http://ipa.medlineindia.com/members/barunhere/activity/3364
Dr. Barun Ranjan Sarkar PharmD. posted an update: 2 years, 3 months ago
Pharmacist Independent Prescribers An Urgent Need For India!.
The United Kingdom as always is the best reference point for our health sector since most of our structures and training of personnel were fashioned along the lines of our colonial masters. Pharmacist Independent Prescribers in the United Kingdom are pharmacists who have a number of years experience practicing in a clinical environment and have received added postgraduate training (usually from six to eighteen months) and are empowered to carry out prescribing duties.
A Pharmacist Independent Prescriber in the UK must be a registered pharmacist whose name is held on the membership register of the Royal Pharmaceutical Society of Great Britain (RPSGB), with an annotation signifying that the pharmacist has successfully completed an education and training programme accredited by the RPSGB and is qualified as an independent prescriber. Once qualified, Pharmacist Independent Prescribers are able to prescribe any licensed medicine for any medical condition within their competence. This only recognizes the fact that pharmacists as creators and producers of all drugs are in a unique position as their expertise in the use of drugs is absolutely incomparable.
The UK’s Department of Health’s working definition of independent prescribing is prescribing by a practitioner (e.g. doctor, dentist, pharmacist) responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing.
Aims of independent prescribing by pharmacists
According to the Department of health, it is the UK governments’ policy to extend prescribing responsibilities to nonmedical professions to:-
According to the Department of health, it is the UK governments’ policy to extend prescribing responsibilities to nonmedical professions to:-
1. Improve patient care without compromising patient safety;
2. Make it easier for patients to get the medicines they need;
3. Increase patient choice in accessing medicines;
4. Make better use of the skills of health professionals;
5. Contribute to the introduction of more flexible team working across their National Health
Service (NHS).
Service (NHS).
Some Question & answer about Pharmacist Independent Prescribers
Q: What is independent prescribing?
A: Independent prescribing is prescribing by a practitioner eg. doctor, dentist, nurse, pharmacist or optometrist responsible and accountable for the assessment of patients with undiagnosed and diagnosed conditions and for decisions about the clinical management, including prescribing.
Q: What can Pharmacist Independent Prescribers prescribe?
A: Any medicine for any medical condition within their competence, with the current exception of controlled drugs.
Prescribing unlicensed medicines and ‘off-label’ / ‘off-license’ prescribing
Q: Can Pharmacist Independent Prescribers prescribe unlicensed medicines?
A: Yes, following changes in December 2009, Pharmacist Independent Prescribers can prescribe unlicensed medicines for their patients, on the same basis as doctors and provided that they are competent and take responsibility for doing so.
Q: Can Pharmacist Independent Prescribers prescribe ‘off-label’ or ‘off-license’?
A: Qualified Pharmacist Independent Prescribers can prescribe medicines ‘off-label’ or ‘off license’.
However, Pharmacist Independent Prescribers must take full clinical and professional responsibility for their prescribing and should only prescribe ‘off-label’ or ’off-license’ where it is best practice to do so.
However, Pharmacist Independent Prescribers must take full clinical and professional responsibility for their prescribing and should only prescribe ‘off-label’ or ’off-license’ where it is best practice to do so.
Mixing of medicines
Q: Can Pharmacist Independent Prescribers mix medicines prior to administration?
Q: Can Pharmacist Independent Prescribers mix medicines prior to administration?
A: Yes. Changes to medicines regulations came into effect from December 2009 that enable Pharmacist Independent Prescribers to mix medicines prior to administration, and direct others to mix.
Borderline substances
Q: Can Pharmacist Independent Prescribers prescribe borderline substances independently?
Q: Can Pharmacist Independent Prescribers prescribe borderline substances independently?
A: Yes, but DH guidance recommends that Pharmacist Independent Prescribers restrict their prescribing to the substances on the Advisory Committee on Borderline Substances approved list, in Part XV of the Drug Tariff.
Use of Botox® and Vistabel® in cosmetic procedures
Q: Can Pharmacist Independent Prescribers prescribe Botox® independently and administer it for use in cosmetic procedures?
