Quantcast
Channel: PJ Online news feed
Viewing all 1883 articles
Browse latest View live

Unlawful cocaine possession leads to pharmacist’s six-month suspension

$
0
0

A pharmacist who accepted a police caution for possession of cocaine has been suspended from the Register for six months by order of the fitness-to-practise committee of the General Pharmaceutical Council.

At its meeting on 17 December 2012, the committee inquired into the case of Opreet Singh Ghag (registration number 2068407). It was alleged that Mr Ghag’s fitness to practise was impaired on account of his accepting a police caution at Westerhope and Newburn Police station for possessing a Class A Controlled Drug.

Mr Ghag was present at the inquiry and was represented by Kevin McCartney, of counsel, instructed by Debenhams Ottaway Solicitors.

John Hepworth, solicitor advocate, appeared on behalf of the GPhC.

The committee heard that Mr Ghag had been admitted to hospital on 12 May 2011 in a deeply unconscious state. He regained consciousness the following morning and said he believed he had taken a quantity of GHB, a Class C CD. At the time, police had searched Mr Ghag’s car and found a quantity of drug which Mr Ghag said he believed was ketamine. However, subsequent analysis had shown the substance to be cocaine. Furthermore, a urine sample taken on 12 May 2011 had tested positive for cocaine and benzodiazepines. The police caution had followed.

Having found Mr Ghag’s fitness to practise impaired by reason of misconduct and the police caution, the committee decided that a period of suspension would be appropriate to send the necessary message to the profession and the public.

The chairman, Douglas Readings, said that suspension “recognises that there is a strongly held belief in the profession that one single incident of illicit drug use should be sufficient to cause any pharmacist to be removed from the Register. But in Mr Ghag’s case there is substantial mitigation and his misbehaviour occurred during a period when he was not working as a pharmacist.

“He is genuinely contrite and has taken active steps to ensure that it will never happen again. The committee considers that it would be inappropriate to deprive the public permanently of the services of a competent pharmacist whose employers are still prepared to trust him,” the chairman said.

Review

Mr Ghah was suspended from the Register for six months. The chairman said: “Before the end of the period of six months the case will be reviewed by the committee. At that review, the committee will be assisted by having evidence from Mr Ghag of his continued good behaviour and any steps which he has taken to maintain his professional skills and competence so that he is fit to return to practice.”


RPS warns against including medicines in personal budgets

$
0
0

Pharmacy’s professional body has warned against including medicines in personal health budgets.

The Royal Pharmaceutical Society said it "would be concerned if medicines were included as part of the personal health budget," in response to the Government’s consultation on direct payments for healthcare, which states that the personal healthcare budget would "not normally pay for medication".

"We agree . . . that patients should have a greater say in their treatment options and the personal healthcare budget is a means to enable this," said Shilpa Gohil, chairman of the English Pharmacy Board, "[but] we believe that nothing should come between a patient and the medicine that they require. Additionally, it could lead to clinical commissioning groups only funding the cheapest medicine available and if patients wished to have a medicine not recommended by the local formulary they would need to fund it themselves."

Medicines management pharmacist network launched

$
0
0

A network for pharmacists and others working in medicines management — Medicines Management Connect — has been set up by Omar Ali, formulary development pharmacist at Surrey and Sussex NHS Trust, with the aim of helping key individuals in medicines management to "seek, share, solve and succeed".

Mr Ali told PJ Online: "From April there will be lots of medicines management pharmacists who will be out of a job and lose touch with each other, so in the first instance this is a way of keeping in contact. Ultimately, the aim of the network is to help colleagues share user-generated information, and we plan to introduce user ratings for content on the site as well, a bit like TripAdvisor."

So far, the network has about 100 members but Mr Ali said: "We are aiming for about 250, so if more medicines management pharmacists out there are interested in joining then they can go to the website and register."

Variety of interventions improve antibiotic prescribing

$
0
0

A Cochrane review of interventions to improve antibiotic prescribing in hospitals suggests that restrictive interventions have greater immediate impact than persuasive interventions but the two types are equally effective after six months (Cochrane Database of Systematic Reviews 2013, issue 4).

The review assessed 89 studies of interventions designed to improve inpatient antibiotic prescribing. Most targeted the choice of antibiotic prescribed. One fifth of interventions were delivered by pharmacists.

Restrictive and persuasive interventions (see Panel) were compared in a meta-analysis of 52 interrupted time series studies. Restrictive interventions had significantly greater impact on prescribing outcomes at one month (32 per cent, 95 per cent confidence interval 2 to 61; P=0.03) and on microbial outcomes at six months (53 per cent, CI 31 to 75; P=0.001) but there were no significant differences at 12 months. The investigators note there have been no direct comparisons of the two types.

Interventions intended to reduce excessive antibiotic prescribing were associated with reduction in Clostridium difficile infections and colonisation or infection with antibiotic-resistant Gram-negative bacteria, meticillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecalis.

In terms of clinical outcomes, four interventions intended to increase effective prescribing for pneumonia were associated with significant reduction in mortality, while nine interventions intended to decrease excessive prescribing were not associated with significant increase in mortality.

"Our review shows that a wide variety of interventions have been successful in changing antibiotic prescription in hospitals," says lead author Peter Davey, from the University of Dundee. But he adds that more studies are needed to explore how the changes benefit patients.

Intervention types

Restrictive interventions: eg, formulary restriction, need for prior authorisation of prescriptions, reviewer changes prescription, and other restriction of the freedom of prescribers to select some antibiotics

Persuasive interventions: eg, distribution of educational materials, reminders, audit and feedback, educational outreach 

 

In search of biomarkers — the science of metabolomics in pharmacy

$
0
0

In our latest science article Kalliopi Dodou and Paul Whiteley take a look at the study of the small molecule metabolites found in biological fluids


Still the less well known relation of the genomic and proteomic disciplines, metabolomics — the study of the metabolome, which consists of the small molecule metabolites found in biological fluids such as blood, saliva and urine — may yet hold some interesting insights into health and illness. As our recent articles on the epigenome (PJ 2013;290:23) and microbiome (PJ 2013;290:247) suggest, the various -omics disciplines are starting to make some real waves across lots of different sectors of science and medicine.

Genomics, the study of the genome, and proteomics, the study of proteins produced by an organism, hold the lion’s share of the funding and research conducted so far under the umbrella of bioinformatics. In this article we turn our attention to a slightly less well known branch of the -omics: metabolomics, based on the analysis of low molecular weight metabolites, their changes over time and their potential relevance to health and disease. The emphasis in this particular discipline is on the analysis and the organisation of collected data to yield homogenous, meaningful results.

The sweet taste of urine (to ants)

Although the term “metabolomics” (or “metabonomics”)1 is a relatively new addition to the biochemistry texts, the notion of analysing a biological sample for functional information about the health or ill health of a person has been around for a while. Diabetes, for example, has a history dating back to medicine in the ancient world, as observations on the sugar content of urine being a measure for the appearance of the disease were noted. “Sweet urine disease” was traditionally diagnosed by the attraction of ants to the sugar content of a person’s urine, equivalent to the modern-day urine glucose dipstick test.
Fast forward a few thousand years and things have moved forward. Ants generally have less of a role to play in modern medicine, although we retain the knowledge that biological samples might hold some important functional clues pertinent to the diagnosis and management of lots of different conditions.

