325 professional matters - The Pharmaceutical Journal · 2012-09-19 · Public Health England (PHE) takes on the responsibility for protecting and improving the nation’s health

professional mattersCAbiNET RESHUfflE | iSoTRETiNoiN gUidE | CoUNTRy UPdATES

Will you support the DoH“Stoptober” campaign? NHs smOKefRee has launched a new28-day quit challenge aimed at encouragingsmokers across england to stop smoking for28 days during October.

If smokers can stay smoke-free for this time,they are five times more likely to stop forgood. There will be lots of support to helppeople on their quitting journey including apack (available for individuals to orderonline), a text support service and even adigital app for real-time support. Local NHsstop-smoking services and a number ofpartners, including pharmacies, will also beproviding support.

This new campaign, known as “stoptober”is designed to appeal to smokers who want tomake a successful quit attempt but find it adaunting prospect. The Department of Healthbelieves the support being provided can reallyhelp ensure success and is keen to work withcommunity pharmacies to encourage smokersto join the campaign.

The high-profile campaign will provide arange of promotional materials for pharmaciesto use and support people stop smoking. Thisincludes “prepare packs” to help smokers getready for their quit attempt on 1 October andin-pharmacy point-of-sale materials. The Department of Health has been runninga high-profile advertising campaign from mid-

september. “This is a fresh and positive wayto engage smokers in making a quit attempt,and the materials could help initiatediscussions about OTC products, smokingcessation services and tailored advice tosupport them before, during and after thecampaign,” the Royal Pharmaceutical societysays.

Pharmacies can order up to 10 toolkits bycalling 0800 678 3173. Large multiplepharmacies may be supporting the campaignon a national level and should check with theirhead office. Chains of 11 or more pharmaciesthat would like to order a toolkit can [email protected].

each in-pharmacy toolkit contains: posters;cards; leaflets; button badges, table-standingdispensers for prepare packs and leaflets; andprepare packs (A5 hard-cover sleeve)containing a welcome letter, a guide withinformation on how to prepare for the quitattempt, a leaflet with information about stop-smoking medicines and an addictions test tohelp quitters assess their addiction levels.

Quit Kits 2013The DoH has also announced thatcommunity pharmacies in england will beable once again to offer patients free stopsmoking NHs Quit Kits in January 2013.

TesTs commissioned by the RoyalPharmaceutical society have demonstratedthat medicines used to treat depression andmental illnesses purchased from illicit websitescan be a real danger to patients. The researchwas documented by ITV News.

Having analysed samples of theantidepressant Prozac and codeine obtainedby ITV News, researchers at King’s CollegeLondon discovered that the amount of theactive drugs in the tablets was lower than itwas indicated on the packaging. Additionally,both medicines contained substances harmfulto health and even highly addictive ones suchas metamphetamine (“crystal meth”) andflunitrazepam.

Jayne Lawrence, RPs chief science adviser,said: “The sample alleged to be Prozaccontained about 95 per cent of the active drugfluoxetine, ie, 19mg instead of the 20mgindicated on the packaging. The sample alsocontained other compounds. The initial testresults strongly indicate that these could beamphetamines.

“The sample alleged to be 15mg codeinetablets contained 74 per cent of the statedamount, ie, 11mg instead of the 15mgindicated. These tablets also contained at least20 impurities. some of them are compoundsthought to be related to codeine, but the testsalso suggested the presence of other drugssuch as triazolam and flunitrazepam andpowerful prescription-only benzodiazepinesused to help with anxiety and sleep disorders.”

The results of the RPs study show that illicitmanufacturers are making both drugs ofabuse and medicines for sale on the internet.Patients who acquire medicines to treat mentalillnesses from such websites are at risk as thesemedicines can be counterfeit, unapproved orcontain undeclared ingredients that interactwith other ailments or medicines.

(Vol 289) 22/29 September 2012www.pjonline.com

The Pharmaceutical Journal 325

Professional matters highlights the activitiesof the Royal Pharmaceutical Society and the achievements of members

This month . . .Page 326Message from the Chief Executive

Page 327Health changes in Cabinet reshuffle

Page 328 RPS highlights dangers of insomnia self-diagnosis

Page 331New RPS fellows honoured at RPS conference

Page 332 Serving the community as a pharmacist and as a politician

Page 334Work on nanomedicine wins RPS Science Award

Page 130Updates from England, Scotland and Wales

Page 132 Professional support bulletin — dealing with self-prescribers

Dangers ofmedicines fromillicit websites

AS ALWAyS the Royal PharmaceuticalSociety has been active in raising the profile ofpharmacy and pharmacists’ teams to helpensure they receive the recognition theydeserve. We have an ongoing programme ofmeetings with those in all sectors of healthcaremanagement to make sure that pharmacistsand their important work is at the top of theagenda.

I have recently had a meeting with DuncanSelbie, the chief executive of Public HealthEngland, during which he made it clear thathe values the role pharmacists play in keepingpeople well. Indeed he is keen to hearexamples of pharmacists excelling in thisimportant area.

As we come to terms with the newhealthcare environment in England, let us alsoremember that this runs alongside separatereviews of pharmacy in Scotland and Wales.

In just a few months the newly establishedPublic Health England (PHE) takes on theresponsibility for protecting and improvingthe nation’s health and well-being, so it is agood time to remember what an importantleadership role pharmacy and pharmacistsplay in protecting the public’s health.

From April next year PHE will beresponsible for: “delivering services”(including healthcare protection, public healthinformation and intelligence and services forthe public), “leading for public health”(encouraging transparency and accountability,building the evidence base and relationshipspromoting public health) and “supportingworkforce development” (which includesbringing together the wider range of publichealth professionals).

FrontlineIncluded among these health professionals, ofcourse, are pharmacists who, with dailycontact with the public, work right at thefrontline of healthcare. Never has it been moreappropriate to remember that every contactcounts as pharmacists continue in theirendeavours to act as a channel to inspirewellness among their patients.

We continue to work with pharmacy andpublic health forums, including the RoyalSociety of Public Health, to develop the roles

of pharmacists in all sectors, and work out thebest possible ways for pharmacists to put theirknowledge and skills to best use for the goodof the public’s health as a whole.

Part of the Society’s role in all this is to helpour members as they take part in discussionsabout their current and future roles. Thesepublic health activities are so important thatwe devoted a number of sessions at the recentRPS Conference in Birmingham to thevarious topics surrounding it.

The RPS has already been working towardssigning a memorandum of understanding withthe NHS Commissioning Board, enshriningpharmacy’s role in the new healthcare regime.

Pharmacy has always played a part in thisbut now we have the perfect opportunity to

make sure pharmacists’ voices are heard evenlouder than before and to ensure that we takethe lead in the areas of healthcare delivery inwhich pharmacists are expert. We havecommon messages and common challenges tokeep people healthy.

We have to make the new regime work for usand take full advantage of the challenges weface and to do that we need leaders to takeforward the best practice models andchampion all the innovation there is inpharmacy.

There is plenty that pharmacists can do tomake a difference and realise their fullpotential. Get involved with a localprofessional network (LPN), which willbecome a statutory outpost of the NHS CB,to provide clinical leadership and facilitateclinical engagement at grass roots level.

Pharmacists could, for example, approachtheir local practice forum or localpharmaceutical committee and find out if theyare involved in the formation of an LPN intheir area.

Pharmacy will need to think about howinformation which supports high-qualitycommissioning can be provided to make ituseful for local commissioning decisions. Thiswill include information about medicines costand use.

ExpertsPharmacists are the experts in medicines useand, therefore, should be involved in each andevery clinical network, as all types of networkswill involve the use of medicines. In theenvironment, there may be more or fewernetworks across England.

