wcr spring 2012

WELSH

REVIEWSPRING 2012

PHARMACY / HEALTH / PRODUCTS / CLINICALS / POLICIES / COMMENTS

Welsh Pharmacy Review does exactly what it says on the tin. It reviews Welsh Pharmacy! Our survey allowed many of you to voice your opinions on what’s happening in the industry at

the moment. Read what your peers had to say....

It’s all happening in Welsh pharmacy!

pharmacy

NEWS:04 ORGAN DONATIONResults of consultation

05 CANCERApproval for prostate cancer drug

06 FUNDRAISINGSponsorship sought for worthwhile cause

44 PARACETAMOLWarning for parents

46 DENTAL HEALTHDental hygiene and heart health

07

38

48

34

SPRING 2012

Z`ZXu VISIT WWW.PHARMACY-LIFE.CO.UK FOR THE LATEST IN PHARMACY NEWS

CONTENTS 01WELSH CHEMIST REVIEW

WELSH CHEMIST REVIEW - IN STRATEGIC PARTNERSHIP WITH CAMBRIAN ALLANCE

CONTENTS

FEATURES:07 SURVEYPublic health in Wales

- 08 Welsh pharmacy today- 11 Responsible Pharmacist- 15 Minor ailments- 17 Discharge Medicines Review- 18 Pharmacist Support

36 ALLERGIESThe link between allergies and our homes

48 TELL US ABOUT THE HONEY MUMMYA new health initiative in Wales

AD TO COME

EDITOR’SLETTERSPRING 2012

COMMENT 03WELSH CHEMIST REVIEW

Welcome to the latest issue of Welsh Chemist Review which, as you will see from our front cover, is changing its name over the next few issues to Welsh Pharmacy Review: a change which is being implemented at YOUR request.

Over the last decade, the concept of pharmacy in Wales has changed beyond recognition. Many pharmacists believe that this ‘new’ pharmacy is no longer reflected in the term ‘chemist’. As always, we are happy to be guided by you, and so are implementing this name change over the next few issues. Despite the change of name, however, you can be sure that the quality and content of the new Welsh Pharmacy Review will more than match that of the Welsh Chemist Review, which you have enjoyed over the last five years.

When Jim Croce wrote his iconic ‘If I could save time in a bottle’ in the early 1970s, he could well have been writing on behalf of community pharmacists in the 2010s! ‘But there never sees to be enough time, to do the things you want to do…’ sang Croce and these words were echoed time and time again throughout our survey which we recently carryed out. Time pressures and multiple initiatives seem to be the order of the day in community pharmacy today and, when you factor in issues, such as drug shortages, it’s little wonder that stress levels are through the roof. Pharmacists throughout the country seem to be divided, for example, in their opinion on the Responsible Pharmacist. David Reissner, Partner, Head of Healthcare at London-based

solicitors, Charles Russell LLP, provides us with the definite low-down on the initiative and answers some of the most commonly asked questions (p11). As stress levels rise, Diane Leicester from Pharmacist Support tells us how calls to their helpline are also increasing (p18). In this issue we also feature the story of a Scottish pharmacist, Asif Ghafoor, who has just gone through two and a half years of what he refers to as ‘hell’ after he was accused by a patient of sexual assault (p38). As always, we are looking for your comments and opinions on everything to do with pharmacy in Wales today. Please email me your views on [email protected].

EDITORDEBBIE [email protected]

SALES DIRECTORDONNA [email protected]

DESIGNMYLES [email protected]

EVENTS MANAGERBRIDGET [email protected]

ACCOUNTS MANAGERJACQUI [email protected]

MANAGING DIRECTORADRIAN [email protected]

Whilst every care has been taken in compiling this magazine to ensure that it is correct at the time of going to press, the publishers assume no responsibility for any effects from errors or omissions. The opinions of contributors are not necessarily those of the publisher. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form, or by any means, mechanical, electronic, photocopying, recording or otherwise without the prior permission of Medical Communications Ltd. All rights reserved. Data Protection - Please Note, your mailing details and copies of any articles supplied will be held on a database and may be shared with associated companies. Sometimes your details may be obtained from, or made available to, external companies for marketing purposes. If you do not wish your details to be used for this purpose, please write to: Database Manager, Medical Communications Ltd, 10 Dargan Cresent, Duncrue Road, Belfast, BT3 9JP. Subscription: £47 a year

DEBBIE ORME - EDITOR [email protected]

04 NEWSWELSH CHEMIST REVIEW

Four world-class institutions from Wales and Ireland have launched an exciting new alliance to lead the way in developing cutting-edge healthcare.

The £1 million Celtic Alliance for NanoHealth (CAN) will help companies on either side of the Irish Sea stay at the forefront of innovation and growth in what is a fast developing and hugely influential healthcare sector. Nano-devices and nano-biosensors allow the detection and measurement of biomarkers in fluid or tissue samples at a level of sensitivity far beyond current methods, aiding the early detection and treatment of a wide range of diseases including cancer and heart disease. Through CAN it is expected that new and faster ways of screening for health diseases using nanotechnologies will be developed. These will provide advances in patient care and safety and enhance the speed at which novel ideas can be developed for patient benefit.

uHEALTHCARE ADVANCES

The Welsh Government’s proposals for a soft opt-out system of organ donation were issued for consultation between 7 November 2011 and 31 January 2012. A soft opt-out system means that unless an individual makes an objection, their organs and tissues will be obtainable for donation after their death. After death, relatives would also be involved in the decision making process around donation. The Minister made her announcement during a visit to Wrexham Maelor Hospital’s Renal Unit, where she met staff and patients. The public consultation on Wales’s proposed opt-out kidney donation scheme showed that 52 per cent of responding people supported the proposal and 39 per cent were opposed. ‘I am very pleased with the excellent number of responses to the consultation on this important piece of legislation, which will save lives,’ said Lesley Griffiths. ‘I am aware the subject of organ donation is highly emotive and that many people have strong views on the issue. The Welsh Government is committed to introducing a soft opt-out system of organ donation which, evidence suggests, could increase the number of organ donations by up to 25 per cent. ‘For people in need of a transplant, like some of those I met at the Renal Unit today, the move towards legislation is significant. While Wales has recently seen an increase in donated organs and tissues, on average one person a week in Wales dies while waiting for a transplant because a suitable donor cannot be found. ‘We will now give those contributions careful consideration as we develop the draft Bill, which we intend to publish for consultation before the summer.The aim is for the new system to be in place in 2015. In the meantime, it is important people discuss their wishes with family and friends, and sign up to the organ donor register.’

uORGAN DONATION

Health Minister, Lesley Griffiths, marked the recent World Kidney Day by announcing the publication of a report on the recent consultation on organ donation.

Consultation response

Exciting new alliance

Lesley Griffiths

As an award-winning pharmacist for her work with her husband in their Pontnewydd pharmacy, Healthplus, Madhvi Dalal is more than used to the bright lights of success.

Recently, however, Madhvi has shown that her talents stretch far beyond pharmacy by winning an award in the Arts Category of the Welsh Asian Women’s Achievement Awards. Growing up in Kenya, Madhvi trained in classical Indian dance. When she came to Wales 20 years ago to train as a pharmacist, Madhvi didn’t want to leave her interest behind and so began studying contemporary Indian dance. She now puts on an annual dance show and has worked with Ballet Cymru as well as companies in Kenya, Austrzalia and India. For more details on Madhvi, visit www.madhvi.org

uTALENT

Award-winning performance

Madhvi Dalal

NEWS 05WELSH CHEMIST REVIEW

Approval for prostate cancer drug

uCANCER RESEARCH

Cancer Research UK has welcomed the news that the All Wales Medicines Strategy Group (AWMSG) has made prostate cancer drug abiraterone available on the NHS.

This will help pave the way for NICE to make a positive ruling when they publish their final guidance in May. Earlier this month after a preliminary review, NICE announced that the drug would not be routinely offered on the NHS because the manufacturer, Janssen, had set the price too high. NICE also said the drug did not meet the End of Life criteria, which would have meant less stringent rules over cost applied. The AWMSG were able to approve abiraterone after assessing it as an End of Life drug and it will now be available on the NHS in Wales until NICE release their final guidance, which will override the AWMSG decision if abiraterone is rejected. ‘We’re pleased that the AWMSG and the drug’s manufacturer, Janssen, have agreed a price that makes abiraterone available for men in Wales who need it,’ said Professor Peter Johnson, Cancer Research UK’s chief clinician. ‘But this is only

guaranteed to happen for a few months until NICE release their final guidance. ‘Abiraterone is an effective drug for men who have advanced prostate cancer that has come back after chemotherapy. Patients and doctors have found it valuable since it has been available via the Cancer Drugs Fund in England, but there is a strong case for it to be routinely funded by the NHS. ‘We want Janssen to lower the price of abiraterone and NICE to take another look at the way they assessed its cost effectiveness. ‘The AWMSG were able to approve the drug because they used the End of Life criteria. This shows that if NICE use these criteria, they could negotiate a price that makes abiraterone cost effective for the NHS. ‘We hope the right decision will be made, and quickly, so that all men with this form of the disease will be offered vital extra months of life, regardless of where they live.’

Major improvements to children’s services Health Minister Lesley Griffiths has opened a new state of the art facility in Bridgend providing round-the-clock care for children and young people with mental health problems.

Based in the grounds of the Princess of Wales Hospital, Bridgend, TD Llidiard cost £26million to build and was funded by the Welsh Government as part of its commitment to improving children’s mental health services. The 19-bed facility, which cares for young people with a variety of mental health problems, has been designed with the help of young patients and staff, and is ideally located at the Princess of Wales Hospital where it can easily link with wider health and children’s services. While visiting, the Minister also announced the publication of the first Annual Report on ‘Breaking the Barriers’ – the Welsh Government’s national action plan for improving children’s mental health services. ‘When children and young people experience mental health problems,’ the Health Minister said, ‘it is important the right services are there ready to provide support to them and their families. ‘Here at Tŷ Llidiard, young patients will receive treatment in a comfortable, friendly and safe environment which is wholly appropriate to their needs while they are at their most vulnerable. ‘The health and well-being of children and young people is a priority for the Welsh Government, as outlined in our Programme for Government. I am very pleased the first Annual Report into provision for children’s mental health shows we are making excellent progress to ensure all young people get the chance to fulfil their potential.’

uMENTAL HEALTH

Professor Peter Johnson

Lesley Griffiths

Making the most out of marketingCompetition may be the buzz word for healthcare provision in England at the moment, but it remains an approach rejected by the NHS in Wales.

Which model will work best is a matter of hot political and professional debate: I suspect in practice both models will demonstrate differing strengths and weaknesses. However, in a manner of speaking, even in Wales there is a form of emerging ‘competition’: that is to say competition for the attention and interest of current and potential patients. Not so long ago, if you wanted advice on healthcare or were concerned about certain symptoms, then the local pharmacist or GP were the obvious professionals to consult. What we are seeing nowadays is a transformation in how people access healthcare advice and support. People have become more consumerist in their attitudes to healthcare: more inquisitive about conditions they may have, more demanding about when and how they seek advice as well as being more willing to by-pass traditional sources of advice. The internet, of course, has played a critical role in this information revolution. As a result, there are hundreds, if not thousands of organisations, professionals and companies vying for the attention of the public: often offering services, advice and support which community pharmacies provide. It is therefore more important than ever that community pharmacies market themselves effectively to the public and patients.

If you find ‘marketing’ an uncomfortable term, think instead of ‘patient education’. Despite fantastic efforts by many pharmacists and their representative bodies over many years, there are still too many people who know too little about what their local pharmacy offers, who visit their GP at the first hint of a cough or cold, and who fail to take their medicines as directed. Every pharmacy needs an effective marketing plan. Are you engaging local businesses to offer services their employees may need, such as flu vaccinations? Are you grabbing the attention of people and engaging local media by participating in national health awareness weeks? What is your presence on the internet? In the good old days simply having a pharmacy in the high street was sufficient to generate footfall. Nowadays, in the internet era with major retailers relocating to out of town retail parks community pharmacies need to view marketing themselves as a core necessity, not a peripheral ‘nice to do if I get the time’ activity. On a busy Saturday, it may not appear as though there is a need to attract even more customers. However, public attitudes, expectations and requirements regarding healthcare provision are evolving rapidly. That will inevitably create winners and losers. Part of our job at AAH is to help our customers become the winners.

Mark James

uCOMMENT


Eight senior managers from Alliance Healthcare in the UK and Alliance Boots have launched a sponsorship campaign for their forthcoming cycle challenge from John O’Groats to Lands End (JOGLE) to raise at least £100,000. The proceeds will go towards Europe’s first state-of-the-art ‘Biobank’ for the study of colorectal cancer.

Starting on 23 May 2012, the ‘JOGLE’ relay challenge will cover 894 miles over three days finishing on 26 May 2012. The challenge is part of the fundraising activities within the five-year pan-European partnership between Alliance Boots and EORTC (European Organisation for Research and Treatment of Cancer) Charitable Trust to raise over €5million for colorectal cancer research through the EORTC Biobank. (www.bmycharity.com/jogle2012) This Biobank will be the first pan-European facility to address the development of tailored therapies for colorectal cancer sufferers through the knowledge available from the mapping of the human genome. ‘The JOGLE Challenge Team and I are delighted to be taking part in this event and raising money for such a worthy cause,’ said Eddie Lawson, General Counsel, Pharmaceutical Wholesale Division, Alliance Boots. ‘We are very much looking forward to the challenge and hope all of our partners, suppliers, customers and staff will dig deep to sponsor the team and help us to really make a difference in the fight against cancer.’

uSPONSORSHIP

New campaign to raise money

Eddie Lawson

WCR SURVEY

‘Time is what prevents everything from happening at once’, said the American physicist, John Archibald Wheeler.

Having spoken to Welsh pharmacists over the last few weeks for our survey, however, it would appear that even time is having difficulty stopping so much

happening in Welsh pharmacy at the moment. With the plethora of new initiatives currently being developed and rolled out, there were plenty of subjects for you all

to comment on. Read on to find out what your peers had to say.....

It’s all happening in Welsh pharmacy!

‘If I could save time in a bottle….,’ sang Jim Croce in his iconic tune from the early 1970s. Our comprehensive survey of pharmacists in Wales would lead us to believe that many of you would love to be able to save it in dispensing bottles! Time pressures seem to be the order of the day in community pharmacy in Wales today and, when you factor in issues, such as drug shortages, it’s little wonder that stress levels are through the roof! Stress and its effect on pharmacists is looked at in our Listening Friends feature elsewhere in the survey, but although most pharmacists agreed that many of the initiatives and core services introduced into Welsh pharmacy had their value, the general feedback from most was ‘STOP!!!’ While many felt that their pharmacy footfall had increased to an extent and that existing patients were utilising the new services, there was no dispute over the fact that these initiatives had already put extra pressure on pharmacists to prioritise the tasks that they specifically needed to do.

Time/workload Time and increased workload were major issues across the board, with many expressing concerns about the time being spent in consultation rooms. The majority of pharmacists, it was pointed out, went into the profession to dispense medicines, yet many now feel that this is a secondary requisite

Introduction...WPR recently carried out an extensive survey of around 50 Welsh pharmacists to gain a comprehensive overview of their concerns. While some requested anonymity, we are grateful to those, who have allowed us to quote them. The results were fascinating.....

08 / SPRING 2012

‘EVERYBODY IS MOANING ABOUT THE WHOLESALING OF MEDICINES OUT OF THE COUNTRY CAUSING ALL THE SHORTAGES AND THE PHARMACISTS ARE BEING BLAMED FOR THIS...’PHIL BULLEN, WELLNESS PHARMACY

of their job, with behind-the-scene consultations and administration taking up a large chunk of their day. The financial implication of the increased workload was also raised by many pharmacists. Quite a few had had to factor in locums’ wages simply to cover the new services on offer, so the financial implications were also uppermost in many minds. Ultimately, however, every pharmacist that WCR

spoke to agreed that pharmacy was changing and developing, and it was up to pharmacists to adapt to – and with – the changes.

Drug shortages Across the country, pharmacists are in no doubt what is causing the shortage in medicines! Medicines being exported is causing major problems and the fact that the number of export licences granted by the MHRA recently increased from around

160 to 250 would indicate that this is a problem that isn’t going to go away in the foreseeable future! Many pharmacists now seem to be spending a considerable part of their already busy day both in trying to source medicines from suppliers and in faxing prescriptions to manufacturers to prove that the prescription is legitimate! Many pointed out that, in addition to having to do this, they then have to phone up to see if the fax was received.

