Category Archives: Pharma

Advanced paramedics in England will be able to prescribe medicines to people who do not need hospital treatment, under new laws starting on Sunday.

 Who will be able to prescribe?

Advanced Paramedics  – those undertaking or having completed a Master’s-level (Level 7) qualification – will be allowed to complete a prescribing module, if their employed role has a need for it (i.e. you must be employed in a prescribing role, e.g. in a GP surgery. An AP cannot complete it if employed in a standard frontline paramedic role where prescribing is not a required qualification).

How does this fit with other professions?

Many other health professions can already prescribe. Nurses led the way, followed by various others including radiographers and chiropodists.

Will this mean frontline paramedics will prescribe?

No. To register, frontline paramedics have only completed a Bachelor’s-level qualification (Level 6) (from 2021), a Foundation level qualification (currently) or an in-work IHCD qualification (in the past), and therefore will not be able to apply for the prescribing module.

Why are paramedics being given the ability to prescribe?

Paramedics don’t just work in ambulances. We also work in GP surgeries, A&Es, walk-in centres, and Intensive Care Units across the country. Many of these roles are limited because the Advanced Paramedic, often employed alongside Advanced Nurses or other Advanded Allied Health Professionals, cannot prescribe, unlike their nurse & AHP counterparts. The change to the law will allow these to work equally to other professions, and will expand the number of range of jobs Paramedics can do (e.g. why employ an Advanced Paramedic who can’t prescribe, when you can employ an Advanced Nurse who can?).

Will there be any prescribing in the Ambulance setting?

Paramedic Prescribing is up to each Ambulance Service Trust to implement. There is certainly scope for benefiting the patient & the system if Advanced Paramedics are able to support frontline crews with prescribing skills. There are many cases where patients are taken to hospital or referred to the out-of-hours GP for a simple prescription that could, now, be handled by the ambulance service.

Is prescribing just for non-emergency cases?

No. Paramedic Prescribing will also widen the range of drugs paramedics are able to administer in an emergency when supported by an Advanced Paramedic. This too will be up to each Ambulance Service Trust to implement.

Won’t people just call for an ambulance for a prescription because its quicker than waiting to see a GP?

This question assumes that ambulances currently only go to emergency cases. This isn’t true, and we already attend many non-emergency cases that could/should be dealt with outside of the ambulance service. This has become the case through a combination of factors discussed in another article. Many of these patients, now they have entered an ambulance system ill-equipped and ill-trained to deal with their non-emergency health condition, are fed into the out of hours GP or hospital system.

Giving the ambulance service the ability to prescribe will not reduce the amount of non-emergency cases we attend, but it will reduce the onward burden of these cases to other health systems.

Furthermore, sometimes patients have multiple needs, some of which are urgent and some non-urgent, which may all contribute to an ambulance call-out. For example, a patient may have fallen and is unable to get up – a paramedic’s bread & butter – but the patient may also have an underlying chest infection or unmanaged chronic pain, which could have caused the fall.

Say you’re wrong. What happens if calls for non-urgent cases do increase?

The underlying issue here is that the Ambulance Services are already stretched between trying to provide quality care to both emergency and non-emergency groups. The concern highlighted in this question is that this tension may increase further if the patients begin to use the ambulance service in order to obtain a prescription quicker.

The solution is not to stop ambulance services from prescribing in order to manage the tension, but to look at the systems that bring about the tension in the first place.

Here I wrote how current ambulance services might overhaul the system by providing only emergency care, while another group of paramedics, either still employed by the ambulance service but with exclusive resources, or employed by new non-emergency ambulance services or by GP surgeries themselves, could handle non-emergency care.

Paramedic Prescribing increases the ambulance services ability to provide 24 hour care in the community, independent of other services, across a whole range of acuities.

This provides a potential solution to the increasing difficulty found by General Practitioners to be able to afford to conduct home visits and to provide out of hours care. Ambulance Services have held GP visits & OOH GP contracts in the past, and have delivered well. As long as we ensure that this doesn’t impact the emergency care delivery, ambulance services could reshape the landscape of care in the community.

Where can I find out more?

The College of Paramedics has led the campaign for paramedic prescribing, and has a lot of good information and documents on their website.

 

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In 1948 the leaflet distributed to every household about the forthcoming NHS said “Your doctor will give you a prescription for any medicines and drugs you need.”

In 2018 NHS England is conducting a consultation which proposes to restrict prescriptions of over-the-counter medicines for 33 minor, short-term health concerns. About £569 million is spent each year on these items and these proposals could save about £136 million.  That sounds a lot, but as a proportion of the £124.7 billion English NHS budget it isn’t a lot.

For most of us that is not a big problem.  Most of this stuff isn’t very expensive.    The recommended Chemists’ Own Head Lice Spray is £5.90, and that is one of the more expensive items involved.  We mostly don’t take headlice as seriously as we used to either.  But do we expect poor people to leave headlice untreated?  That seems a really good way of stigmatising them.  That is why we used to employ nurses specially to deal with headlice.

Nit nurses

But single people under 25  on Universal Credit are expected to live on £251.77 a month.  Once you reach 25 it goes up to the princely sum of £317.82  a month with £231.67  a month for a child. Some of the people to whom this applies are likely to have other problems. For example young pregnant women, who barely have enough money to eat properly.   It doesn’t seem sensible to put them in a position of choosing between food and medication.

There are also problems for people in residential and nursing homes.  Many of them will have difficulty in caring for themselves, won’t be able to buy items over any counter, and have no disposable income at all.   The consultation document says that all care homes should be encouraged to adopt a Homely Remedies Policy, which would enable them to administer these low risk treatments.  It also appears to imply that the home should pay for them.  Given the financial situation of many care homes – and the medical condition of many of their residents, who are very likely to be suffering from minor pain, constipation, diarrhoea and the like – this seems unreasonable.