Maybe you are tempted to find out whatclinical networks there will be in your area. Ifyou are a specialist in a particular area, andnot yet part of the network, then engage withthe relevant clinical network

As RPS member Ash Soni said when hechaired a meeting around the Future Forumat the RPS London office last November,pharmacists need to be engaged with decisionmakers at every level, from commissioninggroups and health and wellbeing boards toworking with the Government.

We must be consistent in what we say andwe must be able to demonstrate where we aremaking a real difference to patients’ lives.

A profession with a new contract thatrecognises and promotes the quality of ourwork rather than the volume of prescriptionsis required for every sector. We must build thecase for pharmacy and develop a differentrelationship with patients.

The view of pharmacy by other healthcareprofessionals, Mr Soni believed at that time,was still an inaccurate one, with pharmacistsseen as a cost rather than an investment.Pharmacists had the reputation for being ableto reduce the medicines bill rather thanprovide medicines safely and efficiently.

Pharmacists need to be engaged withdecision makers at every level. We must beconsistent in what we say and we must be ableto demonstrate where we are making a realdifference to patients’ lives.

The Society fully understands thesepriorities for the public’s healthcare and is, asalways, fully supporting members in theirleadership endeavours.

Taking advantage of an opportunity toraise your profile throughout Britain

professional matters

Helen Gordon, Chief Executive, Royal Pharmaceutical Society

22/29 September 2012 (Vol 289)www.pjonline.com

326 The Pharmaceutical Journal

Pharmacists need to beengaged with decisionmakers at every level

AfTER two years in power, the honeymoonperiod for the Government would be expectedto have ended and recent events demonstratethat it is well and truly over. A series ofchanges in direction for key policies and adouble-dip recession have hardened thehearts of voters, demonstrated by ChancellorGeorge Osborne being booed while awardingmedals at the London 2012 ParalympicGames.

Private conversations with some of thosewithin the coalition team suggested decision-making had to come to a halt as parties vetoedeach other’s proposals with increasingfrequency.

A public spat developed between Nick Cleggand the Conservative Party in relation to thereform of the House of Lords, the movetowards which saw the Upper Chambernarrowly escape reforming as an elected body.The Conservative Party’s flagship legislationreorganising MPs’ constituencies is also on therocks and likely to founder in a tit-for-tatmove by the Liberal Democrats.

At this point previous prime ministers wouldreinvigorate the Government with a change ofpersonnel, and that is exactly what PrimeMinister David Cameron has done.

A reshuffle is a difficult time forgovernments because it creates a group ofdisaffected ex-ministers who act as a rallyingpoint for rebel MPs wishing for change withintheir own party. The PM found a solution byoffering knighthoods and other such honoursthat act as sweeteners to those about to startlife on the back benches.

There is always a period of upskillingimmediately following a reshuffle when newministers are briefed by civil servants on keypriorities and issues within their departments.This period is when ministers are at theirweakest, while they are still learning the detailbehind every key issue and unaware of thetraps awaiting them.

The party conferences this year will takeplace within a matter of weeks andorganisations are now contacting allministerial offices to ensure that new minstershonour the meetings arranged by theirpredecessors.

New health teamThe most affected government department ishealth, where only one minister survived thechanges. Andrew Lansley, Simon Burns, PaulBurstow and Anne Milton all received theirmarching orders, making way for JeremyHunt, Norman Lamb, Dan Poulter and AnnaSoubry.

Pharmacy minister Earl Howe is the solesurvivor and it has been confirmed that he willbut continue his stewardship of pharmacy(see p314).

Jeremy Hunt Jeremy Hunt is seen to have hada good ministerial career to date, recoveringfrom a stumble between his office and NewsInternational. Since then, as minister in chargeof culture, media and sport, he has takenmuch of the credit for delivering the Olympicand Paralympic Games, gaining a reputationfor delivery.

The toughest job in politics this year wasAndrew Lansley’s: delivering his top-to-bottom restructuring of the English healthsystem, a new public health service and arestructured NHS, working closely withsocial care and achieving £20bn ofefficiency savings. After a period of reflection,Mr Lansley will probably be relieved thatthe pressure is not on him to make thatincredible feat of delivering the almostimpossible.

The new Secretary of State for Health isregarded as being a fan of the private sectorand homoeopathy. He also voted for accessto abortion to be limited to the first 12 weeksof pregnancy. Before being elected, Mr Huntran his own business and ran a charitybefore that to help AIDS orphans in Africa.

Norman Lamb Norman Lamb is the LiberalDemocrat minister within the team and comeswith a reputation of being a good minister. Hehas had several ministerial and shadow postswithin the workings of government and is seenas a safe pair of hands. He has been chief ofstaff for Menzies Campbell, a juniorGovernment whip, and the parliamentaryprivate secretary for the Deputy Prime

Minister. He was also the Shadow HealthSecretary and made no secret of hisliking to return. His wish has been grantedand he is now a minister of state in the healthteam.

Dan Poulter Dan Poulter, elected toParliament in 2010, previously worked as anobstetrician and continues to do so on a part-time basis. He is rumoured to have a robustview on pharmacy and is against moves tolegislate for assisted dying.

Anna Soubry Anna Soubry was also elected toParliament in 2010. She is the daughter of aradiographer and had careers in broadcastingand law before she entered politics. MsSoubry was made the parliamentary privatesecretary to former health minister SimonBurns and has been tipped as one to watch.She says that one of her top priorities will beto “look at hospitals”.

The individuals picked by the PM haveextremely good pedigrees with regard tobuilding careers and knowledge of the healthservice and it is clear that he has committedsome highly able ministers to a keydepartment for the forthcoming year. The testwill be whether they can hit the groundrunning and deliver what looks like anextremely challenging programme ofhealthcare creation and integration.

The RPS has already sought meetings withall ministers and anticipates briefing them onthe key issues in pharmacy.

Health changes in Cabinet reshuffle


RPS head of public affairs Charles Willis looks at the new ministerial line up



Jeremy Hunt Norman Lamb




InSOMnIA frequently hasassociated causes, so long-term self-treatment as a result of self-diagnosiscan be problematic.

In a survey of 2,000 adults byYouGov for the RPS, 51 per cent ofpeople with experience of insomniaadmitted to buying and takingsleeping remedies without firstseeking advice from a healthprofessional such as a pharmacist.When questioned, 30 per cent ofsufferers said they had takenremedies for more than a monthwithout seeking advice, including14 per cent who had taken themfor more than six months.A further 18 per cent could not recallhow long they had taken the remedyfor.

Around one in 20 people visithealth professionals with insomnia-related symptoms, but it is estimatedthat approximately one in threepeople experience intermittentbouts of insomnia, so many aremissing out on the help they need toimprove their health and quality oflife.

The most common symptoms ofinsomnia are difficulty falling asleep,waking up frequently during thenight and waking up too early in themorning. These have a significantimpact on daytime functioning, withcomplaints of fatigue, low energy andinability to focus frequentlymentioned by sufferers.

With insomnia being such acommon experience, many patientsfind it logical to assume it is not a medicalproblem. However, only around 20 percent of insomnia is classified as primaryinsomnia, having no other diagnosableconditions directly associated with it. Mostsleep problems co-exist with underlyingphysical or mental health conditions such asanxiety, depression, lung disease or chronicpain.

When asked, 70 per cent of surveyrespondents did not know or significantlyunderestimated the proportion of insomniathat was related to other health issues.

Lack of awareness of the potential rootcauses of insomnia means many patients donot consider asking for advice and insteaddevelop a reliance on over-the-countermedicines, herbal preparations, alcohol orother means of managing their condition.

