Prescription Only Medicines Order

A pharmacy medicine is the definition given to medicinal products not included on the Prescription Only Medicines Order or the General Sale List or to products that are supplied outside the GSL package limit or maximum dosage limit. A few medicines are called pharmacy only (PO) medicines these include medicines that would normally be included on the GSL but where the manufacturer has limited the supply of the medicines to pharmacies only (see Section 1.3.1). Examples include ... 

To allow the pilots for electronic transmission of prescriptions (ETP) to go ahead in England, the Prescription Only Medicines Order was amended to allow authorised prescribers who were participating in the pilot schemes to sign prescription forms digitally in place of ink signatures. 

Further developments in prescribing for health care professionals came with the advent of supplementary prescribing in 2005. Through an amendment to the Prescription Only Medicines Order and NHS Regulations, podiatrists, physiotherapists and radiographers can now train to prescribe in partnership with and independent prescriber (a doctor or dentist) according to an agreed CMP. 

Where a patient orders a product for his own use direct from a supplier in another country, that will not normally be caught by the rules on particular patient supply, since the product will not be placed on the market. However, it is possible that the supplier of that product (which is likely to be a prescription-only medicine) will be committing an offence in the country in which it operates, particularly if it has advertised the product or supplied it otherwise, than in response to a prescription. 

These are medicines that are listed in the Prescription Only Medicines (ffuman Use) Order 1997. If the pack size of a POM is reduced it may be considered for licensing as a P or GSL medicine (see paracetamol example in Section 1.3.1). If a POM is intended for sale below a certain strength or dose then the medicine may be also considered to be a P medicine. An example of this is hyoscine butylbromide tablets 10 mg, which are normally classified as a POM but if packaged and labelled appropriately, a P classification is given. For P classification in this example, the packaging must state that a single dose must not exceed 20 mg and the daily dose must not exceed 80 mg and the pack must contain no more than 240 mg. 

Prescription-only medicines (POMs) are medicines that are listed in the Prescription Only Medicines (Human Use) Order 1997. They are usually obtained on the authorisation of a valid prescription form (either an NHS or a private prescription form) written by a recognised prescriber registered in the UK, presented at a registered pharmacy (although exceptions do exist). 

There are no restrictions in the supply of prescription-only medicines to hospitals and health centres provided that the prescription-only medicine is to be supplied either in response to a prescription that has been written by an appropriate practitioner or an order written by an appropriate practitioner. This applies to both hospitals and health centres within the NHS and private sector. The restrictions that... 

Although controlled drugs are dealt with in Chapter 6, for completeness, it is worth mentioning midwives supply orders here. Midwives supply orders are needed for the lawful supply of certain controlled drugs to a midwife from a pharmacist (i.e. those items listed above that are Schedule 2 or Schedule 3 controlled drugs diamorphine, morphine, pentazocine and pethidine). They are not required for the supply of other listed prescription-only medicines. 

When optometrists present a signed order for a prescription-only medicine (POM) the following details are required ... 

Legally written The prescription-only medicines register entry must either state that the pharmacist knows Dr R U Better is an appropriate practitioner (so long as they do) or the pharmacist must ask for qualifications to be added and record these in the prescription-only medicines register. There is no signature on the order but this is not a legal requirement. 

The Prescription Only Medicines (Human Use), Order 1997 (The POM Order). 

The Prescription Only Medicines (Human Use) Order 1997 allows anyone to administer non-injection (non-parenteral) drugs to the patient for which they are intended and in the manner prescribed. 

Originally, the Medicines Act 1968 and associated secondary legislation allowed only doctors and dentists to write prescriptions for POM. The Prescription Only Medicines (Human Use) Order 1997, known as the POM Order, contains some specific exemptions that allow for the sale or supply and administration of certain POM directly to patients, without the directions of a doctor or dentist. These exemptions, which continue to apply, relate to midwives, ambulance paramedics, optometrists, and podiatrists and chiropodists. 

The relevant modifications to the Medicines Act 1968 are contained in the following pieces of legislation the Prescription Only Medicines (Human Use) Amendment Order 2000 the Medicine (Pharmacy and General Sale - Exemption) Amendment Order 2000 and the Medicines (Sale and Supply) (Miscellaneous Provisions) Amendment (No2) Regulations 2000. 

The exemptions provided by Article 7 of the Prescription Only Medicines (Human Use) Order 1997 (the POM Order) mean that PGDs are not needed for the following countermeasures, when given by anyone in an emergency to save life ... 

The Act makes provision for the legal status of all medicines as either prescription only (POM), general sale (GSL), or by default pharmacy (P) a medicine is Pharmacy status unless listed in the POM or GSL Orders. Some medicines are exempted from POM status (making them P status) if their active substance is within specified limits for strength, dose, pack size, use, route of administration, or dose form. Some medicines may be disallowed from GSL status (making them P status) because their active substance is outside the specified limits for strength, dose, pack size, use, route of administration, or dose form. Pack size of certain GSL medicines is controlled by the Sale and Supply Regulations. 

For safety reasons the UK regulatory authority has recommended that oral TAC products be described and dispensed by brand name only, in order to ensure maintenance of fherapeutic response when a patient is stabilised on a particular brand, and to minimise the risk of inadverfenf swifching befween products from different suppliers [51 ]. Graft rejection and TAC toxicity have resulted when products have been unintentionally switched. If a prescriber considers that switching a patient to a different brand of oral TAC would be of benefit, the change requires careful supervision and monitoring by an appropriate specialist. It is also advised that pharmacists always dispense the exact brand prescribed and that they contact the prescriber if the prescription is not clear, in order to ensure the appropriate medicine is dispensed, and that patients should take careful note of the brand name of their usual formulation and should check with their doctor if fhey receive a different brand. 

The Hippocratic idea that dyscrasia was the cause of nearly all diseases meant that dietetics (= diaita) was necessary for the restoration to normal of the life order . (s. p. 6) Even in antiquity, special forms of nutrition were of great importance in the treatment of liver diseases. In addition to those dietary prescriptions which were within the reach of everyone (e. g. donkey liver with parsley and honey) (s. pp 7, 844), there were also extremely complicated diets for the treatment of jaundice which only kings could afford (Celsus called jaundice the morbus regius). (s. p. 7) During all historical epochs of medicine, dietetic measures have played an essential role in the treatment of liver diseases - even in the so-called dirty pharmacy of mediaeval times, (s. p. 844) Because dietetics also assumed such an important role in hepatology, nutrition, i.e. enteral intake of special beverages and food, was mainly based on mythological and later also on speculative ideas. 

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