Are prescription charges in England fair?

listen to ‘Prescription charges in England’ on Audioboo

Should English MP's be only allowed to vote on English
matters?

Patients on the NHS in Scotland, Wales and Northern Ireland do not have to pay for their medicines. However, NHS patients in England will still have to pay for their medicines, unless they are officially exempt. And with prescription charges per item rising to £7.85 this month, many people south of the border are still questioning why the levy still exists and whether it should go.

Earlier today, I tried to obtain statistics online to find out how many patients in England are exempt from the levy for prescriptions. But sadly the publications hosted by the Health and Social Care Information Centre with those details were unavailable.

However, to illustrate the overall situation regarding prescriptions in England, the Pharmaceutical Services Negotiating Committee have a graph titled "12 Month Rolling Items Dispensed" which shows that at around November 2011, the number of prescription items dispensed broke through the 900 million item mark. And that figure is slowly escalating to a billion. And in my experience working in England last year, the majority of patients do not pay for their prescriptions.

If this is generally the case across England, then I suppose one can be forgiven for questioning the justification for a prescription charge. With the prescription item fee rise this month, it is very clear that the coalition at Westminster has no intention to review the levy. But, politically, you cannot blame some people for raising another issue of whether English MP's should only be allowed to vote on issues affecting England.

And I don't blame them for that. I think it is a major pity and, frankly, astonishing that politicians at Westminster have never considered raising the idea of installing a mechanism to ensure that England has the ability to fully decide on what policies they want implemented, without MP's from other parts of the United Kingdom voting also on those issues despite the fact it will have absolutely no relevance to their constituents.

The Royal Pharmaceutical Society's Neal Patel voiced his opposition to the 20p increase in prescription charges on behalf of the society. I can understand his comments and he is certainly not wrong to give the impression that the exemption system needs to be reviewed.

But in an age of austerity and cuts in public spending, rising costs for medicines and lower employment prospects for pharmacists, are free prescriptions across the whole of the UK really affordable?

The MMR vaccine and the measles crisis in Wales

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Image courtesy of Keerati / FreeDigitalPhotos.net

It's the vaccine that has time and time again found itself in the centre of controversy. Ever since Andrew Wakefield led a study which linked autism to the MMR vaccine, parents have agonised over whether to permit children to have it. But despite many years of anxiety, uptake of the vaccine used to fight measles, mumps and rubella have recovered to an extent.

But what exactly is the MMR vaccine? The vaccine is composed of live measles, mumps and rubella viruses, but they aren't as potent as normal versions. When injected, it will provoke the body's immune system to produce antibodies. Their purpose is to fight infection by making bacteria and viruses much less harmful by recognising a special part of the bacterial or viral target called an antigen. Both the antigen and the antibody bind together which stops the bacteria or virus from causing harm.

The overall purpose of the vaccine is to ensure that any human being who is vaccinated, who happens to catch either one of the three types of virus then their immune system, will combat the viral infection.

Although many studies have dismissed any link between autism and the MMR vaccine, side effects can still occur and can include mild forms of measles. Signs of this include a rash, appetite loss and fever. This can last between 48 and 72 hours and can normally take place between 7 and 11 days after the injection, according to NHS Choices.

But the risks of those side effects are outweighed by the benefits of being vaccinated as being infected by either of the three viruses without the vaccination can be more severe. Measles can be fatal. According to the World Health Organisation, 158,000 died worldwide as a result of measles in 2011.

So why has a major crisis unfolded in Swansea and it's surrounding areas this weekend? So far, according to BBC News, just under 600 people so far have been affected by measles in many parts of Wales which has provoked a dramatic increase in the demand for the uptake of the MMR vaccine. And so far, 1,700 people have been vaccinated during emergency clinics held across hospitals in the south of Wales today. There is still a potential possibility that those figures could escalate even further in the coming days.

And could similar events break out north of the border? STV News reported on a measles outbreak that happened in Lanarkshire last November where nine cases of measles were confirmed, despite a very high uptake of the MMR vaccine.

Currently, there is no imminent threat of any form of an outbreak in Scotland. But there is certainly no room for complacency and events in Wales will, without a doubt, continue to be monitored very closely across these islands.

Exploring chronic pain in pharmacy

Last night pharmacists across the Kingdom of Fife and beyond congregated at Victoria Hospital in Kirkcaldy for a special seminar on chronic pain management. The event consisted of talks from specialists and a series of workshops where pharmacists and other personnel discussed issues ranging from the effectiveness of over the counter medicines for pain relief to more complicated treatments through exploring a series of pre-set case studies.

