Prescriptions on the NHS from the chemist?

Renal

So what are prescribing pharmacists prescribing?

Medicines within the scope of their competencies.

Reply 62

YAP

I took myself off ibuprofen for 4 weeks when I was prescribed ciprofloxacin after I checked the interactions myself. The look on my GP's face when I pointed out the 'increased risk of seizures' red-box interaction between the two - as he well knows, I don't just take anti-epileptics for fun....

You're epileptic and your doctor put you on cipro? Was that the only antibiotic that was sensitive to what you had? Ciprofloxacin itself can reduce the seizure threshold!

Reply 63

IzzTheGreat

Medicines within the scope of their competencies.

First, what does that mean and second, is anyone actually doing it?

Reply 64

Renal

First, what does that mean and second, is anyone actually doing it?

I'm fairly sure someone covered this at the start of the thread. There are two types of prescribing: supplementary prescribing which allows a pharmacist to prescribe any licensed or unlicensed drug including CDs which are part of a clinical management plan which is drawn up by (I'm fairly sure) the PCT for a particular illness.
The second type is independant prescribing which is not governed by a clinical management plan but is limited to licensed drugs - so pharmacists can't prescribe anything unlicensed or any CDs. However they can prescribe anything they feel appropriate within those limits as long as it falls within their competency, and this is traditionally defined as having completed a PIP training programme (a quick search on google shows that KCL, RGU and Bath amongst others run these).

As for whether pharmacists are doing it - well, the first person completed their course in 2007 so this is a relatively recent thing. I'm sure they are around but I've never come across one, but I think as more people complete this course they'll become more prolific.

Reply 65

IzzTheGreat

I'm fairly sure someone covered this at the start of the thread. There are two types of prescribing: supplementary prescribing which allows a pharmacist to prescribe any licensed or unlicensed drug including CDs which are part of a clinical management plan which is drawn up by (I'm fairly sure) the PCT for a particular illness.

Having seen how patients always respond positively to one-size-fits-all committee directed management plans and never have any need to change their treatment, I feel confident that this is an excellent development...

The second type is independant prescribing which is not governed by a clinical management plan but is limited to licensed drugs - so pharmacists can't prescribe anything unlicensed or any CDs. However they can prescribe anything they feel appropriate within those limits as long as it falls within their competency, and this is traditionally defined as having completed a PIP training programme (a quick search on google shows that KCL, RGU and Bath amongst others run these).

What are they competent to diagnose? Are pharmacists now diagnosticians? How have they compressed 6 years of training into 38 days? And what the hell is a competency?

Reply 66

Renal

Having seen how patients always respond positively to one-size-fits-all committee directed management plans and never have any need to change their treatment, I feel confident that this is an excellent development...

It's not supposed to be 'one-size-fits-all' ... they're supposed to be specific to each patient ...

Reply 67

-Emmz-

It's not supposed to be 'one-size-fits-all' ... they're supposed to be specific to each patient ...

*******s they are. If they were, why would they not be written by that patients doctor?

Reply 68

Renal

Having seen how patients always respond positively to one-size-fits-all committee directed management plans and never have any need to change their treatment, I feel confident that this is an excellent development...

What are they competent to diagnose? Are pharmacists now diagnosticians? How have they compressed 6 years of training into 38 days? And what the hell is a competency?

A competency is exactly what it sounds like - are you just being obtuse? If you consider yourself to be competent to prescribe insulin for a diabetic patient having been trained and examined in the care of diabetics then that is a competency.
I think the issue here is that you're convinced pharmacists are thick as pig****. We've been to uni for 4 years and trained for 5 and are capable of being useful in diagnosis with the correct training, which isn't going to cover everything a doctor knows. The idea of the PIP is to save patients' and GP's time with relatively straightforward cases which the pharmacist is competent to deal with.

Reply 69

Renal

*******s they are. If they were, why would they not be written by that patients doctor?

The patient's doctor is party to the plan.

Reply 70

YAP

-Emmz-

You're epileptic and your doctor put you on cipro? Was that the only antibiotic that was sensitive to what you had? Ciprofloxacin itself can reduce the seizure threshold!

