Clinical Pharmacist's monthly news round-up: the top 10
What has been happening in the world of pharmacy? The team at Clinical Pharmacist summarises the month’s top 10 clinical pharmacy and NHS stories.
1. Regulation to include duty of candour
Health professionals who obstruct error reporting in the workplace will not face criminal sanction, the Government has said in its response to the Francis report.
“Hard truths: the journey to putting patients first”, published on 19 November 2013, says that healthcare professional regulators, including the General Pharmaceutical Council, will instead be asked to strengthen their regulations to make it clear to registrants that they have a professional obligation to be candid with patients when mistakes happen.
A statutory duty of candour will also be placed on NHS providers and organisations and, according to the report, will “ensure patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation”. This new obligation will come into effect next year and will be enforced by the Care Quality Commission.
The report also says that a new criminal offence of wilful neglect will apply to individuals and organisations that are thought to be guilty of mistreating or neglecting patients.
2. Future models of care report calls for action
Pharmacists and their employers must recognise the imperative to shift their focus away from dispensing and supply of medicines and towards providing a broader range of services, says a Royal Pharmaceutical Society report.
“Now or never: shaping pharmacy for the future”, published last month, claims that public awareness of pharmacy services is lacking and outward-looking leadership is required to address this.
The Commission on Future Models of Care was set up in spring 2013 by the RPS English Pharmacy Board and was independently chaired by Judith Smith, director of policy at the Nuffield Trust.
“Pharmacists, particularly community pharmacists, are often quite marginalised in the NHS — nationally and locally,” Dr Smith commented. “It is the third largest healthcare profession and I don’t think that pharmacy at the moment punches its weight.” She added that there has been more than enough analysis of what pharmacy can deliver and the profession must now act as an advocate for its own future.
3. Emergency care reviewed
Pharmacists will play a key part in a new “system-wide transformation” of urgent and emergency care in England, proposed as part of a review by Sir Bruce Keogh, medical director for NHS England.
The report, published last month, proposes a greater network of care outside hospital and two tiers of accident and emergency centres. It also details proposed plans for an enhanced NHS 111 service where patients can speak directly to a clinician, including a pharmacist.
The next phase of the review is to develop and test the financial impact, commissioning support, clinical standards and workforce needs required to deliver the new system.
4. Draft care home guidance
Collaboration between care home providers, GP practices and community pharmacies is essential for the management of medicines in care homes, says the National Institute for Health and Care Excellence. The comments were made in draft good practice guidance for managing medicines in care settings, which was published last month.
The guidance covers processes for effective medication review and calls for reviews to be conducted by a pharmacist for all residents at least every six months — placing pharmacy firmly at the centre of good practice. The draft guidance is open for comment until 16 December.
5. CV risk linked to sodium content of medicines
Patients prescribed sodium-containing effervescent, dispersible and soluble medicines are at greater risk of cardiovascular events than those taking standard formulations, according to a new study (BMJ, online, 26 November 2013).
Data on 1.2 million adults in the Clinical Practice Research Datalink were used to compare outcomes for patients who received at least two prescriptions of sodium-containing formulations with outcomes for those taking standard formulations of the same drug.
Patients who experienced the primary outcome (a composite of non-fatal myocardial infarction, non-fatal stroke or vascular death) were more likely to have been prescribed sodium-containing medicines (odds ratio 1.16, 95% confidence interval 1.12–1.21).
Steve McGlynn, specialist principal pharmacist (cardiology) at NHS Greater Glasgow and Clyde, commented: “This is an interesting study that, despite its observational methodology, justifies the avoidance of high sodium-containing medicines not only in patients with, or at risk of, cardiovascular disease, but potentially everyone.”
6. Antiepileptic drugs categorised by MHRA
New guidance on prescribing antiepileptic drugs (AEDs) has been issued by the Medicines and Healthcare products Regulatory Agency because of the potential risks from switching between products. Medicines have been grouped into three categories according to their therapeutic index, solubility and absorption.
