MECS and Prescribing. Jane Bell BSc FCOptom, DipTpIP, Dip Glauc

Transcription

1 MECS and Prescribing Jane Bell BSc FCOptom, DipTpIP, Dip Glauc

2 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

3 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

4 Where should we go? Extending range of medicines available to treat MECS Training & Qualifications Future demand & supply

5 Medicines Legislation Medicines Act

6 Medicines GSL - General Sale List P - Pharmacy medicines POM - Prescription only medicines Optometrists can sell/supply all GSL & P medicines

7 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 eye ointments that contain up to 1% chloramphenicol substances that contain: cyclopentolate hydrochloride fusidic acid tropicamide You must only do this as part of your professional practice.

8 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.

9 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)

10 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

11 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. Definition of a Patient Group Direction

12 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?

13 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 Ketotifen Allergic conjunctivitis

14 Additional Supply (continued) Levocabastine (no longer commercially available in the UK) Lodoxamide Alomide 10ml POM 5 ml P Nedocromil sodium Rapitil Olopatadine Pilocarpine hydrochloride Pilocarpine nitrate Polymyxin B/bacitracin (no longer commercially available in the UK) Polymyxin B/trimethoprim (no longer commercially available in the UK) Sodium cromoglicate P or POM according to size of bottle & condition

15 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.

16 Independent prescribing Statutory legislation introduced in June 2008 Public consultation and advice to Ministers by the Commission on Human Medicines (CHM) CHM's recommendation: 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.

17 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)

18 Australia General List anaesthetics, local (synthetic cocaine substitutes) tropicamide 1% or less cyclopentolate hydrochloride 1% or less atropine sulphate 1% or less homatropine 2% or less pilocarpine nitrate 2% or less physostigmine salicylate 0.5% or less

19 Australia Schedule 4 Anti-infective: includes antivirals, aminoglycides, quinolones Anti-inflammatory: includes non-steroidal & corticosteroid eye drops Anti-glaucoma: most drops Diamox only available from Pharmacist as first aid for acute angle closure

20 Discussion 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?

21 Training & Qualifications 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)

22 Additional Supply Two universities offer specific courses in Additional Supply City University, London Additional Supply for optometrists For more information, contact: Michelle Hennelly at or visit: Glasgow Caledonian University Additional Supply for optometrists For more information, contact: Gunter Loffler at or visit:

23 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

24 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

25 Independent Prescribing Aston University Independent Prescribing course for optometrists For more information, contact: or visit: www1.aston.ac.uk. City University, London Independent Prescribing for optometrists For more information, contact: Michelle Hennelly at or visit: Glasgow Caledonian University Independent Prescribing for optometrists For more information, contact: Gunter Loffler at or visit: Ulster University provisional approval Independent Prescribing course for optometrists For more information, contact: Julie McClelland at or visit: Cardiff??

26 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

27 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

28 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

29 CET & CPD GOC requirements; 3 year cycle Local requirements for accreditation for MECS & other community services LOCSU/WOPEC courses

30 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

31 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

32 GOC Contact Lens Opticians: 36 general points which must include: 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

33 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)

34 LOCSU/WOPEC Glaucoma MECS Low Vision Cataract Children Learning Disabilities

35 Discussion What are your experiences of CET/CPD - is it relevant to your practice? What are your local accreditation requirements for community services?

36 Summary Current position Expanding range of medicines for MECS Training & qualifications CET/CPD/Accreditation

37 Many thanks For your participation & engagement Bruce for chairmanship Download App: Wifi: BTOpenzone Username: Password: noc2016 Twitter: #NOC2016