Within the last few weeks, at least six pharmacists have been subjected to interim order applications - either suspended or had significant restrictions
placed upon their registration pending a full 'Fitness to Practise' hearing into serious allegations being made about their prescribing practices, the Pharmacists'
Defence Association (PDA) has found.
It said that there has been a "dramatic increase in action being taken by the pharmacy regulator (GPhC) against pharmacist prescribers associated with certain types
of online prescribing services".
It has warned pharmacist prescribers who work for online pharmacies about the specific risks associated with remote prescribing using a questionnaire-based model,
typically with no direct prescriber/patient interaction.
Common features that underpin the allegations include the following: Overreliance on a patient questionnaire to inform clinical decision making; No patient/prescriber
interaction; Prescribing high risk medicines without adequate safeguards; Inadequate systems and processes leading to inappropriate prescribing; Very high volumes
of prescriptions being authorised in short periods of time; and Prescribers/patient relationship established via an unregulated online portal.
Health Education England (HEE) has announced launch of a new funded Independent Prescriber courses for pharmacists to be made available before March 2022.
Places are available for both Independent Prescribing (IP) and Clinically Enhanced Independent Prescribing (CEPIP), and eligible pharmacists are encouraged to apply to the course providers directly.
These courses will be allocated on a first come, first served basis, and a further round of funded Independent Prescriber training will be made available from Autumn 2022.
The independent prescriber guide offers practical guidance and support on the prescriber role, such as how to become an independent prescriber, applying for an IP course, or expanding the scope of practice.
Healthcare reform emerged as a cornerstone of the Labour Party's manifesto leading up to the recent general election. A standout pledge was the establishment
of a Community Pharmacist Prescribing Service, aimed at granting pharmacists independent prescribing rights where clinically suitable. This initiative is seen as a
positive step in addressing critical challenges within the National Health Service (NHS).
Numark Chairman Harry McQuillan praised Labour's recognition of pharmacists' role in patient care through expanded prescribing rights.
"Let's be honest, pharmacists are an underutilised resource within the healthcare system. We possess extensive training and expertise, yet our full potential
hasn't always been acknowledged.
"By harnessing pharmacists expanded prescribing rights, Labour is acknowledging our significant role in patient care. This initiative aims to recognise our skills
and enhance patient care, ensuring quicker access to necessary treatments," he said.
However, he pointed out that the concept requires further exploration, as the rights to prescribe are already granted through the recent change to undergraduate
training that incorporates prescribing.
The fusion of the unique in-depth understanding of medicines by pharmacists together with the competence to prescribe offers will improve access to care and
increase capacity in the health system, said the Royal Pharmaceutical Society (RPS) Director for England Ravi Sharma to Parliament at the Health and Social Care
Select Committee's inquiry on workforce on Monday (May 23).
However, he also stated that a new workforce strategy must support and harness the skills of pharmacist independent prescribers in clinical care with investment
in training, both for new and existing workforce; access to supervisors; protected learning and development time; and commissioning of services to make best use of
independent prescribers across care settings, supported by appropriate prescribing budgets in community pharmacy.
"We're about to see new generation of pharmacists independent prescribers that will make a huge difference to the clinical role of pharmacists to support patient care, but this must be underpinned by protected learning time and a more ambitious approach to commissioning new services to use their skills," Ravi said.
He spoke to MPs in Parliament at the Health and Social Care Select Committee's inquiry on workforce, highlighting the vital contribution of pharmacy teams during
the pandemic and called for action to support the current and future workforce.
Some of the key issues highlighted in the parliament included, the risk of burnout and the need to help boost staff retention; staff wellbeing, including a zero tolerance of abuse from the public; the importance of professional development and protected learning time to enhance patient care and support rewarding careers; the potential of new pharmacist independent prescribers and the need for investment in the current workforce and the need for better workforce data and a pharmacy workforce strategy.
The Royal Pharmaceutical Society (RPS) has published a new professional guidance for prescribing practice on Monday (June 6) which it says will be "for the
benefit of all independent prescribers across the UK".
Based on collaboration with multi-professional stakeholders, the document is a guidance tool for prescribers wanting to expand their prescribing scope of practice.
Commissioned by the Welsh government, the document was developed through an expert group with representatives from many healthcare professions, including from Higher Education institutions, professional bodies, regulatory bodies, the National Institute for Health and Care Excellence, NHS Education for Scotland, Health Education
and Improvement Wales, and representatives from hospital, community and GP practice.