The technology

When it comes to metabolomics, technology is key. Biological samples, such as blood, urine, saliva and cerebrospinal fluid, can be complicated media to work with, containing literally thousands of compounds, encompassing both primary and secondary metabolites reflective of both endogenous and exogenous sourcing. Separating out such components is therefore an important first stage to analysis, made all the more easier following the introduction of chromatographic and related methods of separation.

High-performance liquid chromatography and the newer ultra-performance liquid chromatography remain the industry standard processes complemented by the use of gas chromatography (GC) and capillary electrophoresis methods. Based on both sample medium and separation as a consequence of differing characteristics of the analyte(s) under examination (polarity, charge), each separative method offers its own set of advantages and disadvantages.

Detection is the next stage. Only a few decades ago, detecting compounds by HPLC was predominantly carried out by ultraviolet or electrochemical detectors. Although such techniques were generally suitable for the analysis of known metabolites in purified or uncomplicated media, such detection methods, however, did little to aid in identifying unknowns or providing structural information of metabolites of interest. By contrast, modern-day detection offers significantly more sophisticated information, as nuclear magnetic resonance spectroscopy and mass spectrometry take centre-stage.

The final stage of the metabolomics process is data analysis or data mining and how, behind every metabolomist, there is a statistician and a good software package. Depending on the type of metabolomic analysis undertaken, various statistical methods are available, most based around the concept of categorisation and grouping (remember all those Venn diagrams at school) as terms like “principal components analysis” and “partial least squares regression” are the norm.

Systems biology, based on metabolite-protein network analysis, for example, also represents an important tool to metabolomics as individual or collective metabolites are modelled back to their source genes with the hope of a more integrated inspection of pathways of interest. The culminations of all these processes, which are often used in tandem with each other, frequently generate a significant amount of information.

Biomarkers

Given the potential of metabolomics, a seemingly endless supply of research has been generated on all manner of health conditions. Cancer biology represents a core area of investigation. Various themes have emerged, including applying metabolomics to cancer progress and staging, tumour characterisation and predicting drug response and toxicity.2

When it comes to the potential applications of metabolomics to other areas of science and medicine, none is more tantalising than the possibility of a relatively simple diagnostic test  for conditions currently lacking such a luxury. In particular the multitudes of psychiatric and behaviourally presented conditions which are seemingly increasing, and in the most part are idiopathic, are a primary target for the metabolomics field.

Schizophrenia is one of a number of psychiatrically defined conditions that, in both the short and long term, seriously affect the quality of life of patients and those around them. Currently defined solely on the basis of observed symptoms, diagnosis is a time- and resource-intensive operation. The lack of consensus on the underlying genetic and biological causes has hindered the development of a consistent biological test for the condition.

With the application of metabolomics to large research sets, there are, however, some promising data emerging pertinent to a diagnostic test. Oresic and colleagues3 reported initial results delineating schizophrenia from other psychoses and asymptomatic controls based on serum profiles indicating issues with glucoregulatory processes and amino acid chemistry to be central. Yang and colleagues4 using GC-ToF (time of flight mass spectrometry) also presented results based on the identification of patients with schizophrenia over controls.

This trial involved not just the identification of the biomarkers (via the training patient set) but also the subsequent independent testing and confirmation of the identified biomarkers. Based on the identification of five serum and one urinary marker, the authors report perfect separation of the diagnosed and asymptomatic groups. Further replication is awaited. Similar applications have been reported in other conditions, such as depression,5 and autism spectrum disorders,6 realising the interfering issues of heterogeneity and comorbidity are likely to represent important confounding issues.

Prediction

Wang-Sattler and colleagues7 reported results for various novel prodrome biomarkers related to prediabetes (impaired glucose tolerance) in their cohort. Altered levels of three metabolites (glycine, lysophosphatidylcholine 18:2 and acetylcarnitine) were identified in the prediabetic group. Work also continues in other important areas such as predicting Alzheimer’s disease progress8 and also in Huntingdon disease.9

Predicting potential responder characteristics to pharmacotherapies and the influence of medicines on intermediary metabolism represent other important areas of investigation for metabolomics. Kaddurah-Doauk and colleagues10 reported initial results based on responder and non-responder “metabotype” characteristics to sertraline for depression. This same group also reported that differing responses to simvastatin treatment may be governed by differences in the gut microbiome, which may also be detectable via metabolomic analyses.11

Conclusions

The analysis of biofluids for functional measures of disease state and potential for disease is of great medical interest. Metabolomics incorporating facets of biology, chemistry, physics and mathematics is a growth area in this brave new world, as technological advances drive ever more sophisticated analyses at ever more reduced costs.

References

1 Nicholson JK, Lindon CJ. Systems biology: metabonomics. Nature 2008;455:1054–6.
2 Claudino WM, Goncalve PH, di Leo A et al. Metabolomics in cancer: a bench-to-bedside intersection. Critical Reviews in Oncology/Hematology 2012;84:1–7.
3 Orešic M, Tang J, Seppanen-Laakso T et al. Metabolome in schizophrenia and other psychotic disorders: a general population-based study. Genome Medicine 2011;3:19.
4 Yang J, Chen T, Sun L et al. Potential metabolite markers of schizophrenia. Molecular Psychiatry 2013;18:67–8.
5 Zheng P, Gao HC, Li Q et al. Plasma metabonomics as a novel diagnostic approach for major depressive disorder. Journal of Proteome Research 2012;11:1741–8.
6 Yap IKS, Angley M, Veselkov KA et al. Urinary metabolic phenotyping differentiates children with autism from their unaffected siblings and age-matched controls. Journal of Proteome Research 2010;9:2996–3004.
7 Wang-Sattler R, Yu Z, Herder C et al. Novel biomarkers for pre-diabetes identified by metabolomics. Molecular Systems Biology 2012;8:615–25.
8 Ibáñez C, Simo C, Martin-Alvarez PJ et al. Toward a predictive model of Alzheimer's Disease progression using capillary electrophoresis-mass spectrometry metabolomics. Analytical Chemistry 2012;84:8532–40.
9 Verwaest KA, Vu TN, Laukens K et al. (1)H NMR based metabolomics of CSF and blood serum: a metabolic profile for a transgenic rat model of Huntington disease. Biochimica et Biophysica Acta 2011;1812:1371–9.
10 Kaddurah-Daouk R, Boyle SH, Matson W et al. Pretreatment metabotype as a predictor of response to sertraline or placebo in depressed outpatients: a proof of concept. Translational Psychiatry 2011;1pii:e26.
11 Kaddurah-Daouk R, Baillie RA, Zhu H et al. Enteric microbiome metabolites correlate with response to simvastatin treatment. PLoS One 2011;6:e25482.

 

Kalliopi Dodou is senior lecturer in pharmaceutics, Sunderland Pharmacy School, University of Sunderland.

