NPA Game Plan - National pharmacy association

GAME PLAN
Preparing for 2012
London

Contents
Foreword 3
London 2012 4
Olympic and Paralympic Games
Hints & Tips: Pharmacy Services
during the Games
Emergency Contraception 8
EEA and Swiss Prescriptions 11
Legal Requirements
EEA and Swiss Prescriptions 13
Practical Advice
Emergency Supplies 15
Drugs in Sport 17
Identifying UK Equivalents 18
of Foreign Medicines
First Aid for Pharmacists 24
This pack also includes:
Anti-doping advice cards
NHS London posters
NHS London leaflets
Disclaimer
Every care has been taken to ensure
the accuracy of the guidance in this
document, however, no responsibility will
be accepted for any errors or omissions,
or any consequences due to these.

Foreword
This summer is likely to be one of the busiest for
Community Pharmacy Teams across London and
other Olympic sites in recent history as our own
country plays host to the Olympic and
Paralympic Games.
The logistics of organising such events are enormous,
and the impact it has on you and your team to deliver
healthcare to our patients may seem challenging.
To help you continue to deliver high quality
healthcare, the NPA has produced this resource for
members with the assistance of NHS London and
Reckitt Benckiser.
The games present a wonderful opportunity for us
to showcase to visitors from around the world the
high level of care we deliver everyday for people
in our community.
Michael Holden FRPharmS
NPA Chief Executive
Our Information Department is available for members to contact via information@npa.co.uk,
or by calling 01727 891 800, and more information is available online www.npa.co.uk.
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London 2012 Olympic and Paralympic Games
Hints & Tips: Pharmacy Services during the Games
Opening hours
There are opportunities for pharmacies to temporarily open for extended (supplementary)
hours during the Olympic and Paralympic Games to meet any anticipated increase in local
demand. Pharmacies must liaise with their Primary Care Trust (PCT) and ideally provide 90
days notice of any intended change. Pharmacies who are thinking of extending their hours
during the Games, but who have missed the 90 day notice period are advised to discuss
their requirements directly with the PCT who may agree the change with a shorter notice
period. The NHS would encourage increased opening hours, however not at the expense
of reduced hours elswhere. It is essential that Pharmacies inform their PCTs of ANY changes
to opening hours. Further information on amending opening hours can be found on the
Pharmaceuticals Services Negotiating Committee (PSNC) website: www.psnc.org.uk/pages/
opening_hours.html#requirements.
Pharmacies are required to clearly display their opening hours and to signpost patients to
alternative pharmaceutical services when the pharmacy is closed.
Details of pharmacy opening hours and services should be up-to-date on the NHS Choices
website, as well as any other web-presence the pharmacy may have. NHS Choices is being
promoted as the first-line source of information for overseas travellers visiting the Games.
Practice leaflets should be current and pharmacies should have an ample supply available.
Business continuity
Staff should familiarise themselves with the NHS London ‘Olympic guide for Community
Pharmacy’ and the ‘Developing resilient organisations.’ Pharmacies are encouraged to return
their business continuity forms to PCTs as soon as possible.
Assurance
Pharmacies are required to provide assurance of their Games readiness to their local PCT. If
you have not already done so please ensure you do this.
Signposting
Check with the local GP/dental practices to see if their opening hours are varying at all
during the Games to meet expected demand. Find out where the nearest NHS walkin
centre or urgent care centre is and ensure all staff are able to direct visitors to these
resources if necessary. Ensure all pharmacy services are clearly promoted.
Repeat prescription services
Pharmacies should encourage patients to request repeat prescriptions well in
advance and not leave it until the last minute. Ideally these should be dispensed
before the Games commence to avoid patients being caught in travel delays
and delivery disruptions. It is a good idea to advise patients in advance of
pharmacy opening hours over these periods.
Consider arranging a meeting with the local surgery practice managers as
well as the managers of any local care homes, Drug Action Teams etc. to discuss
the impact the Games may have on pharmacy services and to agree strategies to
minimise any problems (e.g.issue prescriptions in advance, multiple prescriptions
for smaller quantities, encourage use of the NHS repeat dispensing scheme).

