Download MECS and Prescribing

MECS and Prescribing
Jane Bell BSc FCOptom, DipTpIP, Dip Glauc
Discussion House Rules
•
Open discussion with everyone participating
•
Respect the view of others; do not criticise or judge
•
There are no right & wrong answers
•
‘Blue sky thinking’
•
We all ‘live in glass houses’
Where are we now?
1.
Medicines Legislation
2.
Exemptions for Optoms
3.
Patient Group Directives
4.
Additional Supply & Supplementary Prescribing
5.
Independent Prescribing
6.
Australian legislation & qualifications
Where should we go?
•
Extending range of medicines available to treat MECS
•
Training & Qualifications
•
Future demand & supply
Medicines Legislation
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Medicines Act 2012
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https://www.gov.uk/government/publications/rules-for-the-sale-supply-andadministration-of-medicines/rules-for-the-sale-supply-and-administration-ofmedicines-for-specific-healthcare-professionals
Medicines
•
GSL - General Sale List
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P - Pharmacy medicines
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POM - Prescription only medicines
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Optometrists can sell/supply all GSL & P medicines
Exemptions for Optometrists
In an emergency can sell/supply or issue signed order for pharmacist to
sell/supply certain POMs
•
eye drops that contain up to 0.5% chloramphenicol
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eye ointments that contain up to 1% chloramphenicol
•
substances that contain:
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cyclopentolate hydrochloride
•
fusidic acid
•
tropicamide
You must only do this as part of your professional practice.
‘Emergency’ Supply
There is no legal definition of what is 'an emergency' for the purposes of the
Medicines Act exemptions or the specific criteria governing referral under the
Opticians Act. It is therefore for the optometrist to make a professional
judgement as to whether there is in fact an emergency and what measures
need to be taken in the best interests of the patient, bearing in mind the
Opticians Act, the General Optical Council (GOC) rules and medicines
legislation.
Commonly used P medicines
•
antazoline (up to 1%) Otrivine Antistin
•
azelastine hydrochloride (up to 0.1% for the treatment of the signs and
symptoms of allergic conjunctivitis Optilast
•
dibromopropamidine isethionate Brolene eye ointment
•
fluorescein sodium
•
levocabastine (up to 0.05% for the symptomatic treatment of seasonal allergic
conjunctivitis) No longer available
•
lodoxamide (up to 0.1% for ocular signs and symptoms of allergic
conjunctivitis) Alomide
•
phenylephrine hydrochloride sympathomimetic (vasocontrictor)
Commonly used P medicines (continued)
•
propamidine isethionate Brolene eye drops
•
rose Bengal
•
sodium cromoglicate (only for the treatment of acute seasonal allergic
conjunctivitis or perennial allergic conjunctivitis and subject to a maximum
strength of 2% for eye drops or 4% for eye ointment - products containing this
substance are also subject to restrictions on maximum quantity, which may be
sold or supplied as a P medicine and are not more than 10ml for eye drops
and 5g for eye ointment)
•
various tear supplements and ocular lubricants
•
xylometazoline hydrochloride Otrivine Antistine
Patient Group Directives
‘PGDs provide a legal framework that allows the supply and/or administration
of a specified medicine(s), by named, authorised, registered health
professionals, to a pre-defined group of patients needing prophylaxis or
treatment for a condition described in the PGD, without the need for a
prescription or an instruction from a prescriber. Using a PGD is not a form of
prescribing’.
https://www.nice.org.uk/guidance/mpg2/chapter/1-introduction1.4
Definition of a Patient Group Direction
Discussion
•
Do you issue signed orders for a pharmacist to supply eye drops/ointment/gel
& if so which ones?
•
Do you sell P or GSL medicines?
•
Do you use PGDs?
•
Do you ask GPs to prescribe specific medicines?