SPECIALFOCUS

WCR SURVEY

‘As an employee, money is a sore topic. There has been no additional remuneration to perform additional services and pay has not kept pace with the increased number of prescriptions which are dispensed (ie, there is no ten per cent pay rise when you add ten per cent to the prescription volume). NHS remuneration has restricted the chance of pay increases for staff, with too great an emphasis being placed on services when the core role of a pharmacy (dispensing) has in no way diminished. ‘Stress levels within pharmacy are certainly increasing. There can be very few industries where the workload would increase at exponential rates without increased remuneration or staffing levels. In addition to prescription growth, we have seen the addition of enhanced services, with no additional staffing, resulting in greater pressures and less time to perform the day-to-day basics of running a pharmacy.’___________________________

‘We are now dispensing five per cent more items every year, but wages are not going up and the number of staff is not increasing. When are we going to get increased staff and remuneration? The workload is going up, but the money is not there to fund it. I’ve been in the business for fifteen years but I’d hate to be starting out in pharmacy now! When I started out we were dispensing 4000 items per month – it now averages between 9-10000 yet there are no extra staff! Nightmare!’Anonymous

‘Everybody is moaning about the wholesaling of medicines out of the country causing all the shortages and the pharmacists are being blamed for this. If we were paid a proper wage, it wouldn’t be necessary to do this. General pharmacy is not paying enough. 2011 was the first year when pharmacists started going to the wall; this would never have happened before and is a worrying omen of things to come.’___________________________

‘Over the last six years we have managed to double our business, through sheer hard work and dedication. Current remuneration from the goverment is similar to what we were getting three years ago. So where is the return for all our hard work? Pharmacy profession as a whole lacks one voice, in the interest of pharmacists. GPs would not have taken this sort of shoddy treatment from the government lying down. Dentists managed to show the ‘digital gesture’ to the government of the time and laid down the terms which suited them. Why can’t pharmacists show such camaraderie amongst themselves? Which other medical professionals have to wait three months to be paid (if at all correctly!)? As a profession, we are impotent to do anything about the increasing workload and a lack of suitable reward for it! Those pen pushers who might see me as a black sheep are perhaps not faced with the daily challenges of running a successful pharmacy business in the face of many adversities. When will we ever wake up and smell the coffee? Maybe the time is now!

‘The remuneration is definitely going down. We were initially sucked into signing a contract but every month the cheques are getting smaller. The burden of red tape is also getting worse. That’s the general situation for pharmacy in Wales: increased, unnecessary red tape for less money. Every year we’re swamped with silly surveys; the clinical governance is getting out of hand. I can see some pharmacies becoming unviable. It’s time to renegotiate. I think there’s an agenda to put small pharmacies out of business.’___________________________

‘With reduced purchase profit, the services are definitely the way forward in terms of making money. I do think, however, that we should do what the nurses did, ie, prove that we can do the services first and then receive the accreditation.’Mark HopkinsHopwoods Pharmacy___________________________

‘Our technician is spending about half an hour some days just trying to source mainly branded drugs from manufacturers. Naturally the customers blame the pharmacist for the shortages. When you factor in the fact that the prices of generics keep going up and down, it’s little wonder that the stress levels are rising!’Anonymous___________________________

‘I am absolutely drowning in paperwork. Between the clinical governance, the IT requirements and the audits, it’s really getting out of hand.’ Anonymous

Ian JenkinsDavies Pharmacy

‘I really think that there are too many ‘gimmicks’ involved in pharmacy now. It’s as if they’re trying to find jobs for people to do. After 30 odd years in pharmacy I’m finding that the workload is just going up and up and the remuneration is definitely on the downward slope.’Gareth RobertsDafen Pharmacy___________________________

‘I do feel the workload of the prescription volume has increased over the years, however this is our bread and butter and until we are paid adequately for other services this primary role of the pharmacy will continue. If we were remunerated in line with dispensing doctors, maybe we could afford to dispense fewer prescriptions and offer more services, at the moment time is the limiting factor on this. At the moment I have to employ a second pharmacist to undertake my MURs.’___________________________

‘The workload is increasing all the time, and much seems to be due to added paperwork for paperwork’s sake. Patient surveys to be carried out, internal and external audits to be completed, etc, etc. In this time of so much computer use, there is now more paperwork to be done and kept than ever before. Having to carry out some of these tasks is quite stressful and time consuming. Surely if patients are unhappy with a service, they walk with their feet. Do we really need to carry out a survey to see if this is happening and what we can do to improve the patient experience?’

Phil Bullen, Wellness Pharmacy

Chirav Dalal, Healthplus

Peter Rees, Tongwynlais Pharmacy

Pete Griffiths, Cwmfelin

OVER TO YOU...

Kevin Hope,Hope Pharmacy Ltd

WCR SURVEY

Little impact major confusionThe Medicines Act 1968 required a registered pharmacy business to be under the ‘personal control’ of a pharmacist where the sale and supply of medicines was concerned.

10 / SPRING 2012

While the idea of personal control was introduced, however, it was never clearly defined and this lack of clarity, along with limited case law, resulted in the emergence of the popular interpretation that a pharmacist is required to be physically present in the pharmacy at all times when medicines are sold or supplied to the public. The popular interpretation of the words ‘personal control’ had also led to anomalies. While a pharmacist must be present when a general sale list (GSL) medicine is purchased from a pharmacy, for example, no such requirement is in place for GSL items, which are purchased from filling stations or newsagents. As a result of this confusion, pharmacy owners and pharmacist had begun to question the restrictions of not only the pharmacist’s ability to leave the premises during business hours, but also the public’s access to medicines that they needed. Our survey shows that the effect of the Responsible Pharmacist initiative varies greatly from pharmacy to pharmacy. WCR looks at the background to the initiative, listens to what the pharmacists had to say and gets the legal lowdown from a top employment

...RP HAD SIMPLY INTRODUCED ANOTHER LOAD OF PAPERWORK AND ADMINISTRATION, WHICH HAD PLAYED CREATED YET ANOTHER TIME-CONSUMING EXERCISE...

lawyer...years ago, therefore, in response to public consultation on ways of making better use of the pharmacy workforce to improve the delivery of pharmaceutical services, 75 per cent of respondents called for changes to the ‘personal control’ requirement in the Medicines Act 1968. The result of this consultation was the Responsible Pharmacist initiative, which came into force in October 2009. These new regulations contained a reworded requirement that the ‘responsiblepharmacist’ ensures the pharmacy operates safely and effectively in relation to the sale and supply of medicines. While the old supervision requirements specified that a pharmacist must supervise transactions involving pharmacy and prescription-only medicines, the new regulations permitted the responsible pharmacist to delegate this task to suitably trained, registered support staff, whereby allowing these transactions to take place in the pharmacist’s absence. Eighteen months into the initiative, WCR asked pharmacists across the country exactly how much difference the Responsible Pharmacist initiative had actually made to the day-to-day running of

their pharmacy. Opinion on the RP initiative generally fell into two camps. Most pharmacists – particularly those with smaller businesses – believed that their day-to-day running of the pharmacy had not changed one iota despite the introduction of the new legislation. Others believed, however, that RP had simply introduced another load of paperwork and administration, which had played created yet another time-consuming exercise. Many expressed concern as to the increased burden of RP once extra initiatives, such as the 50

patients for CMS target, were in full flow. General concern was expressed among many pharmacists as to how far the ‘degree of responsibility’ would run and many felt that this would not be clarified until the first time a case would actually go to court!

AD TO COME

12 / SPRING 2012

‘YOU’RE NOT DOING YOUR JOB PROPERLY IF YOU’RE NOT RESPONSIBLE! AGAIN, I THINK THIS IS A GIMMICK...’GARETH ROBERTS, DAFEN PHARMACY

Q: Who is liable if something goes wrong while a Responsible Pharmacist is absent from pharmacy premises?

A: The Superintendent Pharmacist of a company has professional obligations to put systems in place in relation to any pharmacy owned by the company. The Responsible Pharmacist will have a legal duty to ensure the safe and effective running of an individual pharmacy. In terms of compensating a patient who is injured as the result of a dispensing error, claims are usually made against the owner of a business; and the claim will normally be passed on to the professional indemnity insurer to settle. If an individual pharmacist

has made an error and that pharmacist has his or her own insurance, a claim might be made against that pharmacist and dealt with by that pharmacist’s insurers. If there is a complaint of misconduct, the role played by any pharmacist will have to be examined to see if they fulfilled their respective obligations.

Q: If a pharmacy has a written rota, prepared in advance, showing who the Responsible Pharmacist will be, does this satisfy the legal requirement for a pharmacy record?

A: The Medicines Act 1968 requires the Responsible Pharmacist to make a record of who the Responsible Pharmacist is on any day at any time. This means that, as circumstances change, the record must be changed. For example, if the rota is used as the Pharmacy Record, and it shows that John Smith will be the Responsible Pharmacist on Wednesday 21 April 2012, the Superintendent or the pharmacy owner should ensure that the record is changed if, for example,

John Smith cannot get to the pharmacy on 21 April because he is unwell.

Q: Can a member of staff make entries in the Pharmacy Record, for example because the Responsible Pharmacist telephones to say he is stuck in traffic?

A: The Medicines Act says the Responsible Pharmacist must make the record of who the Responsible Pharmacist is. However, it would often be impractical for the Responsible Pharmacist to write in the record, if for example the Responsible Pharmacist is not at the premises. The requirement for the Responsible Pharmacist to make the record would only make sense if the Responsible Pharmacist can ask or instruct someone else to write in the record. That other person would be acting as the agent of the Responsible Pharmacist, making a record on the Responsible Pharmacist’s behalf.

Q: If a Responsible Pharmacist is absent from a pharmacy for up to two hours, must the reason for absence be written in the record?

A: The Royal Pharmaceutical Society’s guidance says it is good practice to record the reason forabsence, but the Medicines Act does not require the reason for absence to be recorded. The

responsible Pharmacist may be absent for any reason. The reason for absence need not be related to the pharmacy. RP has to be legally tested. It’s really just an extension of what the status quo was. It makes many pharmacists nervous but we need to have more to nip out.

Q: What is the position if the Responsible Pharmacist is a locum who says that he or she is entitled to be absent for up to two hours?

A: Locums are usually engaged to be present in the pharmacy to supervise the supply of medicines. It is always best to have a written contract with locums that spells out a locum’s responsibilities. If a locum is absent without prior agreement, it may well be the case that the locum is not entitled to be paid for any time away from the premises.

Q: All pharmacies (except for 100-hour pharmacies) have to provide essential services for 40 core hours each week. The actual core hours will be recorded in the PCT’s pharmaceutical list eg 9.00 am to 5.00 pm on Mondays to Fridays. Can the Responsible Pharmacist be absent during the 40 core hours?

A: The Department of Health’s view is that the Responsible Pharmacist should be present on the pharmacy premises whenever the pharmacy is open. However, my view is that there is no such requirement because: (1) There might be two pharmacists at a pharmacy. Pharmacist A is the Responsible Pharmacist and Pharmacist B is assisting with dispensing. If Pharmacist A leaves the pharmacy for up to two hours, Pharmacist B would still be able to supervise the supply of prescription medicines. This demonstrates that the need for a Responsible Pharmacist is not linked to the NHS Terms of Service.(2) The NHS Terms of Service do not require prescribed medicines to be supplied instantly on presentation.

The legal review:In light of this confusion, WPR spoke to David Reissner, a partner in law firm Charles Russell LLP, where he is Head of Healthcare (david. [email protected]), in a bid to clarify the situation for those pharmacists, who had expressed concern.

David ReissnerCharles Russell LLP

WCR SURVEY

‘Since the introduction of this role, I have noticed very little change. Although it allows a two hour window for pharmacists to leave the premises to carry out functions outside the pharmacy building, it still imposes the regulations on what can and can’t be done in the period of absence. The ability to leave the premises is useful if a MUR - or indeed a DMR - is to be carried out at home, or if a nursing home visit is required. But even this impacts on the business. If patients are leaving prescriptions in the pharmacy during this period of absence, then they are generally having to be delivered later, using other valuable resources.’___________________________

‘The RP regulations have increased work place pressure on all pharmacists who understand their implications. The increased documentation required for every procedure has added greatly to the day-to-day pressures.’___________________________

‘I believe that the responsible pharmacist register is an utter waste of time! Pharmacists are well aware of their daily duties and responsibilities. What then is the need for legally putting their name to it on a daily basis? With good SOPs in place and its

adherence, there definitely is no need for an extra ‘thing’ for an already work laden pharmacist to do!’___________________________

‘I don’t feel this has had a massive effect on the pharmacy as a whole, however my manager seems to have lost some confidence since the inception. He sells less fewer P meds and more often than not sends the patient to their GP. He also has an ACT working with him, though I am sure he checks a lot of her work, as he is scared stiff of having blame placed on him for any error that might not be his.’Kevin Hope___________________________

‘I’m on my own in the pharmacy so I don’t have to use it as I never leave the pharmacy. It’s not an issue here.’Denise LittlewoodDyffryn Pharmacy___________________________

‘You’re not doing your job properly if you’re not responsible! Again, I think this is a gimmick.’Gareth RobertsDafen Pharmacy___________________________

‘It really hasn’t had any impact on our pharmacy. I’m an independent, single-handed pharmacist, so nothing has changed other than the record keeping. The SOPs are a burden, but otherwise there’s no change.’

‘I think that the RP initiative has enhanced the responsibility of the locum. They were already responsible, but I think that the RP initiative has put greater emphasis on this.’Anonymous___________________________

‘I have no problems whatsoever with the RP initiative. I still wonder, however, what will happen if it’s ever tested in a court of law. It will be interesting to see how that pans out!’Anonymous___________________________

‘RP didn’t really make a big difference to us. We were doing it anyway, so it was simply the paperwork that had to be put in place. In my view it doesn’t make a difference to the daily routine, it just added to the paperwork! A big fuss over nothing.’___________________________

‘RP was just something shoved on to us whether we wanted it or not. It’s another ‘one size fits all’ initiative. I don’t think it was thought through and it needs reforming. It’s crazy to get the pharmacist to sign and it’s certainly not being used by the multiples. It’s just a cop out that is trying to plant blame on the pharmacist.’___________________________

‘RP has to be legally tested. It’s really just an extension of what the status quo was. It makes many pharmacists nervous, but we need to have more free time to nip out.’Anonymous

Pete Griffiths, Cwmfelin

OVER TO YOU...

Ian Jenkins, Davies Chemist Ystalyfera


John Hughes, Treforest Park



Kevin Hope,Hope Pharmacy Ltd

The Pharmacy Defence Association (PDA) has been a lone voice in calling for changes to the RP regulations ever since they were first proposed.

The body called for a delay to their implementation in 2009, supported by a petition of more than 5000 pharmacists’ signatures. Persistent PDA lobbying finally persuaded the Government to ask the RPS to commission the survey, in which the views of 8000 pharmacists were canvassed. Now, armed with these findings, PDA Chairman Mark Koziol believes that the PDA’s calls for changes are strengthened. ‘The results of this survey show what can happen when pharmacy bodies fail to properly engage with the issue of RP regulations and, because of their lack of support, these matters were left to fester,’ he told WPR. ‘The views of thousands of pharmacists have now shown beyond doubt that the Responsible Pharmacist Regulations are fundamentally flawed and that change is long overdue. Rather than try to make a silk purse out of a sow’s ear, we want fundamental changes. We want to look at the basics and consider new models of practice going forward. Common sense says the Department of Health’s consultation on supervision must now be delayed while we sort out these issues. Only then can we realistically develop a supervision regime to support that vision of practice. ‘Another way must be found to drive new roles, while also ensuring the safe supply of medicines.’

Mark Koziol

AD TO COME

WCR SURVEY

Easier access to treatment for common ailmentsMinor ailments is a ‘new’ scheme which is designed to provide easy access to advice and treatment for common ailments.

15 / SPRING 2012

Research has shown that up to 40 per cent of a GP’s time is taken up dealing with patients suffering from minor ailments. Under the new scheme, patients will be encouraged to consult a pharmacist, rather than their GP, for a defined list of ailments, which includes hay fever, warts, head lice, sore throats and indigestion. The pharmacists will then supply medication from an agreed list, give advice, or refer to the GP if necessary. Medicines will be given free of charge. This removes the payment barrier which can prevent patients choosing to see a pharmacist instead of their GP.‘A key commitment in our

Programme for Government is to make better use of pharmacists to improve access to services,’ said Health Minister Lesley Griffiths. ‘We are also committed to make GP services more accessible, and this scheme will help to meet both of these objectives.