NHS repeat dispensing scheme (RA/RD forms)
Patients may request more than one Repeat Dispensing (RD) batch prescription to ensure
they do not run out of their medicines during the Games period. Pharmacists faced with
such requests will need to consider whether such a supply is appropriate and in-line with
the NHS pharmacy contract. Routine requests for more than one RD should NOT normally
be carried out, but may be considered in exceptional circumstances. It is good practice to
notify the prescriber before supplying more than one RD.
Before making a supply, the pharmacist will need to consider:
• Whether a dispensing interval is stated, as this MUST be adhered to
• The NHS Terms of Service checks on whether the patient is experiencing side-effects,
for example, should be carried out for each dispensing of an RD
• If a patient requests multiple RDs it may be preferable to refer them to their prescriber
for a single prescription form.
Instalment prescriptions
Incorrectly written controlled drug (CD) instalment prescriptions often affect the smooth
provision of services for patients. Pharmacists need to rigorously check these prescriptions as
soon as they are received to ensure that they are valid. Any queries can then be addressed
prior to surgeries and clinics closing at weekends for example.
Stock
Confirm order cut-off times and delivery dates with wholesalers in advance because most
manufacturers and distributors are anticipating travel disruptions during the Games period.
Advise patients that there may be a delay in receiving their drugs, especially with any
“special” items ordered over this period. It is important that the response to the challenges
and opportunities posed by the London 2012 Games is proportionate. Pharmacists should
look at the likely local impact of the Games on supply and demand and plan accordingly.
All pharmacies should plan early with your suppliers to ensure you are prepared. Those
pharmacies that are near to the Olympic and Paralympic Road networks, transport hotspots,
central and east London or near other Games-related venues and events, may need to do
more detailed contingency planning than those which are not.
Pharmacies may also wish to ensure that there is sufficient stock of fast-moving lines.
Avoid over-ordering as this will increase the risk of shortages.
Consider increasing stock levels of ‘summer essentials’ to take advantage of the increased
footfall from visitors to the Games, for example:
• Basic over-the-counter (OTC) remedies such as painkillers, diarrhoea and vomiting
treatments, antihistamines and bite-relief remedies
• Emergency hormonal contraception
• Plasters and small packs of tissues
• Foot care (for example cooling sprays, blister plasters, protective pads, etc)
• Alcohol-based hand gels
• Sun protection creams SPF 15 and above (the Olympic and Paralympic venues restrict
liquid containers to a maximum of 100ml)
• Condoms.
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Emergency supplies
Pharmacists should consider the circumstances of each individual request for an emergency supply
and use their professional discretion to determine if an emergency supply would be appropriate.
Where an emergency supply for a patient is refused then the patient should be signposted to
alternative healthcare services and the reasons for refusal documented. Comprehensive guidance
on emergency supplies of prescription-only medicines, including handling requests from European
Economic Area (EEA) and Swiss patients, can be found later in this booklet.
Prescriptions from overseas doctors
Guidance on prescriptions issued by doctors in EEA countries or Switzerland is available
later in this booklet. Prescriptions from practitioners registered in countries outside the EEA
or Switzerland may not be dispensed UNLESS the doctor has registered with the General
Medical Council (GMC) at www.gmc-uk.org. Doctors who are visiting the UK as part of the
medical team supporting athletes competing in the Olympic and Paralympic Games will be
able to temporarily register with the General Medical Council. The doctor’s record on the
GMC website will be annotated to show this restriction.
Athletes
Athletes competing in London 2012 Olympic and Paralympic Games will be expected to
obtain their medical supplies through the Games Polyclinic Pharmacies in the Athletes
Village. In addition to the three Athlete Village pharmacies, which will supply medicines to
athletes and officials, there will be 2 retail pharmacies in the spectator areas of the Stratford
Olympic Park – one in the North of the Park near the Basketball Arena and one in the South
near the Orbit sculpture. These will provide spectators with a range of pharmacy medicines
for minor conditions. A further retail pharmacy will also operate in the Olympic Press and
Broadcast Centre, for the 27,000 members of the media that will inhabit this facility.
