Emergency supply

[Fleegle]

Are British pharmacists "brave enough" to confidently supply medicines to people in genuine need on an emergency supply basis, or are they running scared of the legal department of the RPSGB..the "governing body"?

There appears to be such a stigma amongst pharmacists regarding supply of medicines without prescription in emergency situations...eg. Pallative care patient needs morphine NOW..no script..NO..more than my job's worth..

Without creating a purely legal debate, can I ask you to post your thoughts from both the legal and ethical viewpoints; do we live in fear of being removed from the register for merely carrying out our duty as professionals?

[lamzee]

Re: Emergency supply

At the risk of sticking my head above the parapet, I get the impression that younger members are less likely to supply because they don't want to ruin their career/have lots of student or mortgage debt and can't afford to be struck off. I think those over 50 have less to lose, and are more likely to supply.

[johnep]

Re: Emergency supply

Unfortunately the law does not put the patient first. If you make an ES of morphine likely to end up with a police caution and no trips to USA.
johnep

[Sir_Dispensalot]

Re: Emergency supply

Unfortunately the law does not put the patient first. If you make an ES of morphine likely to end up with a police caution and no trips to USA.
johnep

not to mention getting hauled up in front of statcom and reprimanded or struck off...

[admin]

Re: Emergency supply

At the risk of sticking my head above the parapet, I get the impression that younger members are less likely to supply because they don't want to ruin their career/have lots of student or mortgage debt and can't afford to be struck off. I think those over 50 have less to lose, and are more likely to supply.

Too right - exactly right in fact! You are simply stating the truth.

[ymdawd]

Re: Emergency supply

It is simply illegal to supply morphine in these circumstances. Would not blame any pharmacist who refused to supply.

Have to confess I once did supply diamorphine 100mg amps to a terminal cancer patient who had been left" high and dry" by the system over the weekend. This happened several years ago but it still makes me so angry. Was glad when the Rx turned up on Monday morning though. Nobody was any the wiser. Guess I was just lucky.

Normally I would never do that but I did do a LOT of phoning around to GP's etc to make sure re circumstances of case before I decided to take a chance.

Yes it was technically illegal but I would maintain in any court of law or in front of the statutory commmitee that my carefully considered course of action was the correct one in the circumstances.

[johnep]

Re: Emergency supply

The officials would still chant 'Off with his head'.
johnep

[Steve G]

Re: Emergency supply

I wouldn't supply a CD without an Rx, apart from in some very specific circumstances (i.e. a phone call from a GP who works next door on a Sunday for a terminally ill patient, but they've been called while they were out and haven't got any FP10's with them).

I have supplied CDs against prescriptions that are not strictly legal, for example diamorphine 10mg amps mdu in syringe driver, zomorph 10mg bd, after weighing up the situation and being happy to defend my actions if need be.

[Fleegle]

Re: Emergency supply

This is obviously a sensitive subject with all of us. It's quite simply professional ethics vs the law of the land, with the pharmacist well and truly stuck in the middle. We all know the law, but my heart would not allow me to refuse (e.g.) morphine to a person who, regularly, has only hours left with us. Why is "by syringe driver mdu" not sufficient as a dose?..it bloody well should be..the nurses in these cases know exactly what they're doing and of course the dose will change...the patient is hardly abusing this medication..and has a right to dignity in their last hours.

I fully agree that older pharmacists will have more sympathy/empathy in these difficult cases. Personally I find that the older you are, the more respect you get from the GP.

I left the UK in 1997, and retained my RPSGB membership until a couple of years ago, when the whole "resign or else" debacle reared its ugly head. I resigned.

I have been in Ireland since '97 still practicing. Even as a locum I am on first name terms with every GP..they have no pretensions. We work together for the good of the patient, and CD supply issues are dealt with quickly and efficiently.

I have total confidence in the system here.

No Irish pharmacist has ever been struck off.

[lamzee]

Re: Emergency supply

I have been in Ireland since '97 still practicing. Even as a locum I am on first name terms with every GP..they have no pretensions. We work together for the good of the patient, and CD supply issues are dealt with quickly and efficiently.

I have total confidence in the system here.

No Irish pharmacist has ever been struck off.

Is this because the GPs in Ireland are competing for a market share of patients, whereas GPs in the UK have a fairly captive market?
(just a question--I have worked under Irish and UK systems)

[Fleegle]

Re: Emergency supply

Correct. As pharmacists, we are constantly striving to increase our market share..GP's here are the same..if you're good, with a good reputation, you create your business..dentists as well..the better you are, the more money you make. Symbiosis!

[Jeff]

Re: Emergency supply

Unfortunately the law does not put the patient first. If you make an ES of morphine likely to end up with a police caution and no trips to USA.
johnep

I disagree - if the supply is warranted - no-one is likely to complain - so no cautions from anyone.

If the supply wasn't warranted - then tough luck.


Jeff

[Band6]

Re: Emergency supply

I only do Saturday Locums, but I can guarantee that there will be one or two emergency supplies. I never let the patients off with a 'loan' of a few tablets and always charge. I find it amusing that so many people will suddenly have second thoughts when money is involved - I think that its a useful first filter between serious and non-serious requests!

[Rafael]

Re: Emergency supply

" I never let the patients off with a 'loan' of a few tablets and always charge"

charge for what? or you mean you charge for morning-after pill if customer <21 years old.
we do not charge for ES over here, can we charge for our time or what do you mean?
cheers

[Band6]

Re: Emergency supply

Emergency supply - this is where pharmacists are allowed to supply small amounts of prescription-only medicinesto patients who are currently on them and to interupt treatment would be dangerous or may result in severe discomfort. There must be no way the patient can get a prescription (so usually weekends or out-of-hours), the pharmacist must interview the patient in person and be satisfied that there is a genuine need, and the absolute minimum amount is to be supplied until a prescription can be obtained.
It s considered a private transaction between the patient and the pharmacy (the NHS will not pay for this), so a fee is charged for the drugs and labour.
Controlled drugs are excluded from emergency supplies (although thats a whole other bag of worms).
It usually happens when a prescription hasn't been put in on time, or holiday makers forgetting their medicines.
It does come down to need - I was asked today for a salbutamol inhaler (chap was down from Warwickshire, kept one in his car, had attack and used the last of it - needed a new one as still wheezy), which I supplied. Also asked for lansoprazole (holiday maker who took them for indigestion and had forgotten them), which I did not supply. I directed the patient/customer towards the OTC ranitidine instead - should see her the weekend.