "think the unthinkable" and as that has appeared in other sectors of health care we will not be immune. Doctors who dispense have always had this conflict of interest as have pharmacists who recommend OTC medicines. My original training at Boots in 1977 majored on recommending "own label" products and as we all had shares in the company we were told we had a big incentive to recomment Nirolex over Benylin!! In future I expect prescribing to be part of the undergraduate course and the conflict of interest inherent will have to be managed not avoided. We cannot hold back what I believe to be a core function (prescribing is a key element in the supply function and I believe it should be readily grasped by pharmacists) because we may have an incentive to prescribe one drug v another. Transparency in decision making and evidence based practice are essential. We have lots of other conflicts of interest we need to manage and to me it is part of being a professional as opposed to a tradesman.

Clinical management plans don't dictate whether or not a final check is required. They do, to some extent, limit what may be prescribed and the circumstances under which it is prescribed. They are a partneship between the independent prescriber, supplementary prescriber and the patient and have no impact on dispensing. That is the decision of the dispensing pharmacist.

I am an independent prescriber and record keeping is an essential part of the prescribing process. However, until the law changes, expected imminently, independent non-medical prescribers still require clinical management plans for controlled drugs.

I am not against CMPs for controlled drugs, I believe it to be a layer of governance that protects the prescriber.

With regard to dispensing, there are regulations that allow hospital cleaners to dispense in certain circumstances. Nursing codes of practice include procedures to be followed when labelling medicines (guess what aspirations nurses have!). I do not believe that a pharmacist is the only person who can check a dispensed medicine. (sorry to those that believe such things to be heresy). I believe our specialised knowledge is best employed by using our unique network of sites (community pharmacy) to deliver treatment, including prescribing medicines to patients as spokes from a (possibly polyclinic) hub. We will need to acquire new skills but we should be doing that as opposed to fighting ACTs and opposing change to the supervision requirements.

I will not be in the minority in 10 years time.

[johnep]

Re: Prescribing Pharmacists

PCC Events Online - View events
PCC Events Online - View events
These are the gateway for attending Darzi Day. Apparently being organised by DOH and just using RPSGB as a meeting hall.

You will note that meetings seem geared for 'contractors'. i wonder if employees and locums will even get a look in.

I am now struggling to get to London meeting which I am told is full, places apparently at Manchester--------- details?

johnep

[johnep]

Re: Prescribing Pharmacists

Team: Jointly organised by PCC & Department of Health
Description: Event background:
The Department of Health's Chief Pharmaceutical Officer, Keith Ridge, has been asked by Lord Darzi to lead two events to support pharmacy engagement in shaping the future NHS in England.

The overall objective of the events is to provide Lord Darzi with feedback on how pharmacy sees its role in, and how it can contribute to, a fairer, safer, effective and more personal service for patients.

The first of the highly interactive events will be held on February 27th at RPSGB in London. The second event will be held in Manchester on Wednesday March 5th.

Who should attend:
Representatives from LPC's, Community and Hospital pharmacists, PCT Pharmacy Leads and other pharmacy stakeholders.

Who it has been designed for:
The events are aimed at "frontline" community and hospital pharmacists who will have a real opportunity to input from their areas of expertise. The events will be highly interactive and carefully facilitated to ensure we provide focused feedback.

Agenda outline:
The day will include a facilitated work programme that will aim to give feedback on:
- What is pharmacy's role in the development and delivery of integrated care?
- What are the barriers to making it happen?
- How do we remove the barriers?

These core questions will be discussed with reference to three workstreams:
- Long term conditions
- Staying healthy
- Urgent Care

It is expected that the event will start at 10.30am and close at 4.30pm.
A draft agenda will be available soon.

Keynote speakers:
Lord Darzi, Minister of State, Dept of Health, will be giving the keynote address.


Date: 27th February 08 (10.30 - 4.30)
Registration closes: 11th February 08
Venue: Royal Pharmaceutical Society of Great Britain, London SE1 7JN
Places available: Fully booked


Registration is currently closed for this event.

Note says 'frontline pharmacy' but no mention of frontline employees or locums.
johnep

[johnep]

Re: Prescribing Pharmacists

Today I found that no chance of me getting into Lambeth meeting, so all the hopes and fears of employees and locums rest on the shoulders of those going to Manchester. (regret too far for me).

Points I wished to make:

1) Extra services. MURs are higly regarded as income to multiples. No stock required and some minion does the work. If targets are not reached there is the threat of disciplinary action. Bet surgeons are not disciplined if fail to reach target number of ops.

2) Drug abuse pts. These are also being looked at as source of income by multiples. However, expect larger numbers to be handled without extra resources, If persuaded that Methadose/pump required, then follows afterwards not before. We are then informed that 'shrinkage' is running at £100 per day or more.
It is the weekend locum who is faced with the incorrect CD scripts etc, not the multiple officer playing a round of week end golf.

3) Contractors have the power but employees/locums have the responsibility when things go wrong. This will be exacerbated if employees/locums have to wear the mantle of 'responsible pharmacist'

4 Time away. Employers could well say we will accept scripts all morning and pharmacist will attend in afternoon (and only be paid for afternoon), but still with a days work to check etc.

The govnmt says it wants to talk to 'front line' pharmacists, but instead talks to the 'back room boys' of the multiples.

Make sure the govnmt knows the percentages of locums and employees in the workforce.

Trust the PDA will be speaking on our behalf.

johnep

[richp10]

Re: Prescribing Pharmacists

I know this is a comment a long time after the fact - but I just noticed the post about ScriptBase. A substantial upgrade to ScriptBase has recently been released, version 4 - for which there is a free trial version available (just google scriptbase).

To be up - front on vested interest, I am the developer!

Many regards

Richard