Q: Can Pharmacist Independent Prescribers prescribe Botox® independently and administer it for use in cosmetic procedures?
A: Yes. A Pharmacist Independent Prescriber can legally prescribe and administer licensed parenteral medicines such as Botox® in cosmetic procedures on his or her own initiative.
However, the use of Botox for cosmetic treatment is outside the product’s licensed indications. Pharmacist Independent Prescribers may prescribe medicines independently for uses outside their licensed indications so called ‘off-licence’ or ‘off-label’. They must however, accept professional, clinical and legal responsibility for that prescribing, and should only prescribe ‘off-label’ / off-license’ where it is accepted clinical practice.
However, the use of Botox for cosmetic treatment is outside the product’s licensed indications. Pharmacist Independent Prescribers may prescribe medicines independently for uses outside their licensed indications so called ‘off-licence’ or ‘off-label’. They must however, accept professional, clinical and legal responsibility for that prescribing, and should only prescribe ‘off-label’ / off-license’ where it is accepted clinical practice.
Q: Can Pharmacist Independent Prescribers prescribe Vistabel® independently and administer it for use in cosmetic procedures?
A: Yes. A Pharmacist Independent Prescriber can legally prescribe and administer licensed parenteral medicines such as Vistabel® in cosmetic procedures on his or her own initiative.
Q: Are pharmacists able to issue private prescriptions?
A: Pharmacist Independent Prescribers can issue private prescriptions for any medicine within their competence, with the current exception of controlled drugs.
Q: Are Pharmacist Independent Prescribers able to give directions to a non-prescriber for the administration of a medicine?
A: Yes. A qualified Pharmacist Independent Prescriber may give directions for the administration of any product they are legally allowed to prescribe ie a medicine for a condition within his/her competence. The prescribing pharmacist needs to be satisfied that the person to whom he or she gives the instructions is competent to administer the medicine concerned.
Q: Are pharmacists able to prescribe or supply blood or blood products on the NHS?
A: Blood, including the cellular elements that are packaged for use as ‘packed cells’ and platelets, is not considered to be a medicinal product and is therefore outside the ambit of the Medicines Act and its subsequent amending Regulations. The ‘prescribing’ of blood for a patient is not therefore appropriate for pharmacist independent prescribing or for supply under the terms of a Patient Group Direction (PGD). Pharmacists should discuss the current local policy regarding ordering of these products with their Trust’s haematology department. Consideration could be given to developing local guidelines for the ordering and supply of blood, based on the format of a PGD.
However, products derived from the plasma component of blood such as blood clotting factors, antibodies and albumin are considered to be medicinal products and are required to have marketing authorisations. These products may be prescribed by Pharmacist Independent Prescribers or as part of a supplementary prescribing arrangement. It may also be sensible to discuss any proposed prescribing with the Trust’s Haematology Department, in advance.
Prescription forms
Q: What prescription forms should Pharmacist Independent Prescribers use?
Q: What prescription forms should Pharmacist Independent Prescribers use?
A: Further information on prescription forms, including the types of form and how to order supplies of these, is available in the Department of Health’s prescribing implementation guidance and via the NHS Business Services Authority website.
Improving patients’ access to medicines: A guide to implementing nurse and pharmacist independent prescribing within the NHS in England
NHS prescription services: Prescription forms (opens new window)
NHS prescription services: Prescription forms (opens new window)
Training
Q: Who will decide which pharmacists are eligible to be trained as prescribers?
Q: Who will decide which pharmacists are eligible to be trained as prescribers?
A: Pharmacists must first meet the eligibility criteria as determined by the Royal Pharmaceutical Society of Great Britain (RPSGB). Once these are met, it is a matter for local decision, in the light of local NHS need, benefit and circumstances. No pharmacists will be required to undertake training for prescribing unless they wish to do so. There also needs to be a local need for them to prescribe and for the service.
Q: Can pharmacists employed by prisons or charitable and private organisations outside the NHS undertake prescribing training?
