SECTION 2.5 – CLINICAL CHECK
Section 2.5.1 – Patient Characteristics
Special groups of patients – children, pregnant, BF, elderly, ethnic origin (initial and max dose of
rosuvastatin is lower for Asians), gender (finasteride is contraindicated in women), renal/hepatic
impairment, heart failure, allergies, dietary intolerance, religious beliefs, patients’ beliefs
SECTION 2.6 – PHARMACIST CONSULTATION IN PRACTICE
Section 2.6.1 – Medicines Reconciliation
Sources of information – Pt, Pt’s rep, Pt’s medicines, repeat Rx, GP referral letters, Pt’s GP surgery, hospital
discharge summaries, outpatient appointment notes, community pharmacy Pt medication records, care
home records, drug Tx centre records, other HCPs, specialist clinics, Summary Care Records
Key points:
Use the most complete, reliable and up-to-date source(s) of information
Crosscheck medication histories against different sources and confirmed with Pt
Check whether Pts take any medications PRN or on certain days of the week
Medication history should include current therapies, recently stopped and changed meds
Check for OTC meds, herbals, vitamins, dietary supplements, alcohol/smoking, internet drugs
Medication history – generic drug name, brand name (where appropriate), dose (prescribed and actual),
strength, formulation, administration route (may be unlicensed i.e. ciprofloxacin eye drops for ear),
administration frequency, therapy length, injectables’ administration device and brand, day/date of
administration for meds taken on specific days of the week/month
SECTION 2.8 – PROFESSIONAL DEVELOPMENT
GPhC Standards
1. Provide patient-centred care 6. Behave in a professional manner
2. Work in partnership with others 7. Respect and maintain the person’s
3. Communicate effectively confidentiality and privacy
4. Maintain, develop and use their professional 8. Speak up when they have concerns or when
knowledge and skills things go wrong
5. Use professional judgement 9. Demonstrate leadership
GPhC Standards for Registered Pharmacies
1. The governance arrangements safeguard the health, safety and wellbeing of Pts and the public
2. Staff are empowered and competent to safeguard the health, safety and wellbeing of Pts and the public
3. The environment and condition of the premises from which pharmacy services are provided, and any
associated premises, safeguard the health, safety and wellbeing of Pts and the public
4. The way in which pharmacy services, including the management of medicines and medical devices, are
delivered safeguards the health, safety and wellbeing of Pts and the public
5. The equipment and facilities used in the provision of pharmacy services safeguard the health, safety and
wellbeing of Pts and the public
1
, SECTION 3.1 – CLASSIFICATION OF MEDICINES
Section 3.1.1 – General Sales List (GSL) Medicines
Sold in registered pharmacies plus other retail outlets that can ‘close as to exclude the public’
Classified due to an EU or UK marketing authorisation (product license), traditional herbal registration or
certificate of registration for homeopathic products
GSL meds can only be sold when a pharmacist has assumed the role of RP; however, the pharmacist can
be physically absent for a limited period while remaining responsible
PO medicines – used to describe GSLs for which the manufacturer wishes to restrict sales or supplies
through pharmacies only (i.e. 30-sachet packs of Fybogel)
Section 3.1.1 – Pharmacy (P) Medicines
Sold from a registered pharmacy premises by a pharmacist or a person acting under a pharmacist
Section 3.1.3 – Prescription-Only Medicines (POM)
Subject to the restriction of requiring a Rx written by an appropriate practitioner
Appropriate practitioner – doctor, dentist, SP, nurse IP, pharmacist IP, EEA/Swiss doctors and dentists,
EEA/Swiss prescribing pharmacist/nurse, community practitioner nurses, optometrist IPs, podiatrist,
physiotherapist, therapeutic radiographer IPs
SECTION 3.2 – PROFESSIONAL AND LEGAL ISSUES: PHARMACY MEDICINES
Section 3.2.1 – Pseudoephedrine and Ephedrine
MAX quantity of pseudoephedrine = 720mg MAX quantity of ephedrine = 180mg
ILLEGAL to sell or supply any pseudoephedrine product at the same time as an ephedrine product without Rx
Signs of misuse – lack of symptoms, rehearsed answers, impatient or aggressive, opportunistic, specific
products, paraphernalia (wishes to purchase other items used to make meth like batteries, acetone), large
quantities, frequent requests
Suspicions can be reported to the local GPhC inspection, local CD liaison police officer or accountable officer
Section 3.2.2 – Oral Emergency Contraceptives as Pharmacy Medicines
Levonorgestrel 1500 micrograms – licensed for women over 16yrs for emergency contraception within
72hrs of unprotected sex or failure of a contraceptive method
Ulipristal acetate – licensed for emergency contraception within 120hrs (5 days) of unprotected sex or
failure of a contraceptive method
An advance supply of oral emergency contraception is allowed prior to unprotected sex or if a
contraceptive method has failed.
If religious or moral beliefs impact your willingness to supply oral EHC – inform your employer, your
locum agency and colleagues you will be working with ASAP. Referral may not always be possible.