Although a variety of self-help strategiesmay be useful in overcoming transient orshort-term insomnia, which is often related toa stressful life event, long-term insomniarequires further examination and advice.

Untangling the factors that start the problemand the coping behaviours that can maintainchronic insomnia is complex and takes time.

Community pharmacist Paul Johnson(pictured) will be available at a Society eventfor the media on insomnia on 27 September2012 to answer their questions. He says: “It’sworrying that so many people are overusingsleeping remedies. They should not be takenfor long periods without advice because theycan hide a serious health problem which couldget worse if it remains untreated.”

Factors cont ributing to insomnia includepsychiatric disorders such as problems with

mood and anxiety. Othercontributing factors can includesubstance abuse or dependency onalcohol, caffeine or other stimulants.Various medicines, includingsteroids, certain antihypertensivesand antidepressants, as well ascertain pulmonary and cardiacconditions such as chronicobstructive pulmonary disease andangina also can contribute. And ahost of other issues, includingthyroid disease, gastroesophagealreflux, Alzheimer’s, Parkinson’s,nocturia and the menopause allfrequently cause persistent problemswith sleeping.

In his broadcast interviews, MrJohnston will widen the discussion toinclude general issues around self-treatment. “While self-treatinghealth problems that are mild andself-limiting such as colds, coughsand stomach upsets can be a goodthing, it’s never a good idea to takeany medicine long-term as a result ofself diagnosis,” he says.

“I’ve seen a number of patientswho have ended up treating asymptom of their condition thisway, while the underlying problemwhich is causing it goesunaddressed so their health cannotimprove.”

Simple advice based on good sleephygiene can also help patientsreduce sleep disturbance. Someuseful tips, include avoidingstimulants such as nicotine, caffeineand alcohol later in the day, trying to

keep to a regular sleep and wake pattern,increasing levels of exercise during the dayand making sure the bedroom is a quiet,comfortable place rather than somewhere youwatch TV.

“Insomnia causes distress, frustration andfatigue, and if it’s long-term then it’simportant to get it checked out,” Mr Johnsonadds. “Pharmacists can help raise awarenessof some of the issues behind insomnia bytalking to patients buying relevant remediesand recommending ways of improving theirsleepless nights, signposting to sources offurther help when necessary.”

Coverage of the media day can be found inthe news section of www.rpharms.com andpatient information, including further detailabout good sleep hygiene is available atwww.ipharmacist.me.

Wake up to insomnia —RPS highlightsdangers when patients self-diagnoseThe Society is highlighting the risks of self-diagnosis and self-treatment of insomnia at amedia event this month. RPS corporate communications manager Melissa Dear reports

Paul Johnson: if insomnia is long-term it’s important to get it checked out

Why this guidance is important for youIsotretinoin is a retinoid and when used orally to treat severe acne it has an extremely high risk of causing severe and serious malformation of a foetus and also increases the risk of spontaneous abortion.

Pharmacists are involved in the dispensing of isotretinoin and in ensuring it is not used by women who might be pregnant or are considering becoming pregnant. A Pregnancy Prevention Programme protects females at risk of pregnancy and pharmacists have a significant role in distribution control and in providing counselling to the patient.

What this guidance will tell you

This guidance is aimed at pharmacists. It covers dispensing, distribution control and counselling advice to protect all patients who use oral isotretinoin and females who are at risk of pregnancy.

It does not cover the full list of contra-indications or full details of the isotretinoin Pregnancy Prevention Programme (further details can be found in the Summary of Product Characteristics).

General dispensing checklist for all patients

has been initiated by or under the supervision of a consultant dermatologist.

(See RPS Clinical Check reference guide) http://www.rpharms.com/support-pdfs/ clinical-checks.pdf

Distribution control dispensing checklist for a female at risk of pregnancy

1. Check that the prescription is valid under the PPP, prescriptions are valid only for 7 days and ideally should be dispensed on the date the prescription is written. Prescriptions which are presented after 7 days should be considered expired and the patient should be referred back to the prescriber for a new prescription. Pregnancy status may need to be reconfirmed by a further negative pregnancy test.

2. Check that the quantity is for a maximum of 30 days supply. A quantity for more than 30 days can only be dispensed if the patient is confirmed by the prescriber as not being under the Pregnancy Prevention Programme.

In accordance with MHRA approved guidance do not accept repeat prescriptions, free sample distribution,

Pregnancy Prevention ProgrammeA Pregnancy Prevention Programme (PPP) is in place o protect female patients at risk of pregnancy from

becoming pregnant whilst using oral isotretinoin, and for t least one month after stopping oral isotretinoin.

The programme is a combination of education or healthcare professionals and patients, therapy management (including pregnancy testing before during nd after treatment, contraception requirements), and

distribution control.

Therapy should only be initiated by or under the upervision of a consultant dermatologist and under he conditions of the PPP. The prescriber must check hat the patient complies with, understands and cknowledges the reasons for pregnancy prevention and grees to monthly follow-up, contraceptive precautions nd pregnancy testing.

ome female patients are not at risk of pregnancy, owever they should still comply with the PPP onditions unless the prescriber agrees that there are ompelling reasons that indicate that there is no risk of

pregnancy. Reasons may include persons who cannot become pregnant e.g. hysterectomy or a female who s not sexually active (and there is certainty that sexual ctivity will not start during the period of teratogenic isk)

Dispensing oral isotretinoin and

pregnancy prevention

Further resources

Summary of Product Characteristics (for various isotretinoin oral medicines include full details on the PPP ) http://www.medicines.org.ukBritish National Formulary http://www.BNF.orgOnline MHRA resources including approved PPP documents for doctors, pharmacists and patients. http://www.mhra.gov.uk/Safetyinformation/Generalsafetyinformationandadvice/Product-specificinformationandadvice/Product-specificinformationandadvice-G-L/Isotretinoinforsevereacne/index.htm

© 2012 Royal Pharmaceutical Society of Great Britain

fax prescriptions or emailed prescriptions for oral isotretinoin. A telephone request should only be accepted if this is an emergency supply at the request of a PPP specialist prescriber together with confirmation that pregnancy status has been established as negative within the preceding 7 days.

Counselling checklist

Counselling for all patients (male and female)

person.

disposal when treatment finishes.

stopping oral isotretinoin.

Isotretinoin can cause dryness and thinning of the skin.

and dermabrasion during treatment and for 6 months after treatment. Isotretinoin can cause the skin to become fragile.

Additional counselling for females

information about the Pregnancy Prevention Programme, contraception or their medicines.

you are asked about contraception

ideally 2 forms of contraception are used.

used in combination

considered effective for the purposes of this PPP.

treatment, during treatment and at least 1 month after stopping treatment

When to refer

Pregnancy during treatment or within 1 month of stopping treatment discontinue treatment immediately and advise patient to seek prompt medical attention

Signs and symptoms of depression or worsening of symptoms refer for appropriate medical treatment

Emergence of visual difficulties expert referral required with consideration for withdrawal.

Issued March 2012




ROYAL PHARMACEUTICAL SOCIETYPresident Martin Astbury did the honourswhen some of the 34 newly elected fellows ofthe Society (see Panels below) were presentedwith their certificates at a ceremony during the

annual RPS Conference in Birminghamearlier this month.The President is pictured (right) addressing

those of the new fellows who were able toattend.