Paul Whiteley is a researcher based in the north east of England. Correspondence to: Kalliopi Dodou (email kalliopi.dodou@sunderland.ac.uk)

Lancet review supports breast cancer chemoprevention

$
0
0

Selective oestrogen receptor modulators (SERMs), such as tamoxifen and raloxifene, reduce the incidence of breast cancer during treatment and for at least five years after treatment, according to an updated analysis of chemoprevention trials published online today in The Lancet (30 April 2013).

The benefit:harm ratio is more favourable than previously calculated now that longer-term follow-up data are available. "The benefits of these drugs continue well after treatment has stopped while most of the side effects do not," says lead author Jack Cuzick, from Queen Mary, University of London.

An international team — the SERM Chemoprevention of Breast Cancer Overview Group — carried out a meta-analysis of nine randomised trials. Most involved tamoxifen or raloxifene, but there was one trial with each of the newer drugs lasofoxifene and arzoxifene.

Not all trials were breast cancer prevention trials in high-risk women; some were assessing fracture reduction in osteoporosis, with breast cancer reduction as a secondary endpoint. No trial had mortality endpoints.

After a median follow-up of 65 months, the overall reduction in all breast cancer was 38 per cent (hazard ratio 0.62, 95 per cent confidence interval 0.56-0.69). The investigators calculate that 42 women would need to be treated to prevent one breast cancer event in the first 10 years.

The benefit was due to a reduction in oestrogen receptor-positive invasive breast cancer. Tamoxifen, but not raloxifene, was also associated with a significant reduction in ductal carcinoma in situ. All the drugs increased venous thromboembolic events. Only tamoxifen showed a clear increase in endometrial cancers.

Neither tamoxifen or raloxifene is currently licensed for chemoprophylaxis of breast cancer but in a recent draft guideline the National Institute for Health and Care Excellence recommended use in women at high risk (PJ 2013;290:75).

The investigators say that lasofoxifene looks particularly promising for prophylaxis and that further studies with this drug should be a priority.

Pharmacist who supplied POMs to a patient not registered with a GP is ordered to be removed from the Register

$
0
0

The supply of prescription only medicines, without a prescription, to a patient who was not registered with a GP, has led to the removal from the Register of a pharmacist, by order of the fitness-to-practise committee of the General Pharmaceutical Council.

On 16 January 2013, the committee inquired into the case of Mohanad Kadom (registration number 2060825).

The committee had received notification from Lloyds Pharmacy, Mr Kadom’s employer, that he had been suspended from work pending a disciplinary hearing. It later received a further email stating that Mr Kadom had failed to attend the hearing and had been dismissed. Investigation by the GPhC then led to the allegation that between March 2010 and July 2011, while working as a pharmacist for Lloyds, Mr Kadom supplied an unknown quantity of POMs to patient X without a prescription on a number of occasions while being aware that patient X was not registered with a GP and was not subject to appropriate medical reviews. It was further alleged that Mr Kadom benefited financially from these supplies.

The committee also heard that Mr Kadom had accepted a police caution at Dunstable police station for the offence of theft by an employee, in respect of the theft of medicines to the value of £225. It was accepted that the police caution related to the same circumstances that gave rise to the misconduct allegations.

Mr Kadom was present at the hearing and was represented by Graham Southall-Edwards, of the PDA.

Safia Iman, of counsel, appeared on behalf of the GPhC.

Mr Kadom told the committee that he had not gained financially from the transactions and that the supply had occurred four times. However, after hearing the evidence, the committee decided that a supply of POMs had been made on more than four occasions and that Mr Kadom had intended to keep the money paid by patient X for himself.

The chairman, Stuart Turnock, said: “ The committee concluded that, having decided to make supplies of medicines outside of the accounting regime, it was never his intention to return the money but to keep it for himself.”

Giving the committee’s decision, the chairman said: “The committee is satisfied that . . . there was a potential risk to patients and the public because Mr Kadon was providing POMs to a member of the public outside of the regime that applies to each dispensing. His failure to investigate patient X’s medical condition meant there was clearly a potential risk to him. By his dishonesty and flagrant and repeated breaches of statutory requirements, he has clearly brought the profession of pharmacy into disrepute, breached a number of the fundamental principles of pharmacy and has shown that his integrity can no longer be relied upon.”

Ordering Mr Kadom’s removal from the Register, the chairman said: “Mr Kadom has apeared before the committee and through his representative has express remorse. However . . . his insight is limited and the committee is not satisfied that it can be confident that there would be no repetition. Moreover, in this case the dishonesty is compounded by a deliberate and repeated disregard for legislative requirements governing pharmacists, which are there for the protection of the public.”

Mr Kadom was immediately suspended pending the coming into force of the removal order.

My passion for research and teaching

$
0
0

Oksana Pyzik arrived in London with a scholarship and a suitcase in hand. Now she is a teaching fellow at UCL School of Pharmacy. Jeff Mills looks at her journey so far

With a background in biochemistry, Oksana Pyzik began her academic career at the University of Guelph, Canada, and then went on to pursue a master of pharmacy degree at the UCL School of Pharmacy in London. Now she is pursuing a PhD at UCL in pharmacy education and policy alongside her teaching. 

“A strong foundation in the sciences has enabled me to apply and explore the wide breadth of pharmaceutical sciences from formulation to practice,” she says. “There are certainly exciting developments in personalised medication that will revolutionise how we take and use medicines in the future. I believe the most rapid progress will be made in oncology, where such medicines, although few, already exist.”

In the dynamic field of healthcare, the challenge will be to prepare students for the current market and for what could be a radically different future, says Miss Pyzik. “The current manufacturing and dispensing models are on the verge of change and, in order for the profession to survive, pharmacists must be able to adapt and offer the public a wider set of services and cognitive skills to stay relevant. I believe that future challenges facing pharmacy will require tomorrow’s pharmacists to communicate and collaborate with greater emotional intelligence and situational awareness, employ managerial roles to a greater extent, use a wider range of clinical skills in new environments and operate new technologies.”

She added: “From an educational standpoint this will require more from students than factual knowledge of the ‘classic’ and applied sciences. To practise pharmacy effectively and accountably, it is crucial for students to build a sound, contemporary and comprehensive knowledge base along with patient- and physician-directed communication skills.”

Miss Pyzik believes that, in many ways, pharmacists are educators in their own right, empowering and teaching patients how best to use their medicines. From her own experience, she believes a practice-based approach must be integrated within the sciences and understood from a policy point of view. As not only, an alumna of “The Square”, but also as a former staff member, having previously worked as a teacher practitioner, Miss Pyzik is a familiar face among both staff and students. “Although much has changed since my days here as a student, it still feels like home,” she says.

Since she first arrived in London with a scholarship and a suitcase in hand, she has energetically sought research opportunities in the UK and abroad and, as a result, has extensively widened her network and scope of practice. At UCL, there are many opportunities for students to prepare and pursue international experiences and careers, says Miss Pyzik.

After completing her preregistration training in community pharmacy, she went on to practise as a locum around London. “In delivering healthcare to marginalised minority groups, I was able to witness how various NHS policies and programmes played out in the community, for better or for worse. This deepened my interest in public health and pharmacy law since it underpins all such polices, and led to my research in the field,” she says.