Additional Supply
Provided it is in the course of their professional practice and in an emergency,
additional supply optometrists can sell or supply prescription only medicines
containing the following substances:
•
Acetylcysteine Ilube
•
Atropine sulfate
•
Azelastine hydrochloride Otrivine Antitine P medicine Optimist P
•
Diclofenac sodium
•
Emedastine Allergic conjunctivitis
•
Homatropine hydrobromide
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Ketotifen Allergic conjunctivitis
Additional Supply (continued)
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Levocabastine (no longer commercially available in the UK)
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Lodoxamide Alomide 10ml POM 5 ml P
•
Nedocromil sodium Rapitil
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Olopatadine
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Pilocarpine hydrochloride
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Pilocarpine nitrate
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Polymyxin B/bacitracin (no longer commercially available in the UK)
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Polymyxin B/trimethoprim (no longer commercially available in the UK)
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Sodium cromoglicate P or POM according to size of bottle & condition
Supplementary Prescribing
Supplementary prescribing is defined as ‘a voluntary partnership between an
independent prescriber (a doctor or dentist) and a supplementary prescriber
to implement an agreed patient-specific clinical management plan with the
patient's agreement'. The plan sets out how much responsibility should be
delegated and refers to a named patient and to their specific condition.
Agreement to the plan must be recorded by both the independent and
supplementary prescriber before supplementary prescribing begins. Both
prescribers must also share access to a common patient record.
Independent prescribing
•
Statutory legislation introduced in June 2008
•
Public consultation and advice to Ministers by the Commission on Human
Medicines (CHM)
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CHM's recommendation:
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‘suitably qualified optometrists should be able to prescribe any licensed medicine
(except for controlled drugs or medicines for parenteral (injected) administration)
for conditions affecting the eye, and the tissues surrounding the eye, within their
recognised area of expertise and competence.’
Australia
•
All optometrists graduating from 2012 onwards can prescribe scheduled
medicines as listed in Optometry Board of Australia (OBA) scheduled
medicines standard
•
40% + of optometrists can prescribe these
•
Eligible patients (Medicare card) have some medicines subsidised through
Pharmaceuticals Benefit Scheme (PBS)
Australia – General List
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anaesthetics, local (synthetic cocaine substitutes)
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tropicamide 1% or less
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cyclopentolate hydrochloride 1% or less
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atropine sulphate 1% or less
•
homatropine 2% or less
•
pilocarpine nitrate 2% or less
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physostigmine salicylate 0.5% or less
Australia – Schedule 4
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Anti-infective: includes antivirals, aminoglycides, quinolones
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Anti-inflammatory: includes non-steroidal & corticosteroid eye drops
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Anti-glaucoma: most drops
•
Diamox only available from Pharmacist as first aid for acute angle closure
Discussion
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What is the best way to expand the range of medicines available to entry
level optometrists?
•
Change exemption list
•
Change to undergraduate training
•
Other suggestions
•
What percentage of IP qualified Optometrists do you think we need?
•
What are the issues?
Training & Qualifications
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College of Optometrists Higher Qualifications
1.
Therapeutics (AS/SP/IP)
2.
CL, Glaucoma, Low Vision, Medical Retinal, Paediatric
•
Professional Certificate is the entry point (15-20 credits)
•
Professional Higher Certificate builds on the Certificate (30 – 40 credits)
•
Professional Diploma builds on the Higher Certificate (60 – 75 credits)
Additional Supply
Two universities offer specific courses in Additional Supply
•
•
City University, London
•
Additional Supply for optometrists
•
For more information, contact: Michelle Hennelly at [email protected] or
visit: www.city.ac.uk/optometry
Glasgow Caledonian University
•
Additional Supply for optometrists
•
For more information, contact: Gunter Loffler at [email protected] or visit:
www.gcu.ac.uk
Additional Supply
To qualify in Additional Supply you must:
•
have been practising in the UK and registered with the GOC for two full years
before beginning the clinical placement
•
train in competences which focus on the consultation, prescribing effectively
and prescribing in context
The three stage process is:
1.
taught theory modules on a course
2.
a clinical placement, under the supervision of an ophthalmologist and a
portfolio of practice - 10 sessions (5 days)
3.
an examination based on the portfolio of evidence
Independent Prescribing
To qualify in Independent Prescribing you must:
•
be a registered optometrist
•
have been practising in the UK and registered with the GOC for two full years
before beginning the clinical placement
•
train in competences which focus on the consultation, prescribing effectively and
prescribing in context
The three stage process is:
1.
taught theory modules on a course
2.
a clinical placement, under the supervision of an ophthalmologist and a logbook
of practice evidence which is assessed by the College; an online logbook is
available for College members - 24 sessions (12 days)
3.
an examination administered by the College
Independent Prescribing
Aston University
Independent Prescribing course for optometrists
For more information, contact: [email protected] or visit: www1.aston.ac.uk.