New Royal Pharmaceutical Societyfellows honoured at RPS conferenceRoyal Pharmaceutical Society fellows were presented with their certificates recently

AWARDED SEPTEMBER 2011

Nicholas David BarberDavid Michael Lofts BrandfordJanet Anne HallidayDuncan Stuart Douglas McRobbieSandra Elizabeth MelvilleOrest OlejnikMary Theresa RutterGeoffrey Mark SaundersJohn David SmartAshok SoniPeter Austin TaylorStephen Richard TomlinDavid George Webb

AWARDED MAY 2012

Christopher AcombNuala Margaret BrennanAlastair Robert Livesey BuxtonBipinchandra Kaamarshi ChotaiJean CurtisAntony D’EmanueleLindsey Kathryn GilpinChristopher Francis GreenGerald Burton GreenStephen John HowardAnn JacklinSalim Kassamali Esmail JethaBarry JubrajJonathan Peter MasonJanet McDonald ClarkParesh Bhanji ModasiaMahendra Gulabbhai PatelFelicity Julia SmithMark Campbell StuartDavid ThomsonIan Chi Kei Wong

RPS President Martin Astbury addresses the new fellows

RPS Conference participants watch the fellowship certificate presentation ceremony

THeRe are plenty of synergies betweenpharmacy and politics if Graham Jones is tobe believed. And he should know: he is notonly a community pharmacist but also a localcouncillor, indeed leader of West BerkshireCouncil and chairman of the West BerkshireHealth and Wellbeing Board.

“Being a local councillor is highlycomplementary to being a communitypharmacist” he says. “I am able to deal with awhole range of problems, many of which arehealth and well-being related, for examplehousing and community care, and I have aready knowledge of where to go withproblems. As a community pharmacist I amon first name terms with most my electorate.”

Mr Jones believes that, as a profession,pharmacists often underestimate theirinfluence. He says: “We are hugely trustedand have deep roots in our communities,which make us natural community leaders —but we seldom exploit this position.

“Although we are highly trusted, many ofthe public regard us as shopkeepers ratherthan health professionals. We have to maintainthis trust while developing more professionallyoriented services.”

Mr Jones’s interest in politics started in theearly 1980s when he was a student inLiverpool. “At that time the Militant unionand Derek Hatton were in the ascendancy andmy reaction was against the strife that wasbeing created,” he says.

Elected to the councilThis interest eventually led to him beingelected to West Berkshire Council in 1997,representing the Lambourn Valley ward,where his first pharmacy is located. It tookhim little time as a politician to realise thatpharmacists are in hugely influential positionswithin their communities. “We have hugeexposure to many on a professional level andhave an inbuilt trust lacked by manyprofessions,” he points out.

It was around this time that Mr Jonesopened his second pharmacy, in Shrivenham,with the help of a well known Lambournpersonality, the racehorse trainer JennyPitman and one of her most celebrated horses,Garrison Savannah.

“This was a new rural pharmacy withpredictable hostility from local dispensingGPs,” Mr Jones recalls. But relationships withthe village were quickly established. “We nowhave an excellent relationship with the localGP practice. I believe we have become avalued village resource.”

It was in 2001, Mr Jones says, that he wasable to combine politics and pharmacysuccessfully. “A report by the Berkshire

Health Authority into children’sdental health identifiedLambourn (due to ruralisolation) as having the jointworst record in the county(alongside inner Slough andReading). We campaigned withthe health authority to getpump priming money toestablish a dentist in the village.The dentist opened in 2002.”

PCT memberBetween 2002 and 2005 MrJones was a member ofNewbury and CommunityPrimary Care Trust executivecommittee, although heresigned this position when hebecame leader of the council.

“Last year I was asked to jointhe Pharmacy and PublicHealth Forum to help developour profession for the newlandscape and help deliverimproved public health services.I believe much of our workcould be pivotal for developingpharmacy over the nextdecade,” he says.

Mr Jones took over leadershipof the local Conservativeopposition in 2003. It was whenthe party established a majorityin 2005 that he subsequentlybecame council leader. “WestBerks is a unitary councilresponsible for a huge range ofservices — roads, communitycare, schools, refuse andrecycling, culture, childprotection, economicdevelopment etc,” he says.

“My first role as an electedcouncillor is to represent thepeople and interests of theLambourn Valley. My secondrole is to help run the overallauthority effectively and providethe best possible services within availableresources. Approximately two thirds of thecouncil’s funding comes from centralgovernment, the rest from council tax.Although I am committed to providing thebest possible services, this has to be balancedwith the wish to keep council taxesaffordable,” he says.

With the NHS changes, local councils willsoon become responsible for public health.“We are in the process of appointing adirector of public health for Berkshire and I

am chairman of the West Berks Health andWellbeing Board. HWBs are set to becomeone of the key elements in the new NHS andalso a potentially important commissioner forpharmacy. They bring together all the strategicplayers in the local health economy — clinicalcommissioning groups, local authorities,directors of public health and patients’representatives,” he says.

“They will be responsible for setting thedirection of local health services and for muchof the public health commissioning. It is vital

Serving the community as a pharmacist an West Berkshire pharmacist thinks these a


Have you ever considered the synergies between community pharmacists and local politicians? Je



Graham Jones on the West Berkshire local election campaign trail

that pharmacy gets involved and buildsrelationships with all the players on the HWBand does it fast.”

Many in local government know as littleabout pharmacy as pharmacists know aboutlocal government, Mr Jones says. “Get toknow your local councillor as well as thecouncil leader and community care lead. Goto them, do not expect them to come to you,”he recommends.

“They need to understand what pharmacyhas to offer. We need to ensure we have a high

quality platform from which tobid for services. I believe thehealthy living pharmacy is thatplatform.”

Pharmacy faces somechallenging times ahead andmargins will continue to besqueezed. “But,” Mr Jones adds,“pharmacists are naturalentrepreneurs with so much tooffer the health service and weneed to be selling ourselvesmuch more actively.

“Pharmacy has developed inisolation from many otherhealthcare services; this is botha weakness and a strength.There is much pharmacy cando to develop private self careservices such as vaccinationsand travel clinics where ourcommunity positions arepivotal.”

Part of the role of apharmacist and HWB chairmanis to promote a healthy lifestyle,Mr Jones says, which is partlywhat has encouraged him to getmore involved in another of hispassions — cycling.

charity work“Following involvement in aBerkshire activity for healthprogramme in 2009, partlysponsored by the British HeartFoundation, I took up thechallenge of a cycle ride toBruges. Last year with a team ofcouncil officers we organised abike ride from Newbury toParis for local charity ‘Swingsand smiles’,which is raisingmoney for a play park fordisabled children. “Now wehave established a newchallenge much closer to home— the West Berks Big CycleChallenge — cycling round all

our parishes in a day, some 135 miles.”Mr Jones also makes good use of his political

experience and profile to publicise the roles ofpharmacists at every opportunity.

“My political experience has meant I havebuilt up a lot of local media contacts. I havedone many pieces on pharmacy topics onlocal radio (BBC Radio Berks and Oxfordplus commercial stations) and television andprint media. It is often light relief to dopharmacy as the journalists are less aggressivethan they are with politicians,” he says.




nd as a politician — why this re highly complementary roles

eff millsfinds out more from Graham Jones, who has a foot in both camps

curriculum vitae

GRAHAM JONES has run the LambournPharmacy since 1992 and was first electedto West Berkshire Council in 1997. Sincethem he has been deputy leader of theConservative group, leader of theConservative Group and, since 2005, leaderof the council. He has also served on thelocal primary care trust executive committeeand is presently vice-chairman of the WestBerkshire Strategic partnership.