The system of free prescriptions in England is a complete mess.  There is a list of illnesses which qualify you for free prescriptions. These are conditions for which there was life saving medication in 1968.   Cancer patients were added by Gordon Brown in 2009.   Everyone over 60 gets free prescription but younger people more than a couple of pounds over the means test limit (£57.90 for people under 25) have to pay £8.60 per item unless they can find £104 for a season ticket.

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In 2015, the government made a pledge to assist UK patients to access more online pharmacy services to help the NHS save money. It also made attempts to examine the payments of the sector to ensure the presence of efficiency, innovation and healthy competition. Today, the pharmacy is a major foundational pillar of modern medicine.

In the UK especially, competition has grown with intensity, revenues are now capped, and many expect the pharmacies to begin managing chronic conditions. For a long time, independent pharmacies have been the backbone of the country’s community, but are at risk of being rendered obsolete as more major players surface and capture the market’s value.

Intention to Purchase Online Increases

The industry has continued to consolidate gradually with the rise of supermarkets and out-of-town shopping that present intense competition in the pharmacy landscape. The pharmacy models are also changing with community dispensing dominating in commodity generics. In the modern world, mail-order and internet services are strongly taking over the distribution of pharmaceuticals, and this has seen the growth of online pharmacies in the UK. With the rise of internet savvy consumers, brick and mortar pharmacies will no longer be the only option for consumers to receive their medication.

Today, consumers want it all, from personal care products to prescription services, with their only worry being convenience, expertise and accessibility. This leaves the community pharmacy in a tricky position. As dispensing continues to be a commodity, online pharmacies have developed a sustainable revenue stream that focuses on monetising their role in healthcare.

Online Pharmacies Save Time and Money

In England especially, online pharmacies play a great role in helping patients save both time and money on their prescriptions. An experienced pharmacist provides quality healthcare and uses their clinical expertise and practical knowledge to advise consumers on common problems such as aches, coughs, colds and healthy eating. They can also advise patients to visit a health professional when need be. For patients with a long-term condition under new prescription, online pharmacists are always ready to explain and advice on how the medicine should be taken and the side effects associated with it.

Patients tend to gather more confidence when dealing with online pharmacists, whom they have been noted to talk about very personal and sensitive symptoms and matters, unlike is the case with community services. Typically, it is safe to say that the rise of online pharmacies has changed the norm of medicine in the UK. With the rise of the online market, what should consumers know?

Online Pharmacies Facts

First, consumers need to steer clear of unregulated websites as these are common causes of fake medicine distribution that could potentially harm their health. In the UK, only selected few online pharmacies are regulated to offer online prescriptions. The regulation is designed to assure patients that the pharmacy meets certain standards in terms of who can legally dispense medication. The General Pharmaceutical Council has the responsibility of regulating online pharmacies to ensure that only generic medication is being delivered to consumers.

Normally, UK online pharmacies offer their medication at relatively low prices and in greater quantities. Patients also benefit from the anonymity, giving them the chance to describe embarrassing health conditions.

The other positive side of online pharmacies is that they have the capacity to provide rationed medicines that are not often provided in National Health Services such as facial hair reduction creams. Patients also prefer online services as they can obtain non-prescribed medicines. With the high rise of online pharmaceutical services, it is necessary to find out if the provider is regulated to avoid falling into the hands of a quack.

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With nearly all industries moving toward a more digital presence, it is no surprise that healthcare has taken a similar turn. Patients are demanding greater access to care in the UK, and online service providers are making an effort to meet this growing need. Just like brick-and-mortar health facilities, like dentists, hospitals, care homes, and specialists have an obligation to abide by standards set by the Care Quality Commission – the regulator of all health and social care services in England – online healthcare services must do the same. Unfortunately, a recent report published by the CQC highlights the perils some patients face when trusting the digital trend sweeping healthcare providers.

Dangers in Unsuitable Prescriptions

Errors in prescription medications take place in traditional pharmacy settings and doctor’s office around the world, but the anonymity of online pharmacies creates a higher probability of errors taking place. The most recent CQC report focused on digital healthcare service providers highlights some of the most glaring examples of substandard care in prescribing medications to patients. First, a widely known online pharmacy was found prescribing a large number of opioid-based medications without having a foundational system in place to confirm patients’ medical history or prescription track record. The CQC issued a restriction on the company, forcing it to limit its prescriptions until a sustainable system was established.

Another online pharmacy was cited for prescribing a high number of asthma inhalers, not in line with best practices of traditional providers. The company failed to implement a review system for new prescriptions, putting patients’ lives at risk. In this case, the CQC issued a warning to the online pharmacy to update its practices immediately. Other online providers were cited for not adequately reviewing patient medical histories prior to approving a requested prescription, and accurately identifying GP assessments before prescribing medicine to certain patients. Although the published reports from the CQC are helpful in bringing to light the risk patients face in using online healthcare services, there is only so much the organization can do to stave off potentially fatal issues that arise due to nonexistent safeguards among companies operating online.

How Patients can Help

The risks of using pharmacies and other healthcare services through a digital platform are growing as more individuals seek out immediate care for health-related issues. A representative from a team of medical negligence solicitors dealing with cases of prescription claims and those where harm is caused due to medication mistakes explains the most significant issue online providers present to the public. In essence, the same standard of care should extend beyond traditional settings in which doctors, nurses, specialists, and pharmacists are providing care face-to-face to those who offer medical guidance online. Patients deserve the highest quality care available, and online companies along with the people who work for them have an obligation to protect those who seek their services. That can be done by abiding by the best practices laid out by the CQC, including understanding the medical history of the patient, other medications the patient may be taking, and the recommendations of the patient’s GP.