‘By visiting pharmacists rather than GPs for minor ailments, patients will not need to make an appointment, but they will still be able to get any necessary medicine without charge. This will free up GP time for dealing with more complex conditions, and may also decrease waiting times for appointments. ‘Ultimately, the service will promote a more appropriate use of GP and community pharmacy.’

‘I BELIEVE THAT THIS REPRESENTS A GREAT OPPORTUNITY FOR INDEPENDENT PHARMACIES...’MARK GRIFFITHS

News of the minor ailments service has been welcomed by Mark Griffiths, chairman of pharmacy support group Cambrian Alliance. ‘I believe that this represents a great opportunity for independent pharmacies the length and breadth of Wales and should prove beneficial to all involved. ‘For the pharmacy it increases footfall and strengthens our role as a local healthcare provider. The GPs will have more time on their hands to deal with patients that court higher demand while the patient’s wellbeing is improved through an accessible, convenient and free service. ‘A remuneration package is still to be finalised, but feedback from our Scottish members suggests that it has been of great value and has helped to put them on the local healthcare map. ‘The common ailments highlighted within the scheme can be readily managed by a pharmacist and I’d urge all independents to engage with their communities now so they hit the ground running when it rolls out. ‘I say speak to your patients, make their job of registering with you as easy as possible and let them know what services will be available. ‘This is a great example of the Welsh Government placing faith in the clinical and medical awareness of pharmacists and testament to the sterling work that we carry out daily.’

Lesley Griffiths

Mark Griffiths

16 / SPRING 2012

‘We’ve always done these – nothing will change.’Anonymous___________________________

‘It’s a good idea, but realistically NHS bodies don’t want to put the initial investment into initiatives until they see how much money is going to be saved. I don’t understand why it’s not starting until 2013 – why can’t it start tomorrow?’Anonymous

‘I think that the minor ailments service is a fantastic idea. The only downer is that it’s going to be another 18 months before it gets on to the high street. The new services are great because the dispensing fees have fallen so much that we need to earn money in another way. It’s also good for the patients. It’s not fairly distributed either. Torfaen have been piloting this for three years, so that’s three years’ remuneration they’ve had.’

OVER TO YOU...




Sharing best practice?The Minor Ailments Scheme (NI) and the Minor Ailment Service (Scotland) have already been running for some years. We speak to two pharmacists to find out how the service works.In Northern Ireland, the Minor Ailments Scheme was rolled out across the province in 2005. Since then there have been several hiccups when the scheme was first rejected by the majority of community pharmacy contractors in NI, primarily over funding issues and then restricted due to alleged abuse of the system. Toome pharmacist, Anita Gribben is a great proponent of the minor ailments scheme, but doesn’t believe that it is promoted enough by either GPs or pharmacists. ‘I firmly believe that many patients are still very unaware of the whole service,’ she said. ‘In the pharmacy we still receive scrips from the GPs for items like Ibuprofen and these patients could easily be referred to us through the minor ailments

scheme. ‘As well as saving valuable GPs’ time and consultation, the scheme removes a burden from the doctors’ budget. But I believe that an even greater advantage of the scheme is the fact that the patient can receive comprehensive advice from the pharmacist, who is able to give of both their time and advice, often at more suitable hours than the GP. This is particularly helpful for working mums, who don’t have to take time off to go to the GP’s surgery, but can pop into their local pharmacist perhaps on a Saturday morning for professional advice. ‘Rather than restricting the scheme, I feel that it should be extended to cover other products and should be better by doctors – and other pharmacists! – in a financial climate, which is already coming under tighter budgetary controls.’

According to statistics published by ISD Scotland in June 2011,

Anita Gribben

‘An excellent way in which patients can receive prompt professional advice and also help. This puts the pharmacist at the forefront of patient care. Pharmacies in Wales should be able to give out antibiotics for minor water infections, for example, which a lot of PCTs in England have approved. More minor ailments and treatments should be on the list, which in turn will relieve the GPs more of their time.’

‘I believe this will be a great move as long as we are remunerated adequately and the necessary paperwork to ‘qualify’ for the service is not too long winded and inappropriate.’Anonymous___________________________

‘I’m currently doing the WCPPE distance learning course to find out what’s different about this service.’

790,509 people in Scotland were registered for Minor Ailments Service (MAS), with almost 1.7 million items being dispensed during the financial year 2010/11. The total number of items dispensed in Scotland in 2010/11 was 91.1 million, a rise of 2.4 per cent from 2009/10. The most commonly prescribed drugs by volume were aspirin and atorvastatin. Like Anita Gribben, Kevin Murphy from Wallyford Pharmacy, Musselburgh can see the positives that the service has to offer. ‘Patients can register at any community pharmacy of their choice, although it is recommended that this is their local or usual pharmacy. The registration process only takes a few minutes. A member of staff enters the required information on the PMR

system and a CP2 registration form is generated, which the pharmacist signs and the patient completes in much the same way as a standard prescription form. At the same time, a secure electronic registration request is sent to the central patient registration system via the ePharmacy message store and, if all the details entered are correct, the pharmacy receives a response confirming the patient as registered, usually within a matter of seconds. ‘As regards the future of MAS, well, that’s the big question! I think it will get confusing from the patient’s point of view when the pharmacies ask them to register separately for MAS and the Chronic Medication Service. I think the level of remuneration is fair enough, although the fact that patient registrations lapse after twelve months is a challenge when it comes to getting into the next capitation band. It often feels as if we’re taking two steps forward and one back!’

Kevin Murphy

AD TO COME

18 / SPRING 2012

Great idea.....when it works!When it comes to the new Discharge Medicines Review Service, the gap between the theory and the reality seems to have widened a little……

‘Since the introduction of the DMR, I have carried out several and can see the benefits that they provide for the patient. It is quite a long process though, and if the patient is on monthly prescriptions can take two months to complete, and if on bi-monthly prescriptions, will take four months to complete. The process is much better when related to patients that receive medication in monitored dosage systems. These are the people more likely to be admitted to hospital, and a DMR can be completed sometimes within two weeks of discharge.’___________________________

‘This multidisciplinary team service is a good idea, but only if thoroughly followed by all involved. This is not always the case. We have come across patients whose discharge letters do not get to their GP surgeries at all, creating time delays in correct prescriptions being generated for amended medication records.’ ___________________________

‘Although it’s in its infancy and while I am a firm believer in the aspiration, I strongly feel that delivering the DMR to the targeted levels in the current financial year is a non-starter. We have been set up to fail as far as



Steve Newbury, Steve Newbury Pharmacy

When it was first introduced last November, the NHS Wales ‘Home from Hospital’ medicines service was warmly welcomed by community pharmacy.‘It is an important breakthrough in closer working between secondary care and primary care,’ said Community Pharmacy Wales (CPW) Chair, Ian Cowan, at the time, ‘and will directly benefit the thousands of patients in Wales who, every year, are readmitted to hospital because of medication errors. ‘This service will draw on the important skills and expertise of pharmacists, who are the medicines experts. It will deliver

significant benefits for patients and for the NHS by reducing the number of unnecessary hospital re-admissions and help to tackle the problem of medicines waste. Effective communication between healthcare professionals in primary and secondary care is the key to making this service work for the patient.’ The theory behind the new service is certainly sound enough. The Discharge Medicines Review (DMR) Service, which is designed to ensure that people returning home after a stay in hospital or other care setting continue to receive their correct medicines, will enable hospitals, nursing and

care homes - as well as patients themselves - to take or send a copy of the Discharge Advice Letter, which is currently only sent to their GP, to their local pharmacy. The pharmacist then checks that future prescriptions issued by the surgery include all the medication the patient needs to treat their various conditions. Prior to the service coming in at the end of last year, the Discharge Advice Letter was given to the patient when they left hospital or nursing home and a copy was sent to their GP. Studies had, however, shown that at least a quarter of the letters failed to reach the surgery within two weeks, by which time a new prescription had been issued containing incorrect medicines. This often resulted in patients having to be re-admitted as a result of not taking the correct medication. The DMR service provides for an extra copy of the letter to be produced for use by the patient’s nominated pharmacy. The pharmacist then: l arranges to meet, or have a confidential telephone conversation with the patient or the patient’s nominated relative, carer or representativel checks to make sure that the medicines included on the first prescription issued by the GP following discharge are those which the patient was prescribed by their hospital consultant and includes any medication the patients needs for any chronic or other conditionl makes sure that the patient understands what each medicine is for, what it does and its effectsl follows up that consultation with a second conversation some ten days later to ensure that the patient is benefiting from the medicines being taken. While most of the pharmacists WPR spoke to thought DMR was a good idea, most are finding that the glitches in the system are not good omens…..

OVER TO YOU...

WCR SURVEY

‘We’ve always done these – nothing will change.’Anonymous___________________________

‘It’s a good idea, but realistically NHS bodies don’t want to put the initial investment into initiatives until they see how much money is going to be saved. I don’t understand why it’s not starting until 2013 – why can’t it start tomorrow?’Anonymous___________________________

‘I think that the minor ailments service is a fantastic idea. The only downer is that it’s going to be another 18 months before it gets on to the high street. The new services are great because the dispensing fees have fallen so much that we need to earn money in another way. It’s also good for the patients. It’s not fairly distributed either. Torfaen have been piloting this for three years, so that’s three years’ remuneration they’ve had.’___________________________

‘An excellent way in which patients can receive prompt professional advice and also help. This puts the pharmacist at the forefront of patient care. Pharmacies in Wales should be able to give out antibiotics for minor water infections, for example, which a lot of PCTs in England have approved. More minor ailments and treatments

should be on the list, which in turn will relieve the GPs more of their time.’‘I believe this will be a great move as long as we are remunerated adequately and the necessary paperwork to ‘qualify’ for the service is not too long winded and inappropriate.’Anonymous___________________________

‘I’m currently doing the WCPPE distance learning course to find out what’s different about this service.’___________________________

‘It’s a wonderful idea to free up the GPs’ time. It will hopefully encourage patients to use their pharmacies more.’___________________________

Feedbackpositive...Jonathan Burridge, Numark’s Pharmacy Development Manager for Wales comments...‘It’s been just over three months since the new DMR service was rolled out to contractors in Wales. When I’ve been visiting our members over the last few weeks, we’ve talked about the service and the feedback to date has been broadly positive. It is apparent that, on the whole, the majority of contractors welcome the opportunity to engage with specific ‘at risk’ groups, to provide a professional three part consultation to maximise revenue and retain patient loyalty. ‘This investment in services will enable contractors to show a ‘willing and able’ model which supports the service agenda. Up until now, contractors have been providing the service for free and the availability of funding should ensure that contractors will invest in their staff in order to access this revenue stream. ‘It is really important that pharmacists communicate the advantages of the discharge service to their patients, from within their pharmacies and via marketing vehicles to their local communities, eg, leaflet drops, newspaper advertising, posters etc. What is also vital is that contractors engage with other stakeholders, including their local GPs. The co-operation between professions will ensure that patients comply with their medication and will in turn reduce wastage to the NHS and

improve patient outcomes. ‘The £1400 implementation payment for just ten DMR services before the 31st March 2012 demonstrates the commercial value in supporting this service, but it also shows a commitment to engaging with the service agenda at a local level. ‘Between now and the end of March contractors could be funded up to £5,100 by providing this service. (Based on the maximum 100 DMR services and includes the implementation fee.) ‘Consider how many OTC lines you would you have to sell in order to bring in £5100 in profit? This service is simply formalising what you already do – can you afford not to do it?’

Jonathan Burridge, Numark

2011-2 is concerned. There has been too little time provided for pharmacists to earn the targeted income. On a separate note, the recent introduction of written consent as an obligation to undertake an MUR is an additional step, which any professional would hesitate to argue with. However, these incremental additional burdens now have a very significant impact at the sharp end delivery of care.’___________________________

‘While I believe that, in theory, the DMR is a good idea, the simple fact is that you have to interview patients for this and, since we rarely see patients post-discharge (since they’re generally housebound), time restrictions do not give us the freedom to call at the house of everyone being discharged from hospital.’___________________________

‘DMR is a wonderful service in theory, which has been undermined by red tape and cash-strapped local health boards. A DMR is of greatest benefit to those who are infirm or unable to control/understand their medicines. These patients often receive care. It is farcical that the DMR can be completed with the carer, yet the DMR can not be claimed unless the patient themselves sign the authorisation form. I have had two instances where the patient has become confused/distressed when faced with signing a document which they do not understand, leading to an inability to claim for the service we have performed. Some LHBs have placed restrictions on the DMR service, preventing the patient discharge info from reaching pharmacies (the hospital pharmacist decided who may benefit from a DMR and provides the discharge info accordingly).

Quite how a hospital pharmacist can guarantee/know that a patient’s surgery will provide prescriptions for the correct medication is a mystery.’___________________________

‘DMR is all too complicated. Our hospitals are working out OK but the form filling is a nightmare. I think that’s why so few are taking it up.’Gareth RobertsDafen Pharmacy___________________________

‘We’re certainly not going to get our ten by the end of April! We’re not getting the paperwork through from the hospitals but I believe that the service from the main hospitals is very good.’Anonymous___________________________

‘I think it’s an excellent idea, but sadly it’s not happening. We’re not getting the letters from the hospitals. They’ve reduced the numbers of DMRs that we need to have but we still won’t make it. We simply don’t know when the patients are discharged.’___________________________

‘We’ve had a disappointing uptake so far. I think it’s an unnecessary provision for patients being transferred from one sector to another.’Anonymous

Chris Brewer, Kevin Thomas Pharmacy

Ian Jenkins, Davies Pharmacy

John Hughes, Treforest Pharmacy

20 / SPRING 2012

Little wonder then that the Listening Friends service, provided by Pharmacist Support, has never been so busy! From 1841 to 2006, Pharmacist Support was the Benevolent Fund of the Royal Pharmaceutical Society of Great Britain (RPSGB). In 2006, however, the group became an independent charity and separated from the Society, primarily to highlight their independence from the Society and to make pharmacists feel that their concerns and worries were being addressed in a confidential manner. ‘Once we had become an independent charity,’ said Diane Leicester, Charity Manager at Pharmacist Support, ‘we decided to go straight to the people, who mattered most to us, ie, the pharmacists themselves. Once we had rebranded and expanded, we carried out a survey of pharmacists to see what exactly they were looking for. What came back to us very strongly – and immediately - was the fact that a stress helpline was definitely required to deal with debt problems, addition support and financial assistance. ‘As a result of the findings, we established the Listening Friends helpline: a confidential listening service for pharmacists, who are experiencing stress. The service is delivered by a dedicated and experienced team of volunteers pharmacists who, because they share the same professional background, are uniquely placed to understand the specific pressures affecting those in the profession.’ During its first year as an independent body, the charity was

Listening Friends indeedWith increasing workloads, category M clawbacks and new initiatives popping up every other day, it’s little wonder that pharmacists’ stress levels are continuing to spiral.

‘EVERYBODY IS MOANING ABOUT THE WHOLESALING OF MEDICINES OUT OF THE COUNTRY CAUSING ALL THE SHORTAGES AND THE PHARMACISTS ARE BEING BLAMED FOR THIS...’PHIL BULLEN, WELLNESS PHARMACY

immediately called into action on a hitherto unseen basis. In 2008, the amount of help provided by Pharmacist Support was up by almost 50 per cent on the previous year, as pharmacists and their families turned to the charity for support with money, home and work-related problems. Calls to its Listening Friends helpline were up by 20 per cent on 2009 from 309 to 347, with three quarters of these relating to employment issues, such as being bullied at work, pressure to skip lunch breaks, challenging targets, discrimination and

harassment. ‘Calls to the Listening Friends Service cover a range of issues that generally fall into two main categories,’ said Diane Leicester. ‘There are those of a professional nature and those dealing with domestic and social issues – although in many cases it can be difficult to separate the two. Professional problems include employment issues such

as contracts, relationships with others at work, stress at work, discrimination and harassment. Domestic and social problems cover family matters such as relationship breakdown, divorce and bereavement, financial problems, illness and addiction. ‘In total last year the charity provided more than 800 direct acts of support to individuals in need and there were over 4000 interactions with people seeking information or assistance via our website.

Diane Leicester

WCR SURVEY

‘In terms of a breakdown of our figures by region, the following reflects the numbers of people In Scotland, Wales and England whom we supported financially in 2010.