In 2011 Miss Pyzik relocated to the International Pharmaceutical Federation (FIP) headquarters in The Hague, The Netherlands, where she was the lead pharmacist researcher on a collaborative project titled “Pharmacy law and competition law: feuding laws or working in partnership?”

She has presented her research and debated among experts at international conferences, such as the European Law Students’ Association International Focus Programme, Mid Evaluation Conference on Health Law and Human Rights in Trieste, Italy, the International Pharmaceutical Students’ Federation 58th World Congress in Hurghada, Egypt, and, more recently, at the FIP Centennial Congress in Amsterdam in 2012.

In addition, Miss Pyzic is a contributor to the International Pharmacy Journal, covering topics such as health economics, leadership in pharmacy, pharmacy law, professionalism and multidisciplinary collaboration within the healthcare field.

In 2012, she was selected as an IPSF delegate at the World Health Organization’s 65th World Health Assembly in Geneva, where she assisted in drafting interventions addressing the critical issue of spurious, falsely-labelled, falsified and counterfeit medicines.

Her previous work with student organisations, both as a student and as a teacher, further developed her enthusiasm and interest in education. She has teamed up with colleague Nadia Bukhari, clinical lecturer, student support manager and preregistration co-ordinator, and is a speaker at the Royal Pharmaceutical Society preregistration mock examination and revision conferences.

“Central to my identity as a pharmacist, researcher and lecturer is my passion and commitment, both personally and professionally, to lifelong learning and continuous professional development,” Miss Pyzik says.

“I believe these values and habits must be instilled and practised early on in pharmacy education to increase confidence, competence in practice and, ultimately, optimise patient care. I fully embrace the challenge to inspire our students and professionals alike, and provide them with the skills and self-confidence necessary to succeed as future health professionals and to rise as leaders of the industry.


Six-month suspension for pharmacist after physical assault and failure to report police caution to Registrar

$
0
0

A pharmacist who physically assaulted a person has been suspended from the Register for a period of six months by order of the fitness-to-practise committee of the General Pharmaceutical Council.

Navinder Singh Hayre (registration number 2063782) appeared before the committee on 14 and 15 January 2013. Information had been received that on 9 December 2009, Mr Hayre, together with his sister’s husband, attacked a person (VB). The reason for the attack was, allegedly, VB’s apparent “indelicate approaches” to the registrant’s sister.

Graham Southall-Edwards, of the PDA, appeared on behalf of Mr Hayre, who was present at the inquiry.

Guy Micklewright, of counsel, instructed by Blake Lapthorn Solicitors, appeared on behalf of the GPhC.

The committee heard that Mr Hayre did not deny that there was some sort of altercation on the evening in question arising from his family’s concern about the attention being shown by VB towards his sister. However, he maintained the altercation was between VB and his brother-in-law, and that his role was limited to attempting to keep them apart.

However, the committee also heard that on the evening when the assault took place, VB had received “flirty and light-hearted” texts on his mobile phone, ostensibly from Mr Hayre’s sister. The texts asked him to call round to the house, so that they could have a chat. The registrant told the committee that these texts were in fact sent by him from his sister’s mobile phone. The assault had taken place after VB arrived at the house.

Furthermore, shortly after the assault, the registrant opened VB’s mobile, removed the SIM card and snapped it in two. For this conduct he had accepted a police caution for criminal damage, but failed to inform the Registrar of this as is required by Regulations.

With regard to the assault, although it was reported to the police, the Crown Prosecution Service decided not to go to trial.

The chairman, Patrick Milmo, QC, said that Mr Hayre’s assertion that he was acting as mediator, trying to keep VB and his brother-in-law apart, was hardly compatible with his role in getting VB to call at the house. “It was the registrant who originated and implemented the deception of impersonating [his sister] in texting an invitation from her mobile to VB to see her at the house. What was the purpose of so doing? It was clearly in our view to ensure that VB turned up at the house where he could be confronted and persuaded to cease what the Registrant and [his brother-in-law], and possibly the rest of the family, regarded as VB’s improper and inappropriate approaches.”

Giving the committee’s decision, the chairman said that the committee was prepared to accept that the plan may not have been at the outset to administer a beating to VB, but it was to organise a meeting in an intimidating environment at which VB could be threatened and frightened from further communication with Mr Hayre’s sister. “But it must have been in the contemplation of the registrant and his brother-in-law that the confrontation could turn violent. . . . We have no hesitation in finding that the registrant was an active participant with his brother-in-law in a prolonged joint physical attack on VB which involved punches to the victim’s face and head, and kicks to his body.”

The chairman said that it is well established that members of the pharmacy profession are required to observe proper standards of behaviour in all circumstances, whether acting as a pharmacist or generally as a citizen within the community. To do otherwise would be to lower the reputation of the profession and diminish public confidence in it.

Outrageous and cowardly

Describing the attack as outrageous and cowardly, the chairman observed that Mr Hayre had no disciplinary history and had made favourable impressions regarding his work performance and general demeanour. So a period of suspension was appropriate.

Mr Southall-Edwards urged the committee to impose a short period of suspension of two months. However, the chairman said: “We do not think that that is sufficient. It would not provide adequate recognition of the gravity of the registrant’s conduct and could be construed as an indication that a sustained assault of the kind to which the victim was subjected in this case was only to a limited extent regarded as unacceptable and unbefitting of a member of the profession. In our view the minimum period of suspension which can be described as appropriate and proportionate would be six months and that is the sanction we direct.”

Caldicott review calls for greater sharing of patient information

$
0
0

Relevant health data should be shared among all of the registered healthcare professionals directly involved in a patient’s care, a Government-commissioned information governance (IG) review has concluded.

Dame Fiona Caldicott was tasked last year with leading the review (PJ 2012;288:270), which explored how to strike the balance between sharing and protecting confidential patient information in the NHS. The resultant report, published last week (26 April 2013), sets out 26 recommendations for improving the sharing of patient information, ensuring this is done securely and taking action when mistakes are made (see Panel).

In a foreword, Dame Fiona says: "The Future Forum’s key recommendation relating to IG [in its report last January (PJ 2012;288:26)] stated that data sharing is vital for patient safety, quality and integrated care. We endorse this wholeheartedly, and have been struck by the loss of confidence of many clinicians . . . about when it is safe to share information and the safeguards that are required."

There is an urgent and ongoing need for education and training in this area, she warns. "Everyone working in the health and social care system should see IG as part of their responsibility. Unfortunately that is not currently the case."

Heidi Wright, practice and policy lead for the Royal Pharmaceutical Society in England, said the review has various implications for the pharmacy profession. "Due to unfounded legal fears and procedural issues, [appropriate sharing of information] does not always happen in healthcare at the current time, even when . . . in the patient’s best interest," she said.

Greater sharing of information between NHS service providers, as called for in the report, would benefit pharmacy services, said Ms Wright. "There are other potential benefits for pharmacy in the implementation of this report, concerning availability of information for service commissioning and professional education on IG.

"The Society’s information management and technology strategy group will be reviewing this report to see where it supports our professional strategy, and [to drive] forward its implementation," she said.