What was so striking about last night was the diverse range of opinion and personal learning experiences that participants shared, particularly during the workshop sessions. It became clear to me personally that pain relief is not just some sort of an irrelevant issue that can be brushed aside in pharmaceutical care. There's much more to it.

For instance, one of the consistent highlighted issues that kept coming up was attitudes towards over the counter treatments. It became apparent to me that many perceive simple and basic treatments, such as paracetamol over the counter (or even in a GSL pack) as ineffective and simply because they were being sold without a prescription.

A former British Prime Minister once used an infamous catchphrase, "back to basics". And as far as pain relief is concerned, maybe it is time to head back to basics. Even us pharmacists should become more aware of the opportunity that may arise through speaking with our patients about their medicines, in the fact that all our patients may require is just a chance to put their concerns and thoughts forward about what they are taking and how happy or unhappy they are with the medicines they have been prescribed to achieve the desired therapeutic outcome.

Its amazing how much one can learn from even an event like this. None of us have seen it all and there is always an opportunity to learn something new. It was a terrific night and was especially fun talking with fellow pharmacists about their experiences as well.

Would an independent Scotland benefit pharmacy?

Today the Scottish Government agreed with the Electoral Commission's findings over the proposed wording of next year's question in the forthcoming Scottish independence referendum, due to be held in the autumn of 2014. Pharmacy in Scotland isn't exactly immune from the effects of the recession with pharmacies having to take on the effects of category M cutbacks and pharmacists, particularly newly qualified ones, struggling desperately trying to get their foot on the pharmacy employment ladder.

Would an independent Scotland pave the way for a creative new way to deal with the current issues that are overshadowing the pharmacy profession north of the border?

None of us know what an independent Scotland will really look like. But nobody can also doubt either the opportunity it may bring as well.

Frankly, nobody has the right to assert that Scotland is incapable of running its own affairs effectively. To suggest so would be petulant. Many newly formed independent nations have managed just fine since embracing their own independence and nobody can really deny that whether they support the union or independence.

But the choice next year will be really down to what is in Scotland's best interests. Whether Scotland is better staying together with the rest of the United Kingdom, hoping that the coalition's austerity measures will result in future economic prosperity. Or whether Scotland's position in the union is untenable and therefore being independent is the only way forward.

Scotland already runs its health service very differently from England, Wales and Northern Ireland. The major difference can be seen between the coalition government's proposal to radically reform the way the NHS is administered by allowing GP's more of a say in the way services are commissioned in England. Scotland, under the Scottish National Party run government at Holyrood, has ruled out the private sector from running any aspect of the National Health Service.

A lot of the arguments for independence are based on the way the economy should be run. Many people north of the border do not approve of the austerity measures being brought about by Westminster and want to go down an alternative route by administering their own affairs and economic decisions.

As pharmacy are concerned, I can imagine nearly every contractor up and down Scotland do not necessarily welcome the category M cuts with glee. Although health policy is different in Scotland, could general economic policy from Westminster be holding the profession back?

Or could even a lack of creative thinking be holding back the profession? Some people argue that we already have enough powers north of the border to take an alternative route when it comes to administering and satisfying the needs of the pharmacy profession, pharmacy contractors and pharmacists.

But some others argue that because the Scottish Government has to resort to only a grant from Westminster for funding of public services in Scotland, it doesn't hold enough power to raise the necessary capital to adopt a different economic policy, despite the fact that the Scottish Parliament has the power to vary income tax by three percent over or under the current levels of income tax.

I would quite like to see some sort of a national debate set up and run, for example by the Royal Pharmaceutical Society in Scotland, to see what everyone in the pharmacy profession in Scotland thinks about what Scottish independence could mean for the future of pharmacy in Scotland.

Please let me know what you think: anas@officialanashassan.com

Polypharmacy will eliminate pharmacist unemployment

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Polypharmacy is defined as a scenario where a patient is on a high number of different medicines, some of which could be clinically deemed to be unnecessary for use therefore creating a burden on the patient in terms of adhering to compliance with prescribed medicines. And being on a high number of medicines can be clinically dangerous as a result of its continued use (due to drug-drug interactions or adverse drug reactions).

Unncessary polypharmacy isn't an ideal scenario for a patient's long term pharmaceutical care. Nor is it a help for the public purse especially in times of austerity like now where any savings in public spending will undoubtedly be welcome for taxpayers and the UK coalition government.