Patients using online healthcare providers have a responsibility to do their due diligence when working with a primary care, pharmacy, or specialist company. The best step to take is to ensure that the organization is registered with the Medicines and Healthcare products Regulatory Agency, or MHRA by searching the company name, number, or website online. Additionally, any website that sells medicine to the public is required to show the EU common logo for potential patients to see. As the Care Quality Commission continues its objective to maintain a safe and high-quality healthcare environment for patients in England, individuals can do their part by being knowledgeable of the risks they face when conducting medical business online.

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With the increasing rise in medical costs, more and more people are looking to the Internet for a cheaper solution. This is not to even mention the crisis that the health care system is in. If you are a working individual going to the doctor just isn’t worth it unless it a dire situation. With that being, the Internet can provide tons of low costing solutions, but there are things that you need to be aware of before just blindly purchasing medications online. Below, you will learn about the different risks that are involved with shopping for medications online.

Prices Can Change

The first thing that you need to be aware of is that sometimes the prices of online medication can change. Some pharmacy sites will post lowball prices just to pull you in, and when you are least expecting it they will raise the price. This is something that Canada Drugs pharmacies will definitely never do. All the prices listed on this site are up-to-date and accurate as possible.

Additional Fees

Along with the changing of the prices a lot of online pharmacies will charge you additional fees. For instance, there is probably going to be a shipping fee, which won’t be that substantial. However, there might also be a membership fee, which can cost a little more. This is a fee that sites charge just for setting up an account, so that you can order with them. Most sites are upfront about these types of fees, whereas there are some that are not, so this is something that you need to keep an eye on when shopping online.

Counterfeit Substances

Do you ever wonder why some online pharmacies are able offer such a lower price than legitimate pharmacies? A lot of times this is because they are selling you counterfeit medications. While the medication looks exactly the same it may not produce the same results. Both name brand and generic medications can be faked, which means that the medication may not contain all the ingredients that it normally would. It could also contain additional ingredients that could be harmful or even fatal to your health.

Don’t Safeguard Your Health

Online pharmacies do not know you medical history and there are a lot of them out there that don’t safeguard your health. If an online pharmacy is offering medications that require a prescription you probably want to stay away from this pharmacy. This is probably a good sign that they are selling counterfeit medications. Even if the medication isn’t counterfeit you should never buy prescription medication unless a licensed physician has prescribed it to you, because it could be harmful to you. Just because your neighbor took a certain type of antibiotic to clear up his illness it doesn’t necessarily means that the same medication will work wonders for you.

Protection Of Personal Information

Anytime you shop for anything online there is a chance that someone can get ahold of your credit card information. Websites are also not allowed to share your contact and billing information with other individuals or companies. This is why they post privacy policies guaranteeing that they won’t share your information. Most online transactions are usually secured through the use of some kind of encryption software, which prevents people from getting ahold of your personal and billing information. However, if a pharmacy is selling you fake or counterfeit medications then there is a good chance that they aren’t going to employ these kinds of tactics.

Be on the look out for any online pharmacy that does not offer privacy policies. This could be a good sign that they don’t care about protecting your information.  If you find your credit rating is not good you can get it repaired.

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Pharmaceutical compounding has been gaining popularity in the past several years as people are learning more about the benefits of it. It is basically a combination of art and science to create customized and individualized medications for patients. When a medicine is commercially unavailable, a licensed pharmacist can remake the medicine via compounding.

In compounding pharmacy, a specialized pharmacist analyzes the prescription and blends the individualized ingredients to create a medicine that suits the patient. The pharmacist works in close relationship with the patient and the physician to meet the medical needs.

Pharmaceutical compounding offers numerous benefits. Here are some of them listed:

Access to discontinued medications

Some medicines come and go. Manufacturers sometimes discontinue the production of several drugs on which many patients rely. Compounding pharmacy plays an important role in such scenario. This method provides continued access to discontinued medication by remaking pharmaceutical-based ingredients and makes sure that needs of the patients are met. There are many compounding pharmacies that have all the resources available to recreate medications using standardized techniques and latest research.

Easy use of medications

Medications are usually unpleasant to taste and makes it difficult to intake. Some people, especially children, and elderly patients face immense difficulty in consuming medicines as prescribed. Fortunately, compounding pharmacies work as a remedy here. Compounding pharmacist can create a medicine as per your chosen flavor. This will enable you to consume the medicine much more easily. You can order the medications in the form that seems convenient and easy to you.

Makes medicine allergy-free

Many patients are allergic to medications. When taking a certain medicine, patients can experience unwanted reactions due to the presence of certain chemicals like lactose or gluten. This is a pretty annoying situation. Commercially available medicines may also contain preservatives that cannot be endured by several patients who are intolerant to such substances. A compounding pharmacist can recreate the medication without the inclusion of such ingredients. This will make the medicine safer for the patient and easily consumable.

Allows alternative dosage forms

As time goes on, the dosage form may vary from a patient. Along with adding your chosen flavor to the medicine, compounding pharmacist can even recreate medications in the form of your choice. Many patients face difficulty in swallowing a pill. In such scenario, the pharmacist can recreate the medicine in liquid suspension or chewable tablet form. Some medicines can also be created as creams or gel that simply be applied to penetrate into the bloodstream through the skin. A compounding pharmacist will tailor your medications according to the dosage and strength the patient needs.

Offering exceptional services

Compounding pharmacies offer exceptional services that normal pharmacies do not. These pharmacies address the patients’ needs directly. Prioritizing their patients’ demands is their priority. They will analyze your symptoms and allergic conditions in detail. They will create a customized treatment plan after going through all the subtle details. Compounding pharmacies will serve the patients in a manner to address all they demand completely.

