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Additional prescribing safeguards needed

From Mr S. I. Dajani, MRPharmS


I want to reply to the letter from Michael Twigg and Jessica di Gesso (PJ, 1 September 2012, p234) and explain that I am also mindful of the Royal Pharmaceutical Society’s prescribing guidance and the ethical and moral dilemmas of pharmacists prescribing and dispensing.

Although prescribing and dispensing (and vaccinating and administering to the same patient) are not illegal, clearly there must be additional safeguards in place to ensure that outcomes are safe, expected and desirable. We have two factors to consider in our favour. First, we already have stricter controls in community pharmacy than in dispensing doctor surgeries and these centre around our trained accredited checking technicians and dispensers, our premises being regulated by the General Pharmaceutical Council, and general all-round tighter governance controls.

Secondly, the issue of prescribing and dispensing should depend on the chosen fields of practice. I would not recommend combining prescribing and dispensing roles in high-risk areas such as most chronic disease management or those requiring regular monitoring.

However, in the context of public health, prescribing, dispensing and administering vaccines are safe because generally there is standardisation of dosages and little difference between prescribing and administering on a prescription and prescribing and administering via a patient group direction. I have personally prescribed and administered influenza vaccines to hundreds of patients in my pharmacy with great success, clinical effectiveness and patient feedback. Naturally for travel vaccines we would follow the guidelines (“the green book”) just like a PGD.

We are only human and therefore liable to make mistakes. What matters is that we are able to prove best practice, safeguards, standard operating procedures and competencies to minimise all foreseeable risks.

I am frustrated and disillusioned by the low profile pharmacist prescribers have across government, the health sector and the public because of mismanagement, a lack of strategic direction and national policies, and poor foresight from the NHS and from most primary care trust pharmacists and commissioners. Pharmacist prescribing is in danger of losing its way because it is not the norm, it has not taken its place properly in patient care, it has not realised its full potential and it has not been optimised enough.

I believe we must match the depth of our knowledge and professional integrity with the confidence to implement practice or we will always show fear and timidity as a profession.

To help address this I think we need to stop looking at how to inhibit the combined roles of prescribing and dispensing but improve the standards and focus on fearlessly addressing and meeting the needs of our patients in practice, and on all political and strategic levels. Personally this defines to me what it really means to be a professional and why community pharmacy combined prescribing, dispensing and vaccinating can continue to make a significant contribution to the health and well-being of the public. Community pharmacy should be the place where services for patients are crafted by pharmacists.


Sid Dajani

Andover,

Hampshire


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

Citation: The Pharmaceutical Journal URI: 11106924

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