Pharmacists have already got used to get the list of the preparations recommended by a doctor written on a sheet of paper or just from the patient himself and to choose the cheapest or the most prestigious of the accessible medicines, forgetting about bioavailability, treatment regiment, contraindications, biochemical indexes, often guided exclusively by economic factors, which makes the pharmacy resemble an ordinary shop.
Foreign companies don’t loose their time and promote different brands by any means, in particular through their representatives who come any convenient time with the text approved by the company and learnt by heart which has a magic influence upon the listeners.
The legal division of preparations in England considers the three groups: the so-called GSL (General Sales List); P medicines (pharmacy medicines), i.e. the medicines served without the prescription, but under the control of the pharmacist; and (prescription only medicines), i.e. the ethical drugs. There also exist PML (Medicines for Animal Use) or veterinary medicines, but we are not going to discuss them in this article. Over-the-counter drugs habitual to us are included into the first two groups and make up 30 % of all the medicines. As follows from the name, the GSL preparations are over-the-counter drugs both in pharmacies and in any other places including supermarkets. The rest are to be distributed only in pharmacies, as their distribution presupposes the pharmacist’s recommendations, the verification of their possible interaction, and in case of POM the presence of the prescription.
Instead of the usual prescription written out by a doctor the Englishmen have the opportunity to get it from a nurse, a dentist, a vet (in case of prescriptions for animals), and, which will soon come into force, from a pharmacist.
Depending on the territorial division and belonging to any medical profession prescription forms differ in the colour. Besides, there exist the restrictions for the preparations which are prescribed by nurses and dentists (a special medicament list is introduced for them). All mentioned above satisfy the requirements of the National Health System (NHS). But along with these prescriptions there exist different private prescriptions which can be only written out by a doctor.
Some requirements on the distribution of prescribed preparations are officially assigned and exactly followed, and the prescriptions themselves are checked against the established requirements. Let’s take a medical NHS prescription form as an example.
Before a pharmacist distributes the medicaments prescribed he is to make sure that:
- The prescription is written out by a registered doctor;
- it is signed with ink by the doctor himself;
- the prescription includes the following information (either written with ink, or typewritten, or printed):
- date of prescription;
- address of the doctor;
- professional qualification (doctor, nurse, dentist);
- name, address, and age of the patient.
Prescriptions have the term of validity. Thus, prescribed medicines cannot be served six months later from the moment of its prescription, and in case of controlled medicaments the prescription is liquid for 13 days.
NHS system provides the compensation of the cost of the NHS-prescribed medicines served in pharmacies according to the settled Basic Rate. There exist a number of medicaments not mentioned in the list of NHS prescriptions, and therefore not compensated in case they are served. So the pharmacist must be very attentive while serving medicines and follow the latest issues of the National Form of Medicines and Basic Rate.
If it is prescribed to serve Generic Viagra 100mg/32 pills and in the pharmacy they have only Brand Viagra 100mg/32 pills and according to the Basic Rate this preparation is more expensive than the generic one, the pharmacist either sends the patient to another pharmacy which can serve the prescribed medicine, or orders the necessary preparation and serves it the next day. The pharmacist can serve any brand satisfying the generically prescribed preparation, but he is to remember that only the basic cost provided in the rate will be paid and the pharmacy may bear financial losses.
According to the law, all the prescriptions are written out in English and practically all the medicines are prescribed using the international names (sometimes the doctor names the brand which is necessary for his patient). Thus, prescribing Doxazosin a doctor can add: serve Cardura; if the pharmacist has both the generic and Cardura he is to serve the preparation named by the doctor – Cardura. In spite of the difference in the cost (3.85 and 10.56 respectively) the pharmacist will have compensation the cost of the preparation served as this is proved by the recommendation of the doctor. If Prevacid is prescribed with no comments, the generic Prevacid will probably be served even if there is Zoton brand in the pharmacy.
The prescription form consists of two parts – the prescription itself and the perforated part which is returned to the patient. It doubles the list of the medicines prescribed and reminds the patient when it is necessary to make a repeat order, visit the doctor for consultation, the doctor’s reception hours, the phone number and e-mail for contacts and prescription order. This considerably simplifies the doctor’s work as well as the patient’s life. The patients with fixed regimen can plan the schedule of visiting the doctor and ordering prescriptions.
Besides, by the agreement with the doctor and the pharmacy, the ready prescriptions can be delivered right to the pharmacy, checked, and the prescribed medicaments delivered to patient’s place.
The person who comes to a pharmacy with a prescription must fill in the overleaf. He must sign it (or put the name of the patient), write the address, the paid cost or the kind of benefit.