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Health is wealth. To maintain a healthy body, you need to consume a balanced diet, exercise on a regular basis along with taking sufficient amount of sleep. To avoid unwanted maladies, people consult medical experts. With globalisation at its peak, it is easy to access almost everything. Everything is turned online. With the inclusion of medication in the globalisation spectrum, you can know about your health from home without visiting physicians. Many patients today are seeking advice from online doctors. Online medical consultations are a norm today. Below are few pros and cons of online health consultancy:

Pros:

  • Online health adviser is not limited by actual boundaries. You can access to reputed doctors throughout the world that would otherwise not be available to you. For some reason, if you are not able to leave your home and access to the traditional treatment centres, services like these would provide you with an advantage.
  • Self-diagnosis is a dangerous option. You can look for the cures on Google relevant to your symptoms, but it can never substitute for consulting a doctor. Websites are providing online consultations and online pharmacies like Europa Pharmacy.
  • It is cost effective. Visiting a doctor in person could cost you more than seeking for online medical advice.
  • Most online health service providers operate 24 hours.

Cons:

  • To reach a better decision, doctors take help of diagnostic reports. Online consultation acts like a barrier to fetch reports.
  • It opens a new door for selling prescription drugs. Scam operations are present that target on selling cheap medications.
  • There is no transparency in the sense that you cannot be sure about the qualification of the doctor.

However online medical consultancy is at its boom these days. People still use them because it does provide them sufficient level of comfort in all aspects. But how does it work? There are numerous websites available where you can seek medical advice. Doctors get paid for the answer they provide to the patients, so this can to some extent support the validity of their answers. Some websites allow you to contact doctors from best hospitals. Their blogs provide reliable solutions to everyday common health conditions such as stress issues. JustDoc, one of the websites, allows you to contact doctors through audio and video calls. You can even attach your medical reports if you have one assist the doctor working on you. Sometimes you may get an instant answer depending on the nature and severity of the disease. Lab tests can be performed and shipped directly to your doorstep, which further is convenient. Doctors can sign up on any of their desired website which will provide them with a platform to practice medicine online. They just have to create a profile entering required details such as qualifications and specialities. These websites enable the doctors to connect to their potential clients online and making them earn handsome amount of money.

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The Government’s decision to push ahead with the huge funding cut for community pharmacies shows no understanding of the contribution that community pharmacies make to patients, communities and to the NHS as a whole. I was the proud owner of a community pharmacy in Burnley form 1986-2010 and I know just how vital these community assets are.

That’s why Labour is announcing today that we are calling a vote in Parliament next week on the cuts to community pharmacies and urging Tory MPs to vote with us to save their local pharmacies.

How often have we heard in recent times the NHS slogan “The Right Care, at the Right Time, in the Right place?” For many healthcare and general well being needs, the local pharmacy is the right place to provide treatments, advice and important signposting. Pharmacists have five years of intensive training and really are the experts on all issues related to medication. They keep up to date by means of a comprehensive programme of continuing professional development and standards are rigorously monitored by the General Pharmaceutical Council. As an absolute minimum all pharmacy staff are trained to give advice on the safe use and sale of medicines and it is not unusual for staff to have completed training to support the pharmacist with everything from dispensing to patient counselling.

It really is time that the Government recognised that the contribution of community pharmacies goes way beyond the dispensing of prescriptions and the sale of paracetamols. On the contrary the typical community pharmacy provides a whole range of services to assist with the promotion of health and well being in the wider community. All community pharmacies have consulting areas where patients can speak privately also providing a perfect space for the provision of a variety of important services which typically include smoking cessation programmes, dietary advice, Emergency Hormonal Contraception (the morning after pill) and the administration of flu vaccines.

Far from being a costly drain on NHS resources, community pharmacy is well placed to actually save vital funds in a variety of ways. MURs (medication use reviews) are a good example of this. MURs are offered by most community pharmacies and are particularly helpful for patients who take a lot of medication on a regular basis, ensuring that the patient has the right combination of items, that they understand what their medication is for and when and how it should be taken.

Such reviews often identify medicines that are routinely ordered but no longer needed and thus wasteful stockpiling of such items can be avoided. In many parts of the country minor ailment schemes operated by community pharmacies provide a useful and cost effective service whereby pharmacists can issue treatments for a whole range of minor ailments. Not only is such a service convenient for patients, removing the necessity for a GP appointment it is an immense help to the GP practice freeing up time for doctors to see patients with more serious conditions. It is of course hard to quantify the savings that this generates in terms of the cost of GPs time but they surely go beyond significant and have the added benefit of taking pressure from busy GPs facing unprecedented levels of demand. It is even harder to evaluate the financial benefit and wider social impact of the extensive support that community pharmacies provide for patients with substance abuse issues including methadone programmes and needle exchange schemes.

While the debate has rolled on in recent months there has been much discussion about the value of pharmacies in isolated rural communities. Undoubtedly pharmacies are vital in such communities, but I would just like to take a moment to consider the value of community pharmacies to urban populations and particularly areas of high deprivation. In community settings where low pay, poor housing, child poverty, substance abuse and unhealthy lifestyles combine to affect the life chances and life expectancy of too many, the community pharmacy with its trusted, well qualified community pharmacist really is a godsend. Such pharmacies are the true gateway to the NHS and perform a vitally important role. Community pharmacists are the most accessible health professionals by virtue of long opening hours and ‘a no appointment necessary’ approach. In these times when 1 in 4 have to wait a week or more to see a GP, or can’t get an appointment at all, local pharmacies are often the sole provider of continuity of care and the pharmacist is too often the only familiar face in an overstretched primary care team. Most community pharmacies offer a free prescription collection and delivery service that ensures that housebound patients and busy working people get the medication that they need in a timely fashion. In addition for those who wish to self medicate, thereby saving the NHS money, community pharmacies provide conveniently located, free professional advice on full a range of OTC (over the counter) and POM ( pharmacy only medicines) and as such are often the first port of call for such patients.