‘In 2010, referrals to our specialist advisers at the CAB for debt, benefits and employment advice increased (with total gains achieved for all assisted worth in excess of £400,000). We provided almost £180,000 worth of financial assistance and assisted 36 pharmacists seeking help or information with addiction issues. Our Listening Friends volunteers made 280 calls to pharmacists and their families struggling with stress (both professional and personal). ‘The expansion of the charity’s services has possibly meant that more people are calling the general enquiry line first, as the new services are perhaps addressing some of the issues causing stress (debt, employment law, benefits advice, general information requests). Of enquirers who were referred on for specialist advice, 42 per cent were referred for employment advice and a similar number for benefits advice with the remainder being referred for help dealing with debts. Professional issues were also by far the most common focus of Listening Friends calls. In addition, debt-laden younger pharmacists aged between 30 and 45 emerged as a group experiencing particularly high levels of stress. ‘In addition to the expansion of our services in the last few years,’ said Diane, ‘we also have a partnership with Action on Addiction for pharmacists with addiction issues. Action on Addiction is one of the

country’s top addiction charities, providing specialist addiction counselling and treatment. The service is entirely confidential and pharmacists are supported through treatment.’ ‘We also recently expanded our information service and added six new factsheets including bullying, options for those who have failed their pre-reg exam for a third time, information for prereg trainees, assistance with finding funding, help with stress and returning to practice. These factsheets are available on our website at http://www.pharmacistsupport.org/downloads.asp along with a directory of useful organisations.’ If the workload involved in pharmacy today continues to increase at the current rate, it would seem that the Pharmacist Support team are in for an increased workload themselves!

For more details visit www.pharmacistsupport.org or call the general enquiry line on 0808 168 2233.

To access the Listening Friends service call 0808 168 5133.Health Support Helpline (addiction support): 0808 168 5132

Signs of stressPHYSICALl Allergies l Asthma or breathlessnessl Chest pains l Constipationl Cramps l Fainting spellsl Nausea l Tendency to sweat

EMOTIONALl Loss of interest in others l Aggressionl Anxiety l Fearing failurel Feeling neglected l Increased irritabilityl No interest in life

BEHAVIOURALl Avoiding difficult situations l Craving for foodl Difficulty sleeping l Drinking and smoking morel Restlessness l Loss of appetite

TREATING STRESSl List the things that you need to do l Prioritise theml Decide what you need to do yourselfl Ask someone else to do the other thingsl Make a daily, weekly and monthly timetablel Decide what doesn’t need doing and take it off your list

Now your tasks are in some order, this will help you regain control over everything you need to do.l Avoid nicotine, alcohol and caffeinel Work off stress with physical activityl Make sure you get enough sleepl Manage your timel Accept offers of practical helpl Do one thing at a timel Talk to someonel Use relaxation techniques

FOR WORK STRESS:l Work regular hours and take all the breaks and holidays you’re entitled tol Make your work environment as comfortable as you canl Take a day off work, chores, family, or anything else that puts pressure on youl Know your own limits – don’t be too competitive or expect too much of yourselfl Let off steam in a way that causes no harm (shout, scream or hit a pillow)l Use any available counselling or support

England: 134 (88%)Scotland: 13 (9%)Wales: 5 (3%)TOTAL: 152 152 individuals received financial assistance from the charity in 2010.


The pilot was conducted in ten Numark pharmacies who were asked to recruit patients to a support service and perform interventions. Participating pharmacies were given training to ensure they had the knowledge and skills to engage with this specific patient group. The interventions involved giving key messages about the correct use of the medication and were delivered at weeks one, two, four and eight both face to face and via the telephone. As the pain medication was administered via a patch, a key intervention was the correct application of this. At week eight, over 77 per cent of patients were still adherent to treatment, compared to the 37 per cent of

patients at week eight, who did not receive pharmacist intervention. In addition, at each intervention the pharmacist was asked to collect the patient’s pain score. As the graph below shows, the average pain score dropped from eight to two demonstrating that increased adherence to pain medication leads to a reduction in the patient’s pain. ‘We are all aware that inappropriately used medicines cost a significant proportion of the NHS budget through increased GP consultations, hospital readmissions and medicines’ wastage’ said Mimi Lau, Numark’s director of pharmacy services. ‘It is also recognised that pharmacists could be used more effectively to improve patient adherence that can capitalise on the many benefits community pharmacists have in reaching patients. But the health outcome for the patient is paramount and this service demonstrates that pain can be lessened if the pharmacist performs simple interventions that increase adherence. ‘Although this project was small, it builds on our previous work on adherence and, together, they provide compelling evidence for the role of the pharmacist in ensuring patients take their prescribed medication. We are keen to work with more pharmaceutical manufacturers on future projects.’ Numark has just embarked on its largest patient support programme to date. In February 2012, 200 member pharmacies began to recruit patients to a large scale pain programme which will aim to recruit between 800 and 1000 patients.

Numark has revealed that its latest patient support project on pain management has increased adherence to medication by 40 per cent and has lead to significant reductions in pain scores amongst participants.

uPAIN

Patient support programme increases adherence

Mimi Lau

WelshPharmacy Awards 2012The Welsh Chemist Review is proud to announce the launch of the fourth Welsh Pharmacy Awards. Last year’s event was a tremendous success – for both winners and attendees alike – and we hope that this year’s ceremony will not only build upon that success, but will surpass it.The Awards evening celebrates those in pharmacy, who have not only excelled in their chosen field, but who have made a difference to the profession. The evening provides an opportunity to reward high achievers and celebrate all that is inspirational within pharmacy in Wales. The Awards ceremony, which will take place on Thursday 26 April in Cardiff City Hall, will no doubt match last year’s success.

This year there are nine prestigious award categories:l Pharmacist of the Year (Independent)l Business Development of the Year (Independent)l Medicines Counter Staff Trainingl Asthma Project of the Yearl Delivery of Pharmaceutical Carel Education and Self Development for the Future of Pharmacyl Managing Substance Misuse in the Communityl Innovations in Pharmaceutical Public Healthl Lifetime Achievement

Asthma Project of the Year Award 2012LAURA ELLISThe Co-operative Pharmacy, BarryFigures from Asthma UK show that over five million people in the UK rely on the use of inhalers to treat asthma and other respiratory illnesses. Through a partnership with the Co-operative Pharmacy, GSK and third party specialist in waste, TerraCycle UK, Laura and her team have been able to create an innovative initiative that benefits the environment, their patients and customers. ‘Complete the Cycle’ is the first respiratory inhaler recycling scheme of its kind in the UK, enabling customers to recycle their inhalers in The Co-operative Pharmacy branches.

CRAIG HINKS, New Inn Pharmacy, Pontypool ANDY EVANS, JDS Evans Ltd. Gwent

Craig and Andy ran a trial project for Aneurin Bevan Health Board across two sites with the help and support of Mike Curson at Aneurin Bevan HB. The initiative aimed to teach patients how to use their inhalers more efficiently, helping them to effectively deliver the correct dose of their medication to the lungs, and therefore improving patients’ asthma control. Pharmacy team work has been essential for the success of this initiative, with pharmacy support staff helping to identify suitable patients from the PMR records at the point of dispensing.

RICHARD GRIFFITHSGriffiths Pharmacy, FlintshireThe pharmacy serves a small local community and the wider town of Queensferry, including some remote village locations and a travellers’ community. Due to the industrial nature of the area, the pharmacy team recognised the need for asthma to be supported. They therefore provided inhaler suitability checks for asthmatic patients and inhaler technique training. Through medication usage review service they identified several unstable asthmatic patients and in these cases worked with the local surgeries to ensure these patients had an emergency supply of both antibiotics and oral steroids.

SPONSORED BY NAPP PHARMACEUTICAL HOLDINGS LTD

BIBI ADEBANJO & ASDA PHARMACY TEAMPontprennauThe overriding project of the ASDA project was to make sure that all patients on asthma-related devices really understood the importance of taking their medicine correctly as described by the GP and as directed. All ASDA pharmacists attended individual training events run by GSK. These sessions were interactive, giving a real insight into the possible long-term harm patients could do to themselves by not using their medication correctly. There were talks from GPs, practice nurses and fellow pharmacists showing how much of a lifestyle improvement could be gained by better asthma control.

24 AWARDS FINALISTSWELSH PHARMACY AWARDS 2012

2012Welsh Pharmacy Awards

NEW

AW

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Business Development of the Year Award 2012(Independent)

JANE SOLTYSWashington Pharmacy, Penarth Since the 1950s, Washington Pharmacy has served the people of Penarth from small, cramped and outdated premises. Major investment was therefore put into upgrading the premises and revitalising the business. Washington Pharmacy was transformed into a modern, attractive and inviting pharmacy with state of the art facilities for both staff and patients, with doors opening in May 2011. This major expansion doubled the retail floor area and created new consultation and therapy rooms. As a result, Jane is now able to offer greater patient and customer comfort, and enhanced access for elderly and disabled people.

MADHVI & CHIRAV DALALHealth Plus Pharmacy, Pontnewynydd

Madhvi and Chirav realized that they needed to develop a strategy to analyse the business every four to six months, so they devised a plan and went in guns blazing to market the pharmacy and its services. Their main objective from the word go was to bring the community together, so they created a large community area with sofas and armchairs. They also put in a free lending library where customers could not only borrow books but could stay to read them over a free cup of tea or coffee. As a result, the pharmacy has become a local hub of information and social networking, especially for the elderly.

RICHARD GRIFFITHSGriffiths Pharmacy, Garden City, FlintshireThe business, which Richard took over last year, had not been developed for thirteen years. The reputation of the business was low and the general opinion of the pharmacy was a negative one, so Richard set out to raise the profile of the pharmacy business in the community. The annual patient questionnaire was re-written to gather clear feedback on current service and also to gather ideas for new services. To date, MURs have been set up and over 360 delivered. All local surgeries have also been visited on a number of occasions to build relationships and develop partnership working.

SPONSORED BY AAH PHARMACEUTICALS

STEVE NEWBURYNewbury Pharmacy, MumblesSteve’s pharmacy operates in a highly competitive environment with another five pharmacies within a mile radius, so he can’t afford to be complacent. Steve therefore created a range of Therapy Centre facilities, comprising at least three treatment rooms to support increased specialisation and expertise in skincare retailing and therapies, utilising first floor and ground floor space. The sales area was refurbished to support a change in merchandise inventory, resulting in a high quality environment for the sale of premium and specialist skincare products and fragrance. An enlarged dispensary was also put in place to accommodate larger prescription volumes, particularly improved dedicated facilities for MDS preparation to support the community elderly care service.


AWARDS FINALISTS 25WELSH PHARMACY AWARDS 2012

WINNER ALISON SPARKES, MEDICINE CENTRE, NEATH

“Welsh pharmacy has come a long way and it’s great to see the number of awards. Just very, very pleased – we try to develop and do the best we can so it’s great to hear the judges’ comments. Very humbled.”

LAST YEAR’SWINNER

Medicines Counter Staff Training Award 2012DANIELLE DURHAMLloydspharmacy, Head OfficeAt Lloydspharmacy, counter staff are currently required to complete their HealthCare Assistants Course in order to offer advice and recommendations to the public. In the last year, the company has developed its counter staff further with two training campaigns focusing on up-skilling them in two important areas: diabetes and hypertension. The first training programme was centred around the new diabetes risk assessment, which was introduced to help counter staff more confidently discuss and advise on the condition, as well as encouraging the public to think about their risk of developing the condition and how they could reduce it. Staff were also trained to deliver diabetes tests to those that needed it. This was timed to coincide with the Diabetes UK Cymru campaign.

CAROLINE DAVIES & HAYLEY HUGHESRowlands Pharmacy, Welshpool, Powys

The RPS have an expectation that ‘education and CPD should result in a pharmacy team with knowledge, skills, attitude and values that enable them to discharge their responsibilities to patients and other users of pharmacy services, colleagues and society in general’. Rowlands aims for a holistic approach to training which equips staff to provide support and guidance on a broad range of healthcare issues. Two members of staff in particular - Caroline and Hayley - have proactively embraced the training initiatives and pioneered work in their local community with a people-centred approach. They have extended service provision into providing advice and support on sensitive issues such as bowel cancer and incontinence, and are both keen to ensure they have invested in their own personal development to equip them for their roles in the community.

NICOLA JAMES & LLOYDSPHARMACY TEAM Morriston, Swansea

As a team, Lloydspharmacy Morriston has always prided itself on staff training and development. Each member of staff has an annual performance review, so that personal development and training can progress and unique goals and achievable projects can be set up to further every individual’s skills and knowledge. All staff need to be qualified to perform their roles, so training begins on the first day of employment, when they undergo a full and comprehensive induction that covers everything from health and safety, to selling medicines, till operations, stock and ordering, etc. Even though the counter staff have completed their HCA training, their learning does not stop as they are actively encouraged to attend relevant training days/evenings.

SPONSORED BY RECKITT BENCKISER



WINNER RICHARD GRIFFITHS, MAYBERRY PHARMACY

“I was absolutely delighted. Very surprised to be honest. Pharmacists are led by the life of the company. The success is the result of the investment that they put into it and people know us because of them, so it’s critical that we look after people. We were delighted to receive this award.”

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Pharmacist of the Year Award 2012 (Independent)

ALISON SPARKES, Medicine Centre, NeathAlison believes that the biggest dilemmas pharmacists face daily when dealing with patients are time and resources. To achieve best use of these and to offer clients a positive and rewarding experience, it is vital that the pharmacy maximises efficiency whilst keeping the human touch (which should have no such constraints). Time can be achieved by organisational efficiency. Alison is a big fan of technology, but also believes it is important that it doesn’t make a bad system worse! Pharmacist time can be freed up by developing the team and this is something Alison has been passionate about for a long time, attaining Investors in People in 2000 and constantly developing team members. Alison has been developing her pharmacy services since 2004 and recently celebrated the opening of her Wellness Centre.

MADHVI & CHIRAV DALAL, Health Plus Pharmacy, Pontnewynydd

Just as Madhvi and Chirav were about to purchase the business in December 2005, the Local Health Board announced that the nearest GP surgery was being shut down and that all 4000 patients were to be dispersed among the neighbouring towns. The Dalals decided to take a gamble and purchase new premises. Since then, they have always had to put in a lot of time and effort into maintaining their clientèle, particularly in light of a new Tesco store nearby and the fact that some of the surgeries are located very close to other pharmacies. To date they have done this by making window displays particularly appealing, by liaising with the local school to arrange structured after-school activities, and by offering an aggressive, but customer-friendly marketing initiative.

DANIEL ROSSER, D R Rosser Ltd, Monmouth, Gwent.One of Daniel’s primary interests lies in trying to ensure that patients receive the most from their medication; particularly with preventative medications. He aims to ensure that patients, who are administered new medications, maintain perseverance through the negative side effects in order to benefit from the medication in the long-term. With the pharmacy being in a rural location, and having a number of isolated and potentially vulnerable patients, the pharmacy also has to be extremely flexible with deliveries. Where patients are unable to access the first floor consultation room, a service has been offered outside of opening hours to ensure that their needs are met. This is something that takes place on a regular basis and is extremely appreciated by the patients.

SPONSORED BY CAMBRIAN ALLIANCE & WPR



WINNER DON WILKES, MENDUS PHARMACY, PEMBROKE “I was shocked and delighted. It’s a nice tribute to the team who are behind us.”

LAST YEAR’SWINNER

Delivery of Pharmaceutical Care Award 2012GARETH ROWLANDS, Boots UK, Cwmbran Boots recognise that there are many vulnerable patients in the community that require additional help in making them compliant with their prescribed medication and that some of these patients are at risk of being frequently admitted to hospital or have other medicine management issues. In order to investigate a new model of provision and give the best possible care to all our its patients, Boots decided to build a new purpose-built dispensary in its Cwmbran store and consolidate the existing MDS services being provided by Boots pharmacies in the Torfaen/ Blaenau Gwent areas into one central dispensing location. This has removed workload from the store and has allowed store teams to concentrate on providing the best possible care to their other patients.

DON WILKESA E Petersen Ltd, Mendus Pharmacy, PembrokeThrough a combination of Medicine Use Reviews and the introduction of services such as blood glucose monitoring (BGM) and blood pressure monitoring, Don and his team pride themselves on the high quality of pharmaceutical care that they provide for their patients. In 2011/2012 the pharmacy completed 400 Medicines Use Reviews which were focused on medicines used to treat conditions such as cardiovascular disease, asthma and arthritis. For patients prescribed anti-hypertensive medication, Don will often check a patient’s blood pressure, particularly if this has not been taken for over a year. During the MURs he also checks for synchronisation issues and, where this is a problem, will attempt to resolve this issue. Where compliance is a problem, he discusses with the patients how they could improve this themselves or how the pharmacy can help them.