Pharmacists working outside the Games venues, who are asked to supply prescribed or OTC
medicines for competing athletes at the Games, should follow the London 2012 Organising
Committee (LOCOG) guidance.
An Anti-Doping advice card aimed at elite and high performance athletes as well as coaches
and athlete support personnel can be downloaded from the UK Anti-Doping website:
www.ukad.org.uk/resources/document/advice-card (A copy is enclosed in this NPA Olympic
support pack).
NHS prescriptions for overseas visitors
If the doctor has chosen to issue an NHS prescription for an overseas visitor then the standard
NHS exemptions would apply as they would for UK residents. If the patient does not fall
under any of the exemption categories and believes they should not pay a prescription
charge they should be charged and issued with an NHS receipt (FP57) at the time of supply
and be advised to try to claim the fees back when back in their home country (either from
their insurance company or their health service equivalent).Guidance on NHS services and
charges for overseas visitors can be found on the Department of Health website:
www.dh.gov.uk/en/Healthcare/Entitlementsandcharges/OverseasVisitors/index.htm.
PGDs for overseas travellers
Visitors from overseas are eligible for private pharmacy Patient Group Direction (PGD)
services provided they meet the service specification criteria and are able to fulfil the
consent criteria. Pharmacists should check with their PCT with regards to NHS PGDs.

Training – pharmacy and sports
The Centre for Pharmacy Post-Graduate Education (CPPE) has developed a series of
e-learning programmes that cover the role pharmacy plays in sports and fitness including:
• Doping and anti-doping in sport
• Medical services at international sporting events: a healthcare professional’s perspective
• Pharmacy services and support in sport and fitness
• Overview of the substances and methods in the Prohibited List (further information can
be found on the CPPE website: www.cppe.ac.uk).
Managing prescription owings and unobtainable items
If the pharmacy does not have sufficient stock to supply a patient’s prescribed item, the
pharmacist should consider the risk(s) to the patient of not receiving the medicine.
Where patients are being treated for acute or serious conditions (such as mental health
problems like schizophrenia or bipolar disorder) or where dosing of the medicine is critical
or requires frequent monitoring (e.g. warfarin or ciclosporin) the risk(s) for the patient may
be high and in these circumstances it is good practice to inform the prescriber that the
medicine could not be dispensed.
NPA services
• NPA Information Department telephone service: available Monday-Friday 9-6pm,
Saturday 9-1pm. Email: information@npa.co.uk
• NPA Information Services Database (IRIS): available to NPA members 24/7
at www.npa.co.uk
• NPA Sales. To ensure the pharmacy does not run out of essential pharmacy items during
the Games, it is recommended pharmacies:
- Identifying opportunities for night time or alternative address deliveries
- Identifying which products are critical to the business
- Building stock before the Games to avoid being without key items
- Ordering as early in the day as possible and ideally before 4pm
NPA DX prescription courier service may be affected. Please contact NPA Sales on 0844 736
4199 to discuss individual options (e.g. night-time deliveries, alternative delivery address).
Useful links
• NHS London: guidance for community pharmacy-planning for the London 2012
Olympic and Paralympic Games
www.london.nhs.uk/getting-fit-for-the-2012-games/key-documents/guidance-for-
community-pharmacists
• Ask Your Pharmacist (advice to foreign visitors)
www.askyourpharmacist
• London 2012
www.london2012.com
• Transport for London, London 2012 Games
www.tfl.gov.uk/gettingaround/london2012/21677.aspx
• World Anti-Doping Agency Prohibited List of Substances and Methods in sport
http://list.wada-ama.org
• Global Dro online resource for checking prohibited and restricted drugs in sport
www.globaldro.com
• UK Anti-Doping anti-doping advice card for competing athletes:
www.ukad.org.uk/resources/document/advice-card
• NHS Choices
www.nhs.uk/Pages/HomePage.aspx
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Emergency Contraception
Background
Women presenting in the pharmacy requesting emergency contraception (EC) may not
be aware of all the options available to them. The information below is designed to aid
pharmacists in advising women on which method of EC is best for them.