The Department of Health has made no secret of its efforts to reduce demand on the NHS and it is a fact that no health professional is better placed than the community pharmacist to promote healthy living and therefore the prevention of illness. Community pharmacists dispense thousands of prescriptions each month and every one presents the opportunity for a productive health intervention. In addition these pharmacies play a key role in reducing the number of hospital admissions and the support they provide for the elderly following discharge from hospital is crucial to minimise the risk of re-admission. The government should be trumpeting the advent of Healthy Living Pharmacies and working with the sector to further extend their role thereby supporting patients, reducing costs and easing pressure on other parts of the NHS.

If community pharmacies close, and it was a Government minister who admitted these cuts could lead to up to 3,000 closing, where will all their patients go? They and their problems won’t just disappear. Some will pack out their GP surgery and others will head straight to A&E.
The NHS is already in the throes of a staffing and funding crisis and forcing community pharmacies to cut back services and close down is short sighted in the extreme, and could have catastrophic in the long term.

Labour knows the value of local pharmacies and so do all the communities across the country who rely on them. That’s why we’ve called this vote next week and I urge all responsible, discerning Tory MPs, whose constituents will be hit hard by these cuts, to vote with us.

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WRITING in The Yorkshire Post over the summer, I warned about the devastating impact that Government cuts to pharmacies could have on our local communities and our NHS. And I invited the new Minister, David Mowat, to re-think the plan.

In September, it seemed that the Government might be listening when the Minister told a conference of pharmacists that he was shelving the cuts programme so he could “spend the time… to make sure we are making the correct decision, and that what we do is right for you, right for the NHS and right for the public more generally”. Hear, hear, we said. Mowat was right to look again at this. After all, his predecessor as health minister, Alistair Burt, admitted that that up to 3,000 pharmacies – one in four of those across the country – could shut under the drive to slash millions from pharmacy budgets between now and April 2018. That could mean the closure of 300 chemists across Yorkshire and the Humber, forcing many frail and elderly people to make longer journeys to get the medicines and expert advice they need.

The National Pharmacy Association has condemned them as a “dangerous experiment”. And the public made their opposition loud and clear when the largest ever healthcare petition – now signed by over 2.2 million people – was handed into Downing Street last May by cross-party campaigners and myself.

But last week the Government announced it is pressing ahead with a bumper package of cuts that will reduce pharmacy funding by £113m for this financial year and by a further £95m in 2017-18 – a 22 per cent hike on the original £170m earmarked for cuts.

Last week, I forced Mr Mowat to come to the House of Commons to answer an ‘urgent question’ from me about these cuts to the crucial frontline service provided by pharmacists. The Minister, a chartered accountant before he became a Tory MP, admitted that he just “didn’t know” how many pharmacies will close or which areas will be the worst hit. The Department of Health’s own impact assessment similarly stated that “there is no reliable way of estimating the number of pharmacies that may close as a result of this policy”.

While such candour and clarity from Ministers is refreshing, it is appalling that the Government appears determined to drive through these cuts without any understanding – or thought – for the consequences.

Equally, the Government was unable to say – when I asked them – what the downstream costs to other parts of the NHS might be if pharmacies closed.

Evidence from Pharmacy Voice shows that one in four patients would seek a GP appointment if their local chemist faced closure. In areas of higher deprivation, like in my own Barnsley East constituency, that figure rises to four in five.

This just piles on even more pressure on our already overstretched NHS at a time of another looming winter crisis. The Government claims to have come up with a ‘Pharmacy Access Scheme’ that is supposed to ease the impact of the cuts for pharmacies that are not in so-called ‘clusters’. But my research has found that only around one in 10 pharmacies nationwide are likely to be eligible for any help – and even those who do so will still have to make cuts.

That’s why I am now demanding an urgent vote in Parliament against these cuts. If the Health Secretary Jeremy Hunt and his ministers are so confident that they have devised such a brilliant plan for our pharmacies, why not give MPs a vote on the issue?

The reason is that they might just be in for a nasty shock. It’s not just Labour MPs who have supported the campaign about the threat to thousands of pharmacies. Several Tory MPs spoke out in the Commons last week against the cuts. Colne Valley Tory MP Jason McCartney compared the potential closures to the losses of the last bank branches in rural towns and villages. Of  the Government’s plan, he told Ministers: “I am sorry but I just do not have confidence in it.”

In Yorkshire and the Humber, there are 1,266 community pharmacies that dispense almost 10,000 prescription items every month, as well as supporting public health and providing invaluable medical advice and support on a range of issues. Every pharmacy that is forced to shut its doors will mean hundreds of often frail and vulnerable people having to make longer and more expensive journeys to get the help they need.

If Ministers are so confident that these cuts to community pharmacies are “the correct decision”, let’s have a vote in the House of Commons. But we should do so before it is too late and we see many of our pharmacies closed for good.

This article first appeared in the Yorkshire Post 

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Expecting humanism of pharmaceutical behemoths can be critical when it is denied. What could a hopeless patient do when a life-saving drug eventually causes an irreversible life-threatening condition? Many folks in US face a grave situation now because they used Xarelto on doctor’s prescription. Rivaroxaban/Xarelto was released by pharmaceutical majors in 2011. This novel oral anticoagulant is available only on a life-saving basis for preventing strokes and blood clots in people suffering from DVT (Deep Vein Thrombosis), PE (Pulmonary Embolism), and Afib (Atrial Fibrillation). However, the problems began when uncontrolled internal bleeding began, and that too without any antidote.