Pharmacy

• Graduated in 1985 from Liverpool• Qualified in 1986 after preregistrationtraining with Boots The Chemists inBanbury

•Worked for Boots and Lloyds, and as alocum

• Bought Lambourn Pharmacy in 1992• Opened Shrivenham Pharmacy in 1997(new rural pharmacy)

• UniChem Great Business awards overallwinner in 2002

•Newbury PCT executive committeemember from 2002–05

• Berksire Local Pharmacuetical Committeefrom 2008 onwards

•Media spokesman for National PharmacyAssociation from 2008 onwards

• Pharmacy and public health forummember on 2001

• Director of IPF in 2012Politics

• Elected to West Berks Council representingthe Lambourn Valley, 1997 onwards

• Deputy leader of the opposition, 2002• Leader of the opposition 2003• Leader of Council, 2005• 2011 onwards - Chairman of West BerksHealth and wellbeing Board

We are hugely trustedand have deep roots inour communities,which makes us naturalcommunity leaders —but we seldom exploitthis position

KHOLOUD AL-JAMAL, of the Institute ofPharmaceutical Sciences at King’s CollegeLondon, has won this year’s RPS ScienceAward for her exciting work in the field ofnanomedicine. Dr Al-Jamal has extensiveexperience in the design and development ofnovel nanoscale delivery systems and hercurrent interests involve using novelnanomaterials in therapeutic and diagnosticapplications. Dr Al-Jamal delivered her awardlecture — “Nanomedicines: tiny objects greathopes” — on 12 September 2012 at theAcademy of Pharmaceutical SciencesUKPharmSci 2012 conference inNottingham.

The RPS Science Award has a long history,with previous winners invariably going on tomake significant contributions in the field ofpharmaceutical science. The award ispresented to a pharmaceutical scientist withno more than 10 years’ experience at post-doctoral level who has a proven record ofindependent research and published work thatshows outstanding promise.

Commenting on the presentation of theaward to Dr Al-Jamal, Steve Wicks, thepharmaceutical scientist member on the RPSAssembly and chairman of the RPSPharmaceutical Science Expert AdvisoryPanel, said: “Dr Al-Jamal is a worthy winnerof this year’s RPS Science Award. Heroutstanding work in the area of nanomedicinehas resulted in a greater understanding of thepotential therapeutic and diagnosticapplications of nanomaterials, particularlycarbon nanotubes.”

We interviewed Dr Al-Jamal before theUKPharmSci conference to find out moreabout her work on nanomedicines and howbeing a pharmacist influences her academicroles.

What particular aspects of your research areyou going to talk about at the conference? “Iwill talk about my research in the field ofnanomedicine, and how it can be used toimprove on existing therapeutic approacheswhich employ small drug molecules for thetreatment of cancer.

“Nanomedicine is an emerging field dealingwith the application of nanotechnology inmedicine. Examples of applications includedisease diagnosis, therapy and monitoring. Inthe area of drug delivery by administeringdrug in specifically designed ‘nanocarriers’,ie, by producing a nanomedicine, it is possibleto alter a drug’s pharmacokinetic profile(be it a small molecule or largemacromolecule).”

How did you become interested innanomedicines? “My passion about the‘nano’ field began 12 years ago when I startedmy PhD studies. I was working withexceptionally small ‘nanocarriers’ calleddendrimers. These are hyper-branchedpolymers that are as small as few nanometresin size. Dendrimers have attracted a lot ofattention over other nanoparticles such asliposomes because of their very small size andthe ability to control their size and surfaceproperties. This was an eye-openingexperience for me and gave me a passion forthis field.”

Should we be worried about the health andenvironmental consequences ofnanoparticles? “Most nanotoxicologicalassessments focus on environmental exposurerather than biomedical, which makesinterpretation of the toxicity studies veryconfusing to the general public as well as toscientists. As for other materials, it is difficultto generalise by saying they are ‘safe’ or‘harmful’. Toxicity hugely depends on manyparameters, including biodegradability andbiopersistence of the nanomaterial, size,surface charge, aspect ratio, and interactionwith the biological environment, amongothers.”

Where do you see your research leading inthe future? “Many delivery systems do notmake it to the clinical setting due to limitedunderstanding of the physicochemicalproperties of these systems and the way theyinteract with the biological environment.Moreover, it is widely accepted thatachievements in the nanomedicine field havebeen hampered by the biological complexityof the human body. I am keen to focus myresearch to deepen the understanding of thepharmacokinetic (the effect of the body onnanomedicines) and pharmacodynamic (theeffect of nanomedicines on the body) profilesof nanomedicines. Moreover, a better

understanding of the properties of thebiological target (eg. a whole organ, abiological membrane or even an intracellularorganelle) should improve our knowledge onhow to overcome these biological barriers.”

What impact do you see your researchhaving on the development of newmedicines? “Certain genes have been foundto correlate with diseases, including cancer.Silencing of these genes by delivering smallinterfering RNA (siRNA) into themammalian cell (genetic inhibition), eventhough more challenging in terms of itsintracellular delivery compared with chemicalinhibition using small drug molecules, canoffer significant benefits for a variety ofcurrently untreatable debilitating diseases.Nucleic acids if delivered inside cells atsufficient concentrations will revolutionisecurrent therapies.

“I believe that my research, if successful willhave an impact on the area of gene delivery/gene silencing, by developing safe and stablenanomedicines that are able to deliverbiologics to the cell cytosol, or otherintracellular organelles, at sufficientconcentrations. Moreover, I foresee that genetherapy can be used in combination withcurrent existing therapeutic modalities such asradiotherapy and chemotherapy producing asynergistic effect and improved therapeuticoutcomes.”

Does being a pharmacist influence yourresearch in any way? “My journey to theprofessional side of pharmacy in the UK wasnot a typical one. I took a conscious decisionto undertake my preregistration training atUniversity College London Hospitals after Icompleted my PhD studies. After spendingfour years of research in drug delivery, Irealised that as a pharmacy degree graduate, Ineeded to translate my research experience tothe pharmacy profession and to have closercontact with patients and other healthcareprofessionals.

“After completing my preregistration year, Ireturned to research as a MaplethorpeResearch and Teaching Fellow at The Schoolof Pharmacy, University of London. I waskeen not to abandon the pharmacy profession,so I dedicated some of my weekends to workin a community pharmacy. Currently, I spendtwo days per month in a communitypharmacy as a locum pharmacist, as I believeit is important that I should not lose my skillsas a practising pharmacist. Practisingpharmacy in both hospital and community

Khuloud Al-Jamal wins RPS ScienceAward for work on nanomedicine


As this year’s RPS Science Award is presented to Khuloud Al-Jamal, Jayne Lawrenceand Colin Cable from the RPS science team speak to her about her work



I would tell youngscientists to believe inthemselves, love whatthey do, be observant, payattention to detail and tothink out of the box

sectors has helped me to view my researchfrom a pharmacist’s perspective in addition toa scientist’s. This meant that the patient wasmy first concern. Another skill that practisingpharmacy helped me to improve was myteaching. Students enjoy a lecture where theyare taught a theoretical subject that is put incontext of practice.

“I would also like to add that being anacademic and a researcher has helped me toimprove my pharmacy practice skills, as somepatients like to have scientific discussions

about their medicines and disease conditions.Being a university lecturer has helped me toconvey the message to my patients using aclear educational language which I find self-satisfying. In my view, being able to combineresearch, teaching and practice is a blessing.”

What advice do you give to a young scientiststarting out in a research career? “I wouldtell young scientists to believe in themselves,love what they do, be observant, pay attentionto detail and to think out of the box. Do not

get disappointed if your experiment does notgo the way you wanted and follow it to theend. I would also like to refer to the advice thatI was personally given by my mentor SandyFlorence, which I always found so true: ‘Donot be afraid to get into new areas, be kindspirited to referees who reject your papers, donot feel it is competition, do not be impressedby awards and prizes you get, teaching andresearch is a noble combination, being anentrepreneur is not for everyone.’ Mostimportantly, I would tell them to enjoythemselves.”