A: Yes – pharmacists employed outside the NHS may also apply to undertake prescribing training. Pharmacists employed by non-NHS organisations and who provide the majority of their services to NHS patients can also be considered for SHA funded prescribing training from the Multi-Professional Education and Training (MPET) levy. Other non-NHS pharmacists will need to identify an alternative source of funding. They also need to have identified a medical supervisor who is willing to help with the ‘supervision in practice’ element of the course.
Community pharmacists and any other pharmacists employed by the independent sector, but who supply services to NHS organisations wishing to train to prescribe at NHS expense, will need to have the agreement of their local PCT or NHS Trust with whom they are contracted and have access to a prescribing budget, once qualified.
A: Yes – pharmacists employed outside the NHS may also apply to undertake prescribing training. Pharmacists employed by non-NHS organisations and who provide the majority of their services to NHS patients can also be considered for SHA funded prescribing training from the Multi-Professional Education and Training (MPET) levy. Other non-NHS pharmacists will need to identify an alternative source of funding. They also need to have identified a medical supervisor who is willing to help with the ‘supervision in practice’ element of the course.
Community pharmacists and any other pharmacists employed by the independent sector, but who supply services to NHS organisations wishing to train to prescribe at NHS expense, will need to have the agreement of their local PCT or NHS Trust with whom they are contracted and have access to a prescribing budget, once qualified.
Q: Who bears legal and professional responsibility for the actions of pharmacist prescribers?
A: Pharmacist Independent Prescribers are professionally responsible for their own actions. They should therefore only prescribe in situations where they feel fully competent, using those medicines that they feel are effective for the patient and the condition being treated. Where a pharmacist is appropriately trained and qualified as an independent prescriber, and prescribes as part of his or her professional duties with the consent of the employer or local PCT, the employer may also be held vicariously responsible for the pharmacist’s actions. The Department’s guide to implementation of nurse and pharmacist independent prescribing, advises all independent prescribers to ensure that they have professional indemnity or insurance – for example through membership of a professional organisation or trade union.
A: Pharmacist Independent Prescribers are professionally responsible for their own actions. They should therefore only prescribe in situations where they feel fully competent, using those medicines that they feel are effective for the patient and the condition being treated. Where a pharmacist is appropriately trained and qualified as an independent prescriber, and prescribes as part of his or her professional duties with the consent of the employer or local PCT, the employer may also be held vicariously responsible for the pharmacist’s actions. The Department’s guide to implementation of nurse and pharmacist independent prescribing, advises all independent prescribers to ensure that they have professional indemnity or insurance – for example through membership of a professional organisation or trade union.
The RPSGB Code of Ethics states that all pharmacists who own a pharmacy, superintendent pharmacists and pharmacists managers should ensure that all professional activities undertaken by them or under their control are covered by their professional indemnity or insurance. The standard on prescribing within the Code also says that pharmacists must only prescribe within the limits of their registration and must comply with statutory requirements applicable to their prescribing.
The above mentioned facts were from department of health government of united kingdom.
But my question is, if india can follow British pattern for medical education and practice then why not it is same for pharmaceutical education and practice (Pharmacist Independent Prescribers)?. As due to large population size, India is already lagging in doctor and population ratio!.
Therefore, I think the matter should be considered and necessary measures should be taken .
But my question is, if india can follow British pattern for medical education and practice then why not it is same for pharmaceutical education and practice (Pharmacist Independent Prescribers)?. As due to large population size, India is already lagging in doctor and population ratio!.
Therefore, I think the matter should be considered and necessary measures should be taken .
Barun Ranjan Sarkar
Reference:-
The Indian pharmaceutical industry has carved its niche in both the markets, domestic as well as international with its expertise in high end IT and cutting edge science technology. India has strong research and development (R&D) pipeline, maximum number of US FDA approved manufacturing sites outside the US, low R&D costs, innovative scientific manpower with low cost availability which has attracted multinational pharma companies to invest in India. cont.. above url...
India is lagging considerably behind its key human development index targets, including population control, infant mortality rate (IMR) and maternal mortality rate (MFR), according to figures given by Health Minister Harsh Vardhan in Lok Sabha today.