Speaking at the Electronic Patient Records Conference, held in London on the day of the report’s publication, health secretary Jeremy Hunt said the effective sharing of patient information has enormous potential to improve patient care. But he stressed that patients who do not want their data recorded or shared will have this wish respected.

He has asked Dame Fiona to chair an independent panel to oversee implementation of the review’s recommendations, and advise on IG issues. A full Government response to the report will be made in the summer.

Although the review considered issues in England, many of the findings should prove useful across the UK, Dame Fiona says.

Caldicott review recommendations

Recommendations from the review, "Information: to share or not to share?", include that:

  1. Direct patient care should be provided by multidisciplinary teams comprising both health and social care staff
  2. Relevant confidential patient data should be shared among the registered and regulated health and social care professionals who "have a legitimate relationship with" the patient
  3. Care providers should audit their services against National Institute for Health and Care Excellence clinical guideline 138, "Patient experience in adult NHS services", particularly the information sharing advice
  4. When confidentiality of personal data is breached, the individual or organisation legally responsible for the data must fully explain and apologise to the patient, and take remedial action
  5. Professional regulators must agree upon, and publish, the conditions under which registrants can rely on implied consent for sharing patient data 
 

The RPS Faculty could mean a bright new beginning for all pharmacists

$
0
0

Following on from last week’s piece from Lindsey Gilpin on what the RPS Faculty means to her (PJ 2013;290:475), Steve Hadley explains how his practice will benefit from the Faculty


So what can the RPS Faculty offer me as a community locum? Well, to answer that question, I have to answer a question that some might find difficult to grasp. And that is: what does being a locum pharmacist offer me?  

I became a locum because I am passionate about pharmacy and have a strong desire to practise with professional autonomy. After working as a hospital pharmacist for nine years and as a community pharmacy manager for many more than that, I have a range of clinical and practical experience to benefit my patients and clients. As a locum (and this is true of most of us) I also have additional selling points: adaptability, flexibility and the ability to think on my feet in frequently stressful and, occasionally, bizarre situations. I can walk into any pharmacy and in the face of multiple local quirks, from “unusual” prescribing and procurement procedures, to weird and wonderful collection and delivery demands, through to, shall I say, interesting examples of skill mix, I can turn on my radar (a locum quickly grows one), swim through the treacle and come out the other side as a sticky but highly effective professional.

With professional independence comes a downside, though, and that is the sense of isolation often felt by a locum. There is a niggling feeling that one is professionally “out of the loop” with regard to new initiatives and career progression. Training is for “someone else” and new roles, such as prescribing, pharmacist-led clinics and exciting new public health ventures are “not for us”.

When one does not attend staff away days, and a visit from an area manager may be to check that the locum is getting through the day without being tarred and feathered by an irate patient (or GP receptionist for that matter), even continuing professional development can be something traumatic. When my CPD was called in I was really worried about whether it would be adequate. It would have been nice to have had it peer-reviewed and to have had some reassurance that my CPD was appropriate and is not going to see me thrown into the stocks once revalidation comes in. That is where the Faculty will help.

Career progression and respect

I have never been the type of locum who only cares about hourly rates and is content to do little to justify them (yes, I have heard the horror stories but those days are over). I want to get the same skills, develop the same roles, have access to the same training and be granted the same professional career progression and respect as a pharmacist practitioner as my employed and contractor colleagues. Until now that has not been easy. As a travelling pharmacist, I have undertaken courses for the provision of enhanced services and have had to repeat them in different (now defunct) primary care trusts. How much better to have obtained universally recognised accreditation — and the Faculty should be able to help with that.

Tailor-made development programme

I have undertaken underpinning learning for becoming an independent prescriber in preparation for a course at one of the universities providing them but, again, being a locum, I have lost contact with the GPs needed to mentor me for the 90 hours needed for the reflection logs. I would dearly love someone to help co-ordinate this so that I can get on with learning without the logistical and needless frustration that comes from not having a credible and unifying organisation pointing the way. So no, I do not have area training days, or structured company programmes or even monthly newsletters detailing essential changes to standard operating procedures.

In fact, as a locum, the sheer variability and unpredictability of my professional life means that, unlike a lot of community pharmacists, my CPD evolves from an array of individual incidents, Centre for Pharmacy Postgraduate Education events, workshops sponsored by the pharmaceutical industry and local practice forum events which catch my eye. But what I would really like is a tailor-made professional development programme, with access to a mentor to help me identify my needs and signpost me to appropriate training and events. Someone who understands what it means to be an effective locum pharmacist and who can provide me with support tools and handbooks and, most of all, put me in contact with other locum pharmacists eager to advance our careers and realise our full potential.

Community pharmacy is changing and we will all have to change with it. I have recently become interested in research at an elementary level. It is not something that community pharmacists, and especially locums, often consider but I believe it to be essential if we are not to go the way of the dinosaurs. I understand that the Faculty will put community pharmacists who wish to undertake research in contact with academics who can help them obtain the skills they require. This will be the strength of the RPS Faculty. The inclusiveness and mutual appreciation of all pharmacy sectors means that I can receive mentoring and guidance from those who understand my day-to-day challenges and professional aspirations, but also have access to experts in other sectors who can open up opportunities and release my potential.

Professional ring of confidence

I have a business card that I distribute to new clients and, as I looked at it the other day, it occurred to me how valuable it would be if I could insert my Faculty registration on that card too. A professional ring of confidence that says that “yes, I am a locum, and yes, I am a highly regarded, fully skilled and highly competent peripatetic pharmaceutical practitioner whose post-nominals declare me proud to be a Faculty-accredited locum pharmacist”. It would be gratifying for some of my ongoing training to be recognised by such additional post-nominals. Although it is late in my career, for many of you reading this, it is not. Just think what a difference such recognition would make to your CV.
This could be a new beginning and it starts in June.

Mr Hadley is a member of the English Pharmacy Board, Royal Pharmaceutical Society. The views expressed here are his own and do not necessarily reflect those of the board or the Society

Our professional input­ must not be bypassed by commercial expediency

$
0
0

Community pharmacists need to become more commercially entrepreneurial if they want to take control of their destinies and realise their professional aspirations

Stephen Goundrey-Smith SGS Pharmasolutions, Chedworth, Gloucestershire

 

It has been with some interest that I have followed the discussion in The Pharmaceutical Journal in recent months about the professional status of community pharmacists, and how pharmacists feel that their professional status is being undermined by their employment conditions, with onerous bureaucracy, heavy dispensing workloads, a shortage of support staff and aggressive target setting by non-pharmacist managers.

Given the training they undergo, and the unique knowledge and expertise that they have, it is right and just that community pharmacists should be designated professionals, and it is to be hoped that the Royal Pharmaceutical Society, as the professional body, and the Pharmacists Defence Association, as the union/defence association, will do their utmost in their spheres to maintain the professional standing of pharmacists.