‘Responding to Domestic Abuse: A Handbook for HCPs’ by the DoH – provides practice advice on dealing
with domestic abuse, keeping records, confidentiality and sharing information
2
, Supply of ulipristal to <16s is not restricted but pharmacists should consider:
o <13s are legally too young to consent to any sexual activity
o Sex with <16s is illegal but may be consensual. The law doesn’t prosecute mutually agreed
sexual activity between young people of a similar age, unless it involves abuse/exploitation
o Advice can be given to <16s and the general duty of patient confidentiality applies, hence where
there’s a decision to share info, consent must be sought
Other mechanisms for supply – family planning clinics, GP clinics, providers of PGDs for EHC, GUM clinics
Section 3.2.3 – Paracetamol and Aspirin
Legal Restriction Notes
Paracetamol Max. 100 non-effervescent tabs/caps No legal limits on the quantity of OTC
effervescent tablets, powders, granules or
(as most OTC pack sizes are 16 or 32, in liquids that can be sold to a person at any
Aspirin practice, 96 is the most that can be sold) one time
Section 3.2.4 – Codeine and Dihydrocodeine
Indications – solid dosage forms are restricted to the short term Tx of acute, moderate pain unresolved by
paracetamol, ibuprofen or aspirin alone (NOT for cold, flu, sore throat, minor pain)
Pack size – pack containing >32 units (including effervescent packs) is a POM. Only 1 pack should be sold as
selling more would undermine the reduction in pack size and POM restriction on packs containing >32 units
Patient information leaflet and labels
“Can cause addiction. For three days use only” must be positioned in a clear position on the front of pack
Both PIL and packaging must state the indication and that the medicine can cause addiction or headache
if used continuously for more than 3 days
PIL must contain info on the warning signs of addiction
Section 3.2.5 – Reclassified Medicines (from POM to P)
Amorolfine nail lacquer Mometasone 0.05% nasal Orlistat
Antimalarials* spray Sildenafil
Chloramphenicol eye drops Proton pump inhibitors Sumatriptan
and eye ointment Oral lidocaine-containing Tamsulosin
Emergency contraceptives products for teething Tranexamic acid
*Maloff Protect (atovaquone 250mg with proguanil hydrochloride 100mg)
Avloclor (chloroquine 250mg)
Paludrine (proguanil hydrochloride 100mg)
Paludrine/Avloclor Anti-Malarial Travel Pack (proguanil hydrochloride 100mg/chloroquine 250mg)
3
Section 2.5.1 – Patient Characteristics
Special groups of patients – children, pregnant, BF, elderly, ethnic origin (initial and max dose of
rosuvastatin is lower for Asians), gender (finasteride is contraindicated in women), renal/hepatic
impairment, heart failure, allergies, dietary intolerance, religious beliefs, patients’ beliefs
SECTION 2.6 – PHARMACIST CONSULTATION IN PRACTICE
Section 2.6.1 – Medicines Reconciliation
Sources of information – Pt, Pt’s rep, Pt’s medicines, repeat Rx, GP referral letters, Pt’s GP surgery, hospital
discharge summaries, outpatient appointment notes, community pharmacy Pt medication records, care
home records, drug Tx centre records, other HCPs, specialist clinics, Summary Care Records
Key points:
Use the most complete, reliable and up-to-date source(s) of information
Crosscheck medication histories against different sources and confirmed with Pt
Check whether Pts take any medications PRN or on certain days of the week
Medication history should include current therapies, recently stopped and changed meds
Check for OTC meds, herbals, vitamins, dietary supplements, alcohol/smoking, internet drugs
Medication history – generic drug name, brand name (where appropriate), dose (prescribed and actual),
strength, formulation, administration route (may be unlicensed i.e. ciprofloxacin eye drops for ear),
administration frequency, therapy length, injectables’ administration device and brand, day/date of
administration for meds taken on specific days of the week/month
SECTION 2.8 – PROFESSIONAL DEVELOPMENT
GPhC Standards
1. Provide patient-centred care 6. Behave in a professional manner
2. Work in partnership with others 7. Respect and maintain the person’s
3. Communicate effectively confidentiality and privacy
4. Maintain, develop and use their professional 8. Speak up when they have concerns or when
knowledge and skills things go wrong
5. Use professional judgement 9. Demonstrate leadership
GPhC Standards for Registered Pharmacies
1. The governance arrangements safeguard the health, safety and wellbeing of Pts and the public
2. Staff are empowered and competent to safeguard the health, safety and wellbeing of Pts and the public
3. The environment and condition of the premises from which pharmacy services are provided, and any
associated premises, safeguard the health, safety and wellbeing of Pts and the public
4. The way in which pharmacy services, including the management of medicines and medical devices, are
delivered safeguards the health, safety and wellbeing of Pts and the public
5. The equipment and facilities used in the provision of pharmacy services safeguard the health, safety and