Last week in Edinburgh, I learned a little bit more about how pharmacists across Scotland are tackling the issue. Already to my understanding, NHS Highland, NHS Lothian and NHS Tayside seem to have made the most progress in starting to find solutions with other NHS health boards following suit. The recent "Polypharmacy Guidance" document, published jointly by NHS Scotland and the Scottish Government recognises the consequences of excessive polypharmacy which could cause patients problems.

The document also illustrates, in section 2.1, a criteria which makes an assessment of factors such as whether a medicine is being prescribed correctly, for instance, for a valid indication, at the appropriate dose, whether its clinically effective and whether a more cost effective treatment is available.

Later on in the document, it has been suggested that for 43,190 patients aged 65 or over with two unnecessary prescription items stopped over six repeat prescriptions in a year would bring annual savings of over £5,662,397. Compare that with an annual Scottish medicine bill of approximately £1.18 billion (ISD Scotland, 2011/12) that may only sound like a small drop in the ocean. The money saved could be utilised to either fund expensive treatments for specific groups of patients, for instance there has been talk of a possible cancer drugs fund for Scotland.

But what does it all mean for unemployed pharmacists? The savings made could be used to invest in employing nearly 222 band 6 pharmacists in Scotland. The facilitator/presenter of last week's seminar gave the impression that pharmacists are currently playing a major role in managing polypharmacy north of the border.

And who said that the pharmacist unemployment crisis wasn't solvable?

Why the pharmacy student cap will not really be fully effective until...the end of the decade.

Image courtesy of Salvatore Vuono / FreeDigitalPhotos.net

The Conservative Universities and Science Minister, David Willetts, and the Conservative peer, Lord Howe, announced earlier this month that there will be a cap on pharmacy student numbers in England, according to the Pharmacy Life website. The aim of the cap is to bring about a re-balance between the number of pharmacy graduates and NHS-funded pre-registration placements.

As welcome as this cap may be, it frankly is too little, too late. This is a measure that should have been implemented years ago. Pharmacy has, thankfully, finally caught up with dentistry and medicine in ensuring a balance is maintained between supply and demand. If I predict correctly that the cap will be effective from the next academic year, 2013/2014, then next year's graduates have a much better chance of securing a pre-registration placement in approximately a year to eighteen months time. 

But what about when they go on to qualify as newly qualified pharmacists, when they need to find secure work? This is where the main problem really exists. Right now, many pharmacists are, if they are really lucky, only able to secure occasional shifts often finding themselves heavily underemployed.

And many more are having to make serious decisions about their future. Does pharmacy even have a role in their future career and life? Its a tragedy that graduates across these islands are even asking themselves the previous question. How did it really all come to this? 

This is the reality that has shocked many newly qualified pharmacists everywhere. And we are not talking about people who, in footballing terms, would only find any hope playing in the reserves side of a football team. They are not write offs. They are talented people who have been unfortunate enough to find themselves in the middle of a volatile storm. 

I am no advocate of negativity. Nor do I scaremonger. But if we are really putting the worst scenario forward then it may not be until the end of this decade when real stability will resume in terms of ensuring a healthy balance is struck between the number of pharmacists available and pharmacist jobs and work. And that's if the economic crisis begins to finally properly ease for the first time since 2008.

How many people are going to really quit pharmacy as a profession after working for years to secure their degrees? How many people are going to stay in pharmacy no matter what stage they are currently at in their careers? These are not known and nobody knows how many qualified pharmacists exactly will be registered to practice in Great Britain, Northern Ireland and the Republic of Ireland in the next few years. The job market is simply saturated. And deeply. Unless the amount of work available increases then there will be more unemployed pharmacists who will have to potentially make some life changing decisions.

Scotland, Wales and Northern Ireland are yet to implement similar measures. And as far as I am aware a similar measure does not exist in the Republic of Ireland. The other nations mentioned should implement such measures if they are to avoid worsening this employment crisis as what has unfolded in England. No country is immune from what has happened.

Just because we now have a cap on pharmacy student numbers, it doesn't mean that those who secure pre-registration placements from 2014 onwards will be guaranteed a job. Instead, they will simply have to slow down and join the long tailback on the pharmacy employment motorway.

What is a stroke? And how you can prevent them from happening to you?

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Strokes are formally termed as cerebrovascular accidents. The blood supply to the brain is disturbed and this leads to the brain losing its ability to function properly and this can happen at a very frightening speed. Factors that are responsible for this are thrombosis i.e. a blockage of the blood supply, a lack of blood supply or even internal bleeding.