However, at this point in the history of community pharmacy in the UK, it is worth reflecting on what a profession is, what professionalism is, and how the professional standing of pharmacy can be restored and advanced. First, it is worth noting that there is a distinction between the profession and professionalism. The profession denotes the externals of a job — the organisational structures, the regulatory and practice framework, the privileges and the remuneration. Professionalism, however, denotes the internal behaviours and attitudes of the individual in an occupational or professional practice setting. These relate to the affiliation, identification and socialisation that individuals have with their professional peers and community. Although they are distinct, it is clear that profession and professionalism are interrelated.

Is pharmacy a profession?

Sociologists have, over the years, developed criteria to define what occupations can be classed as professions and what cannot. A number of key criteria have been described, such as specialist training and restrictive registration/licensure, self-regulation and relative freedom from lay evaluation, ability of the profession itself to set standards of education and practice, professional control over legislation affecting the profession and over the working processes and working environment, and high income and status in society. Again, it is clear that some of these factors are interrelated.

By these criteria, a number of developments in recent years have eroded the status of pharmacy as a profession. The modern regulatory environment has meant that all professions, not just the profession of pharmacy, are increasingly open to public/lay scrutiny and there are often lay members or patient representatives on regulatory or professional committees.

In pharmacy in particular — but in other health professions, too, such as dentistry — business ownership has moved away from the profession and into the hands of commercial companies. Many pharmacies now are owned by multiples, with non-pharmacist directors and managers, rather than by individual pharmacists, and in these companies, pharmacists are employees. In this context, the responsible pharmacist Regulations have led to pharmacists being professionally responsible for people and processes outside their control, and few pharmacists feel that they have the genuine authority to make changes to enable a pharmacy to operate safely and effectively. Furthermore, pharmacy professional services, such as medicine use reviews, are being exploited as commercial revenue streams and the provision of these services is being driven by the corporations, not the profession.

In any case, pharmacists in all pharmacy business have little control over their dispensing workload, which is governed largely by the activities of doctors and other primary care professionals, and the commissioning priorities of the local NHS.

So while pharmacy may now have the regulatory framework for a modern profession, the reality is that pharmacists have little control over their working environment, and any professional authority they have is being subsumed to the diktats of non-pharmacist policy-makers or the commercial interests of their non-pharmacist employers. Pharmacy is often disregarded as a profession by the political establishment, as is evidenced by the “methadone millionaire” comments of Jenny Marra, MSP, and the claim by Philip Lee, MP, that pharmacists are just “Smartie counters”.

The Government may pay lip service to pharmacists being “well placed” to provide a range of new services, and the profession’s leaders may opine about the “professionalism” of pharmacists. But this rhetoric will only go so far when, on the ground, the professional status of pharmacists is being undermined. Until pharmacists are working in an environment where they have real professional responsibility, authority and control, as well as accountability, morale will continue to decline and good pharmacists will continue to leave the profession for careers where they feel they can take the initiative and make a difference.

Restoring professional status

To restore their professional status, pharmacists need greater control of the businesses they work in. Although there are still many independents and smaller multiples that are owned and run by pharmacists, there is a pressing need for more pharmacists in the community to have a stake in their businesses, rather than being salaried employees of corporations whose business interests go well beyond the pharmacy professional sphere.

A number of new models of pharmacy ownership have been discussed recently in The Journal, and include limited liability partnerships, as is the case other professional businesses such as law and accountancy, the John Lewis style employee partnership model, or co-operative ownership.

If pharmacists are more entrepreneurial commercially, they are more likely to achieve their professional aspirations. First, if there are more pharmacist owners and partnerships, the profession will have a greater influence over contractual negotiations, and the resulting remuneration and commissioning of services will favour the profession. Secondly, greater pharmacist control over local pharmacy business would ensure that the many technologies now available to support the medicines use process — pharmacy automation, smart packaging, telemedicine etc — are implemented appropriately in each locality.

This would increase the acceptance and adoption of innovative technologies in community pharmacy, and ensure that the technologies support the unique expertise of pharmacists in service provision, rather than bypass pharmacist professional input for commercial expediency. It is no accident that independently owned pharmacies are prominent in adopting new technologies to support their professional activities.

If entrepreneurial pharmacists in community pharmacy take up this challenge, the status of the profession will be enhanced, and the profession will be a step closer to greater public recognition. Pharmacists are professionals and should have professional status — professionalism alone is not enough.

Sixth pharmacist suspended after BBC investigation

$
0
0

Another pharmacist accused of illegally supplying medicines following a BBC Inside Out investigation has been suspended from the Register by the General Pharmaceutical Council.

Mohammed El-Hadi-Abdul-Razzak, of Safeer pharmacy, was handed a 12 month interim suspension order at a hearing on 25 April 2013. Last December, the BBC programme broadcast evidence of nine pharmacists supplying morphine, benzodiazepines, sildenafil and amoxicillin without a prescription. In total, six pharmacists have now been suspended by the GPhC following the programme. The investigations into these pharmacists and other pharmacists the programme implicated are ongoing and no fitness-to-practice hearings have yet been scheduled, the GPhC confirmed. 

Commissioning restrictions could be unlawful

$
0
0

Imposing restrictions on the type of pharmacy that can be commissioned to provide services is potentially unlawful and local authorities should tread with care, partner at Charles Russell solicitors David Reissner has warned.

His comments were made at the 2013 Charles Russell legal and regulatory pharmacy conference, held in London yesterday (30 April 2013), in response to a question posed by Boots UK professional standards director Paul Bennett. Mr Bennett expressed concern about local authorities and health and wellbeing boards seeking to place certain restrictive criteria on service providers — for example, requiring pharmacies to be healthy living pharmacies (HLPs).

Restrictions of this kind are potentially unlawful, said Mr Reissner. “Local authorities are going to have to be very careful about how they impose [such] a restriction. . . . It’s potentially discriminatory against [pharmacies] from outside the area, who won’t have had the opportunity to acquire HLP status,” he explained.

Market entry also of concern

Mr Reissner also warned that the new, highly localised approach to market entry risks being a “closed shop”, and breaching an EU treaty on freedom to set up businesses and provide services.

When carrying out pharmaceutical needs assessments — which will form the basis of decisions on applications to open a new pharmacy — health and wellbeing boards are only required to consult with organisations based within their locality. This “risks discriminating against people from outside the immediate local area, who won’t have had a right to make representations on the PNA,” he told conference attendees.

In 2003 the Office of Fair Trading recommended scrapping pharmacy market entry controls altogether, and they were maintained after hard lobbying from the profession, said Mr Reissner. “It may only be a matter of time before the OFT takes a fresh interest in market entry,” he said.

Community pharmacists are rising to meet the challenge of the new LETBs

$
0
0

New local education and training boards will hold funding for health professional education and training. Pharmacists must engage with them, writes Ailsa Colquhoun

 
The next few months will be a crucial time for pharmacy to engage with the emerging local education and training boards (LETBs). With functions including holding and allocating funding for education and training for the entire local health and care workforce, LETBs are clearly an important “friend” for pharmacy to make. Organised (in the main) to be co-terminous with the former strategic health authorities, with which the responsibility for NHS workforce and development previously lay, LETBs will comprise a significant number of staff “lifted and shifted” from SHAs.

