The Pharmaceutical Journal 299 Letters (Vol 285) 18 September 2010 www.pjonline.com RESPONSIBLE PHARMACIST Regulations not working From Mr S. I. Dajani, MRPharmS The Royal Pharmaceutical Society believes that calls for suspension of the responsible pharmacist Regulations are “an unnecessary distraction” (PJ, 7/14 August 2010, p139). I would disagree because the Regulations are not working. No one disputes that there are many advantages to pharmacists, their patients and their staff in having a clearly accountable person in charge. However, the system is operationally dysfunctional because in reality: • Employers see it as a way of opening for two hours longer with a responsible pharmacist signed on, but unpaid • Proper rest breaks are being denied so that responsible pharmacists remain signed in during lunch and rest breaks, allowing general sale list medicines to be sold and dispensed medicines to be handed out RPS CONFERENCE Marketing tool From Mr C. O. Agomo, MRPharmS Although I was only able to attend the first day of the Royal Pharmaceutical Society Conference (PJ, 11 September 2010, p257), I think the conference organisers did a good job, particularly in terms of the topics covered, research presentations and the organisations that attended. I believe there is a need for the new professional body to encourage ordinary pharmacists, preregistration trainees and pharmacy students to attend future conferences by making the conference fee affordable. The present fee arrangement, although an improvement on previous fees, is still expensive. This is important because the new professional body could use the conference as a tool to market its relevance to pharmacists. Chijioke Agomo Borehamwood, Hertfordshire transfer responsibility and apportion blame for their own shortcomings. For these reasons, I would like the Regulations to be suspended until responsible pharmacists can be properly empowered and supported, and legislation is improved. For example, Crown Prosecution Service guidance still fails to protect us from criminal liability for single dispensing errors. I, for one, am sad that the current Royal Pharmaceutical Society cannot show more solidarity with its members and concern for public safety, However, it is only a matter of a few weeks until a more member- oriented, new Royal Pharmaceutical Society will. Sid Dajani Andover, Hampshire Mr Dajani is a member of the Royal Pharmaceutical Society’s English Pharmacy Board. The views expressed here are his own and do not necessarily reflect those of the Society or the board. — EDITOR. • Employers blur the edges between responsible pharmacist rules and contractual matters and bully responsible pharmacists into changing their minds when they attempt to sign off and close the pharmacy rather than continue operating with unsafe resources • Responsible pharmacists are not allowed to make professional decisions that might influence their working environment, for example, requests for more staff are often denied by employers • Responsible pharmacists are not supported when issues arise, for example, about the type of training that is required to ensure staff are competent to undertake the tasks required of them Despite all efforts and employees standing up for themselves, pharmacies are still controlled by employers or by someone other than the responsible pharmacist. So now, in effect, the responsible pharmacist has become an easy target to whom employers and superintendent pharmacists can
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The Pharmaceutical Journal 299
Letters
(Vol 285) 18 September 2010www.pjonline.com
RESPONSIBLE PHARMACIST
Regulations not workingFrom Mr S. I. Dajani, MRPharmS
The Royal PharmaceuticalSociety believes that calls forsuspension of the responsiblepharmacist Regulations are “anunnecessary distraction” (PJ,7/14 August 2010, p139). I woulddisagree because the Regulationsare not working.
No one disputes that there aremany advantages to pharmacists,their patients and their staff inhaving a clearly accountableperson in charge. However, thesystem is operationallydysfunctional because in reality:
• Employers see it as a way ofopening for two hours longerwith a responsible pharmacistsigned on, but unpaid
• Proper rest breaks are beingdenied so that responsiblepharmacists remain signed induring lunch and rest breaks,allowing general sale listmedicines to be sold anddispensed medicines to behanded out
RPS CONFERENCE
Marketing toolFrom Mr C. O. Agomo, MRPharmS
Although I was only able toattend the first day of the RoyalPharmaceutical SocietyConference (PJ, 11 September2010, p257), I think theconference organisers did a goodjob, particularly in terms of thetopics covered, researchpresentations and theorganisations that attended.