Strokes, no matter the level of severity, are extremely dangerous and can cause permanent injury to an individual and can even be fatal. When the brain becomes affected then functions such as being unable to move your limbs on either or both sides of your body, not being able to speak normally or understand speech and even vision can be affected.

Strokes can happen to anybody at anytime. According to The Stroke Association, 150,000 people across the United Kingdom suffer from a stroke and it is the third most common cause of death.

However, they are beatable and there is something you can do now to minimise the possibility of you suffering from a stroke. Lifestyle factors are critical - high blood pressure, smoking and a poor diet resulting in high cholesterol are major contributors to strokes. Preventative measures are essential and it doesn't require too much of an effort to make the necessary changes that will help you in the future.

Decrease the intake of fatty foods - cut down on your intake of takeaway food (you can still have the odd treat once a week!), eat less sweets and chocolate bars. And increase your intake of good food such as fruit and vegetables (remember your five portions a day). Have Scotland's finest breakfast - porridge! It is a super source of slow releasing energy and you can make it taste delicious too by having a different flavour of porridge every morning for instance.

Cut down on your smoking. The National Health Service now run smoking cessation clinics everywhere. Find out where your nearest one is by contacting either your local pharmacy (many pharmacies now run smoking cessation clinics) or GP practice. Did you know that, according to the National Stroke Association, smoking doubles the risk of a smoker when it comes to potentially having a stroke in comparison to a non-smoker?

So start making those simple changes to your life now and soon enough you will be living a happy and healthier lifestyle and thus minimising the risk of you having a stroke or something else that could badly affect your health.

Pharmacy student? Pre-reg? Maybe even newly qualified?

Image courtesy of Salvatore Vuono / FreeDigitalPhotos.net

Pharmacy student? A pre-registration pharmacist? Or maybe even just newly qualified?

I would like to hear from you as I plan to carry out a personal investigation into the growing crisis facing the pharmacy profession with regards to pharmacist unemployment and particularly our young people in the profession who's futures matter for the future evolution of pharmacy.

And this is where your important role comes into play. I want to hear from you with regards to your hopes, aspirations, concerns and even fears about where your future is going.

I would also welcome any input from the General Pharmaceutical Council, Royal Pharmaceutical Society, academics, community, hospital and industrial pharmacists, pharmacy leaders and entrepreneurs, managers, journalists within pharmacy/healthcare or any other person directly or indirectly related to the pharmacy profession.

Your time and input will be hugely valuable to me as I hope to seek solutions and answers with regards to this growing crisis and also instil hope for everybody so that a bright, positive and prosperous future exists for the pharmacy profession.

If you are interested in helping me then please e-mail me: anas@officialanashassan.com

I look forward to hearing from you.

The curse of the Norovirus

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Its nasty. Its unpleasant. It inflicts torture. Its the norovirus.

According to a report in The Independent newspaper this morning, vomiting bug cases have almost doubled since last year, affecting up to nearly a million people. It has disrupted school classes, closed hospital wards and caused problems in other care settings.

And I know what its like. I've been struck by the norovirus. Twice.

The bug is highly contagious and anyone can catch it if they make contact with anything that is contaminated, including any object. It is also very easy to catch from another person and even no contact is required. 

Sadly, there is no cure for it so any infected individual must let the virus run its course. Generally the virus will end its run within one or two days after it begins. However, according to NHS Choices, any individual suffering from the norovirus can make certain measures to minimise its disruption:

- Drink plenty of fluid to avoid dehydration.

- Use paracetamol appropriately to combat any pain, aches or fever.

- Eat foods that are easy to digest if you need to consume food.

- Do not go to your doctor as nothing can be done and the norovirus is contagious.

- If your symptoms last for a few days or if you have a serious illness then contact your GP for advice.

Regarding the fourth point, I would also add don't go to accident and emergency either because again nobody there can do anything for you and the last thing you would want is the virus spreading to another patient in the hospital. When I had the virus second time round, a long time ago, I was in such agony that I insisted on going to hospital. But when the staff at A & E told me it was probably the norovirus then that put everything beyond doubt.

And its also best to stay at home as well in order to minimise the impact of the norovirus. You don't want to infect anyone else after all!

This morning, Ward 2 at Stracathro Hospital has been closed due to the outbreak of the virus there. Anyone planning to visit the hospital ward to see family relatives or friends is advised by the hospital not to head there for 48 hours.

With just less than a week to go until christmas, the last few days will be a little more nervous for everyone. Lets hope this virus is contained and in control well in time for then.