NHS-payment for one prescribed unit from this April is 6.30 pounds.
There exist some peculiarities in the payment for prescribed preparations, for example, if Augmentin 250 mg and Albenza 400mg tablets are prescribed in one prescription form the patient will make one payment.
As for the contraceptive preparations, they are served according to the NHS-prescriptions free of charge. The patients grant exemption from the payment for some reason or other. These reasons can be:
- the age – either under 16 or over 60;
- 16 – 18 year-old getting stationary education;
- getting unemployment benefit;
- low income;
- prepayment for the medicaments;
- veterans of war;
- medical release (diabetes, thyrotoxicosis, epilepsy, etc.).
All the information on the patients including the information on the benefits is introduced into the database of the pharmacy or pharmacy network. Respectively every pharmacy is provided by the computer system (some systems are spread among the British pharmacy network). The patient’s file includes both personal data (name, address, age, benefits, doctors’ names, etc.) and medical (allergy, intolerance, all the served medicines, etc.).
The pharmacist can always resort to the file of the patient and ground the recommendations on the preparations basing on the probable interactions or contraindications.
It is obvious that the pharmacist won’t check against the file if the asthmatic asks ibuprofen because of the evident contraindication, on condition that the patient has already had the experience of successful taking ibuprofen under his doctor’s control, the medicine can be permitted for taking.
The computer pharmacy network allows not only to support the database of the patients and doctors and checking the interaction of the preparations, but also to control product traffic, automatizing orders, keeping records and executing the obligation to supply every medicine served with the suitable label.
The labels play an important role as they carry the instructions of the doctor in charge and the warnings of the pharmacist obligatory to follow for the purpose of effective treatment. It is not the copy of the instruction.
As a rule it is indicated in them:
- patient’s name;
- name and address of the pharmacy served the medicine;
- name of the preparation;
- alerting about using the drug, e.g. “shake before use”;
- general quantity in the container (package, bottle);
- for external use (in case of external);
- other special instructions.
Usually pharmaceutical technologists are occupied with the preparation of the prescription and the sticking of the labels, and the pharmacist checks the correctness of the prepared medicaments (signs in the corner of the label), examines the possible interactions, side effects, contacts with the doctor in case of need, and gives recommendations on drug taking and is responsible for the work of the pharmacy and the serving of the prescribed and over-the –counter drugs.
Special attention is paid to the safety of keeping medicines at home. That is why patients are recommended to keep medicines in places inaccessible for children, and they are served in the so-called “child-resistant containers” – containers which are opened with effort. More over patients are advised to return unnecessary medicaments to the pharmacy where they can be destroyed – the law prohibits reusing medicaments returned even if they have an appropriate keeping date and the package wasn’t open.
The requirements to the serving of medicaments under control somewhat differ from those to prescribed. Controlled medicines are divided into five categories and different requirements are made of them respectively to their keeping, registration and serving. That part of the medicines which undergoes special recording must be included into the Register of the medicines under control when arriving to a pharmacy and serving. Besides the majority of these preparations are to be written by a doctor with the indication of the concentration and the quantity (tablets and liquid) in figures and letters. Unfortunately, English doctors also have a disgusting handwriting.
Very seldom there happen prescription falsifications; that is why all the prescriptions are to be checked very carefully when arriving to a pharmacy. The pharmacist suspecting the falsification can contact to the doctor who “has written out” the prescription and if the suspections are confirmed must inform the police.
Medical people are in the close connection controlling and correcting the treatment of their patients. This really helps their work as even at serving over-the-counter drugs the checkup of possible interactions and undesirable effects takes place. Pharmacists have key positions in this professional cooperation as the patient to get a medicine, over-the-counter or prescribed preparation written out by a dentist, a nurse or a doctor, goes to a pharmacy .
If in some doctor’s prescription some medicine incompatible with the prescription of another appears, the pharmacist solves the problem consulting with the colleagues and recommending the most suitable medicine.
The feedback also works: doctors as well as nurses resort to pharmacists’ advice, recommendation and calculating of the doze. It makes patients much good as they can rely on the high-quality professional help whatever they address.
Of course this system is not ideal, but it is developing, reforming and tending to improve patients’ service. Thus, since 2005 pharmacy computers take electronic prescriptions.
The meaning of the prescription in the qualified medical help service in Great Britain is great and many-sided – it is first of all the main bearer of medical information, the document for recording and compensation financial costs of pharmacies, the primary information about the course of the treatment, the patient, and statistically valuable information allowing to plan the public-health budget in general. And undoubtedly, British doctors, chemists and all the NHS system could not have functioned without such an ancient invention as a prescription.