If you could have dinner with threescientists, who would they be and why? “Iwould love to meet Alexander Fleming, whodiscovered the most famous antibioticpenicillin by accident. As a meticulousscientist, Fleming did not throw away thestaphylococcus petri dishes contaminated byfungi — which another conventional scientistwould have considered a mistake. Rather, heinvestigated why a clear area that was bacteria-free had appeared. I would have liked to tellhim that his approach to scientific researchnot only made him famous but mostimportantly had a huge impact on the wholeworld through the discovery of penicillin, andemphasising the importance of ‘happyaccidents’, or what is called serendipity in thescience field.

“Marie Curie is the female scientist whom Iwould have liked to meet. She has aninteresting life story moving from her countryPoland to France at the age of 24 to study forher higher degree and to do her scientifictraining, an experience similar to mine. Shewas the first woman to win a Nobel Prize andthe only scientist to win a Nobel Prize in twodifferent fields (physics and chemistry). Shecompromised her health to progress the fieldof radiotherapy. Not many scientists would dothat.

“Finally, if I could forward the clock, then Iwould like to meet a scientist from the future.I am intrigued to know how pharmaceuticalscience as a whole and the nano-world inparticular will have progressed over the next100 years.”

What does this prize mean to you? “I am gladto join this illustrious list of previous winners.This award is my first after starting mylectureship at King’s College London in 2011.Receiving the RPS Science Award is anhonour and will certainly have a positiveimpact at both professional and personallevels. It made me believe that I couldconvince the judges that I deserve this awardand my research has the potential to progressin the future.

“The lecture that I will deliver in theUKPharmSci meeting to present my work isgoing to be a nice introduction of myself toother scientists of different disciplines who willperhaps hear me talk for the first time. I wouldsincerely like to thank The RoyalPharmaceutical Society for giving me thisgreat opportunity and the prestigious award atthis important stage in my career.”




Dr Al-Jamal is pictured (right) when she received her PhD certificate from Sandy Florence, a former dean at The School ofPharmacy, University of London, who was her supervisor and also the Society’s Science Award winner in 1973

SCoTlAnD’S first set of events focusing onsupport for preregistration trainees has justtaken place in inverness with the Highlandsand western isles local Practice Forum. Theevent started with a “speed dating” sessionwhere each preregistration trainee had a one-to-one chat with pharmacists from varioussectors.

The trainees and the “speed daters” got a lotout of these quick fire discussions. one traineesaid he “knew it would help me learn moreabout the areas of pharmacy” and a speeddater found that the event “helped a lot in myday-to-day job as a pre-reg manager”.

After that there was a session with the lPF’soutgoing and incoming chairmen to talk aboutpriorities of the new board and how the lPFand its members can input into this. This wasa great opportunity to inform trainees at anearly stage of their careers how they can

influence and support the board and becomethe “arms and legs” of the Society.

An equally successful event was runrecently by great western lPF, where traineesassembled for a “meet and greet” with thelPF steering group at an informal welcomeevening in Bristol, organised by lPFpreregistration and newly qualified leadsDanielle wigg and Jaimin Thakrar.

“we wanted to let our members’ networkinformally so the attendees enjoyed a buffetand glass of wine before our lPF lead PhilipRogers introduced all our steering groupmembers. They then talked about their careersto date and, most importantly, what being amember of the Royal Pharmaceutical Societyreally means to them,” said Ms wigg. “Theattendees were shown how to access all theresources on the lPF webpage, the currentevents programme and also the concept of

mentoring, and the benefits to professionalpractice for both,” Mr Thakrar added.

guest speaker Sandra gidley, englishPharmacy Board member, inspired theaudience with an address on professionalpractice and encouraged those who were notyet members to join and reap the benefits,with the valuable support that great westernlPF can provide.

These events showcase the importancelPFs can have for preregistration trainees insupporting pharmacists of tomorrow from theoutset of their career paths.

Readers are asked to remind their traineesabout the valuable online tools they have viathe virtual networks, the local lPFs andindeed the value of the mentoring databasethat can help support them throughout theirtraining year. — Sara Fletcher and LianneDenton.

Support for preregistration trainees


RPS local practice forum facilitators provide an update of LPF activities



Peninsula LPF turns thespotlight on transfer of careTRAnSFeR of care has become a focus ofattention for lPFs since the RPS produced itsreport highlighting the shortcoming in thecurrent medicines management system whenpatients move between care providers,principally upon leaving hospital andreturning to community care.

Stephen Jacobs, lead for Peninsula lPF andchairman of the Cornwall Pharmacists group,said: “Part 1 of our transfer of careprogramme, in which both hospital andcommunity pharmacists participated andwhich was excellently moderated by Unalordan of Pfizer, dissected the patient’smedicines management pathway fromcommunity into hospital and back again.

“Based upon this analysis, the workgroupthen focused on what they perceived to be thecritical areas, for example, lack ofcommunication, faster rollout of e-dischargeinformation, problems with post-dischargeMURs, before finally giving suggestions onhow the current system could be improved.”

in Cornwall, reference has also been made totransfer of care problems through researchcarried out by the lPF research lead Mikewilcock, stressing communication problemsbetween hospital and the patients’ communitypharmacy.

Following the meeting, Mr wilcock and theRoyal Cornwall Hospital Trust (RCHT)originated a progamme to extend a westCornwall transfer of care project to the countyas a whole, focusing on patient discharge andthe communication barriers between hospitaland community.

“Fostering communication between thedischarged patient and their communitypharmacy was a major strategic ambition forthe attendees, as was the need to ensurepatients went into hospital well prepared and,while in hospital, received adequateinformation on any new medicines they mayreceive,” Mr Jacobs said.

Part 2 of the programme, again with Pfizer’sparticipation, will incorporate a progressreport on the outcomes from the first eventplus a discussion on the RCHT proposal.

it is encouraging to see that many of theideas and suggestions put forward by theattendees at the June event have in fact beenput into action, even in the relatively shortintervening period. This should give a boost tothe September meeting, where participantscan see the fruits of their labours, and shouldstimulate a fertile discussion on the merits ofthe RCHT programme.

Being an active partner in the transfer ofcare project illustrates the opportunities forthe lPF to be fully involved in the evolutionof the practice of pharmacy, and lays thefoundation for future success. — LianneDenton.

Following on from previous toolkits andguides the Royal Pharmaceutical Society hasdesigned for local practice forums i would liketo tell you about two more exciting andhelpful guides that are to be released nextmonth for all RPS members but in particularfor lPF leads who have a keen interest insocial networking and media.

Many people have asked us for advice onsocial media and most are aware of thegrowing strength of Twitter but may not knowhow to start up an account. we have simplifiedit all for you with our “guide to social media”.So afterwards you will be able to join thediscussion on Twitter and tweet about theSociety’s work and your lPF events as muchas you like.

in addition to this guide we have alsorecently revised the PR toolkit with updatedinformation. This can be used by all lPF leadswho wish to write articles for publication innewspapers locally or who may well getinvolved with speaking to the press.

This more detailed toolkit works alongsidethe five-minute guides to writing forProfessional matters and also the five-minute guides for press releases, along withthe library of template press releases we havealready.

All of these are available via the leadershipnetwork on the Society’s website, as will boththese new guidebooks next month, but for anyinitial queries speak to your local facilitator orthe Society’s press team who will be able tohelp you with any press or media enquiries. —Sara Fletcher.

New tools for LPFsand RPS members

It is encouraging that ideasand suggestions havebeen put into action

“A”-level on grading inmy view.

