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Letters
Here are the e-mails and letters that I have drafted today.
E-mail to the APPG:
I am a member of the newly founded EPB but am e-mailing you purely on my own behalf. I read the transcript of your latest evidence session with interest and would like to bring some points to your attention. As a practising pharmacist I can attest that the majority of Doctors now prescribe generically. This sounds good but there are certain times when generic prescribing is dangerous. Lithium for Depressive disorders should never be prescribed generically because if the wrong brand is given it can be life threatening. Patients on certain controlled release preparations should stay on the same brand so these should not be prescribed generically. Insulin prescribed generically increases the chances of a life threatening mistake being made. Controlled drugs prescribed generically especially controlled release preps and patches can lead to sub therapeutic doses and possible overdoses. In these instances generic prescribing can be extremely dangerous but I have a possible solution. If prescribers prescribed all drugs by brand but the law was changed so that pharmacists could substitute generics where they saw fit then the problem would be solved. We would no longer have dangerous generic scripts but generics would be dispensed 100% of the time where it was appropriate. I also see that Medicines Usage Reviews were mentioned re their cost effectiveness. I would like to point out that MURs were aprt of our new contract and the money for them was actually taken from the old pharmacy contract. In effect community pharmacists have to do MURs to get theit old money back, The uptake was not brilliant at first but this is probably due to the increased workload involved, time needed to get the shops up to PCT regulations for conducting reviews and the logistics of getting the dispensary organised so the pharmacist could get the time to do MURs and fill out the paperwork. The problem with MURs is that unless it is an intervention MUR where a problem has already been seen then a number of MURs will turn up no prescribing problems whatsoever. I would therefore ask that if MURs are deemed to be not cost effective enough to be aid for that the money be given back to pharmacy so that it can fund more cost effective pharmacy initiatives. The EPB and the RPSGB are pushing for all sorts of new and old incentives to be picked up e.g. Pharmacists with Special Interests and Pharmacist Independent Prescribers along with others. Yours
Letter to my MP:
I am a member of the newly created English Pharmacy Board. This is one of the boards formed by the Royal Pharmaceutical Society of Great Britain set up with the intention of forming pharmacy policy in the newly devolved not quite so United Kingdom. One of our remits is to try to create new targets and goals for pharmacists in England. I stood for election to the board because I have always been interested in the way that pharmacy is run and have not always been happy with the direction down which we were being led. I am writing now with my own voice and not on behalf of the board but I have several issues which I would like to bring to your attention. The Pharmaceutical Society was formed in 1841 and was granted its Royal Charter by Queen Victoria in 1843. It has long been a widely renowned body and up until the Shipman Inquiry was lauded by everyone including the Government for its ability to both regulate and represent the profession of pharmacy. But we have now had the publication “Trust, Assurance and Safety” and the RPSGB has been told that it must split its dual role. I actually believe that the Society splitting could be a good thing as the current Society is so intent on showing that it is not biased towards pharmacists that it seems to be over regulating them, but there are several ways in which this split is being handled that I believe bear further investigation. As this split is being forced upon us by the government as an about face on its earlier view then I feel that the Government should pick up at least some if not all of the estimated £3m bill. Another worrying development was Lord Hunt’s reported views on how the new “Royal College” should look. He may be the minister of state for health but I do not see how this entitles him to tell a Royal body of professionals how to run its own representational body. I have attached an article from the Pharmaceutical Journal showing his views. It seems very much that we are being pushed down a road that we are not all happy about taking and being expected to pick up the bill for it. The next issue I have is with a recent evidence session of the All Party Pharmacy Group. A transcript of the session is available at: http://www.publications.parliament.uk/pa/cm200607/cmselect/cmpubacc/uc670-i/uc67002.htm An issue was raised concerning generic prescribing. Certain medicines should not be prescribed generically as a change in brand given to the patient can be life threatening. Often it is left to the pharmacist to try to glean from the often confused patient what brand they take. If prescribers were told to prescribe by brands this problem would not happen. If the law was then changed so that pharmacists could substitute generics where appropriate then generics would be given a majority of the time saving the NHS money and life threatening problems could be cut down. If we were just given a six month trial I bet the savings to the NHS would forego any thought of going back to the way it is now. The same evidence session also mentioned the cost effectiveness of Medicine Use Reviews. Medicine Use Reviews were brought in as part of the New Pharmacy Contractual Framework and a pharmacy that undertakes MURs receives £25 for each one but the money came from the old pharmacy contract and pharmacists therefore have to work at doing MURs to get their money back. The uptake of MURs has not been brilliant so far but it is increasing and I believe the initial reticence was due to the cost of making pharmacy premises fit for validation by PCTs for MURs and the need to alter pharmacy dispensing practice so that pharmacists were free to do MURs. The big problem is that the MUR money has not been ring fenced so we have already had cases where PCTs that have not had to pay out for MURs using the money for other things. Community pharmacists have been shoring up other holes in the PCT budgets. If MURs are deemed to be too cost inefficient to continue I would ask that the money is given back to the pharmacists it was taken from so that they can use it to fund initiatives that are cost effective. The RPSGB and the EPB both have ideas for ways forward for pharmacy that could very well fit this bill. Please feel free to contact me for further discussion. Yours
If you would like to pilfer any/all of my ideas/rhetoric please feel free to do so. Cut and paste the whole damn thing if you want to!
Just write, write and write again to any and all who might listen!
Together we might be able to make a difference!
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