Women presenting in the pharmacy requiring EC should be made aware of all the options
available to them and assessed for the most suitable form of EC based upon risk factors
such as the timing of unprotected sexual intercourse within the cycle. The Faculty of Sexual
and Reproductive Healthcare (FSRH) consider a copper intrauterine device (Cu-IUD) to be the
preferred method and pharmacists should consider the FSRH guidance in their counselling.
FSRH general principles of emergency contraception:
• Women requiring EC should ideally be provided with a (Cu-IUD) at the first presentation
Where this is not possible, oral emergency hormonal contraception (EHC) can be offered
in the meantime and the woman signposted to appropriate services where a device can
be inserted
• If oral EHC is used, women should be advised about the potential for disturbances to
occur to their menstrual cycle. If there is concern, a pregnancy test should be performed
three weeks or later after unprotected sexual intercourse occurred
• Women receiving EC should be offered the opportunity to undergo testing for sexually
transmitted infections and offered advice on ongoing contraception
• If the pharmacist is unable to supply a suitable method of EC, patients should be referred
to an appropriate service.
Supply EHC in Pharmacy
When deciding on the appropriateness of EHC for patients, pharmacists should consider the
following points:
• The timing of unprotected sexual intercourse within the current cycle.
• The most likely date of ovulation based on the date of the last menstrual cycle and the
usual cycle length
• What contraception the patient usually uses and why they are at risk of pregnancy, for
example, the number of missed pills or failure of barrier method
• Use of other medicines that may affect contraceptive efficacy
• The length of time between unprotected sexual intercourse and presenting for EHC.
Those women who are nearer in their cycle to ovulation will be at a higher risk of
pregnancy, as will those who present later for levonorgestrel after having unprotected sexual
intercourse (the efficacy of levonorgestrel decreases over time). The FSRH states that the
most effective form of EC is the Cu-IUD. For those patients at higher risk a Cu-IUD may be
the most appropriate form of EC, but levonorgestrel could be given in the interim and the
patient signposted to a relevant service. The different methods of EHC are outlined overleaf,
along with the main counselling points.
Levonorgestrel
Levonorgestrel is available on prescription (Levonelle 1500) or as a pharmacy medicine
(Levonelle One Step). Pharmacists selling levonorgestrel should counsel patients to
decide on the appropriate use of levonorgestrel as EC. Pharmacists should advise that
oral levonorgestrel does not provide contraceptive cover for subsequent unprotected
sexual intercourse occurrences. Pharmacists should also signpost women attending for
levonorgestrel to services where they can receive testing for sexually transmitted infections.

Women who are considered to be more at risk of pregnancy, as detailed previously, should
be advised that the Cu-IUD is the preferred method in this situation. Although it is possible
to supply levonorgestrel, women should be advised that the Cu-IUD is more effective and
referred to a service where one can be inserted.
For women who have taken levonorgestrel and are continuing to use a hormonal method of
contraception, they should be advised to use additional contraceptive methods for:
• Most hormonal contraception–7 days
• Progestrogen-only pill–2 days
• Qlaira–9 days.
If a woman who has taken levonorgestrel vomits within two hours of taking it, they should
be offered a repeat dose or be referred for a Cu-IUD, the FSRH recommends.
The summaries of product characteristics for levonorgestrel products state that if patients
vomit within three hours, additional EC should be used. Levonorgestrel can be taken more
than once in a cycle, according to the FSRH. The summary of product characteristics for
levonorgestrel products state that repeated administration is not advisable because it may
disrupt the menstrual cycle.