RICHARD GRIFFITHSGriffiths Pharmacy, Garden City, FlintshireThe focus of Richard’s pharmacy has been to place patient care at the centre of everything the pharmacy does. To this end he has gathered feedback from patients through surveys both within and outside the pharmacy. This has given an insight into the local needs of patients which has allowed the team to develop patient-centred approaches. One example was a severe head lice problem amongst children at the local school, which led to the pharmacist visiting the school and giving a presentation on head lice and its causes. Due to the industrial nature of the community the pharmacy serves, a high usage of inhaled therapy was identified, which led to a supportive approach to inhaler use involving technique counselling and inhaler suitability reviews.

SPONSORED BY QUANTUM PHARMACEUTICAL



WINNER JOHN DAVIS, LLOYDSPHARMACY, PORT TALBOT

‘I was shocked! We beat all targets, we beat all projections, and I didn’t know where it was going to end. At one stage we were 94 per cent up on last year and ended the year 78K up on last year. This award was in recognition for the team, I’m just the man who collected the trophy.’

LAST YEAR’SWINNER

Managing Substance Misuse in the CommunityAward 2012STEVE NEWBURY, Newbury Pharmacy, Mumbles, Swansea Steve Newbury’s Pharmacy is involved with the treatment of substance misuse through three separate programmes; a syringe and needle exchange scheme, which has run for the last 20 years, a supervised consumption of methadone and buprenorphine service for more than fifteen years and, for the last 18 months, a novel shared care prescribing service through the SIPPS scheme (Swansea Integrated Pharmacist Prescribing Service). The latter scheme involves Steve operating a supplementary prescribing service as part of a shared care arrangement with the local Community Drug and Alcohol Team for clients who are stabilised on a maintenance opioid regime so as to reduce waiting times for new clients coming in to CDAT. In order to be able to offer the SIPPS scheme, Steve undertook the RCGP Part 2 Certificate in Substance Misuse followed by qualifying as both a Supplementary Prescriber & Independent Prescriber.

ANDREW MALONEY/ANNA ASPROUBoots UK, Wood St. Cardiff The pharmacy team in the Wood St store has been providing a substance misuse services to patients in Cardiff for many years and has developed both a real rapport with their patients and a close and effective working relationship with the CAU and the GPs providing shared services. The team currently provides a service to around 70 clients and an additional 30 patients access the pharmacy on the weekend via the Crime Reduction Initiative (CRI) administered through the courts. Recently this has been augmented by the store acting as a pilot site for the CAU in supplying Naloxone on a PGD. All staff have been given training in customer care, with a particular emphasis on treating patients with drug problems in a caring and sympathetic way.

PHIL BULLEN, Wellness Pharmacy, Cardiff Wellness Pharmacy offers a complete substance misuse service package: ordering of repeat prescriptions via shared care; discussing treatment options with CAU and daily and weekly consumption options with regular and ongoing client health checks. The development of the service has evolved over the past ten years. The pharmacy technician is heavily involved with the service and, along with the pharmacist, constantly updates the pharmacy’s knowledge on the variety of substances being misused within the community in order to provide both pharmaceutical advice and ‘street’ advice. The pharmacy has access to the internet to view appropriate discussions and training so that the team is not ‘cocooned’ within the confines of the pharmacy.

SPONSORED BY MARTINDALE PHARMA



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Education and Self Development for the Future of Pharmacy 2012ANDREA LIVINGSTONThe Co-operative Pharmacy Head OfficeIn 2010, The Co-operative Pharmacy began a campaign to increase the capability of its management and leadership teams. The company began the project by setting up a workshop with ten of its best performing Branch Managers, during which they investigated what made these managers successful. The workshop revealed that it was the way in which the Branch Managers approached their day-to-day role and responsibilities that made the real difference. In her role as Learning and Development Manager, Andrea was responsible for much of the training that the managers subsequently underwent. Each group was given one or more ‘challenges’ to take away from the training. The challenges were then reviewed at the next session and, overall, the trainees have reported great results and a shift in confidence.

DEBBIE CROCKFORD & CLAIR EDGERowlands Pharmacy, Preston Brook

In 2011, area manager, Debby Crockford from Portsmouth, who had been very involved in Healthy Living Pharmacy (HLP) initiatives, proposed a new initiative to Rowlands MD, Kenny Black, to roll the HLP concept out nationally across Rowlands pharmacies. Debbie subsequently became HLP manager. Clair Edge and the service facilitator team all trained and completed their Level 2 RSPH Understanding Health Improvement (Healthy Living Champion qualification) and 40 staff, from 24 pharmacies in Wales also trained and achieved the same qualification. Debbie also invested in discussions with Community Pharmacy Wales re introducing the HLP concept to Wales by 2012. North Wales is starting to roll out HLP and in order to ensure they ‘get it right’, they refer to both the Portsmouth model and to Debbie’s national experience.

SAM GHAFARBoots, Wales Office, CardiffBoots UK believes that the development and education of its professional team is vital in delivering the highest quality patient care through its pharmacies. The company realised that Discharge Medicine Reviews were completely new to its healthcare teams and was concerned that there were no existing training materials that the company could use. Sam Ghafar investigated Boots UK’s readiness for implementation of this key Welsh Assembly service and then worked to set up an implementation program for the DMR service. Sam also carried out a hospital mapping exercise and set up a network of ‘DMR lead pharmacists’, so that a local pharmacist was identified in each Health Board area to coordinate visits to both GP surgeries and pharmacy departments in their local hospitals to explain the benefits of the new DMR service.

SPONSORED BY PFIZER



WINNER PAUL HARRIS, BOOTS UK

“I was totally shocked but quite excited. I’d been sat there all night and never thought….but I think we did do quite a lot of work revolved around EHC and it’s nice to have that recognised. Personally, I was just delighted.”

LAST YEAR’SWINNER

Innovations in Pharmaceutical Public Health Award 2012STEFFAN RHYS JOHNRowlands PharmacyBarmouthWith the number of anti-depressant prescriptions increasing it had become apparent to Steffan that the NICE first line treatment of cognitive behavioural therapy (CBT) was not being offered in the local area so, when the Welsh Assembly Government offered a Rural Health Innovation Fund, he took the opportunity to offer computerised cognitive behavioural therapy through pharmacy. All members of the pharmacy team were involved in the development of the new service. An initial team meeting concentrated on looking at anxiety and depression, educating staff about the signs and symptoms and the need for referral to the pharmacist when patients presented with these symptoms. Following on from this, the team looked at the recommended treatment options and came to understand exactly what CBT had to offer to patients.

DON WILKESA E Petersen Ltd, Mendus Pharmacy, Pembroke The pharmacy currently participates in the various areas of the Public Health programme that have been implemented. These include the emergency contraception enhanced service, the needle exchange enhanced service, a blood pressure monitoring service, a cholesterol testing service and a cardiovascular risk assessment service. These services are fee paying services and can produce information to the patient on their total cholesterol, HDL cholesterol and their ratio of TC:HDL in isolation or as part of a CV risk assessment. Following completion of the RCGP Certificate in the Management of Alcohol Misuse in Primary Care, Don is now able to undertake short questionnaires to identify alcohol use with patients, particularly during MURs. The results of the questionnaire then determine the level of brief interventional advice that may be suitable for the patient from the pharmacist.

CAROL ANN HUDSONLloydspharmacy, GelligaerCarol Ann’s predominant focus this year has been on Type 2 diabetes awareness and early identification, but has also included other areas such as blood pressure and healthy living. She started out by making contact with the Women’s Institute and subsequently held a health and well-being day for South Wales. The session, which was designed primarily to promote awareness of diabetes and blood pressure, but also included information on cholesterol, diet, pain relief and smoking cessation, was interactive, allowing the ladies to ask questions. A second evening with the local Caerphilly branch of the WI followed some weeks later, where a brief summary of the path into pharmacy was outlined and the rest of the time used for short presentations on diabetes, blood pressure and healthy living.

SPONSORED BY NPA



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Centres of excellenceCommunity pharmacy already provides a range of health and wellbeing services that improve public health, but an increasing number of pharmacists across the UK are going down the holistic route…..

uHEALTH & WELLBEING

In Portsmouth a pioneering initiative – Healthy Living Pharmacies (HLPs) – is being piloted to bring more NHS health and wellbeing services to pharmacies. The city currently has 17 Healthy Living Pharmacies, which deliver a range of NHS services to help people maintain and improve their wellbeing. These include free support to stop smoking, lose weight or cut back on alcohol, medicine reviews and emergency contraception. The pharmacies are all committed to promoting healthy lifestyles and providing advice for patients. They have all been awarded a quality mark by NHS Portsmouth so that the public can easily identify them. The Healthy Living Pharmacies are certainly making a real difference to the health of people in Portsmouth! Early indications show that HLPs have greater productivity and offer higher-quality services. Early evaluation results include a 140 per cent increase in smoking quits from pharmacies compared with the previous year; and 75 per cent of the 200 smokers with asthma or chronic obstructive pulmonary disease, who had a medicines use review, accepted help to stop smoking. ‘The Healthy Living Pharmacy scheme has been so successful in Portsmouth that I really believe that many other areas should replicate it,’ said Rita Majithia, a Healthy Living Champion and manager at Goldchem in Albert Road, which is one of the pharmacies involved in the pilot scheme. ‘I can see the support we offer people here is making a difference and people like getting health services in a pharmacy. In addition to the fact that they know that we have expertise, they also appreciate the fact that the conversation is confidential. We can see them in a private area, but it is informal too in that they don’t have to make an appointment!’

spin-offs. ‘The stomach’s natural function of peristalsis becomes impaired through tension therefore digestive disfunction can happen during sustained stress ie, constipation, cramps, diarrhoea etc. Headaches are often caused by prolonged stress and tension, while sustained stress can also lower the body’s immune system thereby reducing the body’s ability to resist bacterial infections, viruses and other diseases. We suggest taking action to release tension and therefore supporting the health of both mind and body.’

A contractor pharmacist since 1982, Elizabeth Roddick sold one of her two pharmacies in 2008 so that she could concentrate on developing her complimentary/holistic business, New Life Pharmacy, in Netherlee, south Glasgow. ‘I have always had a holistic approach to my business, looking at the whole person and how aspects of their life impact on their health. In addition to my hectic schedule in the pharmacy, I’m also a fully trained life coach, having trained at the Coaching Academy. Life coaching helps you decide what your main goals are and allows you to prioritise what’s important to you. As a life coach I ask people a series of questions, which are designed to bring out the answers and allow the person to discover a structure, which helps them to move towards their goals. ‘I often hold talks (sometimes with a guest speaker) on health supplements, anti-ageing, pain, menopausal issues and weight management within the pharmacy (we can seat 24 people) as well as community group venues. ‘Life is certainly very varied! Last week, for example I did two talks: one to a church group on ‘Your mind and improving your memory’ and the other to a women’s group on ‘The Seven Secrets of Staying Young’. I also do a fortnightly slot on Insight Radio as the resident pharmacist!’

Anita Gribbin

It has long been accepted that community pharmacy is an efficient mechanism to effectively roll out new public health initiatives. Community pharmacists and their teams see many people who are not registered with GPs; they can provide accessible and personalised services that can reach the individuals that GPs are missing. But now, many pharmacists are choosing to go down the ‘holistic’ route and offer a range of services, which treat the ‘whole person’ in order to maximise optimum health for patients. Anita Gribbin Pharmacy Ltd was independently opened in 1993 and was the sole healthcare provider in Toomebridge until a GP practice opened in the year 2000. In addition to providing traditional pharmacy services, Anita has always been very proactive in all aspects of health promotion on a physical, mental, emotional and social levels. In 2008 she established a Wellness Clinic: a multi-disciplinary clinic, which offers many different therapeutic treatments by a range of professional therapists in the one place. ‘We aim to offer our patients both an approach to stay healthy when well and a way to regain health if they have lost it,’ Anita told SCR. ‘We believe a health practitioner’s priority is to encourage and promote maintenance of patients’ health as well as treatment of illness. ‘Life today is often lived at a fast pace – pressures at work, demands of family life, achieving ‘success’ in our lives and dealing with upsets or perhaps traumas which happen all create situations which can trigger our stress response. Lots of situations can trigger this stress response; in fact stress is quite a natural part of life. What’s not natural however is sustained stress. Sustained stress is where body functions begin to break down – not only do our bodies become dysfunctional, but sustained stress also affects our family, social and other functions. Tension gets compounded upon more tension which has many negative

Elizabeth Roddick

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Rita Majithia

AD TO COME

* REGISTER TODAY

Don’t miss out

Medical Communications Ltd, publisher of the Welsh Chemist Review, will host the inaugural Welsh Pharmacy Conference in Cardiff City Hall on the 26th April 2012.

Influential and relevant speakers will be announced in the next issue of the Welsh Chemist Review and will also be released on our website pharmacy-life.co.uk. The conference agenda will focus on those issues pertinent to the successful development of pharmacy in Wales over the next 12-18 month period. This is not a ‘blue sky’ conference.

The savvy among you will realise the conference is being held on the day of our Welsh Pharmacy Awards Gala which will be held later that evening. This full day of pharmacy activity is intended to maximise your valuable time. Don’t miss out and register today FREE at www.pharmacy-life.co.uk

Welsh Pharmacy Conference 2012

WELSH CHEMIST REVIEW PRESENTS THE INAUGURAL

12.00-12.30Coffee, light refreshments, meet and greet

12.30-12.45Opening addressIntroduced by Michael Holden

12.45-13.10The Professional PharmacistA view of the ‘near’ futureMr Mark Koziol - Pharmacy Defence Association

13.10-13.40Public Health & PharmacyMr Roger Walker - Chief Pharmaceutical Officer

13.40-14.20Discharge Medicines Service - £3.6m, are you getting your share? The logistics of the service

14.20-14.55Retail survival in challenging timesAn insight into increasing margins and reducing working capital.Mr John Donnelly - Retail Pharmacy Consultant

14.55-15.40The Skills GapAnalysing the skills gap necessary to support and develop medicines counter staff in pharmacyMr Trevor Gore - Global Healthcare Training Manager, Reckitt Benckiser

15.40 - CloseSummary and close

PROGRAMME:

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uRESPIRATORY DISEASE

As concerns rise as to the level of hospital admissions for patients with respiratory disease, Margaret Allan, Head of Programme Delivery and Pre-Registration, WCPPE, tells WCR of new training designed to alleviate this.

Training the trainer to alleviate admissions

Many health boards across Wales were initiating work to address concerns regarding the level of hospital admissions of patients with respiratory disease. Evidence had shown that many respiratory patients had their conditions poorly managed, which was resulting in acute admissions to hospital. Work undertaken in the Isle of Wight had shown that training healthcare professionals in Advanced Inhaler Technique (AIT) and the use of these skills in reviews with patients had had a dramatic effect on patient outcomes in terms of effective control of their condition. This innovative training, developed and presented by medical physicist Jon Bell, has

been delivered throughout Wales via WCPPE and RPS Local Practice Forum events. Over 200 pharmacists across Wales have already participated in Advanced Inhaler Technique (AIT) training adding to their skills in supporting respiratory patients. There had, however, been an increasing number of requests to deliver training to healthcare professionals and this resulted in WCPPE recognising the need to develop a sustainable method of using the Bell tools and techniques without relying on his personal delivery. Patients do not always receive the maximum benefit from the inhalers they use due to a lack of understanding of the

techniques necessary to optimise the drug delivery to the lungs. In the past, there has been an assumption that healthcare professionals have a full understanding of the techniques needed for different inhalers. However, evidence has shown that this is not always the case and many patients are not receiving the correct or consistent messages from the healthcare professionals regarding teaching patients the skills to use their inhalers effectively. Several health boards intend to focus on inhaler management as part of the local audit and this has made this project even more relevant.

Margaret Allan

Training the trainer to alleviate admissions

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So what does the WCPPE project involve?WCPPE are working with Jon Bell to develop a ‘train the trainer’ approach to establish a network of trainers to deliver AIT sessions to pharmacists and fellow healthcare professionals (HCPs) to enable them to better support patients in inhaler use. We feel that pharmacists are ideally placed to train fellow healthcare professionals on medicines use. Our first cohort of trainers will be taken through the ‘train the trainer’ programme during March 2012 and will deliver a series of AIT events in early summer. Details of these events will be available in our summer programme. This first cohort involves 20 pharmacists who are currently actively involved in working with patients in the clinical setting providing support and advice on the management of their respiratory symptoms. These pharmacists practice in both the acute and primary care sectors which will encourage cross fertilization of messages to the patient across the care pathways.

What will pharmacists gain from this initiative? Pharmacists are in a unique position to make a major impact on improving the outcomes for patients with respiratory disease. Of all the healthcare professionals, pharmacists have the most frequent and regular contact with the patient and their intervention with respiratory patients could make a huge difference. This work is a great opportunity for pharmacy to showcase the profession’s dedication to helping the patient to get the most from their medicines and improve their quality of life.