The hopelessness

The hopelessness is unimaginable! You took a prescription drug to save your life, and now you face an irreversible life-threatening condition. Many have unfortunately died. Patients and their family members do have the right to file a Xarelotolawsuit against the pharmaceutical services that brought this catastrophe for profits. The drug is a product of Bayer, J&J, and Janssen Pharmaceuticals. Neither Bayer nor Johnson & Johnson’s warned patients properly of the grave risks. Nor have they had the humanity to develop an antidote to this bloodied concern. Filing a lawsuit on negligence and failure to warn through experienced lawyers is the only way of compensation. You deserve an apologetic compensation for the sustained physical injury, emotional pain, and, death of a dear person.

Why this neglect?

Such grave events raise a most serious concern. Why do patients must suffer because of medical negligence? You are paying for the drug in full. The treatment you receive is against the primary ethics of good business. The manufacturers made millions! You are bleeding with pain and hurt. You lost your loved ones maybe. The worst part is, this is irreversible. There is no way to stop the acute internal hemorrhage. Is it your fate to bleed to the end? It must not be so! You deserve the best treatment immediately besides a fair compensation for all damages. Get in touch with competent legal professionals specializing in assisting people on medical compensation.

Selecting a lawyer

Finding the right attorney to defend your hope is very crucial. Make sure the lawyer has sufficient expertise in handling this specific circumstance. Your lawyer should be fully aware of the irreversible damage from Xarelto. Get in touch with your preferred service. The best attorneys would assist you with an initial FREE legal consultation after hearing your grievances. Essentially, find lawyers whose motive is to bring justice to you by cash settlement, and not fleece you on false hope. Unfortunately, many legal agents further damage the motivation of pained patients and bleed them financially and emotionally. Find a service you can trust.

Verify carefully whether your Xarelotolawsuit lawyer shares your concern with a compassionate attitude. To speak in metaphors, you should settle for no one less than a ‘Devil’s Advocate’ because it is a hard case. Pharmaceutical giants invest millions to attend legal concerns and you would need someone who has the guts to fight against it. Your concerns are fair and establishing the compensation may seem difficult, but in the end, truth triumphs. Make sure your lawyers have won cases on this before.

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You need medical marijuana, but you don’t want to smoke it. Fortunately, for you, there are many different alternatives you can use to ingest it and get the benefit of cannabis. Here are a few preferred methods.

Oils

This is probably the most widely-recognized method as a substitute for inhaling through smoking. If you’re going to make an oil preparation, make sure you:

• Make a large batch each time. You get a more consistent dose each time.
• Use high quality butter or olive oil as the carrier. Using lower-quality oils may not mask the (awful) taste of the oil and may make it harder to take.
• Use 1-4 oz cannabis trim to 16 oz oil. Your exact dosing depends on your desired potency.
• Use the same size capsule each time.
• Keep capsules in the freezer until use. This helps them from becoming mushy and inhibits mildew and mold growth.
• Start with just 1-2 capsules. Wait at least 45 minutes before taking more, since the full effects might be delayed up to 3 hours.

Some Oregon marijuana dispensaries can help you find the high-grade weed necessary for oil extraction.

Where you can get horny goat weed?

Edible Preparations

If you don’t want to take the time to prepare an oil, you can eat weed. Edible preparations or tinctures, are good because they’re easy to make and transport. Usually, you do not have a cannabis odor with this method and they can be consumed almost anywhere. You can even eat them at your desk just like any normal medication.

Dosing can be difficult because, unlike smoking, edibles take longer to take effect. You might end up taking more than needed or intended while waiting for the effect to come on. Since cannabis’ effects can take up to 3 hours to reach full potency and effect, you might be waiting for hours and not know whether the dosing was correct.

There are ways to improve the safety of this process, however. Start with a very small amount, then wait 2 hours before taking more. A good dose is 5-10mg of THC to start. Then, increase the dose when you know how it affects you (assuming you need more).

Vaporization

Another easy alternative to smoking is vaping. Most people are familiar with this because it’s what ex-smokers often turn to. It involves heating the plant and extracting the active ingredients. These ingredients are usually distilled down to an oil.

So, you will be back to making an oil preparation. But, instead of ingesting the oil (which delivers a lot of THC at once), you inhale the THC through vapor. It’s not the same as smoking, and doesn’t carry the same risks, but it does still involve inhaling.

There are several types of vape pens: ones you fill with your own oil and ones that come pre-filled. Patients tend to like vaporizing because it lets them titrate their own dose, and they get the right effect almost immediately so no waiting around. Plus, there’s little or no burnt organic matter, so you’re not inhaling nasty stuff into your lungs.

Topicals

Finally, there are topicals, which are like gels or oils you rub into your skin. You get pain relief without intoxication, which makes it great for the office. But, it’s localized, so the pain relief will be localized.

Danny Russell works as a medical research assistant. In his free time he likes to write articles on medical related topics for the general public. These appear on health/medical blogs as well as news and lifestyle.

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The genesis of this talk was in the realisation that my ideas have changed over thirty years, and rightly so. The days when healthcare professionals told the public what they were graciously going to do for them have gone, I hope; and I see now that some of the things I used to think were completely wrong. In fact, they are so wrong that I have managed to come to this conclusion without the need for my wife to point it out to me.

In 2000 I decided that I was fed up with doing training courses that lasted a few hours, and I wanted to do something more substantial, and I saw an advertisement in the British Medical Journal for a Master’s degree in medical law and ethics at Glasgow University. With my wife’s support – and how generous she has always been in supporting me – I completed the degree and graduated in 2003 as a Master of Philosophy. Incidentally, my graduation ceremony was in the first week of December in Glasgow, and after it the university laid on orange juice in their quadrangle gardens, an event marked by the guests clustering in tight groups trying to keep warm.