I believe there is a need for thenew professional body toencourage ordinary pharmacists,preregistration trainees andpharmacy students to attendfuture conferences by making theconference fee affordable. Thepresent fee arrangement,although an improvement onprevious fees, is still expensive.This is important because thenew professional body could usethe conference as a tool to marketits relevance to pharmacists.
Chijioke AgomoBorehamwood,Hertfordshire
transfer responsibility andapportion blame for their ownshortcomings.
For these reasons, I would likethe Regulations to be suspendeduntil responsible pharmacists canbe properly empowered andsupported, and legislation isimproved. For example, CrownProsecution Service guidance stillfails to protect us from criminalliability for single dispensingerrors.
I, for one, am sad that thecurrent Royal PharmaceuticalSociety cannot show moresolidarity with its members andconcern for public safety,However, it is only a matter of afew weeks until a more member-oriented, new RoyalPharmaceutical Society will.
Sid DajaniAndover, Hampshire
Mr Dajani is a member of theRoyal Pharmaceutical Society’sEnglish Pharmacy Board. Theviews expressed here are his ownand do not necessarily reflectthose of the Society or the board.— EDITOR.
• Employers blur the edgesbetween responsible pharmacistrules and contractual mattersand bully responsiblepharmacists into changing theirminds when they attempt tosign off and close the pharmacyrather than continue operatingwith unsafe resources
• Responsible pharmacists are notallowed to make professionaldecisions that might influencetheir working environment, forexample, requests for more staffare often denied by employers
• Responsible pharmacists are notsupported when issues arise, forexample, about the type oftraining that is required toensure staff are competent toundertake the tasks required ofthem
Despite all efforts andemployees standing up forthemselves, pharmacies are stillcontrolled by employers or bysomeone other than theresponsible pharmacist. So now,in effect, the responsiblepharmacist has become an easytarget to whom employers andsuperintendent pharmacists can
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300 The Pharmaceutical Journal
Letters
18 September 2010 (Vol 285)www.pjonline.com
Those who arepharmacists can joinFrom Dr R. C. Jacob, MRPharmS
In response to the Leading articlethat posed the question “Shouldnon-pharmacists be admitted tothe Royal PharmaceuticalSociety?” (PJ, 21/28 August2010, p185), my unequivocalanswer is “no”.
Can it be imagined that theBritish Medical Associationwould admit to membershippersons who are not medicallyqualified? Or that the BritishDental Association would admitpersons who are not dentalsurgeons, or the British VeterinaryAssociation would admit personswho are not veterinary surgeons?I have checked with these bodiesand was told what I fullyexpected. They do not.
If non-pharmacists were to beadmitted to the new professionalbody, what would be their status?Affiliates, associates or licentiates?And how would it be determinedas to who became what? Let therebe an end to this pointlessprocrastination. Those who arepharmacists are eligible and thosewho are non-pharmacists are not.
I hope that the reasoningbehind the proposed admittanceof non-pharmacists is not simplyto get more money into thecoffers.
R. C. JacobOrpington, Kent
COMMUNITY PHARMACY
Re-educate the publicto trust pharmacists’professional judgementFrom Dr H. C. Gallagher
British pharmacists might beinterested in recent legislativechanges in Ireland, which hasaffected the public’s view ofpharmacists.
On 1 August 2010, newlegislation came into force inIreland relating to the supply ofcodeine by pharmacists to thegeneral public. Preparationscontaining codeine are nowstored out of sight of the public inan area of the pharmacy under“direct pharmacist control”.
The change has made it moredifficult for those in the habit ofusing codeine-containingpainkillers to treat sports injuries,joint pain, period pain and evenhangovers to obtain thesemedicines. Pharmacists must nowpersonally interview anyone whowishes to purchase these productsand satisfy themselves that the useis warranted.
Advertising of codeine-containing products is nowbanned. From a regulatoryperspective, the new legislation isdesigned to ensure patient safety.By international standards, ourprevious rules were somewhat laxin not designating codeine as aprescription-only medicine.Doctors and pharmacists are
Letters to the editorLetters are welcome from all readers
Letters for publication can be posted, faxed, or sent by email [email protected] and should not normally be of more than 400 wordsand should cover one topic only. The Journal reserves the right to abridgeletters and to edit them for clarity and style. Pharmacist and registeredpharmacy technician correspondents should supply their membershipnumbers, and a contact telephone number should always be given.