wellbeing of Pts and the public
1
, SECTION 3.1 – CLASSIFICATION OF MEDICINES
Section 3.1.1 – General Sales List (GSL) Medicines
Sold in registered pharmacies plus other retail outlets that can ‘close as to exclude the public’
Classified due to an EU or UK marketing authorisation (product license), traditional herbal registration or
certificate of registration for homeopathic products
GSL meds can only be sold when a pharmacist has assumed the role of RP; however, the pharmacist can
be physically absent for a limited period while remaining responsible
PO medicines – used to describe GSLs for which the manufacturer wishes to restrict sales or supplies
through pharmacies only (i.e. 30-sachet packs of Fybogel)
Section 3.1.1 – Pharmacy (P) Medicines
Sold from a registered pharmacy premises by a pharmacist or a person acting under a pharmacist
Section 3.1.3 – Prescription-Only Medicines (POM)
Subject to the restriction of requiring a Rx written by an appropriate practitioner
Appropriate practitioner – doctor, dentist, SP, nurse IP, pharmacist IP, EEA/Swiss doctors and dentists,
EEA/Swiss prescribing pharmacist/nurse, community practitioner nurses, optometrist IPs, podiatrist,
physiotherapist, therapeutic radiographer IPs
SECTION 3.2 – PROFESSIONAL AND LEGAL ISSUES: PHARMACY MEDICINES
Section 3.2.1 – Pseudoephedrine and Ephedrine
MAX quantity of pseudoephedrine = 720mg MAX quantity of ephedrine = 180mg
ILLEGAL to sell or supply any pseudoephedrine product at the same time as an ephedrine product without Rx
Signs of misuse – lack of symptoms, rehearsed answers, impatient or aggressive, opportunistic, specific
products, paraphernalia (wishes to purchase other items used to make meth like batteries, acetone), large
quantities, frequent requests
Suspicions can be reported to the local GPhC inspection, local CD liaison police officer or accountable officer
Section 3.2.2 – Oral Emergency Contraceptives as Pharmacy Medicines
Levonorgestrel 1500 micrograms – licensed for women over 16yrs for emergency contraception within
72hrs of unprotected sex or failure of a contraceptive method
Ulipristal acetate – licensed for emergency contraception within 120hrs (5 days) of unprotected sex or
failure of a contraceptive method
An advance supply of oral emergency contraception is allowed prior to unprotected sex or if a
contraceptive method has failed.
If religious or moral beliefs impact your willingness to supply oral EHC – inform your employer, your
locum agency and colleagues you will be working with ASAP. Referral may not always be possible.
‘Responding to Domestic Abuse: A Handbook for HCPs’ by the DoH – provides practice advice on dealing
with domestic abuse, keeping records, confidentiality and sharing information
2
, Supply of ulipristal to <16s is not restricted but pharmacists should consider:
o <13s are legally too young to consent to any sexual activity
o Sex with <16s is illegal but may be consensual. The law doesn’t prosecute mutually agreed
sexual activity between young people of a similar age, unless it involves abuse/exploitation
o Advice can be given to <16s and the general duty of patient confidentiality applies, hence where
there’s a decision to share info, consent must be sought
Other mechanisms for supply – family planning clinics, GP clinics, providers of PGDs for EHC, GUM clinics
Section 3.2.3 – Paracetamol and Aspirin
Legal Restriction Notes
Paracetamol Max. 100 non-effervescent tabs/caps No legal limits on the quantity of OTC
effervescent tablets, powders, granules or
(as most OTC pack sizes are 16 or 32, in liquids that can be sold to a person at any
Aspirin practice, 96 is the most that can be sold) one time
Section 3.2.4 – Codeine and Dihydrocodeine
Indications – solid dosage forms are restricted to the short term Tx of acute, moderate pain unresolved by
paracetamol, ibuprofen or aspirin alone (NOT for cold, flu, sore throat, minor pain)
Pack size – pack containing >32 units (including effervescent packs) is a POM. Only 1 pack should be sold as
selling more would undermine the reduction in pack size and POM restriction on packs containing >32 units
Patient information leaflet and labels
“Can cause addiction. For three days use only” must be positioned in a clear position on the front of pack
Both PIL and packaging must state the indication and that the medicine can cause addiction or headache
if used continuously for more than 3 days
PIL must contain info on the warning signs of addiction
Section 3.2.5 – Reclassified Medicines (from POM to P)
Amorolfine nail lacquer Mometasone 0.05% nasal Orlistat
Antimalarials* spray Sildenafil
Chloramphenicol eye drops Proton pump inhibitors Sumatriptan
and eye ointment Oral lidocaine-containing Tamsulosin
Emergency contraceptives products for teething Tranexamic acid
*Maloff Protect (atovaquone 250mg with proguanil hydrochloride 100mg)
Avloclor (chloroquine 250mg)
Paludrine (proguanil hydrochloride 100mg)
Paludrine/Avloclor Anti-Malarial Travel Pack (proguanil hydrochloride 100mg/chloroquine 250mg)
3