Studying law changed the way I think. Any medical science is largely a collection of facts. Our exam questions are numerous but fairly short. Having to maintain an argument over essays of 5 to 20,000 words was a new skill I had to acquire, but a really valuable one, and it began right at the outset.

One of the first topics we tackled was that of consent. As you will know, whenever you are faced with an operation, the doctors will ask you to sign a consent form. Things have changed, but when I worked there this was largely a box-ticking exercise, a step you had to go through in order to get your operation, and there were elements of the process that I could immediately see were unsatisfactory. Let me concentrate on three.

First, we ask for your consent when we conduct surgery on you. After all, your surgeon is about to attack you with a knife, and as a judge noted as far back as 1913, that is a criminal offence that is only excused by the fact that you have agreed that he or she may do so. But have you ever been asked for your consent to receiving a medicine? We have assumed that you give your consent by turning up and asking for some kind of treatment; and you demonstrate continuing consent by taking the tablets. Except, of course, that a great many people do not take the tablets; a recent estimate was that £300 million in medicines goes unused in the UK each year. The authors of that report came up with five reasons for that waste:

  • Non Compliance – where the patient takes the medicines, but not in the intended way. For example, taking at irregular intervals or in incorrect doses.
  • Intentional Non Adherence – patient stops taking medication due to side effects or personal beliefs.
  • Unintentional Non Adherence – patient stops taking medicine due to forgetfulness.
  • Non-Preventable Waste – patient dies or a change in treatment means current dispensed medicines are no longer required.
  • Preventable Waste – patient stockpiles medicines “just in case”.

But it seems a little unfair for us to complain about intentional non-adherence when the patient was never asked to agree to take the medicines in the first place.

Second, an important and necessary step in obtaining consent is that all the possible alternatives are laid out for the patient. It is true that some patients find that unhelpful, because they do not feel equipped to choose between them. Many doctors report that patients say “What would you do?” or “Do whatever you think you should.” But that is not a reason to bypass this step. And too often it is omitted in talking about medicines with patients, and they do not complain. That is one reason why I think a bolshie patient is a good thing. It challenges us to give the explanation we ought to have given in the first place.

To some extent the NHS recognises this. It has two free services for patients that pharmacies provide. The New Medicines Service involves talking to patients when a new medicine is dispensed for the first time, and twice more during the first month, because the evidence is that if a patient is going to deliberately stop it is likely to happen during the first month. It is a common experience that when you leave hospital a lot of things are said to you, sometimes when you’re just relieved to be going home, and it is hard for patients to retain and understand what was said. The New Medicines Service reinforces that information when, we hope, people are better placed to receive it. An evaluation by the University of Nottingham showed that the service increases the number of patients who correctly take a new medicine by around 16%. For existing medicines, there is the Medicines Use Review. Some people refuse these because they think their doctor is already doing it, but they are confusing two different things. The doctor carries out a clinical review – is this the right medicine for the condition this patient has? – but our Use Review looks at whether you understand how and why to take your medicines.

Let me give you an example. We noticed that a gentleman ordered his blood pressure tablets every month, but did not always order his arthritis treatment. It turned out he had plenty left over. The reason was simple. The GP told him to take one with his supper, and some nights he didn’t have supper, so he didn’t take the tablet. When we explained that what the GP meant was to take it, but not to do so on an empty stomach, he took them more reliably.

The third imperative is that whoever collects your consent should be able to answer your questions and give you a fair and complete account of the pros and cons of the treatment that is proposed. Now, here I think we may still have some work to do. The last time I was in hospital the job of getting my consent was given to a junior doctor, and you have to ask whether such a doctor is in a position to answer all the questions that we might have. It would, of course, meet the case if they start the process and then fetch someone else if there is a difficult question. But it is important that people should not feel pressured to sign until they have had all the explanation that they feel they need, and if that means being a bit bolshie, so be it.

It is also important to note that any consent you give is a limited consent. It allows only what is specified, and we have moved away from the kind of consent form that says “Do whatever you want”. It is only sensible that for some operations we include a term that allows the surgeon to get on and fix something that he finds without having to stitch you up and then start again a couple of days later; and there is always the common law duty to act in your best interests which means that if you are unable to give your consent, we do whatever we think is best for you. I hesitate to mention this so soon after lunch, but it’s a good example. The very first operation I observed was for a man who was thought to have cancer of the penis and was going to have it amputated, but when the surgeon cut into the skin it became clear that actually it wasn’t a tumour, but a very large infected cyst. Now, the only thing the surgeon could do according to the consent form was to go ahead and amputate it anyway, but instead he drained the cyst and packed it with antibiotics. That’s what we thought the patient would prefer. On the other hand, there is a famous case, Perry v Shaw, where a surgeon was sued because having performed a tummy tuck on a lady, he used the spare material to give her an unexpected breast enlargement. She went to sleep as a 34B and woke up as a 40DD, and was unhappy about it, and his defence – “I thought she’d like it” – did not impress the judge.

So here we have the first legitimate use of bolshieness – you should be fully informed of the options, the risks and benefits before you begin treatment, and if you are not, you are entitled to be politely stroppy.

Let me expand on this a bit by referring to the work of NICE and other guidelines. NICE is such a big part of our lives that we forget that we have to explain why it is important to others. The National Institute for Health and Care Excellence weighs the evidence for each type of treatment and tells us what we should be doing. For example, if you have diabetes NICE will tell you that you should be offered at least six different drugs because you have an increased risk of stroke or heart attack. That does not mean that you must accept all six, or that your doctor will be failing you if he does not insist on all six.

