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SUMMARY OF THE COMMISSION ON HUMAN MEDICINES MEETING HELD ON THURSDAY 20 APRIL 2006.

Department of Health (DH) introduced the proposals saying they were intended to update the exemptions currently held by registered podiatrists for the sale, supply or administration of specific medicines in the course of their professional practice.

In conclusion, the Commission accepted the balance of positive views from the consultation exercise and agreed that the following medicines should be added to the range of medicines available to podiatrists: i. For parenteral administration: Methylprednisolone Acetate, Levobupivacaine Hydrochloride, Robivacaine Hydrochloride and Adrenaline. ii. POMs for sale or supply in the course of their professional practice: Silver Sulfadiazine, Tioconazole 28%, Amoxicillin, Erythromycin and Flucoxacillin. iii. P medicine: Terbinafine 1% and Griseofulvin 1%.

I have contacted the Society the MHRA and the HPC but nobody seems to know what the next stages are in this consultation process.
How vague we are as a profession! Can anyone throw any more light on this subject.

Regards
Mark

There was an update for Society members a couple of months ago in Podiatry Now. I'll find out the current posistion and get back to you.

Mark Russell

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Thank you for your reply.

Regards
Mark

any news as yet on POM's

Current position is advised by the MHRA that we are waiting for Ministerial approval to have the new schedules on the statute books - probably around Oct/Nov this year. What is less certain is what position the HPC will adopt regarding competencies and what upgrades may be necessary for practitioners who presently hold certification in POMs. We should find out in the next eight weeks. Will keep you posted.

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Dear Mark,
Thank you for the information on the current position regarding the proposed
extension to the range of medicines for Podiatrists/Chiropodists.
Did you obtain this information from the MHRA?

Many Thanks
Mark

Indirectly. The following is a list of approved medicines with an appendix of those awaiting approval later this year.


PRESCRIPTION ONLY MEDICINES

Podiatrists who hold a certificate of competence may administer and/or supply a range of medicines in accordance with an exemption in the Medicines Act 1968, a Prescription Only Medicines Amendment Order (1998) in Stautory instruments 107 and 109 added a number of specified drugs listed below.

Chiropodists: sale or supply

The restrictions do not apply to state registered chiropodists who hold a certificate of competence in the use of the medicines specified below issued by or with the approval of the Chiropodists Board:

(a) Co-dydramol 10/500 tablets where the quantity sold or supplied to a person at any one time does not exceed the amount sufficient for three days’ treatment to a maximum of 24 tablets
(b) Amorolfine hydrocholoride cream where the maximum strength of the amorolfine in the cream does not exceed 0.25 per cent by weight in weight
(c) Amorolfine hydrocholoride lacquer where the maximum strength of the amorolfine in the lacquer does not exceed 5 per cent by weight in volume
(d) Topical hydrocortisone where the maximum strength of the hydrocortisone in the medicinal product does not exceed 1 per cent by weight in weight.
(e) Ibuprofen, other than preparations of ibuprofen which are prescription-only-medicines. In the case of ibuprofen an amount sufficient for three days’ treatment where the maximum dose is 400mg, the maximum daily dose 1.200mg and the maximum pack size 3,600mg.

The sale or supply shall be only in the course of their professional practice.

The restrictions also do not apply to the sale, offer or exposure for sale, or supply of certain medicinal products by state registered chiropodists, provided:

(a) the sale or supply is made in the course of their professional practice, and
(b) the product has been made up for sale or supply in a container elsewhere than at the place at which it is sold or supplied.

The medicinal products to which this exemption applies are:
(a) Medicinal products for external use that are on a general sale list; and
(b) any of the following pharmacy medicines for external use:
(i) Potassium permanganate crystals or solution; (ii) ointment of heparinoid and hyaluronidase; and (iii) products containing as their only active ingredients, any of the following substances, not exceeding the strength specified in each case:

Borotannic complex 9.0%
Buclosamide 10.0%
Chlorquinaldol 3.0%
Clotrimazole 1.0%
Crotamiton 10.0%
Diamthazole hydrochloride 5.0%
Econazole nitrate 1.0%
Fenticlor 1.0%
Glutaraldehyde 10.0%
Hydrargaphen 0.4%
Mepyramine maleate 2.0%
Miconazole nitrate 2.0%
Phenoxypropan-2-ol 2.0%
Podophyllum resin 20.0%
Polynoxylin 10.0%
Pyrogallol 70.0%
Salicylic acid 70.0%
Thiomersal 0.1%
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Chiropodists: administration

State registered chiropodists who hold a certificate of competence in the use of analgesics approved by the Chiropodists Board may administer parenterally in the course of their professional practice prescription-only medicines containing any of the following substances:

Bupivacaine hydrocholoride
Bupivacaine hydrochloride with adrenaline where the maximum strength of the adrenaline does not exceed 1mg in 200ml of bupivacaine hydrocholoride
Lignocaine hydrocholoride
Lignocaine hydrocholoride with adrenaline where the maximum strength of the adrenaline does not exceed 1mg in 200ml of lignocaine hydrochloride
Mepivacaine hydrochloride
Prilocaine hydrochloride

Appendix 1: Medicines approved by MHRA 2006

Additional POMs for administration

Methylprednisolone Acetate
Levobupivicaine Hydrochloride
Ropivicaine Hydrochloride
Adrenaline

POMs for sale or supply

Silver Sulfadiazine
Amoxicillin
Flucoxacillin
Erythromycin
Tioconazole 28%

P list medicines for sale or supply

Terbinafine 1%
Clotrimazole 1%

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Dear Mark,
Thank you for the information.
I anticipate that Ministerial approval will take its time along with the Society in
organising appropriate pharmacology courses. This progression will undoubtably precipitate a first for the profession in post graduate education!

Regards
Mark

No problem. The biggest thanks go to Philip Milsom and David Ashcroft at the Society for the immense amount of work they have done over the last few years to gain these advances for the profession. More often than not, the people who deliver these milestones for podiatry never receive the acknowledgement they deserve. A simple 'thank you' from members of the profession as and when they meet these guys would not go amiss.

Best wishes

Mark Russell

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http://www.mhra.gov.uk/home/idcplg?I...y+optometrists

I see Optometrists are hoping for Independant Prescriber status.
Maybe we should have gone the whole hog.

DF

Hi,
I think the sale or supply of the proposed new range of medicines approved by the MHRA for registered chiropodists & podiatrists within appendix 1 gives as much independance as anyone could wish for, especially in view of the number of years it has taken to acheive this most successful of outcomes. :)
I agree with Mark Russell that our gratitude and thanks go to Philip Milsom and David Ashcroft at the Society.
What additional benefit of independant prescriber status do you feel could improve on the sale and supply of the new proposed additional POMs ?

Regards
Mark C.