Leaving the English National Board

For the past three years I have been serving as an elected member of the English National Board of the Royal Pharmaceutical Society, and for the past year the Society’s Assembly. The nominations for the 2016 elections closed on the First of April at 12:00, and I made the difficult decision not to submit my nomination.

Significant workplace responsibilities and pressures over the next 12 months, as well as challenging work as Chair of Governors at a local school, have led me to regretfully decide that the wisest choice is not to stand at this moment in time. If I was to serve on the RPS board, I would wish to do so at full capacity. The members who elect Board Members should accept nothing less.

I will attend my last assembly and board meetings this month. Over the past 3 years under the leadership of David Branford and Sandra Gidley, and the Presidency of Ash Soni, I have seen the board become more tightly focused, with a series of successful campaigns (such as the Pharmacists in GP surgery campaign) to raise the awareness of the role of pharmacists in new and existing roles. It has also become a more responsive organisation, dealing with multiple consultations and media enquiries.

It has been a pleasure to work with the staff at the Society, who deeply care about pharmacists, and with my fellow elected board members. Working in different sectors, the board pull together for the good of all pharmacists. I have learnt much from both staff and fellow board members, and I hope that my contribution over the past 3 years years has been useful.

The Society has also completed a complex move to a new headquarters. Despite celebrating its 175th anniversary this month, the Royal Pharmaceutical Society is still in many ways a new organisation, finding its feet after many years of a difficult dual role as a regulator and professional body. Much work remains to be done to secure the long-term future of the organisation, and take the final step to Royal College Status. I see the continued development of the Society’s Faculty as a crucial part of this strategy.

After years of slow motion, a number of changes in education, technology, and NHS funding structures are changing the environment pharmacists are working in faster than ever before.

It has been said many times that pharmacy has been at a crossroads, it now appears to be in a Formula 1 race. It is the Society’s role to support pharmacists through this challenging time, which has both significant opportunities and threats. Certainly, in my talks with pharmacists, the individual pressures they are under seem ever higher. There has never been a greater need for a professional leadership voice.

I wish those who have submitted nominations good luck in the coming elections. They should find it hard work, but rewarding.

I would like to thank Helen Gordon, the RPS Chief executive, Howard Duff, Dr Catherine Duggan, all the staff I have met and worked with, and my fellow board members. Finally, and most importantly, many thanks to those who voted for me back in 2013, and who placed faith in me.


Fringe session at the Royal Pharmaceutical Conference 2014

Birmingham Library

If you are attending the Royal Pharmaceutical Society’s Conference this Sunday and Monday, Birmingham and Solihull RPS would be pleased to see you at our breakfast Fringe session at 8am until 9:30am on Monday the 8th of September 2014. There will be coffee and danish pastries… Further details should be in your Conference Pack and at the registration desk. There is a form to register at the end of this post.

Here’s what you can see, and there will be time for Questions and Answers.

Innovation in pharmacy practice: Three case studies.

1. West Midlands Emergency Department Project (8:10am until 8:30am)

Health Education West Midlands identified a role for the Pharmacist in areas such as pre-discharge medicines optimisation in the ED and Acute Medicine Units, as well as within Clinical Decision Teams in the undertaking of medicines-related and minor¹s-focused clinical duties. This project aims to develop enhanced roles for Pharmacists, to improve patient safety, the patient experience and to increase capacity in the acute care pathway.

2.RPS BNFc QRG and SCRIPT Paediatric E-learning Modules (8:30am-8:50am)

SCRIPT eLearning is an established innovative and interactive eLearning programme to improve prescribing competency. Initially commissioned by Health Education West Midlands for Foundation trainees, the project has recently been extended to Paediatric Specialist Trainees, with 12 modules commissioned for development in collaboration with the University of Birmingham and Birmingham Children¹s Hospital. This exciting project sees Paediatricians, Specialist Paediatric Pharmacists and Nurses collaborating to develop module content that will improve knowledge relating to prescribing and therapeutics, with the overall aim of reducing medication errors in the paediatric setting. The learning will be made available online at www.paediaticprescriber.org.

3. PINCER: The use of a pharmacist led technology intervention method to show a reduction in patient harm (8:50am-9:10am)

The PINCER trial published in the Lancet February 2012 demonstrated that a pharmacist-led technology intervention method was effective in reducing a range of medication errors in general practice. Walsall CCG medicines management team has implemented a systematic process across all member practices to implement these safety interventions utilising the expertise of the informatics team and a software tool from PRIMIS. The improvement is safety and quality of prescribing has been demonstrated by the reduction in numbers of at risk patients across all categories and reduction of new patients identified.


Here’s a link to my brief piece on e-cigs in The Pharmaceutical Journal:

No drug is safer without regulation and that includes nicotine. Licensed e-cigarettes used as part of pharmacists’ smoking cessation role would be a step forward. Concern at the meeting that e-cigarettes were becoming an “easy fix” was supported by suggestions that smoking cessation services were not being renewed on the basis that e-cigarettes had solved the problem. Pharmacists need to defend the added value of those services and ensure e-cigarettes are an option when we have a licensed product.