How can pharmacists become involved in this initiative?Pharmacists can be involved in a number of ways. Those who have an enthusiasm and specialist interest in working with respiratory patients, and are motivated to teach others, can be part of the train the trainer programme and should contact WCPPE to register an interest. Alternatively, you can attend one of our AIT events across Wales delivered by the new WCPPE trainers, details of which will be available in our summer programme.

What other resources are available to pharmacists in supporting patients with respiratory disease?We have already developed ‘Quick Practice Guides’ for each of the targeted MURs including respiratory disease and these can be downloaded from our website and used as

aide memoirs in the workplace. Make sure you register for WCPPE online on our website (www.wcppe.org.uk) so that you can keep up to date with the events we are running on AIT and can access the resources we have available to support pharmacists in their practice.

this and deserve nothing less.

COMMENT: What is happening at Cardiff & Vale University Health Board?Fiona Walker, Senior Prescribing Advisor

Inhaled corticosteroids account for £6.5 million of annual spending in Cardiff and Vale University Health Board (UHB). Much of that cost is incurred in primary care treating patients with asthma and COPD. National guidelines exist for the treatment of patients with these conditions, but there are large variations in prescribing between practices in primary care probably reflecting different inhaler device preferences rather than variations in disease severity. The health board are producing both asthma and COPD pathways and prescribing policies for the management of adult patients in primary and secondary care bearing costs in mind. Pharmacists can help patients manage their asthma and COPD more effectively by educating them about their condition, the causes and triggers, and how to use their medicines correctly. One major issue with treating respiratory conditions is poor compliance due to inadequate inhaler technique. For patients to gain maximum benefit from their medication they need to be educated by competent healthcare professionals whose own inhaler technique meets accepted standards. Inhaler technique should be checked routinely at every available opportunity. Patients need to be taught correct inhaler technique and observed at subsequent opportunities ensuring they continue to demonstrate optimum inhaler technique. To ensure healthcare professionals within Cardiff and Vale UHB are competent in educating patients on inhaler technique a group of local pharmacists (community pharmacists and pharmacists employed by the health board) are participating in the WCPPE AIT ‘train the trainer’ programme. These pharmacists will subsequently provide training to other healthcare professionals (GPs, practice nurses, community pharmacists, hospital pharmacists and pharmacy technicians) who will then be able to ensure patients receive high quality education on optimum inhaler technique and are prescribed a device appropriate for them. Initially the project will be concentrated in two neighbourhoods within the health board area before being rolled out further.

The air that we breatheAs asthma and allergy rates continue to rise, WPR looks at the role played by central heating and ventilation.

l Almost a third of the UK population will develop an allergy at some time in their livesl Almost one in eight children has asthma and 85 per cent of these are allergic to house dust mites l More than five million people in the UK now have asthmal About six million people in the UK have eczemal Asthma, eczema and rhinitis have increased almost three-fold over the last 20 yearsl Allergies appear to increase at about five per cent per year and almost half of those affected are children. Compared to our recent ancestors, as 21st century human beings we spend a considerable part of our lives indoors, both

There is no doubt that double glazing, central heating and wall-to-wall carpeting all help to make our homes cosier. But modern, energy-efficient homes have reduced the intake of fresh air and air changes needed to remove airborne pollutants and allergens and to prevent condensation problems. Good ventilation is crucial to a healthy indoor environment. Research suggests that the rate at which indoor air exchanged for fresh air is now ten times lower than it was 30 years ago. While there is no proven direct correlation between the indoors air that we now breathe and the incidence of asthma, allergies etc, there are some interesting facts that seem to closely correspond with the 21st century mode of living:

36 ALLERGYFEATUREWELSH CHEMIST REVIEW

at home and at work. While the air that we breathe at work is subject to controls and regulations, it remains a fact that, prior to the new 2006 Building Regulations, relatively few such regulations existed for our homes. Our homes are getting more and more sealed up with better insulation and, although this is great for saving precious heat and energy, it also reduces the air quality of our homes due to decreased ventilation.

Central heatingCentral heating warms the surrounding air and. as warm air holds more moisture than cold air, it sucks the moisture from other sources. Warmer air dries out the mucous membranes of the nose, which can cause

SPECIALFOCUS

The air that we breathe

colds and aggravate asthma and allergies. Skin will also become drier and can even chap or become itchy. Unfortunately there is no type of heating that is best for everyone with asthma. Research evidence has indicated that wood and coal fires without adequate flues can cause a mild worsening of breathing problems compared to central heating. Research has also shown that some people who have storage heaters and ducted air heating also find that their asthma gets worse.

House ventilationInadequate ventilation is a big issue in newer houses, flats and some older houses that have been sealed with replacement doors and windows. In many older homes (say early 1960s and before) the level of indoor air pollution is quite low because the original construction of buildings was not subject to tight insulation and air-tightness regulations. Despite there being regulations around how much air change should be designed into them, relatively few have integral chimneys and many have now turned into almost hermetically sealed units. Severely lacking in ventilation, air change has become minimal and the atmosphere often contains far more CO2 and water vapour than is healthy for us (some suggest that inside air contains more than ten times the pollution of outside air).

Dust mitesOne of the downsides of this lack of ventilation is that increased humidity provides an ideal breeding ground for unwanted visitors such as moulds, mildews and house dust mites. Dust mites are present in furniture, curtains, carpets and mattresses (the average bed could be home to 1.5 million of them). Anyone who has asthma, or is prone to allergies, can have a major problem with dust mites. Their faeces, skin casts, and bits of their dead skeletons contain substances that are thought to trigger asthma attacks, inflammation in the nose, and even eczema in sensitive people. What’s worrying is that a temperature range of 21ºC-24ºC and a relative humidity range of 60-80 per cent – standard for most homes - can provide almost perfect conditions for the common house dust mite to survive! Dust mites live in our mattresses, pillows, duvets, carpets and upholstery throughout the year and in winter they thrive on the warm, sealed environment we create with our central heating on and the windows shut. As they multiply, so do their droppings and for many the sneezing and wheezing begins!

Do air purifiers help?The argument for an against air purifiers has raged for some time now. Air purifiers (ranging from £30-£600) have been marketed as helping to reduce the risk of airborne allergens at home, but don’t think for a moment that they get rid of allergies. Indeed, a January 2000 study of asthma and indoor air exposure by the US Institute of Medicine found that air cleaning ‘is not consistently and highly effective in reducing [asthma and allergy] symptoms’. Other scientific studies have found similar results. When researchers evaluated ten studies on air-filtration devices and people with asthma, they found that the systems had no effect on medication use or morning peak expiratory flow rate (PEFR) values.

Making the home more asthma/allergy friendlyT here are a number of things that can be done to make the home more asthma friendly: Smoking: No one should be allowed to smoke in a home where someone has asthma. The harmful substances in smoke are numerous and include nitrogen dioxide and carbon monoxide, exactly the same as industrial pollutants.

Furnishings: For sofas and armchairs, leather, wicker or iron are best as they harbour fewer house dust mite and pet allergens. Washing their covers frequently also helps.

Ventilation: Keep windows open to air the house and improve ventilation as much as possible. This will reduce the build up of indoor pollutants such as smoke and cooking fumes.

Linen: If house dust-mites are a trigger, then bed linen including pillows should be washed at 60 degrees at least once a week. Barrier covers are also a good idea. Cleaning products: Where possible, it’s best to use solid or liquid cleaning products, rather than sprays as these can contain volatile organic compounds or VOCs, which may trigger asthma symptoms.

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KEY FACTS ON ASTHMA: l 5.4 million people in the UK are currently receiving treatment for asthma: 1.1 million children (one in eleven) and 4.3 million adults (one in twelve)

l There were 1,131 deaths from asthma in the UK in 2009 (twelve were children aged fourteen years or under)

l On average, three people per day or one person every eight hours dies from asthma

l An estimated 75 per cent of hospital admissions for asthma are avoidable and as many as 90 per cent of the deaths from asthma are preventable

l 42 per cent of people with allergies say that their allergies affect their social life

l 61 per cent of people with asthma say that their asthma stops them from getting a good night’s sleep

l In Wales, 314,000 people are currently receiving treatment for asthma: 59,000 children and 256,000 adults.

Q: When is a pharmacist not competent?

Asif Ghafoor is a quiet, unassuming man, who has dedicated his professional life to pharmacy. Never one to seek the limelight – despite the many awards he has won over the last eight years – two and a half years ago Asif found himself thrust into a very unwelcome spotlight when he was accused by a patient of sexual assault. After an astonishing 31 months, Asif was finally cleared of the charges. Asif tells us his story……

‘I have been a pharmacist for nearly eight years now and know that I am a better pharmacist now, than I was when I qualified in 2004. As with most pharmacists, it is experience that has made me a better professional. When I first started out I didn’t examine patients and just took their word for it when they came in complaining of conditions such as athlete’s foot or thrush. I learned quickly, however, that everything was not always as it seems. ‘On two occasions I had patients requesting something for a ‘sore calf muscle’. On closer examination, however, I referred the patients to hospital with possible blood clots and, on both occasions, these were confirmed. ‘I’ve also had many patients, who have come in for antihistamines for ‘rashes’. Again, on further questioning, severe cases

of cellulitis were diagnosed. I also had one case of a patient, who wanted medication for a ‘wart’. On closer examination I suspected skin cancer and, again, a correct diagnosis was later confirmed. ‘In any of these cases the repercussions of making the wrong diagnosis would have been deadly, had I not asked more questions and been pro-active. It was only by examining them that I could make the right diagnosis. ‘Since becoming a pharmacist, I have always felt that giving a patient the privacy to talk was essential for a correct diagnosis and for that reason I have always used consultation rooms for discussions, which involved cystitis, thrush, the morning after pill, diabetes screening and, more recently, CMS. ‘I have, however, always been on alert for any patient that I think is unstable and wants a one-to-one consultation. On any occasion when I have felt uncertain, I have always taken a chaperone. This is not, however, always an option as often there is no-one available to act as a chaperone.” In March 2009, Asif’s professional life was to take a horrendous turn when a woman – a known methadone patient referred to as DH – complained to him of pain in her lower back. Asif immediately suspected the possibility of a UTI. As the patient was wearing a crop top dress, her lower back was exposed. Asif pressed on her lower back area to ascertain exactly where the pain was. He prescribed accordingly and the woman left. She then returned on a further occasion to speak to Asif regarding a different matter. In May 2009, to his horror, the police informed Asif that the woman had made an allegation of sexual assault on three occasions against him. On 29 May 2009, Asif reported to Paisley police station on a voluntary basis to answer these allegations. ‘I actually attended this interview on my own

without any legal advice or lawyers. At the end of the interview the police stated that no charges were to be filed and that they would leave the matter with RPSGB, who at that time were the pharmacy regulator. ‘On 29 September I received notification from RPSGB that they intended to investigate me for these allegations, and that they were going to try to suspend me as soon as possible in order to ‘protect the public’. This was four months after the police interview. ‘The above led to me first going into shock and then depression. But then I was thrown into further turmoil when the RPSGB sent an inspector to my pharmacy and asked my boss, who was covering for me to sign a letter to say I was mentally unstable. It appeared that they were going to try to use the evidence of my mental health as a factor. I wondered if other pharmacists knew that the GPhC (who took over from the RPSGB as the regulatory body) had the powers to get hold of a pharmacist’s health records? I certainly did not! ‘At the end of October 2009, the Disciplinary Committee agreed to put conditions on my registration, such as I could not see any female patient on a one-to-one basis in a room. I also had to notify all members of staff – wherever I worked – that I had conditions on how I worked. This condition on my registration was to be reviewed every six months, for a period of 18 months at most, but could be further extended by going through a court. ‘In April 2010 I attended an interview at RPSGB offices in Edinburgh under caution with my legal aid. The interim order was renewed for a second time at the end of that same month. The legal wrangling continued on over the next 18 months. On one occasion, in November 2010, the patient actually went ‘missing’. Despite her disappearance, however, the case was still pursued.’

38 DISCUSSIONWELSH CHEMIST REVIEW

IT COULD HAPPEN TO YOUAs additional services continue to be rolled out across Wales, here’s a sobering tale of the repercussions of one Scottish pharmacist’s one-to-one consultation with a patient…..

IT COULD HAPPEN TO YOU

DISCUSSION 39WELSH CHEMIST REVIEW

‘...I HAVE ALWAYS FELT THAT GIVING A PATIENT THE PRIVACY TO TALK WAS ESSENTIAL FOR A CORRECT DIAGNOSIS AND FOR THAT REASON I HAVE ALWAYS USED CONSULTATION ROOMS FOR DISCUSSIONS.” ASIF GHAFOOR

After 18 months of legal wrangling, on 1 December 2011, the Disciplinary Committee of GPhC cleared Asif of the sexual component of the charge, but found him guilty of ‘inappropriate conduct’ because he had touched the patient’s back as part of a diagnostic check. Asif was given a warning, but it is obvious from speaking to him that the mental scars of the whole process will linger for a long time. ‘I feel pharmacy is now at a major crossroads and that all pharmacists have an important role to play in how we go forward. I hear and read all the time how the healthcare professions have changed so much, but I feel that the biggest changes have occurred in community pharmacy, where pharmacists are being asked to take on a lot of the functions that were formerly the responsibility of the doctor. We don’t, however, have the same protection and are working in a very ‘grey area’.’ Asif’s concerns seem to be borne out by the ruling of the GPhC’s Fitness to Practise Committee, which sat as the Disciplinary Committee under the Pharmacists and Pharmacy Technicians’ Order 2007 on 1 December last year. In the ruling the Committee referred to the definition of ‘circumstances in which a person’s fitness to practise may be regarded as impaired…..In a case called Nandi v GMC (2004) EWHC 9Admin) 2117 Collins J defined misconduct, in circumstances which may be applicable to this case, as ‘conduct which would be regarded as deplorable by fellow practitioners’. We find that definition of assistance in this case.’ In summing up, the ruling states that ‘Mr Ghafoor must have regard to Principles 3.9 and 6.5 of the Code of Ethics, which require him to take special care when dealing with vulnerable individuals, and to adhere to accepted standards of professional conduct. Those standards include recognising the limits of his professional competence and practising only in those areas in which he is competent to do so. A pharmacist is not competent to undertake a physical examination, which includes the touching of a patient’s body as part of a diagnostic procedure.’

The case has, needless to say, had a devastating effect on Asif. ‘Of all the professions, we are the most accessible to the public - on hand and no appointment required - to make important changes to the health of our community. It is, however very difficult to do so if your hands are literally tied to what you can do. This is unfair to us as a profession. ‘I feel that pharmacy - as a profession - is not very vocal in the positive effects it has

on local communities, and you can contrast that with the nursing and medical profession, which is always in the news as at this moment, with the changes to the NHS bill. ‘I feel that we need a new body which will listen to its members and share our aspirations. Otherwise, the future for pharmacy is not good. We would end up staying behind the dispensary and that would be a shame for pharmacists, the profession and - more importantly - to the patients. If pharmacists cannot examine this is bad for the profession and bad for the local community. Patient safety is also compromised. ‘This whole episode has left me questioning if this is the career I want to pursue, as the dangers of the job, in terms of consultation rooms have been clearly laid out. I have not been able to bring myself to do any consultations in the room since my name was cleared, and will only do so once cameras are installed so as to afford me protection from any malicious accusations in the future. ‘In light of my experience, my advice to fellow pharmacists now is to never examine a patient on your own. Always have a chaperone and log all consultations involving examinations. Keep a note of why

the examination occurred, the date, the chaperone name, etc. A patient can complain tomorrow, next month, or in two years’ time. Will you remember if you have no notes? I doubt it.....if it is good enough in medicine then it should be for us. ‘The last two and a half years have been a nightmare, and I would not wish this on another fellow pharmacist. I am so glad that I have had so many letters of support from pharmacists all over Britain and even the pharmacy department of Wolverhampton University. ‘I have no complaint about this case being investigated, but I have serious concerns about the time that was taken to make the initial contact and the processes used by the RPSGB. I am also dissatisfied with the time it took to bring the case to committee. Looking back, on this occasion, I was probably too trusting, which, it would seem, is not a good thing in these times.’ Are other pharmacists even aware that ‘a pharmacist is not competent to undertake a physical examination, which includes the touching of a patient’s body as part of a diagnostic procedure?’ You have to wonder....