This is not in itself a bad thing, say pharmacists and educationalists, because it ensures that the NHS retains organisational skills and memories, which will be important for the ongoing development of the NHS pharmacy workforce. Where the lift-and-shift model may fall down, though, is in the development of the community pharmacy workforce. Thanks to the strategic recommendations of the Department of Health and Health Education England, LETBs’ roles and responsibilities now cover the community pharmacy workforce, including pharmacy technicians — a role not previously managed by SHAs.

Academic health science networks

The work of the local education and training boards (LETBs) will be informed by academic health science networks (AHSNs). Their role is to bring together academia, NHS commissioners, providers of NHS services and industry, and foster collaboration and innovation in and between education, training, research, informatics and healthcare delivery, in order to improve patient and population health outcomes.

Pharmacists, such as former strategic health authority prescribing and pharmacy lead (East of England) Carol Roberts, have been appointed to the AHSNs. In some cases, LETBs and AHSNs are coterminous and even have joint boards.
 

 

London difference

London pharmacists, additionally, have other challenges to manage. In London, the new LETB structure is not co-terminous with the former SHA. Since 1 April 2013, London has three LETBs — officially titled Health Education North West London, Health Education North Central and East, and Health Education South London following the recent LETB rebranding exercise — and, as a result of the divergence from the previous NHS structure, London’s LETBs begin the process of creating their five-year skills and development strategies as new organisations. According to Susan Sanders, who is facilitating the London Pharmacy Workforce Group, this is not, inherently, a bad thing. She suggests that as the new workforce structures develop and become staffed they will bring with them new people with new ideas, which can be combined with the skills and experience of those former SHA staff still working in NHS workforce and development.

London community pharmacists have not been slow to ensure their voices are heard and among the LETB community pharmacist appointments already made is Ash Soni, who joins the HE South London board.

Sanjay Ganvir, superintendent of Green Light Pharmacy, is among those also offering community pharmacy input to his local LETB via new local forums. He says a key challenge is to ensure that pharmacy makes a strong business case for education and training funding in an environment of austerity.

He says: “There are so many issues to overcome with respect to community pharmacy workforce education and training development: a lack of workforce data, a historic lack of long-term macro-level strategic workforce development and the diversity of community pharmacy. There is a challenge for LETBs to ensure they support education and training in a way that suits the large and diverse range of independent contractors that exists in primary care — that is to say community pharmacists, GPs, practice nurses, dentists and other allied health professionals.”

Multidisciplinary emphasis

London will also benefit from the resource of the London Pharmacy Workforce Group (which now includes community and NHS pharmacy employers, and which is linked with the three London LETBs). This will be working to ensure that pharmacy, as a whole profession, gets its fair share of attention. Ms Sanders says: “In some LETBs the leadership is by people who may not have a great understanding of the education and training needs in pharmacy. But there is a need to keep the emphasis multidisciplinary and focused on the HEE (including Modernising Pharmacy Careers) and LETB priorities; there is a real need to be engaged at an early stage. LETBs have a huge remit, but NHS money is tight and so pharmacy will need to convince LETBs that there is a case for spending money on the sector.”

Helping NHS trusts gain foundation status

With performance, quality and safety at its heart, the work of the new NHS Trust Development Authority is the perfect opportunity for pharmacy to demonstrate its professional skills, Richard Seal, chief pharmacist and clinical lead for medicines optimisation, believes.

Operating from regional centres across England — including London, Birmingham, Manchester and Derby — each TDA centre will manage a footprint comprising up to 100 non-foundation trusts, taking forward NHS business priorities such as safety, clinical outcomes and effectiveness and the patient experience. Mr Seal believes the new TDA structure brings a clarity of purpose to this work that the strategic health authorities and the Department of Health — with their larger remits — were unable to deliver. He also believes the work is perfectly aligned with the skills on offer to the NHS from the pharmacy workforce. “Pharmacists understand about finance, they are familiar with new ways of working and they are well equipped to drive quality, despite cost challenges. I hope that the TDA will show the benefits to the NHS of pharmacists in trusts being engaged in trust business.”

 


Where next for Francis?

$
0
0

“We all know deep down that there’s a little bit of Mid Staffs in every trust.” A senior pharmacist told The Journal this at a Royal Pharmaceutical Society event this week. It is a bold statement — uncomfortable, stomach-turning and most likely true.

It is tempting to seek to distance yourself from the Mid Staffs mess — to claim that that kind of catastrophic neglect could not possibly happen in your patch. Mid Staffs is an extreme case that highlights how wrongly things can go when organisational culture is fundamentally flawed and cash trumps care. But, painful as it might be, clinicians and managers should get as close as they can to QC Robert Francis’s report.

It is a call for action to ensure patients are considered first and foremost in the delivery of care. Ways that pharmacy can make a real impact post-Francis were the focus of the RPS event, held at the Law Society in London. The meeting brought together around 80 leaders and practitioners to discuss the implementation of the inquiry’s recommendations through professional leadership.

Counsel to the Francis inquiry QC Tom Kark spoke at the event, where he acknowledged the lack of consultation with pharmacy throughout the inquiry. Keith Ridge, chief pharmaceutical officer for England, set out some of the Government’s next steps in the context of pharmacy and medicines optimisation.

The event really came alive in breakaway sessions, where participants collaborated to come up with actions in eight key areas: safety, information, transparency, accountability, consistency, assurance, culture change and strengthened regulation. If the outputs of the sessions are anything to go by, the RPS should be able to produce a hugely relevant report for the profession. But the discussion did not stop at the door and The Journal was impressed when, on Twitter (#RPSFrancis), RPS member Aamer Safdar made public his own personal pledges. He was part of the discussion about leading on safety, and we summarise his commitments here:


• To improve patient experience by giving patients information and explaining when things go wrong

• To empower trainees and staff to report incidents and poor practice; not to accept or tolerate poor practice

• To ask staff how they define their professional roles; what are their boundaries and when do they think it is not their problem?

• To ask staff how they define patient safety and what they would be happy to get into trouble over with regard to patient safety

• To inform students and trainees of pharmacists’ role in patient safety; what are their responsibilities and accountabilities?


He challenges colleagues to come up with their own pledges. At the very least, we say, pharmacists should read as much of the Francis report as they can bear.

 

Latest GLP-1 agonist boasts administration and cost benefits

$
0
0

A third glucagon-like peptide-1 agonist, lixisenatide (Lyxumia), was launched by Sanofi in London yesterday (30 April 2013) after receiving its European marketing authorisation in February. The injection is licensed for use in combination with oral antidiabetic medicines or basal insulin, or both, when control of blood glucose levels has not been achieved in patients with type 2 diabetes.

Like liraglutide (Victoza), a GLP-1 agonist launched in 2009, lixisenatide requires once-daily injection. However, according to Anthony Barnett, emeritus professor of medicine at the University of Birmingham, the new drug has a different activity profile, with a more profound lowering effect on post-prandial glucose. Speaking at the launch, he said that although head-to-head trials comparing liraglutide and basal insulin combination treatment with lixisenatide plus insulin had not been conducted, “in theory, you might not get as profound an effect on HbA1c [with liraglutide], but that has not been tested in practice”. In addition, he pointed out that use of liraglutide with insulin is currently unlicensed.