In the meantime, we cannot support the sale of unlicensed e-cigarettes in pharmacies. This places pharmacists in a difficult position of selling an essentially recreational product with no licensed medicinal claim. There is potential for variation in dosing with unlicensed e-cigarettes, without the regulatory oversight of quality and safety the MHRA provides.


Ecigs and pharmacist autonomy

The surge in the use of ecigs has taken the health sector, including professional bodies, the pharmaceutical industry and regulators, by surprise. It’s a fascinating rise of a novel new delivery system, which has happened outside of the normal regulatory process.

This post isn’t about the evidence as to whether ecigs are harmful, whether they are a gateway to smoking, or whether they are an effective form of smoking cessation therapy (in future, they may have a role, but that should be after normal scientific evaluation and regulatory processes), but about the issues of professional autonomy they raise for pharmacists, and whether they are a good test case for exerting that autonomy.

Yesterday the Chief Pharmacists of the UK published an open letter raising concerns about ecigs. Their main points were:

  1. Health, safety and well-being of patients must be the first concern of pharmacy owners and superintendent pharmacists (as it is for pharmacy staff)
  2. Pharmacy staff should be empowered to exercise their professional judgement in the best interest of patients and public
  3. They point out ecigs are unlicensed and have limited scientific evidence
  4. They say they do not support their use as smoking cessation aids and that they should not be presented as having any therapeutic value

The response from companies who have decided to stock ecigs is interesting. Boots have agreed with concerns, suggesting that their decision to spend two years developing a ecig offering with a company is a responsible way forward. They hope to be the first to get a licensed preparation. Before that happens, Boots seem happy to sell an unlicenced product with no proven therapeutic value. Lloyds has said it is not selling ecigs as nicotine replacement therapy. Which begs the question what are they selling them for? None of this counters the concerns of chief pharmacists about the suitability for ecigs as a product pharmacy sells. At best, it is mitigation for a wrong decision to stock an unlicensed ecig in the first place.

Individual pharmacists are faced with the fact that their companies, and their superintendent pharmacists,  are happy to stock a product that is:

  • Not proven to have a therapeutic benefit
  • Is unlicensed
  • Is unsupported by the Royal Pharmaceutical Society
  • Is strongly felt should be a licensed product by the government and the MHRA
  • Is a matter of concern for all the Chief Pharmacists in the UK
  • Is also a matter of concern to the GPhC, who feel the RPS and MHRA guidance should be considered.

They should ask themselves if they are equally happy about this (and some may be).

They could of course, just ignore the ecigs and follow the advice that they tell patients they are not a smoking cessation aid. That still leaves them in the position of supplying a product they might not have personally stocked in the first place.

It is arguable that if acting as the responsible pharmacist within a pharmacy you could make a good case for removing any ecigs from display within the registered pharmacy premises on the grounds of maintaining the health, safety and well-being of patients. Certainly, you have the GPhC, the RPS, the MHRA, and all the Chief Pharmacists to support your stance. The fact that the superintendent of the company has a different opinion, does not invalidate your own professional judgement. In reality, it isn’t that simple. There may be local pressure from non-pharmacist managers who do not feel it is the place of pharmacists to make this decision – after all they have material from head office saying this is a perfectly OK product. The pharmacist may be putting themselves in a difficult position in terms of future performance reviews. It would be nice if superintendent pharmacists actually issued a statement that such action would be permissible, that the professional autonomy of individual pharmacists on stocking such products was key and that no detriment would come to pharmacists who made this professional judgment.

As for regulators, in a recent case of MUR fraud the GPhC recently said:

“What we have to ask ourselves is whether, when there are pressures [and] mistakes, as inevitably there will be, can we have confidence that the registrant might be able to stand up and not ‘buckle’?”

Should it always be down to individual pharmacists having to exert their professional independence in a battle of wills? Is that the best we can do? Hope people don’t “buckle” when they are under immense work pressures? Is it time for regulators to regulate the industry in a manner that reduces the toxicity of this commercial environment, and help create a more supportive environment for individual acts of professionalism? Of course individuals need to take responsibility, but it is naive to think that the environment they practice in has no influence. Recent NHS scandals note both the role of individuals and the culture of organisations. Could the GPhC exert more control over superintendents? Could they make it clear that employee pharmacists should have the professional autonomy as individual pharmacy owners to remove items from sale they feel are incompatible with the best interests of patients and the public? Ecigs make a great test case for what actual control pharmacists over the materials they provide to the public, just as GPs have control over what they prescribe to the public.

And from there we might make some other steps forward on OTC medicines and homeopathy….

Photograph: Creative Commons from Vap in Liberty.