Let me explain why that is with some examples. One of our patients was given a statin when she left hospital. She is 89. She said the doctor told her it would prolong her life, but quite reasonably she asked me “How much difference can it make at my age? And, actually, I’m not sure I want to live longer.” My advice to her is that she is entitled to say to her doctor “Thanks, but no thanks.” So long as he is satisfied that she understands the implications, the GP will usually be happy simply to note that it was offered and refused. You’re an adult, and you’re entitled to say no. We had a lady who was given a water tablet for her high blood pressure, but because she wasn’t very mobile she had some accidents and decided she didn’t want it any more. She wasn’t too polite about how she expressed it to her doctor, and I doubt he could have put the tablets where she suggested anyway without some difficulty, but she was entitled to say no.

Better that than that she should do what another patient did. She stopped taking her water tablets, but decided not to tell her doctor in case he was cross with her. When she developed fluid on her chest, he doubled the dose, except, of course, that now she didn’t take two tablets instead of taking one. She declined further and was admitted to hospital, where the doctors looked at the treatment she had been having and decided that if two tablets weren’t working they had better give four, but by injection because it was quite urgent now. Suddenly introducing a drug she hadn’t actually been taking proved fatal. So there you are; be bolshie, don’t be dead.

People worry that their doctors will be cross with them if they argue or say no. They won’t – or, at least, the majority won’t and none of them have any right to be. After all, we regularly discuss with people at the ends of their lives how much treatment they want. It is not at all uncommon for them to say “Thanks, but I’d just like to stop the drip and go home now, and let nature take its course.” Nobody yells at them “But you’re going to die if you do that!” It’s their life, and they have every right to make that choice.

Occasionally people will say “But life is a gift from God, and we have a duty to keep it as long as we can.” I observe, however, that if the fact that life is a gift from God trumped other considerations, St Paul would have told Christians to sign anything that meant they didn’t get martyred, and he didn’t. Given a choice between spending your Saturday afternoon in the garden and finishing up as a tasty snack for a lion, I know which way my vote would be cast.

I may add that if you decline treatment, you do not have to give a reason. It’s nice to know, just so we are confident it isn’t because we have misled or confused you, but you are not obliged to share it. In a famous legal judgment known as re T, Lord Donaldson said “An adult patient who … suffers from no mental incapacity has an absolute right to choose whether to consent to medical treatment …. This right of choice is not limited to decisions which others might regard as sensible. It exists notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-existent.”

The other observation I ought to make is that the relationship between a patient and their pharmacist – or other healthcare professional – depends to a great extent upon trust. I am aware that like Mary Bennet in Pride and Prejudice, I may shortly be told that I have delighted you long enough, or I might continue at length about the grounds of trust. It matters because there have been several recent books pointing to an erosion of that trust. In fact, in many cases when we give consent, we give it not because of any rational argument we have weighed, but because at bottom we trust the professional concerned. Why do we do so?

There is an argument that trust derives from the professional standing. We trust doctors generally, even if we have not met them before, because we know that they have taken an oath to do their best for us. We know that they face professional sanctions if they do not do so. And we know of no reason why they would wish us any ill-will. Dr Shipman did not do a lot for that last argument, of course, but I worked on the aftermath of his crimes and it was remarkable that even after he had been convicted a lot of people in Greater Manchester still thought highly of him. It was easy to find people who believed that there must be some other explanation for the death of nearly a tenth of his patients.

This general trust – trust of a class of people – is one reason why some of my colleagues, particularly those who work for pharmacy chains, will argue that it doesn’t matter if you see a different pharmacist each time because they all work to the same procedures and protocols, and are bound by the same standards. All that is true, but our experience of this wonderful city and its people is that they prize the continuity of seeing a familiar face. They trust us, and they forgive us our mistakes because they know we are not indifferent to them.

I recently read an excellent little book by Professor Katherine Hawley, from the University of St Andrews, on the subject of trust, in which she points out that it would be impossible to live a life without trust. How could we sleep if we did not trust our partners not to put a pillow over our faces during the night? What could we eat if we did not trust that our supper was not poisoned?

And what is that trust built upon? It is built upon predictability. We trust because we believe that we know what the person we are trusting will do (or not do). I trust that Gillian will not strangle me in bed, because she never has, despite, no doubt, considerable provocation. I trust that she will not put deadly nightshade in my salad because it hasn’t happened yet. That is why lost trust is so hard to regain – once you haven’t behaved as predicted, how can anyone predict what you will do yet? It is, of course, possible to be predictably unreliable. David Niven once said of Errol Flynn that he was completely predictable, because he always let you down, so you never depended on him. But in our business we try to earn your trust, and to keep it once we have it, by relentlessly doing our best.

One of the delights of being in practice here for so long is that we have seen a whole generation pass through our hands. We have seen babies born who now have babies of their own; we have cared for people who were still vigorous and active, but who have become frail and dependent. We have been much blessed, personally and professionally, but we are very aware of Luke 12:48 and its reminder that much is demanded of those to whom much is given. You taxpayers paid for our education and we have been trying for nearly forty years to repay that debt in some small way.

To close: the celebrated management writer Robert Heller published a book in the eighties which mentioned my then employers, Allen & Hanburys, along with a group of others that had survived over 250 years – Barclays, Lloyds, Fry’s, Rowntrees, Terry’s to name but a few. Apart from a concentration on banking and chocolate, why had they survived when others did not, he asked? And he concluded that their Quaker beginnings had played a large part. Allen & Hanburys was also a Quaker firm and Heller argued that their belief in a duty to give their customers full weight at a fair price, to trade for the lifetime rather than the moment, was what enabled them to keep going. In short, they were trusted; perhaps less so now, but still more than some others. That’s how important trust is.

The person others might describe as a bolshie patient we see as someone who is simply trying to look after their own interests. We need more of them, because if I can’t convince you to do what I think is best, I have no right to demand it of you.

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