At the moment, the neurologist isn't sure what's wrong with me. I lost the ability to walk when I began taking 400mg Tramadol daily - I could try to walk, but my legs would convulse. Three months in, I was still in pain, so I eventually was allowed to try Gabapentin; which I took and could walk 24 hours later. My GP didn't put two-and-two together at the time that my new symptom might be related to what I'd just started taking the week before. With Baclofen, it was somewhat clearer - convulsions the next day. So generally, it's medication related when I get it. Odd, though, that they'd give me cipro if I'm sensitive to the seizure-lowering effects of medication. I got away with that one though - I'm off the Tramadol but still on the Gabapentin (waiting for it to help with the pain) so it's prophylaxis against a lower seizure threshold at least.

As for what it was - acute bacterial prostatitis. Another option would be trimethoprim, but first-line locally is ciprofloxacin. Again, highlighting the limitations of GPs, the one who gave me ciprofloxacin in the first instance insisted I only needed a 7 day course, and if I was still symptomatic would then need prostate milking etc. I went back a week later, saw my GP, and got the other 21 days, as I knew full well that (i) 7 days would risk progression to chronic BP, (ii) prostate milking is contra-indicated, the nitwit :rolleyes:

.

Reply 71

IzzTheGreat

A competency is exactly what it sounds like - are you just being obtuse? If you consider yourself to be competent to prescribe insulin for a diabetic patient having been trained and examined in the care of diabetics then that is a competency.

Competency is a neologism, it's bandied around a lot when it comes to stuff like this but nobody actually knows what it means. What is competent to treat diabetes and how do you become it? Not to mention that diabetes is one of the most brittle illnesses going and pretty difficult to manage.

The idea of the PIP is to save patients' and GP's time with relatively straightforward cases which the pharmacist is competent to deal with.

And as has been seen before this is either not actually going to save any time or it is going to harm patients. Being intelligent of thick as pig**** has nothing to do with it, but no matter how you dress it up 5 years of pharmacy training and 38 days of medical training cannot give someone clinical experience or teach them clinical judgement.

Reply 72

-Emmz-

The patient's doctor is party to the plan.

Then why do the PCT need to be involved?

Reply 73

Renal

Then why do the PCT need to be involved?

To be honest, I wasn't aware they had to be. I understood supplementary prescribing to be a partnership between a medical practitioner (who is an independent prescriber), the pharmacist and the patient. The medical practitioner makes the diagnosis and starts the treatment. Then a pharmacist who is qualified as a supplementary prescriber monitors the patient and prescribes further supplies of the medicines. The patient has to agree to it.

Reply 74

YAP

At the moment, the neurologist isn't sure what's wrong with me. I lost the ability to walk when I began taking 400mg Tramadol daily - I could try to walk, but my legs would convulse. Three months in, I was still in pain, so I eventually was allowed to try Gabapentin; which I took and could walk 24 hours later. My GP didn't put two-and-two together at the time that my new symptom might be related to what I'd just started taking the week before. With Baclofen, it was somewhat clearer - convulsions the next day. So generally, it's medication related when I get it. Odd, though, that they'd give me cipro if I'm sensitive to the seizure-lowering effects of medication. I got away with that one though - I'm off the Tramadol but still on the Gabapentin (waiting for it to help with the pain) so it's prophylaxis against a lower seizure threshold at least.

As for what it was - acute bacterial prostatitis. Another option would be trimethoprim, but first-line locally is ciprofloxacin. Again, highlighting the limitations of GPs, the one who gave me ciprofloxacin in the first instance insisted I only needed a 7 day course, and if I was still symptomatic would then need prostate milking etc. I went back a week later, saw my GP, and got the other 21 days, as I knew full well that (i) 7 days would risk progression to chronic BP, (ii) prostate milking is contra-indicated, the nitwit :rolleyes:

.

Ah I see. Well, at least you seem to be well on top of your medication and what you should and shouldn't mix!

Reply 75

-Emmz-

To be honest, I wasn't aware they had to be.

Neither did I to be honest.

IzzTheGreat

supplementary prescribing which allows a pharmacist to prescribe any licensed or unlicensed drug including CDs which are part of a clinical management plan which is drawn up by (I'm fairly sure) the PCT for a particular illness.

Reply 76

Renal

Neither did I to be honest.

Well I've looked in Medicines, Ethics and Practice for pharmacists and pharmacy technicians and it doesn't mention the PCT anywhere. Just the medical practitioner, the pharmacist and the patient.

The clinical management plans aren't drawn up for particular illnesses either (obviously for example what's suitable for one patient with hypertension may not be suitable for another so they wouldn't work), they're made for specific patients to detail all their needs (like allergies, things that indicate referral back to the medical practitioner etc)... well that's what I understood unless IzzTheGreat can elaborate on what the PCT do? :smile:

Reply 77