Select Committee on Health Written Evidence


Evidence submitted by the Royal Pharmaceutical Society of Great Britain (EPR 56)

1.  INTRODUCTION AND SUMMARY

    —  27% of medication errors are caused by poor information availability, costing the NHS £500 million per year.

    —  Pharmacists should have appropriate role based access to any electronic patient records.

    —  The modernisation agenda of the NHS is threatened without appropriate access.

    —  The pharmacy profession has received no firm assurances that it will have access to the electronic records.

  1.1  The Royal Pharmaceutical Society of Great Britain (RPSGB) is the professional and regulatory body for pharmacists in England, Scotland and Wales. It also regulates pharmacy technicians on a voluntary basis. The primary objectives of the Society are to lead, regulate, develop and represent the profession of pharmacy. The Society leads and supports the development of the profession within the context of the public benefit.

  1.2  Pharmacists are the healthcare experts in medicines and spend four years in University before undertaking a years pre-registration training. Community pharmacies are located in the communities in which people live and work, and are the most easily accessible part of the NHS.

2.  INFORMATION THAT SHOULD BE HELD ON THE RECORD

  2.1  A prescription is an almost universal intervention for patients with Long Term Conditions, and is a factor in the management of most acute episodes. In most cases the only accurate description of what has actually been dispensed to a patient comes from pharmacy computer systems. We would expect this information to be part of future electronic record systems.

  2.2  When considering patients preventing personal data being placed on systems it is important to consider the potential consequences of this data not being available. For example, clinicians may not be aware of drug allergies, duplications in treatment or previous dose adjustments which could have serious patient safety implications.

3.  PHARMACY ACCESS TO THE RECORD

  3.1  The RPSGB believes that pharmacists should have appropriate role-based access to any electronic patient record. The information they would have access to would be a pre-determined data set and only information that was required to carry out their role with regard to the individual patient. This might include medication, clinical conditions, allergies, laboratory results and previous adverse reactions.

Effective Treatment

  3.2  Currently, pharmacists in community pharmacy only have access to the information included on the prescription they dispense and any previous prescription that they have dispensed for the same patient. If the patient obtains some of their prescriptions from other pharmacies or from secondary care, the pharmacist may not have a full picture of all the medicines being prescribed for the patient. They will also have little information about the conditions being treated. This makes it difficult to assess the appropriateness of the medicines prescribed or whether they may interact with other medicines that the patient is taking. In turn, it is difficult to advise fully the patient about their medicines without an understanding of what diagnoses have been made.

Patient Safety

  3.3  The NHS Connecting for Health NHS Care Records service website[60] quotes the following figures:

    —  The root cause of 27% of medication errors is poor information ability.

    —  1,200 people die each year in England and Wales as a result of medication errors, costing the NHS £500 million a year.

  3.4  Other research[61] shows that 6.5% of admissions to hospital are related to an adverse drug reaction at an estimated cost of £466 million per year. Pharmacists have the skill and knowledge to be able to detect and prevent many of these safety issues, but do not have access to sufficient patient information to be able use systematically their knowledge and skills to reduce the number of errors, adverse drug reactions and admissions to hospital.

  3.5  Access to the record would support pharmacists in helping the Government meet its target of reducing by 40% the number of serious errors in the use of prescribed drugs as well as helping reduce the human and financial cost of prescribing errors.

Modernisation of the NHS

  3.6  The Government has been pursuing an agenda of modernising the role of Health Professionals. Pharmacy has been at the core of this. New legislation now allows pharmacists to prescribe independently of GPs. The government has launched its "Pharmacists with a Special Interest" framework to allow pharmacists to provide a more specialist service to patients and to improve access and convenience to patients.

  3.7  The new primary care contractual frameworks allow pharmacy to play a more central role in patient care, with more scope for making clinical interventions and integration with the primary health care team. As part of these new arrangement, community pharmacists undertake Medicines Use Reviews, conduct public health campaigns and advise patients on self care and the treatment of minor ailments. Many pharmacists are also involved in providing other locally commissioned services to meet the needs of patients in their locality, for example diagnostic testing, substance misuse, sexual heath and services to care homes.

  3.8  Appropriate role-based access to electronic records could also support the seamless transfer of care between primary and secondary care, and improved multidisciplinary working for example with GPs.

  3.9  All of these new services have been designed to fully utilise the pharmacists expertise in medicines and integrate this into the NHS. These new pharmacy roles are already improving patient access to services, helping to reduce waiting times, reducing admissions and increasing capacity in primary and secondary care and delivering value for money. However, future success is dependant on appropriate access to electronic records. Without it, the benefits of all of these recent changes may never be fully realised.

Pharmacy Access

  3.10  To-date there have been no firm assurances that community pharmacy will have access to the care record database or to the other IT developments other than those required to operate the electronic prescription service.

  3.11  Access from pharmacy is also supported by the consumer group "Which?" who have stated "consumers want and expect continuity of care and all healthcare professionals (including pharmacists) involved in their care to have access to their medical record. Without this, how can care be patient centred?" Access was also supported by MP panel members at the October 2006 meeting of the All Party Parliamentary Group on Patient Safety.

4.  CONFIDENTIALITY

  4.1  Pharmacists are bound by a professional "code of ethics" produced by the RPSGB. Breaches in this code can lead to removal from the register, meaning that person can no longer practice as a pharmacist.

  4.2  Pharmacists have operated patient medication records for a number of years and already have robust systems in place for handling patient confidential information, and in addition to the above ethical requirements are subject to a wide range of legal, ethical and professional requirements.

  4.3  Pharmacy contractors are required to comply with the legal obligations of the Data Protection Act 1998 and the common law duty of confidence and under the NHS community pharmacy contract, pharmacy contractors and their employees must conform with the NHS code of practice on confidentiality. The clinical governance framework ensure compliance by including policies for ensuring staff are appropriately trained and that all staff contracts include clauses on patient confidentiality.

  4.4  The RPSGB welcomes the additional safeguards being introduced, including the use of "smartcards" to control access. It is important that these safeguards, however, do not impinge on patient safety by unduly restricting access at the same time respecting an individuals right to confidentiality.

5.  PROGRESS OF CONNECTING FOR HEALTH

  5.1  The RPSGB feels that the CfH programme would benefit from greater clinical engagement, and welcomes the recent changes to its structure that are being made to address this. There are still concerns, however, over the level of engagement with the pharmacy profession and its involvement with this and other aspects of the programme.

  5.2  Overall the RPSGB is supportive of the Connecting for Health programme and the progress it is making.

The Royal Pharmaceutical Society of Great Britain

16 March 2007







60   http://www.connectingforhealth.nhs.uk/delivery/programmes/nhscrs (accessed 15 March 2007). Back

61   Pirmohamed M et al Adverse drug reactions as cuase of admission to hospital: prospective analysis of 18,820 patients. BMJ 2004; 329: 15-19. Back


 
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