If we cannot restrictthe numbers registeringfor pharmacy coursesand graduating thenhow do we manage theincreased numbers?The lack of sufficientpreregistration trainingpositions in communityand hospital pharmacy(and even fewer in theindustrial sector) meanswe have pharmacygraduates who will notbe able to register andpractise. Not only isthis bad publicity forthe profession but italso begs the questionof whether it is morallyand ethically right toallow a student tograduate if the route tobecoming a pharmacistis blocked by a lack ofpreregistration places.

The heavy financialand emotionalinvestment is borne notonly by the students butalso by their families.however, there are

other professions such as law where there isno guarantee of obtaining training to becomea barrister, for example, upon graduation.Should pharmacy be any different?

It is well known that the additional pressureof increasing pharmacy workload meanspharmacists are hesitant about taking onpreregistration trainees, because they feelunable to support the student during thetraining year. In hospitals there has been areduction in Band 6 junior pharmacist postsfrom 24 per cent in 2009 to 15.7 per cent in2010, then to 11.25 per cent in 2011, which Ibelieve has squeezed the capacity forpreregistration training places.

AT ThE recent RPSConference, the BritishPharmaceuticalStudents’ Associationorganised a wellattended debate on whatcan be done to resolveconcerns around thenumber of pharmacyundergraduates andwhich organisation(s)should be leading onthese. There are externalfactors, such as marketforces, that have animpact on studentnumbers and possiblyon the quality ofgraduates. Concerns feltby pharmacists centreon the impact onemployment prospects,including the reductionin locum positions.

It was quicklyapparent that cappingthe numbers of studentsor raising the entrygrade requirementswere not magicsolutions. Universitiesare being encouraged toincrease the numbers offee-paying students aswell as increase the number of schools ofpharmacy. The pharmacy course that runs forfour years is lucrative for universities.

Although the entry grade requirements maybe set at A, A and B “A”-level passes,eventually, through clearing, some schools ofpharmacy may accept a variation in grades. Isthat a good thing or a bad thing? On apersonal note, when I applied for a place onthe pharmacy course, selection was on apoints system which I missed by a couple ofpoints. If the grade requirement had beenimposed as strictly as suggested, I would nothave become a pharmacist. The true reflectionof the quality of the student goes beyond

In the pharmaceutical industry the numberof places has also reduced. For example, in2011 Pfizer closed its Sandwich site, whichmeant that students had to be relocated toother placements at the start of theirpreregistration year. This creates difficulty inorganising split placements for preregistrationtrainees and for schools of pharmacy offeringsandwich courses.

It is not only the numbers, quality, lack ofpreregistration training places and increase incompetition for employment that we shouldbe aiming to resolve. We will have to beinnovative and look at developing the future ofpharmacy by evolving newer roles forpharmacists across all areas of practice —some that we may never have consideredbefore.

The English Pharmacy Board has beenactively working with Modernising PharmacyCareers, shaping the future of undergraduateand postgraduate education and training. Weare reflecting the views of our members andgathering evidence to foster an informeddebate about the future of pharmacy.

Our aim is to create an education andtraining environment that delivers excellentpractitioners within a vibrant and successfulprofession. Now is the time for the professionto innovate and to grow our role in scienceand healthcare.

RPS ConferenceI attend the RPS Conference for manyreasons: to meet those whom we never findtime to catch up with on account of our heavyworkloads and to hear about innovation inevery sector of our profession. But the mostimportant reason for me to attend is to hearpresentations from individual pharmacistswho are making a real difference to patientcare.

This year I was even more impressed by thelevels of professionalism, dedication andcommitment to patient care. I saw a focus onprofessionalism and innovation to provide aservice fit for the 21st century.

I am looking forward to next year’sconference, which I urge you all to attend.

Student numbers — are there any magicsolutions to supply and demand?


English Pharmacy Board chairman Shilpa Gohil reflects on pharmacy student andpreregistration training place numbers, and her attendance at the recent RPS Conference



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NICoLA STuRGeoN isno longer Scotland’s CabinetSecretary for Health. on 5September 2012, theScottish Cabinet saw areshuffle one day after DavidCameron reshuffled the uKCabinet. Both reshuffles sawa change in leadership foreach country’s NHS. unlikethe departure of england’sAndrew Lansley, however,who introduced radicalreforms that were politicallycontentious and not widelysupported by the healthprofessions, Ms Sturgeonhad broadly been seen as aneffective minister who operated fairly withNHS Scotland’s stakeholders.

Ms Sturgeon remains Scotland’s DeputyFirst Minister. She will now overseeinvestment and infrastructure policy. She hasalso taken to her new role responsibility forsocial and welfare policy (from her old healthbrief). Media attention, however, will beabsorbed with her other major newresponsibility — organising the SNP’spreparations for the 2014 referendum onScottish independence.

Ms Sturgeon had been the longest servingCabinet Secretary for Health since Scottishdevolution in 1999. In her time as CabinetSecretary she impressed with a demonstrationof calm under pressure during the 2009 swineflu outbreak. She also successfully pushedthrough two of the SNP’s most controversialpolicies: the introduction of minimum pricingfor alcohol and support for gay marriage.other innovations included the introductionof health board elections, the Patients’ RightsAct, further restrictions on the sale of tobaccoproducts and clearer definitions on who canprovide health services for the NHS.

For pharmacists, Ms Sturgeon continued thejourney started by the previous Labour-LibDem coalition in Scotland that hadbrought in the era of “The right medicine”.on one hand, Ms Sturgeon provided

continuity; on the other, inher willingness to develop aworking relationship with theRoyal PharmaceuticalSociety, she displayed acommitment to transformingthe role of pharmacists inScotland and tapping intotheir potential. In the pastfew years she renewed theScottish Government’scommitment to introducingpolicies such as the chronicmedication service and alsoagreeing that, in principle,community pharmacistsshould have access to healthrecords.

So Mr Neil has a hard act to follow. But it isnot for us to sit back and wait and see how hegets on. It is essential that the RPS activelyseeks opportunities to show Mr Neil the valueof the profession to the NHS. Importantly, wedo not start with a totally blank sheet of paper.The RPS took Mr Neil on a tour ofCrawford’s Pharmacy in Shotts, part of hisconstituency, a few months ago.

STV covered our pharmacy tour with MrNeil, reporting that “he met current ownerand pharmacist Laura McGregor and herstaff, along with Iain Brotchiefrom the RoyalPharmaceutical Society. MrNeil said, ‘I was delighted toaccept the offer from theRoyal PharmaceuticalSociety to have a tour of alocal pharmacy and found itall very interesting.Crawford’s is certainly aninnovative pharmacy andprovides more than yourbasic service — the patientsin the shop when I wasthere were more than happyto tell me about how Lauraand her team go out of theirway for the localcommunity.’”

That is not a bad start but the agenda forpharmacists in Scotland is particularly heavyat the moment. We need to be doing more.The outcomes of the “Review ofpharmaceutical care for patients in thecommunity” and the growing uncertaintysurrounding the plans to merge adult healthand social care require us to lobby theGovernment effectively on all levels.

Locally, pharmacy needs to secure effectiverepresentation on emerging health and socialcare partnerships which are beginning toreplace community health partnerships. Thecombination of professional practicechallenges, organisational change, and risinghealth and social care costs adds up touncertain times. It underlines the need for theRPS to talk clearly to the new CabinetSecretary about the role of the profession andhow pharmacists hold the key to many of thechallenges for which he is now responsible.