Ulipristal acetate
Ulipristal acetate (EllaOne) is available as a prescription-only medicine. Pharmacists should
consider the following points when dispensing the product. Women continuing to use a
hormonal contraceptive method should be advised to use additional contraception for the
following:
• Most hormonal contraception–14 days
• Progestrogen-only pill–9 days
• Qlaira–16 days.
Women who vomit within three hours of taking ulipristal should be offered a repeat dose
or a Cu-IUD. Ulipristal should not be used more than once per cycle. Ulipristal should not
be taken by women taking drugs that induce liver enzymes, or within 28 days of stopping
these medicines. Women should not use ulipristal if they are using drugs that increase
gastric pH (e.g. antacids, histamine H2 antagonists, proton pump inhibitors).
Copper intrauterine device
The Cu-IUD is a T-shaped device made out of plastic and copper (also known as the coil or
loop). The device is inserted inside the uterus. It can be inserted up to 120 hours after the
first episode of unprotected sexual intercourse, or up to five days after the earliest expected
date of ovulation. The device works by releasing copper, which is toxic to ovum and sperm.
It works in both the pre- and post-fertilisation stages. It is at least 98 per cent effective
at preventing pregnancy. Factors such as age, not having given birth, previous ectopic
pregnancy and risk of a sexually transmitted disease are not contraindications to use.
Practical guidance
• Pharmacies should be aware of all the local services available so that women can be
signposted accordingly. These include the local GP surgeries, sexual health clinics, A&E
departments and clinics for sexually transmitted diseases
• Women requesting a supply of EHC should be advised of all the methods available to
them both as EC and as future contraception
• A supply of EHC can be made providing that the patient fulfils the criteria of supply.
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Advance supply
Advance supply of levonorgestrel to patients by pharmacists can be considered.
However, there is no evidence to support this as a routine provision.
Special Considerations
Enzyme-inducing drugs
For women taking enzyme-inducing drugs (or within 28 days of stopping such drugs) a
Cu-IUD should be offered initially. For women who are not suitable for a Cu-IUD or decline
this method, two levonorgestrel 1.5mg tablets should be taken within 120 hours of
unprotected sexual intercourse (the efficacy after 96 hours is unknown), the FSRH advises.
This would fall outside of the product licence and pharmacists should refer patients to an
appropriate service so that it can be prescribed.
Obesity
All doses of EC can be used in obese women. An increase in the dose of oral EHC is not
recommended.
Working with young people
Young people (under the age of 16) are entitled to access EHC (as they are other GU/FP
services) and have their confidentiality protected. To assess a person under the age of 16,
pharmacists should use the Fraser Guidelines to assess the young person is competent to
consent to the treatment. Further information on this can be found on:
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/
Pressreleases/DH_4086804
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/
digitalasset/dh_4086914.pdf
Girls under the age of 13 (with their consent) should be referred to appropriate services
following child protection guidelines.
Further resources and training
• England and Wales: training on contraception and emergency contraception can be
accessed via the Centre for CPPE and Welsh CPPE
• Northern Ireland: training on emergency contraception and sexual health can be accessed
via the NI Centre for Pharmacy Learning and Development
• Scotland: training on sexual health and hormonal contraception can be accessed via NHS
Education for Scotland
• Clinical guidance from the Faculty of Sexual and Reproductive Healthcare (FSRH).
• Local training, including child protection training
• NPA Information Department Telephone: 01727 891800 / 0844 736 4201
or email: information@npa.co.uk.
References
• Emergency contraception guidance, Faculty of Sexual and Reproductive Healthcare,
August 2011 (updated January 2012)
• HS Choices, Intrauterine device (accessed 13/03/2012)
www.nhs.uk/conditions/Intrauterine-device-(IUD)/Pages/Introduction.aspx

EEA and Swiss Prescriptions Legal Requirements
UK legislation allows prescriptions written by a doctor or a dentist from another EEA
country or Switzerland to be dispensed by pharmacies in the United Kingdom. In addition,
pharmacists can, where appropriate, make emergency supplies.