All letters are considered on their merit and are accepted for publication on the understanding that they have not appeared anywhere, includingelectronic media, previously.This includes PJ Online. If the issue is of suchsignificance that the correspondent has simultaneously submitted the letterelsewhere, it is the responsibility of the correspondent to inform The Journalat the time. Further to a recommendation by the Journal Oversight Board(PJ, 1 March 2008, p244), pharmacists and pharmacy technicians whosenames appear on the non-practising part of the relevant register are asked to make their status known. Letters that are critical of individuals,organisations or companies may be sent to the person or body concernedso that they are given a simultaneous right of reply. In these instances, theauthors’ identities will not be disclosed until publication, and publication will usually be delayed.
Anonymity will only be accepted in exceptional circumstances. Thesecircumstances will be at the discretion of the editor and the decision made in consultation with the correspondent. Published letters will appear on PJOnline as a matter of course after publication.
NEW PROFESSIONAL BODY
Dilute the membershipand we will diluterepresentative powerFrom Mr R. M. Gartside, FRPharmS
From out of nowhere out of theshadows, it seems, has come aproposal to dilute themembership of the RoyalPharmaceutical Society byadmitting non-pharmacists tomembership.
Despite numerous articles thathave appeared, as if by magic, invarious publications, no one hasbrought forward any solid reasonsfor believing that such a changewill improve the immediatetreatment of a single patient inany conceivable clinicalcircumstance.
It is also noteworthy that thosepharmaceutical scientists who,presumably, wish to becomemembers of the Society had nosuch wish when membershipautomatically meant compliancewith a code of conduct and ethicswith severe sanctions for non-compliance.
It is only now, when thosesanctions will no longer apply,that non-pharmacists express awish to join the Society. One mustpresume that they now see amarginal personal advantage insuch membership that is nolonger counterbalanced by the
burden of the code of conductand ethics.
The medical royal colleges donot admit non-doctors intomembership and neither shouldthe Society admit non-pharmacists. The variousinstitutions that represent andadminister different kinds ofengineers do not admit non-engineers to membership. TheLaw Society does not admit non-lawyers. The list goes on.
Dilute the membership of theRoyal Pharmaceutical Societywith non-pharmacists and itseffectiveness as a representativebody will also be diluted.Pharmacists are a unique breed ofprofessional, with uniqueknowledge and insights, and it isvitally important for patientwelfare that this uniqueness ispreserved.
This absurd proposal must beaccepted by two-thirds of themembers in a vote, perhapssometime in the new year. I wouldurge all pharmacists who valuetheir profession to give aresounding “no”.
Bob GartsideCaernarfon, Gwynedd
Mr Gartside is a member of theWelsh Pharmacy Board. Theviews expressed here are his ownand they do not necessarilyrepresent the views of theboard.— EDITOR.
FROM PJ ONLINE
We get what we pay forOver the Easter bank holiday Saturday this year, I had to deal with twoparents who had run out of omeprazole suspension for their childrenbefore supplies came into the pharmacy from the specials manufacturer.Both children had nasogastric tubes so dispersible tablets were not anoption.
After the holiday, on further investigation, it was apparent that weused a manufacturer with a poor service record, and we have to waitlonger between ordering and the stock arriving, because this is thecheapest alternative and had been agreed with local GPs. Followingthese difficulties, we changed to a different but more expensive supplier.
Obviously, in an ideal world, we would not have patients dischargedfrom hospital the Thursday before a bank holiday with only three days’supply of omeprazole suspension, nor would we have a parent whobroke the bottle of omperazole suspension and failed to contact thepharmacy to advise a new supply would be needed sooner despite thehighlighted warning on the label to reorder a week before needed.However, in this case, to an extent, we got what we paid for. Yes, Iwould like to save money and use the cheaper supplier but, with ahistory of late deliveries, this seems incompatible with maintainingpatient care.