We also need the message to Scotland’spoliticians about pharmacy to come fromother professions, too. We want pharmacists tobe more integrated with other members of theNHS team. We are working with organisationssuch as Royal College of General PractitionersScotland to make that happen. It is moreconvincing for Scotland’s politicians to hearabout the need for better use of pharmacists if

they hear it coming fromGPs. Similarly, we want toimprove pharmaceutical careof patients, particularlyvulnerable groups such asthe elderly. Again, sucharguments are going to havemuch more traction comingfrom older people ororganisations that representthem than if they onlycome from us. This is whywe are reaching out topatient groups as well as toother health professions tomake a compelling andcohesive argument forpharmacy at the heart ofScotland’s NHS.

Farewell Nicola Sturgeon, CabinetSecretary for Health. Hello Alex Neil


Scottish Pharmacy Board chairman John Cromarty looks at what Nicola Sturgeon hasdone for pharmacy in Scotland and argues that Alex Neil has a hard act to follow



Nicola Sturgeon continues in the ScottishParliament as Deputy First Minister

Alex Neil has been appointed the newCabinet Secretary for Health

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into decisive action. It will enable the voices ofindividuals to be heard at every level of theprofession and across all sectors. As a result, Ibelieve the RPS in Wales will be ever moreeffective in identifying and responding to thevoices of its members.

The new group will be meeting in thecoming month or so for the first time. I expectthat it will meet monthly after that so watchthis space and please make your voice heard.

Patient safetyOne issue which I hear as a constant priorityfor our members is patient safety, and we areworking strategically to ensure that the voiceof pharmacists is heard clearly on this agenda.The work that RPS Wales is doing to influencethe future of patient safety, which wasfeatured in last month’s Professionalmatters (PJ, 18/25 August 2012, p198), israpidly gaining momentum and is set to peakthis autumn, with the coming together of anumber of key events, all promoting the roleof pharmacy in patient safety.

Bookings have now opened for the mainevent on medicines safety this year — the RPSWales’ conference entitled “medicines safety:knowing the risks, plugging the gaps” on 20November 2012 in Newport. Aimed atpharmacists, NHS managers, third sectorrepresentatives and other health professions,the conference will bring together

IN my previous article for Professionalmatters (PJ, 21 July 2012, p97), I identifiedan important theme for my work as chairmanof the Welsh Pharmacy Board —communication. I called for a greaterconnection between the board and ourmembership in Wales, not only in terms ofletting members know what we are doing topromote their work but also by finding newways of listening to and understanding theirissues and concerns. What is important to youon an individual level, and what do you feel isimportant for pharmacy as a profession?Knowing what really matters to our members,and also what our members expect of us, isthe key to being a powerful and successfulprofessional body.

I am pleased to say that for the WelshPharmacy Board, engagement with membersis a number one priority. We are activelyinvolved in listening to members’ views andgathering information from across thecountry, through the local practice forums,our virtual networks and face-to-facediscussions.

We are taking steps this autumn tostrengthen both our connection andresponsiveness to the interests of members.This will start by drawing together somemembers of the board to focus specifically onturning board decisions into action. This newgroup will meet separately from official boardmeetings and will be tasked with deliveringresults for our members. It will implement thedecisions made by the board and, crucially,will act on the views and concerns ofmembers. I strongly believe this is the rightway forward and this group will present a newopportunity to build a more powerfulconnection between members and theirprofessional body in Wales.

This new structure in Wales shows how weare leading the way in member engagement.An implementation group to support theboard will, I hope, give it sharper teeth,ensuring that its words are converted quickly

professionals from all sectors to meet andshare ideas. It will represent an importantstage for the development of safer healthservices and show how pharmacy, representedby the RPS, is driving the agenda nationally. Afull conference programme is available on theRPS website, together with a booking formand more information.

Alongside the conference, we are alsoholding a number of LPF events inSeptember to address medicines safety issuesat a local level. Focusing on new improvementmethodologies to improve patient safety,details of these events can be found on ourwebsite and through your LPF.

The Society’s partnerships with otherhealthcare professions and key organisationsin Wales are the backbone of our success inthe medicines safety agenda. Our input intothe 1000 Lives Plus improvement guide forpharmacy and our joint commitment with theRoyal College of General Practitioners tobreak down barriers between GPs andpharmacists are examples of how ourengagement with others is creating the rightplatform to influence change in Wales. Weknow there is more value in well co-ordinatedmultiprofessional approaches to health careand we will be taking these messages to areception of Welsh Assembly members theweek before our medicines safety conferencein November. Our joined-up approach, usingpartnerships to push forward the concerns ofour members, is a mainstay of our activity. Weare working at a local, regional and nationallevel at the same time, communicating yourkey issues across the healthcare professions,government and third sector organisations.

There may have been a time whenpharmacy as a profession was content to shyaway from the limelight, preferring not tobang the drum about its own vital role. TheRPS is determined that, in the evolving NHSlandscape, pharmacy is not only a visible partof the NHS, but is right at the heart of theaction.

Joining the dots — connecting RPSmembers with changes in NHS Wales


Chairman of the Welsh Pharmacy Board Mair Daviesoutlines how the board isgoing to increase two-way communication with RPS members in Wales



Knowing what really mattersto our members, and alsowhat our members expect ofus, is the key to being apowerful and successfulprofessional body

• • • •• • • • •




Dealing with self-prescribersRPS Support has issued advice on what do when presented with prescriptionswritten for the prescriber or his or her friends and relations

PharMaCISTS are occasionally asked todispense medicines that have been self-prescribed by a prescriber or have beenprescribed for close family and friends of theprescriber. although a prescription (includingone for a Controlled Drug) in thesecircumstances may fulfil the usual legalrequirements, pharmacists should consider thefollowing before making a supply:

• It is generally considered poor practice toself-prescribe or to prescribe for persons forwhom there is a close personal relationship

•The professional judgement of theprescriber may be impaired or influenced bythe person they are prescribing for

• It may not be possible for a prescriber toconduct a proper clinical assessment onthemselves or on close friends or family

•The regulatory body for doctors (GeneralMedical Council) advises within the “GoodMedical Practice” that doctors should nottreat themselves and, wherever possible,should avoid providing medical care toanyone with whom they have a closepersonal relationship

•The regulatory body for nurses (Nursingand Midwifery Council) advises within thedocument “Standards of proficiency fornurse and midwife prescribers” that nursesand midwives must not prescribe forthemselves and, other than in exceptionalcircumstances, should not prescribe foranyone with whom they have a closepersonal or emotional relationship

•The existence and content of any local trust,board or hospital policy covering self-prescribing

•The abuse potential of the drug beingrequested

•Controlled Drugs should only be supplied inexceptional circumstances and detailsdocumented (where appropriate, the supplyor request may prompt referral to the localCD accountable officer)

In an emergency, after exercisingprofessional judgement, a pharmacist may

decide that it is appropriate to dispense amedicine that has been self-prescribed orprescribed for persons with whom theprescriber has a close personal relationship.

In circumstances where refusing to supply isthe most appropriate action, be prepared forthe person requesting the supply to bedisappointed. One strategy would be toexplain, clearly and calmly, that in yourprofessional judgement it would not beappropriate to supply the medicine.

In some circumstances where there is a riskof harm to patients or the public, there may bea duty to raise concerns with the appropriatebody (eg, General Medical Council).

No 16, September 2012:Self-prescribed prescriptions andprescriptions for friends and family

FURTHER INFORMATION

For further information on this topic or othermatters covered in other RPS ProfessionalSupport Bulletins contact the RPS SupportTeam on 0845 257 2570 or emailemail [email protected].

Further reading

• General Medical Council. Good medicalpractice (www.gmc-uk.org)

•Nursing and Midwifery Council. Standardsof proficiency for nurse and midwifeprescribers (www.nmc-uk.org)

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325 professional matters - The Pharmaceutical Journal · 2012-09-19 · Public Health England (PHE) takes on the responsibility for protecting and improving the nation’s health