A head-to-head study has, however, been carried out with exenatide (Byetta), the first GLP-1 agonist launched, and which requires twice-daily dosing. (A once-weekly product, Bydureon, is available but is not currently licensed for combination with insulin.) The currently unpublished study, conducted by Sanofi and which involved 634 people, demonstrated non-inferiority, the company claims.

What may attract prescribers is that Sanofi has priced lixisenatide over 25 per cent cheaper than Victoza (at a 1.2mg daily dose).

Richard Brice, a GP with a special interest in diabetes and clinical commissioner in Kent, said at the launch: “[Lixisenatide] should enable more people access to this newer class of therapy with the same amount of money. This has got to be an advantage in today’s financial climate when we are trying to give everyone the best possible care with ever more challenging budgets.“

Professor Barnett argued that 40 to 50 per cent of patients could be treated with GLP-1 agonists and suggested that the low uptake was due in part to them being from a relatively new class of drug, partly because of cost concerns, but also because of an inactivity among many health professionals.

“Traditionally diabetes management is [about] waiting for failure – we wait until the HbA1c is up in the sky then we bring in the next therapy. [The National Institute for Health and Care Excellence] itself says this is bad medicine – it’s setting up our patients for long-term complications. We need to be getting in earlier with effective treatment.”

Product details

Action: GLP-1 receptor agonist
Dose: 10mcg once daily within an hour before the first meal of the day, increased to a maintenance dose of 20mcg once daily after 14 days
NHS list price: 14 x 10mcg doses (1 pre-filled pen), £27.07; 28 x 20mcg doses (2 pre-filled pens), £54.14; 14 x 10mcg doses (1 pre-filled pen) plus 14 x 20mcg doses (1 pre-filled pen), £54.14
Legal category: POM

 

Consultation on self selection of P medicines unlikely

$
0
0

Community pharmacists will not be consulted on plans to allow pharmacy medicines to be made available for self selection, the General Pharmaceutical Council has confirmed.

The GPhC said that the profession’s views about the move had already been sought as part of its consultation last year (2012) on the new standards for registered pharmacies.

It decided at its council meeting last month (April 2013) that it would be “unlikely” to consult specifically on the move “given the strength of the case for maintaining the overall outcomes focused approach to the standards”.

Any fears about medicines safety around the self selection of P medicines have already been addressed in the new standards, which place a risk management and safety responsibility on pharmacy owners and pharmacy superintendents, it said.

The Pharmacists’ Defence Association said the decision not to consult has caused “indignation” and “frustration”. Its chairman Mark Koziol said: “Pharmacists simply cannot understand how such a massive change in practice can be proposed by the GPhC without providing coal face practitioners the opportunity to register their views and despite very serious reservations being formally expressed by a number of pharmacy organisations.”

The PDA has organised a series of local meetings during April and May for pharmacists to discuss the issue and to “gauge the depth of feeling and inform a practical plan of action”.

Reports suggest wholesalers are deliberately inflating prices

$
0
0

Contractors are being urged to challenge wholesalers that set prices significantly above concessionary levels. The Pharmaceutical Services Negotiating Committee said earlier this week (29 April 2013) that it has received reports of wholesalers deliberately inflating prices and informing contractors that “No cheaper stock obtainable” concessions will be granted.

“We also know that some contractors have successfully challenged high prices.

“Where contractors are being charged prices that are higher than the agreed concessionary prices, we would urge them to challenge their wholesaler, and if this is not successful, to send their invoices to us.”

In a statement, the PSNC said that shortages are becoming even more of a problem for contractors, with market manipulation making the situation increasingly complicated and having a significant impact in some areas.

However, it has had to decline requests from some contractors to publish wholesalers’ pricing information, adding: “Publishing lists of some suppliers’ prices could result in us being legally challenged for breach of competition law, so we are not able to do this.”

In the statement, the PSNC said it is continuing its “urgent discussions” with the Department of Health to find a solution to deal with generic shortages, as well as challenging concessionary prices set by the DoH which it believes do not reflect actual market prices or stock availability.

Guiding principles for medicines optimisation widely backed

$
0
0

Four guiding principles for medicines optimisation have been published today (2 May 2013) by the Royal Pharmaceutical Society, which is calling on all healthcare professionals in England to adopt them.

The principles (see Panel), which form part of good practice guidance entitled "Medicines optimisation: helping patients make the most of medicines", have been developed with input from pharmacists, doctors, nurses, patients, lay representatives and the pharmaceutical industry. The guidance is backed by NHS England, the Royal College of General Practitioners, the Royal College of Nursing, the Academy of Medical Royal Collegesand the Association of the British Pharmaceutical Industry.

The RPS says that medicines use is too often suboptimal and that a step change is needed in the way health professionals support patients to get the best possible outcomes from their medicines; medicines optimisation is that step change.

Simple but important principles

In a foreword to the guidance, Sir Bruce Keogh, national medical director at NHS England, and England’s chief nursing officer Jane Cummings and chief pharmaceutical officer Keith Ridge, say the principles are simple but important and could revolutionise medicines use and outcomes. They encourage everyone to adopt them whether prescribing, dispensing, administering or taking medicines.

The guidance states that pharmacists can provide leadership and support in medicines optimisation but that the principles need to be used by everyone involved in the patient’s care, adding that they could also be used by those developing pathways and services.

Heidi Wright, English practice and policy lead at the RPS, told PJ Online: "In the current economic climate we need to ensure that the investment made in medicines realises its full potential and the way to do that is to talk to the patient and support them in taking their medicines. Pharmacists need to lead this agenda at a local level and we will be looking at what extra support we can provide to assist them in doing this. But ultimately medicines optimisation is about all healthcare professionals, and patients, working together — an enhanced level of patient-centred professionalism."

Bigger role in support for long-term conditions

RPS President Martin Astbury added: "I’d like to see pharmacists play a much bigger role in monitoring and supporting patients with a wide range of long-term conditions. As the most frequent users of health services, accounting for 50 per cent of all GP appointments and 70 per cent of the primary and acute care budget in England, better use of medicines is absolutely critical to this group of patients."

Chief executive of Pharmacy Voice Rob Darracott said: "The signatures of the NHS medical director and the chief nurse on the foreword to this document should dispel any lingering doubt that improving patients’ use of medicines is not going to be at the centre of health care over the next few years.

"The new medicine service and targeted medicines use reviews should be the basis on which to build medicines optimisation programmes that contribute routinely to improved patient outcomes and provide pharmacists’ contribution to managing long-term conditions. We may not have made the philosophical leap in every pharmacy that medicines optimisation is what we are going to be focusing on in the future, but it is crystal clear that we should."

The guidance includes case studies and a section on using the principles to reflect on practice.

The RPS has also published information for patients in partnership with patient groups, which will be featured on the NHS Choices website.

The four principles for medicines optimisation

Principle 1: Aim to understand the patient’s experience

Principle 2: Evidence based choice of medicines

Principle 3: Ensure medicines use is as safe as possible

Principle 4: Make medicines optimisation part of routine practice 

Viewing all 1883 articles
Browse latest View live