RPS president Claire Anderson said: "It's fantastic to see the growth in prescribing, both across the profession and more widely, to improve patient care.
Boots is planning to invest more than £3.5 million to accelerate its capacity to offer prescribing services in its stores across England.
The company is inviting 500 of its pharmacists to apply for a bursary which will cover the cost of pharmacist independent prescriber (PIP) courses starting this
September.
The value of the bursary is up to £7,000 per pharmacist, and it will enable time off work for those who need it to complete the training.
The move by Boots will support its current pharmacists to gain this qualification via courses accredited by the General Pharmaceutical Council (GPhC). From 2026,
all qualified pharmacists will be able to prescribe as part of new curricula for pharmacy degrees.
Under current GPhC guidelines and with an independent prescribing qualification, pharmacists can prescribe autonomously for any condition within their clinical
competence.
Marc Donovan, the chief pharmacist at Boots, said the ambition of the company was "to have a pharmacist prescriber available at every store".
Health Education England (HEE) has developed funded training offers for community pharmacists, including locums aiming to become independent prescribers.
Almost 3000 independent prescribing training places will be available to pharmacists from March 2023.
This training enables pharmacists to support patients from diagnosis to prescribing, and to provide advice and follow-up - while also helping them to feel confident
and prepared for the new challenges of their role.
Courses will be available between April 2023 and March 2024, with several universities offering multiple dates for cohort intakes. Start dates will depend on the
university provider.
Training will enable the provision of new models of care: supporting patients from diagnosis to prescribing, providing advice and follow-up, and preparing pharmacists
to provide clinical care, as pharmacy services become more widespread within emerging clinical pathways.
The Pharmacist's Defence Association (PDA) has raised concerns over the adoption of Digital Clinical Excellence (DiCE) guidelines for online prescribing
of GLP-1 receptor agonists for weight management in adults.
This follows a clash with expert recommendations commissioned by the General Pharmaceutical Council (GPhC) as the PDA "believes the final guidance conflicts
with the expert opinion underpins the GPhC's prosecution strategy towards pharmacist prescribers under investigation."
In a recent statement, the PDA highlighted the discrepancy between DiCE's guidance and the expert report employed by the GPhC to prosecute pharmacist
prescribers using a questionnaire-based consultation model.
This conflict has prompted the PDA to withhold its endorsement of the DiCE guidance as it differs from an expert report commissioned by the GPhC.
The PDA's reservations stem from the inherent risks associated with questionnaire-based prescribing.
Following the publication of a new study by the British Medical Journal (BMJ) that estimates the economic impact and prevelance of hazardous NSAID
prescribing in England, the Royal Pharmaceutical Society (RPS) has underscored the pressing need for enhanced safety measures in medication management.
The study, led by RPS Fellow Rachel Elliott, reveals significant health and financial costs associated with the high-risk prescribing of oral non-steroidal
anti-inflammatory drugs (NSAIDs) among vulnerable populations.
James Davies, Director for England at the RPS, emphasised the critical findings of the research.
"Improving the safety of NSAID prescribing requires a multi-pronged approach, that educates and supports prescribers on the risk, as well as uses the skills
of pharmacists in the primary care team to help identify higher risk patients and prescribing scenarios," Davies remarked.
The study highlights that NSAIDs, while effective in managing pain and inflammation, are associated with serious adverse events, including gastrointestinal
bleeding, renal dysfunction, and cardiovascular issues.
With the Labour Party now in power, there is keen interest in the healthcare initiatives they pledged during their election campaign and how these proposals
will shape the future of NHS.
One of the key pledges in their healthcare reform is the introduction of the Community Pharmacist Prescribing Service, which aims to empower pharmacists with
independent prescribing rights where clinically suitable.
While pharmacists appreciated Labour's acknowledgment of their role in patient care through expanded prescribing rights, they foresee some challenges in
implementing the service.
"Budgets will be a key issue," said Pharmacist Thorrun Govind, also a Healthcare Lawyer (Brabners LLP).
However, she noted that, given the success of pharmacist prescribing services in the devolved nations, there is "a road map in place."
Centre for Pharmacy PostGraduate Education (CPPE) has announced the launch of a new learning programme, Preparing to train as an independent prescriber.