‘‘I HAVE NO COMPLAINT ABOUT THIS CASE BEING INVESTIGATED, BUT I HAVE SERIOUS CONCERNS ABOUT THE TIME THAT WAS TAKEN TO MAKE THE INITIAL CONTACT AND THE PROCESSES USED BY THE RPSGB. ” ASIF GHAFOOR

COMMENT: Mark Koziol, Chairman of PDA, sounds a warning for pharmacists everywhere

Asif’s case is an example of cases which we are seeing on an increasingly frequent basis. Where a patient utters the words ‘sexual impropriety’ this usually spells disaster for the pharmacist. It appears not to matter whether the complaint is credible or not the GPhC will seek to issue an interim suspension order. Understandably, the regulator will have the protection of the public at the forefront of their mind, but what does this do for a pharmacist? Under the current regulatory rules, using an interim suspension order the GPhC can prevent a pharmacist from practising within a few weeks. He may be barred a whole year ahead of any statutory committee meeting which would ultimately establish innocence or guilt. This is an alarming and unacceptable prospect for pharmacists. Whilst these orders are unlikely to be stopped (because of the public interest), the PDA applies considerable energy and expertise in persuading the GPhC that these interim suspension order applications should not lead to an immediate suspension from the register, but should instead be conditional). For example seeking to avoid working in a consultation room until the outcome of the full statutory committee hearing. To date we have been successful in convincing the GPhC to let this happen and in this way we were able to help Asif. This nuanced defence requires specialist case experience and it is a reactive defence service that the PDA is equipped to provide. However, the outcome of Asif’s case requires a more proactive form of defence on behalf of all pharmacists going forward. A chairman of the GPhC’s Fitness to Practise Committee – a non pharmacist, has stated that; ‘A pharmacist is not competent to undertake a physical examination which includes the touching of a patient’s body as part of a diagnostic procedure.’ We strongly disagree. For decades, pharmacists have been examining patients. Pharmacists involved in fitting trusses or in certain diagnostic tests will have necessarily had the most intimate contact with patients – are we contemplating that this should stop because of the comments made by a statutory committee chairman? We think not. In making his determination, the basis of the Chairman’s decision should have been to consider whether a pharmacist had the correct level of competency to be able to examine a patient, not that pharmacists as a profession should not be involved in examinations at all. Undoubtedly, many pharmacists do have the necessary skills and training to carry out such examinations. Others - those that cannot demonstrate that they have had the relevant training may not. It would be disastrous both for patients and also for the profession if this chairman’s remarks where to lead to a cessation of pharmacist led patient examinations. The PDA, at its next meeting with the GPhC will be challenging them to consider this issue again. We will ask the regulator to clarify the situations under which such examinations by pharmacists would indeed be acceptable.

DISCUSSION 41WELSH CHEMIST REVIEW

Mark Koziol

RPS SCOTLAND: ‘In this case Mr Ghafoor has acted with the best of intentions and we have a lot of sympathy for the situation he found himself in.

‘There are lessons for pharmacists in this case in terms of when to seek professional and legal advice. Guidance would also be timely on when pharmacists should use chaperones and how they should interact with vulnerable patients. ‘The RPS was keen that the GPhC clarified their position in this case as it seemed to go against existing pharmacy practice and the direction of travel for the profession’s development. The RPS is glad to see that they have now provided some clarification in their bulletin ‘Regulate’ (Feb 2012, Iss.3). In it they wrote that physical examination can be useful in making a diagnosis but only with the appropriate skills and training for that type of examination and with explicit patient consent. We will explore this further with the GPhC. It is important that pharmacists can practice with confidence in this area.’

GPHC: The GPhC declined to comment but referred us to a recent article in their member bulletin, Regulate.

A recent Fitness to Practise case has raised the issue of pharmacists undertaking physical examinations. Our standards of conduct, ethics and performance emphasise that pharmacists must recognise the limits of their professional competence and practise only in those areas in which they are competent to do so. Physical examinations of patients can sometimes be useful in making a diagnosis, but pharmacists should only undertake them when they have the appropriate skills and training for that type of physical examination. It is also vital to gain explicit consent from the patient for examinations –our new guidance on consent is helpful in understanding what you need to think about when obtaining consent. Students and trainees are likely to receive some limited training in physical examinations. Pharmacists may go on to develop further skills, depending on the nature of their practice and continuing professional development.

Ian JenkinsDavies PharmacyThis case highlights the confusion surrounding modern day pharmacy practice. Pharmacists are left confused as to their role within the structure of the NHS; some stick rigidly to their ‘Old’ role of purely supply of medicines, some have attempted to expand their clinical role to an extent to which they are not ‘competent’, most have developed a happy medium whereby advice and support is provided within the confines of our skills and training. With little guidance and direction from our governing bodies we have drifted into a position where we are no longer sure of our

‘niche’ in the NHS structure. We need to be mindful that our strength lies in our knowledge of medicines, their actions in the body and their correct use. I have never received any training in diagnosis, not in university or in my post-uni life, nor would I wish to; I am not a GP. It is quite clear that Mr. Ghafoor believed that his actions were in the best interests of the patient. Sadly, they were not in his interests for our own practice. Several arguments have been put forward to counter the ‘Touching the patient’ issue. Indeed, it is not possible to perform the role without a degree of contact with patients: Flu vaccines, BP testing, etc. The difference with these and this scenario are that they are everyday activities expected of appropriately trained pharmacists, diagnosis is not. The reaction of the RPSGB was to be expected. ‘Gulity until proven innocent’ appears to be the thought process adopted with each complaint. Hopefully this heavy handed approach will change with the development of the GPhC, indeed everything I have heard from Duncan Rudkin would suggest that they are progressing in this way. We can but hope.

We asked a selection of you for your views.....

Ian Jenkins


Pete GriffithsCwmfelinI have been practising for more than quarter of a century and in that time have carried out many investigations at patients requests. Times have changed, and the introduction of a ‘consulting room’ has maybe lead pharmacists astray a little. We are not taught to physically examine a patient and that should be left to the appropriately qualified practitioner. However, when measuring blood pressure, examining eyes etc, the patient is fully aware that some degree of touching of the body will have to happen.I wonder whether some pharmacies that have a fully equipped examination room have thought hard over what they might be accused of and have adequate safeguards in place. Chaperones are the ideal, and i suppose if not available, then CCTV monitoring could be used to ensure that any incidences are refutable. I am always very conscious of vulnerable patients, and would not take addicts into the consulting room without another member of staff present, whether they are male or female.

Pete Griffiths

Kevin Hope Hope Pharmacy Ltd.In relation to Mr Asif Ghafoor he has my utmost sympathy at the heavy handedness in his treatment by the RPSGB. However, in the 25 years that I have practiced, if I felt the need to examine someone (mostly children with rashes) I tend to do this in the shop area when quiet, with member of staff and a parent/guardian present. If more privacy is required, I would definitely be accompanied in the consultation room. I do believe he was overly naïve to have examined a known methadone user without a chaperone. This was probably due to inexperience. I have the added advantage of being in a community pharmacy in a small town where most patients are known to us and I’m known to them. There is therefore an element of trust already between the prospective patient and the pharmacist.

Kevin Hope

David Reissner Charles Russell Law Firm ‘Pharmacists will read the quote from the GPhC’s ruling with alarm. The suggestion that a pharmacist is not competent to undertake a physical examination, which includes the touching of a patient’s body as part of a diagnostic procedure, runs counter to modern community pharmacy practice. I believe, however, that the quote should be taken in context. I sympathise with Mr Ghafoor, but in my view, he committed errors of judgment. If a patient comes in complaining of a sore eye, a pharmacist might naturally be expected to touch the patient’s face when taking a look. However:• Mr Ghafoor should have explained that he intended to touch her back;• Mr Ghafoor should have suggested that the patient bring a chaperone into the consulting room;• Mr Ghafoor should have been alert to the risk that he might be accused of trying to take advantage of an addict; conversely, some addicts might use the examination as an opportunity to blackmail him, threatening to make an accusation unless he supplied drugs inappropriately;• Mr Ghafoor should not have agreed to be interviewed by the police or GPhC without having a solicitor present.

David Reissner

Steve NewburyNewbury Pharmacy, MumblesThis highlights for me the danger of practising at the sharp end. You are faced with decisions umpteen times per day – the critical thing is the context, your level of expertise and consent. You have no business touching patients if there is no clinical value to it.

Steve Newbury

AD TO COME

Experts have warned that paracetamol misuse could lead to liver damage in children.New research by the Royal Pharmaceutical Society (RPS) has revealed that only 27 per cent of parents know which medicinal products for children actually contain paracetamol. With many of these products being used to treat ailments that they have no proven effect on, there is a danger that some children could be exposed to liver damage through accidental paracetamol misuse. According to the results of the survey conducted by YouGov on behalf of the RPS, one in six (17 per cent) surveyed parents of children aged twelve or under did not know that Calpol, one of the most popular products used in children’s treatment contained paracetamol. The knowledge of other popular medicines among parents was even more worrying, with more than two thirds unaware that commonly used products such as Disprol (68 per cent), Medised (79 per cent) and Medinol (76 per cent) contain paracetamol. ‘The decision to use paracetamol in a child is often undertaken by parents and carers without discussion or contact with a healthcare professional,’ said Steve Tomlin, RPS spokesperson and consultant pharmacist. ‘This, combined with the lack of awareness on which products contain paracetamol, may have serious effects on children’s health, such as exposure to long term liver damage. Whilst taking paracetamol at the recommended dose and frequency is safe, evidence shows that only small increases of just an extra dose a day over the course of three days can potentially cause liver damage. ‘The risk of accidental overdose is even higher if children have multiple carers, as monitoring of the medicine administration is much more difficult.’ Considering the fact that carers often carry on treatment for several days without seeking professional advice (over a third of those surveyed (34 per cent) said they have used paracetamol or Calpol for three or more days to treat their child, before seeking professional advice), it is not surprising that problems can happen. Survey results also reveal confusion

amongst parents as to which ailments paracetamol is actually an effective treatment for. Although, they would mostly consider using paracetamol (eg, Calpol, Disprol, Medinol etc.) correctly for a number of conditions in young children aged twelve or under – including teething pains (70 per cent), fever (80 per cent) and stomach pains (36 per cent) – the findings also show that some parents would consider using the same products to treat ailments on which paracetamol has no proven effect, with 20 per cent using it for cough and six per cent for sleep. As many as 38 per cent of parents perceive paracetamol to be a relatively ‘safe drug,’ because it is sold over the counter, with over half (52 per cent) saying the same about Calpol. According to the survey, almost a quarter (24 per cent) of parents in Britain admit to giving their child two or more over-the-counter products containing paracetamol at some point during the course of their illness. The recommended doses of paracetamol have been changed in order to ensure that children get the most effective dose of paracetamol. The introduction of the new dosing instructions and advice was introduced in November 2011, with companies who produce paracetamol for sale in the UK, required to put information regarding the new doses in the patient information leaflet.

Warning for parents...

uPAEDIATRICS


More Health Boards sign upAnother milestone has been reached in the battle against smoking as Aneurin Bevan and Cardiff and Vale University Health Boards become the latest to ban smoking on hospital grounds. The move leaves Hywel Dda in mid and west Wales as the only one where smoking is still permitted. The Board is, however, currently in the process of developing a ban. ‘It’s the natural next step from May last year,’ said Executive Director of Public Health, Dr Sharon Hopkins, ‘when we were the first Welsh Health Board to declare our entrances smoke free and make a commitment to going completely smoke free using a phased approach. ‘Our staff have a role to play as ambassadors for healthy living and promoting good health and, in working to change a culture in which it’s OK to smoke on a hospital site. This takes time and commitment and so I’m pleased to see other UHBs also working to create smoke-free environments.’

uSMOKE FREE ZONES

Quantum Pharmaceutical has announced the appointment of Brian Fisher as Commercial Director. With extensive experience of the pharmaceutical industry built over many years in wholesale and distribution, Brian has a wealth of knowledge of the healthcare market, across pharmacy, hospitals, dispensing doctors and manufacturer services. Previously responsible for sales and customer engagement across all business channels as Head of Sales at Alliance Healthcare (Distribution) Ltd, Brian has a strong reputation and proven track record in business development, change management and implementation of programs which enhance and improve customer value and experience.

uAPPOINTMENT

Brian Fisher

New Commercial Director

AD TO COME

Parents need more support in understanding the vital role they have in keeping children’s teeth healthy, a report by an influential committee of AMs has said. The report, by the National Assembly’s Children and Young People Committee, says a more consistent message needs to be provided by the Welsh Government about the importance of getting fluoride onto children’s teeth. Their investigation found a significant number of schoolchildren were affected by dental decay, with disease levels being highest in deprived areas. The recommendation is one of ten to come out of the committee’s inquiry into children’s oral health which looked at the effectiveness of the Welsh Government’s ‘Designed to Smile’ programme in improving the oral health of children in Wales, particularly in deprived areas. The report also recommends that the Welsh Government sets out how it intends to improve the oral health of all children in Wales, including those who are not currently targeted by Designed to Smile, and what role the Community Dental Service will play in this. It further recommends the Welsh Government makes changes to the NHS dental contract to enable better integration

of prevention and treatment across dental practices, and to ensure it encourages dentists to undertake preventative work with children. Designed to Smile, which was launched in 2009, is the Welsh Government’s national child oral health improvement programme. It consists of three elements: a supervised tooth brushing scheme for three to five year olds, a promotional programme for six to eleven year olds, and a preventative programme from birth to three years old. The committee’s report follows longstanding concerns over the dental health of Wales’ children. Last year, the Western Mail reported that children in Wales have the worst teeth in the UK, with five year olds in Wales having an average of two to three teeth missing, filled or decayed. In the most deprived communities this figure was much higher. In Merthyr Tydfil, the average number of decayed, missing or filled teeth for every five year old was 3.9. And in 2009, only four out of ten children living in the area had seen a dentist in the previous two years.

Parents urged to keep kids’ teeth healthy

uDENTAL HEALTH


Poor dental hygiene The report by the National Assembly’s Children and Young People Committee couldn’t have come at a better time in light of the findings from the recent meeting on cardiovascular nursing, which took place in Copenhagen in Denmark. The conference heard that poor dental hygiene behaviours in patients with congenital heart disease were increasing their risk of endocarditis. Teens with congenital heart disease floss, brush and visit the dentist less than their peers. They do, however, have healthier behaviours when it comes to alcohol, cigarettes and illicit drugs. Adults with single ventricle physiology (a type of congenital heart disease) also have poorer dental hygiene practices than their peers despite having better health behaviours overall. For the first study, lifestyle information was collected from 429 adolescents with congenital heart disease aged between fourteen and 19 from the longitudinal study i-DETACH (Information technology Devices and Education programme for Transitioning Adolescents with Congenital Heart disease). Of these, 401 were matched with a control of the same age and gender without congenital heart disease. In adolescents with congenital heart disease, substance use increased with age (p<0.001). Compared with matched controls, adolescents with congenital heart disease had significantly lower substance use (p<0.001) and health risk (p<0.001) scores, and significantly higher dental hygiene risk scores (p=0.04). The results reveal that health risk behaviours are prevalent in adolescents with congenital heart disease and they increase with age. They also show that in general, the health behaviour of adolescents with congenital heart disease is better than their peers except for dental hygiene. For the second study, the same questionnaire was used to collect lifestyle information from adults aged 16-48 years (average age 24 years) with a type of congenital heart disease called single ventricle physiology. In patients with single ventricle physiology, 85 per cent drank alcohol; 26 per cent were binge drinkers; 20 per cent smoked cigarettes and 20 per cent had not visited the dentist during the last year.

uHEART DISEASE

AD TO COME

uRESEARCH

The healing properties of honey have never been in any doubt, but now a Welsh initiative has been set up to find honeys, which can counteract bacteria.

Tell us about the honey, mummy!

Honey has been around from time immemorial. In fact, the oldest evidence of man collecting honey is to be found in a prehistoric painting found in caves near Valencia, Spain. Painted in red, it is thought to be some fifteen thousand years old! Now, beekeepers in mid and north Wales are being urged to help with research into the healing properties of honey as scientists look to counter MRSA. Cardiff University and the National Botanic Garden of Wales launched the hunt last summer for honeys, which can counteract bacteria. They have created a honey map of Wales, pinpointing where the jars are coming from but they want to fill the gaps. Bee keepers in south Wales and other parts of the UK are taking part. Honey’s anti-bacterial properties have been known since ancient times and it is believed it was used by both the ancient Greeks and Egyptians. Last year, scientists also found that Manuka honey could be used to combat some of the most hard-to-treat infections that are resistant to powerful antibiotics. Since last summer’s appeal, scientists at Cardiff University’s school of pharmacy and pharmaceutical sciences have been analysing honey sent in from

across the UK. The honey is being checked for its potential to counter hospital acquired infections MRSA and Clostridium Difficile. It will then be sent to the National Botanic Garden in Llanarthne, Carmarthenshire, where the DNA of the most powerful honeys will be profiled. It is hoped that scientists will then be able to create new treatments as a result. ‘We have had a very enthusiastic response to our honey appeal,’ said Professor Les Baillie of Cardiff University, ‘with jars coming in from as far afield as the Isle of Wight. To date we’ve had some 200 samples sent in, 60 of them from Wales, and we also have some very promising candidates for further research. ‘We now want to build up our picture of what’s happening in Wales, and for that we need more honey from the middle and the north of country.’

