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PJ Online | (Meeting) Pharmacist prescribing is the end-point of medicines management

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The Pharmaceutical Journal
Vol 268 No 7184 p185
9 February 2002

Meetings & Conferences

Developing future pharmacy services

Pharmacist prescribing is the end-point of medicines management

At a conference held in London on 29 January, speakers provided an update on the progress that is being made with the goals set out in the Government document "Pharmacy in the Future". The conference focused on medicines management, extended roles, electronic prescribing, electronic transmission of prescriptions, risk management and associated legal issues. Dawn Connelly reports

The conference was organised by IBC UK Conferences (

Dr Jim Smith: no better chance to reshape pharmacy

Medicines are central to the National Health Service with more than 15 per cent of its revenue spent on medicines each year, explained Dr JIM SMITH, chief pharmaceutical officer, Department of Health. In the Government paper "Pharmacy in the Future", one goal is to help patients to get the best from their medicines. This is one key element of medicines management. Another is ensuring that medication requirements are met accurately and promptly on hospital admission and discharge. "This is an area where we must do better," said Dr Smith.

"In many ways I see pharmacist prescribing as the end-point of medicines management," commented Dr Smith. He went on to say that pharmacist prescribing was not about making pharmacists feel good because they felt empowered, but about improving patient care. He said that progress has been made in the past year and that ministers now have the legal powers to designate new categories of prescriber. Subject to parliamentary approval, he hopes that the first pharmacist prescribing will begin in mid-2003. Supplementary prescribing will be the first priority. "There will not be a better chance to reshape pharmacy services," he added.

Impact of the IT revolution pharmacy could be seen as a threat to community pharmacy services, said ANDY MURDOCK, pharmacy director and superintendent pharmacist, Lloydspharmacy. However, world-wide experience suggests that e-pharmacy is complementary to traditional face-to-face contact with a pharmacist, not a substitute.

Mr Murdock described his "health fantasy" whereby electronic prescriptions are delivered to an appropriate pharmacy and then routed by a sophisticated in-pharmacy workflow management system to a central processing unit. Here they are dispensed robotically and delivered either back to the pharmacy or direct to the patient's home. Eighty per cent of prescriptions processed by community pharmacists are for repeat items. This remote system would be appropriate in this situation. Personal contact with a pharmacist could still be maintained for processing of acute prescriptions.

Mr Murdock described examples of alternatives to the internet including digital television which could be used by patients to request repeat prescriptions. He also described the concept of a "rural vending machine" for remote populations. This would be like a sophisticated cashpoint but delivering medicines instead.

CHRIS CAIRNS, chief pharmacist, University Hospital Lewisham, said: "Information technology is a tool and we should be the masters of it. Different solutions are needed for different situations."

Electronic transmission of prescriptions

"With the current 7?11 per cent growth in prescription numbers, the present system is unsustainable. Eventually it will break, it is just a matter of when," said Ewan Davis, partner Woodcote Consulting and chairman of PharMed. This is one of the many drivers for electronic transmission of prescriptions. Mr Davis went on to say that a key issue of ETP is the extent to which it can be integrated with electronic health records. He suggested that it should be an incremental, evolutionary approach. ETP is not difficult, he explained, but to integrate it fully with electronic health records will take 10 years or more.

National roll out of ETP is not expected to be completed until 2006 (PJ, 2 February, p123). He speculated that the Department of Health might "encourage" implementation of agreed standards through amending contractors' terms of service to require use of ETP or simply by saying to pharmacists: "If you don't use ETP, you won't be paid for prescriptions."

Risk management

Mike Cross: a cultural change is required

Based on a study which showed that 5.5 per cent of oral hospital administrations are in error, MIKE CROSS, director of pharmacy, Barts and the London NHS Trust, estimated that 98 per cent of patients would suffer an oral medication administration error during an average-length stay in hospital.

He explained that researchers at Barts and the London have tried to quantify what the risks of drug therapy are in the NHS. To achieve this they interpreted a selection of the most significant research papers relating to the shortfalls of drug therapy and placed this on a website. Pharmacists are encouraged to visit the website and make comments. It can be viewed at The website represents work in progress for the estimate of the avoidable shortfalls of drug therapy in financial terms, this currently stands at £3.1bn a year to the NHS.

Clinical pharmacy services, electronic prescribing, and improving compliance are all areas known to dramatically reduce adverse drug events, explained Mr Cross. Other "quick wins" could include patients with repeated admissions, patients who require specialist monitoring, and drug history taking on admission. He believes that a "cultural change" is required. Pharmacy must understand and accept that a serious quality problem exists, become more involved in research and focus on the provision of safe systems.

Control of entry

"Abolition of control of entry regulations is not a forgone conclusion," said DAVID REISSNER, partner Charles Russell solicitors, during his legal update regarding future pharmacy services. Talking about the current controversy surrounding control of entry regulations, Mr Reissner told participants that the Office of Fair Trading does not have the power to abolish control of entry because it comes under a different Government department with its own policies. The OFT will have to make its case to the Department of Health in order to change the law, he explained.

Dawn Connelly is on the staff of the Pharmaceutical Journal

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