The programme aims to build the confidence and competence of pharmacists who are planning to apply and train as independent prescribers and is open to pharmacists
from all sectors of practice, including community pharmacists who are planning to commence their independent prescriber training with a Higher Education Institute
(HEI).
The course is made up of four main components, including a self-directed e-course and self-assessment framework, a mandatory online workshop to support you to review
your self-assessment of competencies, an optional online workshop to support your readiness for academic writing and reflective practice, and optional peer support
sessions, providing the opportunity for you to develop your professional network and establish communities of practice.
Three leading healthcare bodies in Scotland have called for action to reduce the environmental impact caused by medicine prescribing.
The Academy of Medical Royal Colleges and Faculties in Scotland, Royal Pharmaceutical Society and the Royal College of General Practitioners Scotland have all
urged policymakers to enable a more sustainable approach to prescribing.
This includes prioritising the introduction of electronic prescribing across the NHS, introducing the requirement for an environmental impact in NHS medicines
procurement and improving the availability of data about the environmental impact of medicines.
"We call on Scottish government, including the chief medical officer, to enable the delivery of a realistic medicine approach to prescribing by developing a
supportive infrastructure for green social prescribing across Scotland," said the healthcare professionals in a joint statement.
They have called on the pharmaceutical industry to make information about the environmental impact of medicines readily available in a standardised data format.
The Pharmacists' Defence Association (PDA) has raised concern over the Health Education England (HEE)'s decision on cutting funding to independent prescribing
training.
The HEE has reportedly decided that no funding will be available to back-fill trainees undertaking the pharmacist independent prescribing (PIP) qualification, or
for the supervision of trainees by DPPs and DMPs.
The PDA noted that, whilst all successful trainee pharmacists will be entering the GPhC register as independent prescribers from 2026, the existing pharmacist
workforce is reliant on opportunities to undertake prescriber training through release from their employment, and the ability to secure a Designated Medical
Practitioner (DMP) or Designated Prescribing Practitioner (DPP) to support the 90 days of supervised practice required.
The association said it has already heard examples of potential DMPs or DPPs requesting a significant fee from trainees before they will provide supervision,
adding that meeting that request is not an option for many.
"This latest decision threatens to undermine the availability of the large numbers of pharmacists seeing supervisors as more IP training becomes available," it
said in a statement.
Recognising the changing practices in healthcare, the Royal Pharmaceutical Society (RPS) has revised and updated its position on the separation of
prescribing and dispensing or administration of a medicine by the same healthcare professional.
It's previous guidance, published in March 2020, restricted prescribing and dispensing by the same healthcare professional only in exceptional circumstances.
The new guidance, jointly developed with the Royal College of Nursing (RCN), has made prescribing and dispensing of medicines more flexible.
It clarifies that "where there is a risk assessment in place and in the best interests of the patient, the same healthcare professional can be responsible for
the prescribing and dispensing / supply / administration of medicines."
The change in the position statement follows an extensive year-long engagement exercise with medical associations, members, fellows, expert advisory groups,
patient groups and the RPS Country Boards.
Wales has begun the rolled-out of a community pharmacy prescribing service as part of reforms agreed by the Welsh health minister last December.
Eluned Morgan approved wide-ranging changes following re-negotiation of the Community Pharmacy Contractual Framework with Community Pharmacy Wales, the
representative body for community pharmacies in Wales.
The roll out will allow appropriately trained community pharmacists to treat an extended range of conditions that currently require people to visit their GP.
Initially pharmacist prescribers will be able to prescribe medicines, including antibiotics for acute illnesses like urinary tract and upper respiratory tract infections, and also prescribe routine contraception.
The first of its kind in the UK, the service is being rolled out progressively across Wales, building on local schemes which are already in place.
Royal Pharmaceutical Society (RPS) and the Royal College of General Practitioners in Scotland hosted an event celebrating the collaborative work of the health
professions and policy makers in Scotland on reducing the environmental harm from prescribing and medicines use.
To share priorities for the Scottish Government, Alpana Mair, Head of Effective Therapeutics and Prescribing spoke and National Clinical Director Jason Leitch
appeared virtually. Gillian MacKay MSP, Scottish Greens spokesperson for Health and Social Care also joined in-person.