Why honey is so good Honey delivers energy in a concentrate,

which is unobtainable anywhere else in the natural world because it is

pre-digested, ready to act on the metabolism. Although there

are other sugars within honey, all of them are

eventually converted to two forms –

fructose and glucose – by the bees’ secretions of enzymes. These two

sugars are the perfect ‘dynamic

duo’: glucose offers immediate energy,

while fructose builds reserve energy. A teaspoon of honey contains twenty-two calories, whereas the same amount of sugar contains fifteen. Honey is much more valuable to us, however, as it refuels the brain within minutes thanks to the ‘dynamic duo’! Fructose confers longevity on the energy provided by glucose. Although similar to glucose, fructose converts glucose not into fat, but into a food reserve in the liver. The magical combination of glucose and fructose in honey directs energy towards the liver, where it is stored for if and when the brain or body requires it. It’s also perfectly safe for a pregnant woman to eat honey. The gut flora of adults and children over a year old are able to fend off the botulism spores that may be present in honey, and render them harmless. Since the spores would be killed in your gastrointestinal tract, they would not make it into your bloodstream and therefore cannot be passed to the baby.In fact, milk with honey is good and safe for pregnant women who are desperate to get a good night’s sleep.

Professor Les Baillie

48 HEALINGFOCUSWELSH CHEMIST REVIEW

Tell us about the honey, mummy!

As a natural healing remedyConstipation: Liquid honey has a mild laxative effect, and is especially appropriate for constipation associated with ageing, and the digestive bloating caused by a diet rich in processed foods.Calcium boost: Combining honey with a calcium supplement can increase calcium uptake by 20 per cent thanks to the fructose and glucose content. Colds: Honey is a natural antiviral, so there is no upper limit on how much can be taken. Children’s colds can be warded off with honey at mealtimes on yogurt or cereal. (Due to the naturally occurring bacterial botulinum spores in honey, honey should never be given to a child under twelve months of age). Insomnia: If given before bedtime, honey can lead to a noticeable improvement in overnight dryness, especially in young children. Two to three teaspoonfuls should be offered at bedtime on cereal, bread or in milk.Instant energy: For an instant energy drink, two litres of pre-boiled warm water should be into a large pan. Two hundred grams of unprocessed honey and three grams of salt should be dissolved and finished off with the juice of one to two lemons. The mix can be stored in the fridge for two to three hours before drinking to chill.

As a beauty aidBathe like Cleopatra! A milk and honey bath is for beautifying the skin, not for cleaning and scrubbing it. Women who wish to have a milk and honey bath should first wash themselves in a normal bath and then half-fill the bath with very warm water. Two cups of full cream milk powder should be stirred in, followed by a half cup of natural liquid honey. Hair shine rinse: After washing hair, two or three teaspoons of liquid honey should be poured into rinsing water. Hair should then be dried under a gentle, moderate heat.Face mask: Two teaspoons of honey and two teaspoons of milk are mixed together and smoothed over the face and neck. The mixture is allowed to soak in for ten to fifteen minutes, then splashed off gently with warm (not hot) water.

HEALINGFOCUS 49WELSH CHEMIST REVIEW

‘WE HAVE HAD A VERY ENTHUSIASTIC RESPONSE

TO OUR HONEY APPEAL...WITH JARS COMING IN

FROM AS FAR AFIELD AS THE ISLE OF WIGHT....’

PROFESSOR LES BAILLIE

50 PRODUCTUPDATESWELSH CHEMIST REVIEW

CLINICAL PROFILETEVA UK LIMITED LAUNCHES GENERIC NARATRIPTAN FILM-COATED TABLETSWe are pleased to announce the day one launch of generic Naratriptan film-coated tablets. This is the second product launched this month for migraine sufferers. Naratriptan is a generic version of Naramig® (Naratriptan Hydrochloride) from GlaxoSmithKline UK. It is indicated in the acute treatment of the headache phase of migraine attacks with or without aura. Naratriptan is available immediately in Teva’s award-winning 360 livery. Key product information is as follows:

Product Strength Pack Indication Teva Brand Size retail price priceNaratriptan 2.5mg 6 Acute treatment of £6.14 £24.45 film-coated the headache phase of migraine attacks with or without aura

Naratriptan 2.5mg 12 Acute treatment of £12.28 £49.10 film-coated the headache phase of migraine attacks with or without aura

Kim Innes, Commercial Director said: “We want to make more medicines accessible for more people and Naratriptan is our fifth day-one launch this year to add to our portfolio of over 700 products. It’s good for Pharmacy because patent expiries provide opportunities for increasing margins and keeping costs down. Importantly, it also means we continue to help save the NHS over £9bn on generic prescriptions.”

CLINICAL PROFILETEVA UK LIMITED TO SUPPLY ZOLMITRIPTAN TABLETSWe are pleased to announce the day one launch of Zolmitriptan orodispersible tablets, and Zolmitriptan film-coated tablets. Both are available for generic prescription. Zolmitriptan orodispersible is a version of Zomig Rapimelt® (Zolmitriptan) and both versions are sugar free. The Zolmitriptan film-coated tablets are a version of Zomig® (Zolmitriptan), by AstraZeneca UK Limited. Both are indicated in the treatment of acute treatment of migraine headache with or without aura. Both are available immediately from Teva. Arrow Generics Limited holds the Marketing Authorisation (MA). The livery is Arrow, with a Teva bar code.

Product Strength Pack Indication Teva Size retail priceZolmitriptan 2.5mg 6 Acute treatment £14.40 film-coated of migraine headache with or without aura

Zolmitriptan 2.5mg 12 Acute treatment £7.20 film-coated of migraine headache with or without aurav

Zolmitriptan 2.5mg 6 Acute treatment £7.16 Orodispersible of migraine headache with or without aura

Zolmitriptan 5mg 12 Acute treatment £9.16 Orodispersible of migraine headache with or without aura

Kim Innes, Commercial Director said: “We are pleased to add Zolmitriptan to our portfolio, which is the widest in the UK.” New or existing customers can order through their local Teva Territory Sales Manager, major wholesalers or call 0800 085 8621 l To find out more about Teva UK Limited, visit www.tevauk.com

PRODUCT PROFILEALVITA EXPANDS INCONTINENCE RANGEPRODUCTS NOW TO INCLUDE HEAVY INCONTINENCE

Alvita has expanded its personal hygiene offering with the addition of heavy incontinence products to its range, providing patients with an even wider choice of quality assured products. The products are highly effective and discreet, providing patients with comfort, security and confidence. Product features include: an ultra-soft cover, which keeps moisture away from the skin, for comfort and dryness; absorbent layers to rapidly trap fluids and prevent leakages; the Alvita Air System, which makes products breathable, to minimise the risk of skin irritation; odour neutraliser, to control urine odours; a wide adhesive strip, to hold pads firmly in place; and, elasticated leg cuffs, to prevent leakage and soft re-sealable tapes, for a comfortable fit. Cynthia Correa, Senior Product Manager, Alvita and Almus OTC, commented: “We are delighted to have introduced heavy incontinence products to our range, offering even more choice and better value to our customers. Incontinence affects several million men and women in the UK and can develop at any age. We are constantly evolving our offering to meet the changing needs of patients in the UK.” The Alvita incontinence range comprises pads, pants, all-in-ones and bed protectors, with most products available in various sizes to suit different needs. Alvita incontinence products offer patients all the comfort and security of branded alternatives, at a considerable lower cost.

PRODUCTUPDATES 51WELSH CHEMIST REVIEW

CAMPAIGNNEW P&G RESEARCH CONFIRMS VITAL IMPORTANCE OF EFFECTIVE SUPPLIER RELATIONSHIPS IN GENERATING MEASURABLE SUCCESS IN PHARMACY

A new research report commissioned by P&G as part of their PharmacyCare programme, has confirmed the importance of effective help and guidance from branded companies for pharmacists and their staff in generating real business results and adding value for patients.

P&G has continued to invest in the pharmacy channel and through talking directly to 300 pharmacists nationally across Alphega, Numark, Lloyds and independent pharmacies, the objective was to understand what pharmacists and pharmacy staff find particularly useful in terms of tactics which deliver. As well as commercial success, the research also investigated the role of effective training and education, especially for pharmacy staff, which in turn gives them the confidence to make the best recommendations for their patients.

Category management, a core component of the PharmacyCare programme, which has recently introduced a new series of Retail Skills modules specific to Pharmacy, emerged as a vital skill central to business growth. Over a third of pharmacists said that they follow a planogram ALL the time and 38% perceive compliance with it will increase their sales. This highlights the consistent P&G PharmacyCare message promoting the role suppliers such as themselves can play in working closely with pharmacy customers, advising on key best selling products and impactful merchandising.

The research also demonstrated the vital role of pharmacy staff, with patient feedback suggesting that 45% of people choose their pharmacy based on friendly and helpful staff. 43% of pharmacy shoppers who bought an over-the-counter medicine received a specific recommendation from staff and an amazing 99% of them went on to buy that product.

Another key component of the P&G PharmacyCare programme is training and education, to ensure that factual knowledge about products and treatment options are understood fully, leading to the best and most effective recommendations, which will ensure patients return to the pharmacy whenever they need advice and help.

“We have launched the all new Retail Skills Programme as a way of engaging with the pharmacy staff. We can also demonstrate that if these principles are followed it can make a real difference to the bottom line of the business. We know from our own research that those people who have already adopted these best practice principles have seen a sales uplift of between 7-20% ,” explains Dave Ewan, P&G’s PharmacyCare business leader.

P&G also believes in paying close attention to those who work day-to-day in pharmacy. “We want to listen and learn from those on the ground, delivering pharmacy services day in and day out,” says Dave. “We at P&G are fully committed to investing in pharmacy for the long term and want to work closely with the sector to instigate change for the better. Our PharmacyCare programme is a long term commitment to deliver quality results for Community Pharmacy,” concludes Dave Ewan. l So, if you are interested in maximising your retail skills, log into www.pharmacyretailskills.co.uk/

PRODUCT PROFILEFAST-DISSOLVING ALLERGY RELIEFCLARITYN RAPIDE – DISSOLVES IN AN INSTANTSufferers can now be even more prepared to combat the misery of hayfever this summer and get relief from their symptoms with Clarityn Rapide. Fast-dissolving Clarityn Rapide provides ‘on-the-go’ relief for hayfever sufferers with its melt-in-the-mouth format that dissolves in an instant.

New 60-tablet pack sizeClarityn is also launching a new 60-tablet pack size this year, so sufferers will have access to a ‘one-stop-shop’ for their hayfever symptoms. Hayfever sufferers will start to see the new pack size available in pharmacy from March. A Clarityn spokesperson said: “When discussing hayfever solutions with their customers, counter-staff should consider recommending a larger pack size, such as the Clarityn 60-tablet size, over smaller packs. This is much more economical for people who are likely to suffer for weeks, not days, during the hayfever season, and represents a higher value sales return for the pharmacist.” Clarityn contains the active ingredient loratadine, which is an effective antihistamine that is a non-sedating in most people.1,2 Clarityn keeps working – a single dose offers all day relief from hayfever symptoms.3

CLINICAL PROFILETEVA LAUNCHES GENERIC QUETIAPINE ON DAY ONEWe are pleased to announce the launch of generic Quetiapine film-coated tablets and Quetiapine (Sondate) XL tablets, on day one of patent expiry. Quetiapine is a generic version of Seroquel®€ (Quetiapine) by AstraZeneca UK Limited. It is indicated in the treatment of schizophrenia and the treatment of moderate to severe manic episodes. Quetiapine (Sondate) XL is a generic version of Seroquel® XL€ by AstraZeneca UK Limited. It is indicated in the treatment of schizophrenia and bipolar disorder, and add-on treatment of major depressive episodes in patients with Major Depressive Disorder (MDD) who have had sub-optimal response to antidepressant monotherapy*. Please read Summary of Product Characteristics for more in-depth information. Both versions are available immediately on Teva’s PriceWatch service, which is guaranteed to match the month’s average market price or Teva’s list price – whichever is lower.

Quetiapine film-coated tabletsStrength 25mg 100mg 150mg 200mg 300mgBrand Price £40.50 £113.10 £113.10 £113.10 £170.00Initial Teva Retail Price £6.08 £16.97 £16.97 £16.97 £25.50

Quetiapine (Sondate) XL tabletsStrength 50mg 200mg 300mg 400mgBrand Price £67.66 £113.10 £170.00 £226.20Initial TEVA Retail Price £50.75 £84.83 £127.50 £169.65

Teva products are available through major wholesalers, local Territory Managers or contact 0800 085 8621.

l To find out more about Teva UK Limited, visit www.tevauk.com

Reducing waste...

‘I am concerned that the Welsh Government’s own figures clearly highlight the unacceptably high level of medicines waste occurring within NHS Wales. While the creation of an element of medicines waste is inevitable, a significant amount of waste occurs as a result of inefficiencies in the system and the lack of a sustained and systematic approach to waste reduction. During 2009/10 68.5 million items of medicine were prescribed in Wales and the Welsh Assembly Government has estimated that a staggering 1.5 million of these items could be for medicines that were either not needed or were over supplied. ‘The story doesn’t end there, as the irony of the situation is that the Welsh Government, through its Local Health Boards, has then to pay for the waste to be incinerated. Waste contractors regulated by the Environment Agency declared that 254 metric tons of pharmaceutical waste originated in Wales. This figure does not include the estimated ten per cent of waste medicines that are disposed of through other channels - by disposal with other household waste, incineration with garden rubbish or into the sewer system. ‘The true cost of these unwanted medicines is unknown, but Community Pharmacy audits and other estimates believe it is about £50 million a year (excluding the cost of collection and disposal and environmental impact). ‘The last thing we want to do is to stop patients from ordering the medicines that they need, but what I think my recommendation will do is to prevent some of the unnecessary waste in the system. It is all about awareness! ‘The important message pharmacists are delivering to the Welsh Government is that inappropriate ordering and prescribing really is

COMMENT: Raj AggarwalCentral Pharmacy Cardiff

receive and that they understand how to use their medicines. Despite there being a capacity to provide up to 70,000 patients with this new service, fewer than 400 patients have currently benefited from the service. ‘Pharmacists across Wales are furious that hospitals and health boards are not actively supporting the new service, which has a real potential to improve safety and to reduce medicines waste. From the small number of Discharge Medicines Reviews undertaken to date, it is clear that there are lots of errors in the discharge process and pharmacists are spotting errors which, if not spotted, could have resulted in wastage and in many cases significant harm to the patient. It is inexcusable for health boards and hospitals to hide behind administration difficulties when patient safety is at risk and pharmacists across Wales are standing by to provide the new service. ‘I would encourage all patients that have been discharged from a hospital, or all carers looking after someone who has just left hospital, to ensure that they let their local pharmacist know that they, or someone they know, has been discharged so that they can benefit from this valuable and completely free service. ‘Putting the value on medicines prescribed is simple, will raise awareness and stop a lot of wastage.’

As the spotlight once again falls on the issue of medicines wastage, Raj Aggarwal from Central Pharmacy, in Cardiff suggests a way of helping to reduce the ‘medicine mountain’.

52 COMMENTWELSH CHEMIST REVIEW

uMEDICINE FINALCOMMENTRAJ AGGARWAL

only part of the problem. In a large number of situations it is the way that medicines are used that is a driver of waste. If, though a lack of understanding, a patient does not get the best out of their medicine they will often return to their doctor for an increased dose, a larger quantity, an additional medicine or a completely new medicine. The real way to make inroads into medicines wastage is to improve patients’ understanding and knowledge of their medicines and it is for this very reason that pharmacists introduced the Medicines Use Review service, which is a free service that is designed with this problem very much in mind. ‘Community pharmacists are also aware of the high level of wastage that occurs when patients are released from hospital. The new Discharge Medicines Review service has now been launched across Wales and is available in all pharmacies. It is designed to ensure that patients receive the medicines they should

wcr spring 2012

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