GPhC working through implications of Cass Review for pharmacists

The General Pharmaceutical Council (GPhC) has reached out to the Department of Health and Social Care (DHSC) to begin work on the recommendations of a major review into gender identity services for children and young people.

Speaking in a council meeting on Thursday, GPhC chief executive Duncan Rudkin, said the regulator recognised ‘a degree of urgency’ in addressing the implications of the recently published Cass Review for the profession.

And he stressed that clarifying the role of pharmacists in dispensing private prescriptions will be a ‘key theme’ as part of this work.

GPhC ‘taking a proactive approach’

Published earlier this month, the Cass Review recommended that the GPhC and DHSC work together to ‘define the dispensing responsibilities of pharmacists of private prescriptions and consider other statutory solutions that would prevent inappropriate overseas prescribing'.

In an update this week, Mr Rudkin confirmed he had reached out to the DHSC to begin the process of engagement to take this recommendation forwards.

In the meantime, the GPhC wanted to continue taking a ‘proactive approach to communicating with the profession on these topics’, and was doing ‘quite a lot of thinking and discussing ourselves in terms of the different strands of our work’, he said.

In addition to the Cass Review, NHS England (NHSE) last month issued a new policy which set out that puberty supressing hormones are not available as a routine commissioning treatment option for treatment of children and young people in England who have gender incongruence/gender dysphoria.

At the time, the GPhC issued a response statement instructing pharmacists to ‘take account’ of the guidance and take ‘active steps’ to assess whether prescribers, including those in private clinics based outside the UK, comply with latest policy.

While the Cass report’s recommendations and the NHSE guidance apply to England, Mr Rudkin said it would be important to also take into account the context and evidence gathered in Scotland and Wales.

And he said it was ‘vitally important’ for the pharmacy regulator to be ‘on the same page with other key regulators and relevant professional bodies’ so that pharmacists could receive a ‘consistent set of messages’.

Mr Rudkin also said the regulator recognised that there was ‘a degree of urgency’ around this.

‘Clarity on dispensing not yet provided’

During Thursday’s meeting, GPhC council member Neil Buckley raised concerns that the regulator was not yet in a position to provide clarity to the profession around dispensing private prescriptions for puberty supressing hormones.

He suggested that providing this clarity was ‘very urgent’ as he felt that the burden of risk currently lay with the pharmacist.

And he suggested that the GPhC might want to set out what type of questions, if any, pharmacists should be asking patients when presented with a private prescription for puberty supressing hormones, to help avoid the risk of asking inappropriate questions.

Mr Buckley also suggested that the GPhC should set out the threshold pharmacists should use when deciding whether to dispense private prescriptions for puberty supressing hormones, and when they should ‘override the clinical decision of the prescriber’.

‘We need answers sooner rather than later,’ he said.

‘Pharmacists should safeguard patient care not prescription validity’

New council member Ade Williams told the council that he is regularly presented with, and must make decisions, about whether to dispense non-UK prescriptions.

He suggested that the role of the pharmacist and pharmacy teams should not be to gatekeep whether a patient can get their medication, but rather to safeguard the ‘care of the patient’.

Another council member noted that it would be important to include the experience of pharmacy professionals while developing guidance on this issue.

Need to consider role of dispenser vs prescriber?

In concluding this section of the meeting’s agenda, Mr Rudkin suggested that a wider consideration may be needed around a ‘more up to date sense generally’ of what was expected from a pharmacist’s role in dispensing in relation to the role of the prescriber.

And he questioned to what extent the GPhC should give ‘categorical guidance’ on clinical matters, stressing that the regulator wanted to promote well-informed professional decision making.