Medicines account for around 25% of the NHS's carbon emissions and have an ecological impact when they enter our wastewater system or our rivers and oceans.
Tackling the impact of prescribing will be a key part of meeting the ambition of a net zero NHS Scotland by 2040 at the latest.
Together, RCGP Scotland and RPS have held two roundtable events on sustainable prescribing, and in June 2022, released a joint statement calling for a wide range
of actions, which was signed by the Academy of Medical Royal Colleges and Faculties in Scotland, the Royal College of Physicians of Edinburgh, the Royal College of
Anaesthetists, the College of Radiographers, Royal College of Nursing, Queen's Nursing Institute Scotland and Chartered Society of Physiotherapy.
Continuing the work of RPS at the International Forum on Quality and Safety in Healthcare, the event aims to mark an opportunity for health professionals and
decision makers alike to join a global movement of sustainability in healthcare, and pledge to continue the important work of cutting the climate impact of medicine
use while maintaining the highest level of patient care and safety.
Pharmacists with 'relevant experience in a pharmacy setting' can enroll for accredited independent prescribing course, as the General Pharmaceutical Council (GPhC) has decided to scrap the requirement of spending at least two years on the register and having previous experience in a specified clinical or therapeutic area before enrolling for the course.
The GPhC Council meeting held on Thursday instead proposed that applicants must have "relevant experience in a pharmacy setting and be able to recognise, understand
and articulate the skills and attributes required by a prescriber." This experience and awareness will act as the basis of their prescribing practice whilst training.
The regulator noted that the majority of stakeholder organisations, including the Chief Pharmaceutical Officers, the Royal Pharmaceutical Society and the statutory education bodies, were in favour of removing the requirement in a consultation on the topic.
They highlighted that a specific two-year period was not in itself a robust indication of whether an individual was ready to become a prescriber.
They also highlighted that the rapidly developing roles in the profession meant more pharmacists were likely to gain the necessary experience more quickly than in the past. A smaller number of organisations and a larger minority of individuals were opposed, citing that a specific two-year period gave pharmacists the time they needed to develop experience and confidence before being ready to enrol on a course.
All 42 integrated care boards (ICBs) in England have signed memorandums of understanding for the NHS Independent Prescribing Pathfinder programme, the
first nationally-funded prescribing service in the country.
Anne Joshua, interim deputy director of pharmacy commissioning at NHS England, made the revelation during the 'Chief pharmaceutical officer bi-monthly
webinar' held on 7 March 2024, as reported by The Pharmaceutical Journal.
In the initial phase of the programme, 210 community pharmacies across all ICBs will trial independent prescribing, ahead of establishing a commissioning
framework for the service.
Giving an update on the pathfinder programme, Joshua confirmed that 164 of these potential pathfinder sites had registered for the programme as of 29 February 2024.
Additionally, she announced the clinical models to be followed by the participating pharmacies and presented a graph showing an overview of the services they will
provide.
The Royal Pharmaceutical Society and Scottish Academy of Medical Royal Colleges co-hosted the NHS Education for Scotland annual virtual conference to discuss
the environmental impact of prescribing.
One of the conclusions drawn from the conference on Thursday (April 28) stressed on environmentally sustainable prescribing should be embedded in undergraduate
and postgraduate health care education.
Delegates at the session said they or their teams needed more education. They also needed more information and resources when prescribing to be able to consider
environmental issues.
Sharon Pfleger, Consultant in Pharmaceutical Public Health at NHS Highland, told the session: "There's a lot of work to be done to reduce carbon emissions. The
NHS has identified the use of metered-dose inhalers as its second biggest cause of carbon emissions as the propellant gases have significant global warming potential.
The General Pharmaceutical Council (GPhC) has announced that the new requirement for independent prescribing courses will be applicable from 1st of October 2022.
Pharmacists currently taking independent prescribing courses and those who apply before 1 October won't be affected by the changes.
The new guidance was agreed at the council meeting on 8 September and went to the initial education and training Advisory Group on 22 September where it was well
received, the GPhC said.
"The guidance is now being finalised to reflect the discussions at the Council meeting and the initial education and training advisory group and will be published
in October."
The new guidance is relevant for both course providers and applicants and gives some specific suggestions and examples of what we may expect. It will support
consistency in the way education providers applied the new standards and will help individual pharmacists to understand the relevant experience they would need
before enrolling on a course.