Patients on category 1 AEDs should be maintained on a specific manufacturer’s product. Examples of category 1 medicines are phenytoin and carbamazepine.
For those taking category 2 AEDs, the need for continued supply of a particular manufacturer’s product should be based on clinical judgement and consultation with the patient or carer. Prescribers should take into account factors such as seizure frequency and treatment history. Examples in this group include valproate and lamotrigine.
Patients taking category 3 AEDs do not need to be maintained on a specific manufacturer’s product, unless there are concerns relating to patient anxiety, risk of confusion or dosing errors. Levetiracetam and gabapentin are examples of medicines in this category.
7. Strategy for rare diseases
Pharmacists, GPs and other professional groups need access to high-quality information about rare diseases and associated treatment pathways to enable them to support patients presenting with these conditions, according to a new report from the Department of Health.
The UK Strategy for Rare Diseases, launched last month by health minister Earl Howe, describes a vision that focuses on: empowering patients with rare diseases; identifying, diagnosing and preventing rare diseases; and highlighting the role of research.
A rare disease is defined as one which affects up to 0.1% of the population, according to the document.
8. PPRS scheme agreed
NHS spending on branded drugs — which stands at £12bn per year — will remain flat for two years, followed by increases of less than 2% for the following three years, the UK Government and the pharmaceutical industry have agreed.
The deal came through after the Association of the British Pharmaceutical Industry agreed to the terms following a protracted discussion on the voluntary Pharmaceutical Price Regulation Scheme.
The new arrangements will start on 1 January 2014. Companies that do not sign up to the PPRS will have to introduce an automatic 15% price cut from this date.
9. Revalidation process to incorporate peer review
The General Pharmaceutical Council has given a green light to broadening its current system of ensuring fitness to practise of pharmacists and pharmacy technicians.
Continuing professional development procedures are set to be modified and a new element of peer review will be added along with external performance indicators. The new system will be consistent with the principles of revalidation agreed by the Department of Health’s Non-medical Revalidation Working Group in 2008.
The regulator has, in the past, said that the current CPD system is inadequate. “This new framework will look at both the competence and professionalism of pharmacists and pharmacy technicians. Over time it will strengthen our assurance to patients and the public that the pharmacy professionals they seek advice and care from are up to date and fit to practise,” said GPhC chief executive Duncan Rudkin.
It is envisaged that the new system, to be called “continuing fitness to practise”, will be in place by 2018.
10. No benefit from ACEi and ARB dual therapy
Dual therapy with an angiotensin-converting enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) is no more effective than monotherapy for treatment of proteinuric diabetic nephropathy, but is associated with an increased risk of adverse events — according to a US trial (New England Journal of Medicine, online 9 November 2013).
Some 1,448 patients received losartan plus lisinopril or losartan plus placebo. Combination therapy was associated with increased risk of acute kidney injury (hazard ratio 1.7, 95% confidence interval 1.3–2.2; P<0.001) and hyperkalaemia (HR 2.8, CI 1.8–4.3; P<0.001). There was no difference between the two groups in the risk of the primary efficacy endpoint (renal disease progression or death).
Natasha Jacques, principal pharmacist, specialist services, Heart of England NHS Trust, said that the trial reinforces current clinical practice of not using the combination of ACE inhibitor and ARB. She said that dual blockade might have been tried in the past, predominantly to try to improve blood pressure control, but tends now to be avoided because of its adverse effects.
In these pages we summarise the 10 news items from the past month that we believe will be of greatest interest or relevance for your practice. The full stories, accessible on PJ Online (www.pjonline.com), usually contain more detailed information, data and expert comments.
We work closely with the PJ Online daily news team to get clinical and healthcare news out as soon as possible after the stories break. And so if you want to keep up to date throughout the month, the best way of doing so is to visit our landing page (www.clinicalpharmacist.com) regularly, where you can also sign up to our clinical news RSS feed.
Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11131306
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