Latest Scottish Pharmacy Review magazine

I am delighted to announce that just a few minutes ago, I discovered that my article regarding why politicians do understand community pharmacy in Scotland has been published in the latest edition of the Scottish Pharmacy Review.

To take a look at it, please visit: http://www.pharmacy-life.co.uk/ and head to the 'Magazines' section.

Please note that only suitable healthcare professionals within the pharmacy sector will be permitted to access this section of the website.

Then make your way to the latest magazine. I feature at the end of the magazine.

Alternatively, if you are expecting a copy at your community pharmacy place of work then you can check me out in the magazine too! Print or online, I'll be there!

Politicians DO get community pharmacy in Scotland

Forget recent negative comments about pharmacy, lets applaud our politicians in Scotland for showing insight into community pharmacy and what pharmacists can do for our communities.

Scotland has always led the way when it comes to taking the quality of our healthcare forward, particularly since devolution came to life in 1999. And Scottish community pharmacy has also led the way when it comes to showcasing the talent, ability and innovation that equates to the success story that is community pharmacy and our talented community pharmacists in Scotland.

The budget across the country in all areas of life is being squeezed year on year. But having said that, the publicity that community pharmacy is winning is a welcome boost for pharmacy in Scotland. The last few weeks has seen our profession attacked so unprovokedly, unnecessarily and unacceptably by a minority of elected representatives.

But if you take a look at the MSP's visit section of the Community Pharmacy Scotland website then it really is not fair to ignore the hard work MSP's are making to actually recognise the welcome value that pharmacists in Scotland bring to the NHS and healthcare provision.

And whether its Scotland's First Minister or members of all the political parties or none from Holyrood who take time out of their busy schedule to see community pharmacists in action, the work that they undertake on the observational visits is more than enough to combat the unfair accusation levelled at politicians that they seem to be doing 'nothing' about pharmacy.

Its also worth noting that pharmacy in Scotland is the envy of the rest of the United Kingdom and beyond. When the new pharmacy contract was implemented, it demonstrated that pharmacy in our nation was ready to elevate to the next level.

The Minor Ailments Service has enabled the much welcomed autonomy given to pharmacists to be able to directly support patients who may not have the time to see the GP but still receive appropriate treatment for a minor ailment. Whether its athlete's foot, a cough, eczema or even hay fever (the list is not exhaustive, see the full list here) then this much welcomed service has been a major success story in Scotland, enabling pharmacists to make full use of their patient-focused skills and freeing some of the GP's time. Some other parts of the UK are now implementing a similar kind of service, like Wales, however many more patients in other parts of these islands still don't benefit from such a service.

The Acute Medication Service see Scotland's pharmacies accepting GP10 prescriptions including barcodes on them. A patient with a prescription can wait less longer as all the pharmacy needs to do is scan the prescription, receive the content of the prescription electronically without the need to input data into the dispensing computer and then just get the pharmacist to check to clinically check the prescription before the patient receives their medicines. Convenient for patients. Convenient for pharmacies.

The Scottish pharmacy contract also contains an element which is the Public Health Service and this enables pharmacies to play a role in enabling their patients to be encouraged, educated and supported in self care. Pharmacies are expected to take part in campaigns run nationally (where they normally have to display a health promotion poster) covering public health issues such as smoking cessation, healthy eating and annual flu vaccinations.

And finally, the Chronic Medication Service. In England, these are called Medication and Use Reviews (MUR's). But Scotland has its own unique service. It is broken down into three stages. Stage I consists of the patient registering their interest, with full permission given by them, in using the service if they are taking medicines for long term conditions. Stage II involves the pharmacist using a pharmaceutical care plan in order to identify the needs of their registered patients regarding their care and addressing those needs. And Stage III involves establishes the integrated effort of care provision where the GP issues a prescription at appropriate time intervals over an agreed period of time where at the end of that period of time an 'end of care summary' is sent to the GP electronically covering issues such as compliance and any recommended courses of action that the GP may choose or choose not to take.

After all that detail, it is fair to say that our politicians, stakeholders and pharmacy leaders have gone beyond the call of duty when it comes to addressing the needs of patients who utilise pharmacies and also has enabled pharmacists in Scotland to make maximum use of their clinical and patient-focused skills within a nationally agreed framework.

Our elected representatives must maintain, sustain and protect the defence of the role of the pharmacist within the healthcare system in Scotland, and the rest of the UK. But in a time when one negative comment or assertion can ignite a passionate outcry of lack of fairness and a sense of victimhood, lets pay tribute for a change to the vast majority of our politicians for recognising the hard work that pharmacists perform in Scotland's National Health Service.