City University, London
Independent Prescribing for optometrists
For more information, contact: Michelle Hennelly at [email protected] or visit:
www.city.ac.uk/optometry.
Glasgow Caledonian University
Independent Prescribing for optometrists
For more information, contact: Gunter Loffler at [email protected] or visit: www.gcu.ac.uk.
Ulster University – provisional approval
Independent Prescribing course for optometrists
For more information, contact: Julie McClelland at [email protected] or visit:
www.ulster.ac.uk/
Cardiff??
Higher Qualifications
Accredited courses
Contact Lens Practice
Professional Higher Certificate – City University
Professional Higher Certificate – Moorfields Eye Hospital
Glaucoma
Professional Certificate – Cardiff University
Professional Certificate – City University
Professional Certificate – Ulster University
Professional Certificate – University of Bradford
Professional Higher Certificate – Cardiff University
Professional Higher Certificate – Moorfields Eye Hospital
Professional Diploma in Glaucoma - Cardiff University
Higher Qualifications
Accredited courses
Low Vision
Professional Certificate – Cardiff University
Professional Certificate – City University
Professional Certificate - Ulster University
Professional Higher Certificate – Cardiff University
Medical Retina
Professional Certificate – Cardiff University
Professional Certificate – City University
Professional Certificate – Ulster University
Paediatric Eye Care qualifications
Professional Certificate – Cardiff University
Professional Certificate - Ulster University
Discussion
•
Why become an IP optometrist?
•
What is the value & relevance of CoO Higher Qualifications
•
What obstacles do you perceive in doing
1.
Independent Prescribing Qualification
2.
Other Higher Qualifications
CET & CPD
•
GOC requirements; 3 year cycle
•
Local requirements for accreditation for MECS & other community services
•
LOCSU/WOPEC courses
GOC
Optometrists: 36 general points which must include:
1.
At least one peer review
2.
All of the optometry competency units, specifically:
•
Communication
•
Standards of Practice
•
Ocular examination
•
Optical appliances
•
Contact lens
•
Ocular disease
•
Assessment of visual function
•
Assessment and management of binocular vision
GOC
Dispensing Opticians: 36 general points which must include:
1.
All of the dispensing competency units, specifically:
•
Communication
•
Standards of Practice
•
Ocular examination
•
Optical appliances
•
Contact lens
•
Low vision
•
Refractive management
•
Ocular abnormalities
•
Paediatric dispensing
GOC
Contact Lens Opticians: 36 general points which must include:
1.
18 of the 36 points must be obtained in contact lens specialist CET
2.
At least one contact lens activity which involves peer review
3.
All of the contact lens optician competency units, specifically:
•
Communication
•
Standards of Practice
•
Ocular examination
•
Verification and identification
•
Contact lenses
GOC
Therapeutic specialist optometrists must gain 36 general points which must
include:
1.
At least one therapeutics activity which involves peer review
2.
All of the optometry competency units, specifically:
•
Communication
•
Standards of Practice
•
Ocular examination
•
Optical appliances
•
Contact lens
•
Ocular disease
•
Assessment of visual function
•
Assessment and management of binocular vision
Plus: 18 additional therapeutics specialty CET points (gained at a rate of six
per year)
LOCSU/WOPEC
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Glaucoma
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MECS
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Low Vision
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Cataract
•
Children
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Learning Disabilities
Discussion
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What are your experiences of CET/CPD - is it relevant to your practice?
•
What are your local accreditation requirements for community services?
Summary
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Current position
•
Expanding range of medicines for MECS
•
Training & qualifications
•
CET/CPD/Accreditation
Many thanks
•
For your participation & engagement
•
Bruce for chairmanship
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