Emma Anderson, Nottingham
PJ, 18 Sep, p299-301 letters_Layout 1 9/15/2010 3:53 PM Page 300
The Pharmaceutical Journal 301
Letters
We are pleased to announce that Janssen-Cilag and its divisions Tibotec and Ortho-Biotech, have become known in the UK as ‘Janssen’. This change unites the Janssen Pharmaceutical Companies of Johnson & Johnson under a globally consistent visual image.
Having one identity will allow us to operate more eff ectively and deliver improved solutions to our customers and their patients. Janssen, part of the Johnson & Johnson family of companies, is one of the world’s leading research-based pharmaceutical companies. In the UK Johnson & Johnson has 5,000 employees, of whom 800 work for Janssen.
The name ‘Janssen’ comes from the founder of one of the pharmaceutical companies in the Group, Dr Paul Janssen, who took as his mission to save, prolong and improve the lives of patients.
The Janssen name embodies a commitment to help patients by advancing science and medicine on their behalf. This mission, guided by our values, has been the impetus for some of the most remarkable advances in modern medicine.
Janssen. Extraordinary eff orts for a normal life.
www.janssen.co.ukArtwork from the National Art Exhibitions of the Mentally Ill inc: Peyi
Item code: NPR/10-0063 AUG 10
Janssen-Cilag Ltd50-100 Holmers Farm Way, High Wycombe, Bucks, HP12 4EG , T: 01494 567 567
acutely aware of an increasingproblem with codeine abuse andaddiction, which can creep upgradually on patients who,initially, may be taking theseproducts for minor ailments, suchas headaches, that would oftenrespond to safer medicines.
However, the most interestingaspect of this initiative from thepharmacist’s perspective is thepublic’s reaction. Numerousangry letters to the editor werepublished by leading broadsheetnewspapers, and the Irishtradition of debating this matterover the airwaves led to hours ofradio time.
Few of these comments werepositive, with most patientsregarding this, at best, as aninconvenience and, at worst,“personally intrusive”,“ridiculous” or a prime exampleof “nanny-state regulation”.
Although some in thepharmacy profession haverecognised that this public furoreproves that the legislation willultimately succeed, the reactionamong patients clearly indicates alack of awareness of theprofessional role of pharmacists.
Join in
onlinew w w . p j o n l i n e . c o m
METFORMIN
Metformin MR cautionFrom Miss J. A. Smyth, MRPharmS
Since the licensing of a modifiedrelease formulation of metformin,I have seen a large number oferrors relating to this product.Working in hospital, I haveencountered administration,prescribing and dispensing errorsboth in community and hospital.The rate of errors appears to beincreasing as the number ofpatients prescribed the modifiedrelease formulation increases(rather than decreasing asprescribers and pharmacy staffbecome more aware of theproduct).The availability of themodified release formulation atthe same strength (and oftengiven at the same frequency) asthe standard formulation (ie,
Many patients believe that, ifcodeine is not a prescription-onlymedicine, they are legally entitledto obtain it, thus they resent theirpharmacist preventing them fromdoing so. However, this is not thecase.
Under Clause 9 of thePharmacy Act, 2007, pharmacistsin Ireland are required to deliverpharmaceutical care to theirpatients. This has always requiredthat pharmacists supplymedicines only where their use iswarranted and safe.
Awareness campaigns arerequired to re-educate the publicso that they trust the pharmacist’sprofessional judgement at least asmuch as that of their prescribingdoctor.
Moreover, communitypharmacists must lead thiscampaign if they wish to fulfiltheir true professional role at thecentre of primary care.
Helen C. GallagherSchool of Medicine and Medical
ScienceConway Institute, University College DublinIreland
500mg twice daily) appears to bethe main problem. I have seenmis-selection of product(standard formulation packslabelled “modified release”),hospital prescribers transcribingfrom repeat prescriptions butomitting the “MR” from theirinstructions and nursesadministering standardmetformin against administrationorders for the modified releaseformulation.
I think we all need to be awareof the high potential for errorwith modified release metformin500mg.
Jen SmythWrexham, Clwyd
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