Prescription requirements
To be legally valid, the minimum standards that an EEA/Swiss prescription needs to
comply with are:
• The prescription must be written by a doctor or dentist registered in an EEA state
(excluding the UK) or Switzerland and the prescriber must be practising in the relevant
EEA state or Switzerland
• The prescription must be signed in ink with the name of the prescribing EEA/Swiss doctor
or dentist
• The rest of the prescription must be written in ink or otherwise indelible and include:
- The address of the EEA/Swiss doctor or dentist
- The date the prescription was signed by the EEA/Swiss doctor or dentist
- The qualification(s) of the EEA/Swiss doctor or dentist
- The name of the patient
- The prescription is valid for 6 months from the date on which it was signed by
the practitioner (unless for a Schedule 4 CD, which is valid for 28 days).
Additional validity considerations
EEA and Swiss prescriptions do not need to state the address of the patient, or the age
of the patient if the patient is under 12 years old. The missing particulars can be obtained
from the patient’s ID card or passport if needed. UK prescriptions still legally need this
information.
The legislation only allows the prescribing of medicinal products that have a valid marketing
authorisation in the UK. Therefore, EEA/Swiss prescriptions for any foreign products cannot
be legally dispensed in the UK. Pharmacists cannot substitute with a UK product.
EEA/Swiss doctors and dentists CANNOT write a prescription whilst in the UK for any of
their patients or themselves.
Controlled Drugs
Schedule 4 and 5 CD prescriptions from an EEA/Swiss doctor or dentist can be dispensed in
the UK. Additionally, pharmacists can make an emergency supply where appropriate (see
emergency supply requirement) for these schedules. EEA/Swiss prescriptions for Schedule 2
and 3 CDs CANNOT be dispensed in the UK.
Prescriptions for Schedule 4 CDs are valid only for 28 days from the appropriate date.
Emergency supplies
Supplies can be made following either a request from the EEA/Swiss doctor or dentist, or at
the request of a patient who is under the care of an EEA/Swiss doctor or dentist.
Pharmacists should follow the normal procedure for making an emergency supply.
Pharmacists can make an emergency supply of a Schedule 4 or 5 CD at the request of an
EEA/Swiss doctor or dentist or the patient.
Emergency supplies for Schedule 1, 2 or 3 CDs (including phenobarbitone for epilepsy) are
NOT allowed at the request of the EEA/Swiss doctor or dentist or at the request of a patient.
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Repeat prescriptions
Repeat prescriptions are allowed under similar circumstances to UK prescriptions.
The following conditions must be met:
The first dispensing of a prescription-only medicine should be made within six months of the
date on which it was signed or within 28 days for a Schedule 4 CD.
Any dispensing instructions of the prescribing EEA/Swiss doctor or dentist should
be followed.
If the number of repeats is not specified, the prescription can only be repeated once
(dispensed twice in total). The only exception is when oral contraceptives have been ordered
on a repeatable prescription in which case it can be dispensed a total of six times (five
repeats) before the end of the period of six months from the appropriate date.
Record keeping
Dispensed EEA/Swiss prescriptions need to be recorded in the prescription-only medicine
register in the same way as private prescriptions issued by UK-registered prescribers.
Any emergency supplies made to EEA/Swiss patients should also to be recorded in the
same manner to existing requirements.
It is good practice to document any appropriate checks that have been carried out to
determine the authenticity of prescribers and/or actual prescriptions.
Wholesale dealing
EEA/Swiss doctors and dentists CANNOT request medicinal products by way of wholesale
from a UK registered pharmacy.
Charging for services
EEA/Swiss prescriptions are private prescriptions. The charges levied to the patient are a
matter for individual pharmacists and may incorporate extra expenses incurred, such as
telephone calls.
Information about Foreign Prescribers
Doctors
The GMC has a document on its website (see link below) that contains the contact details
of the equivalent competent authorities within the relevant EEA member state. The GMC
can also be contacted directly on 0161 9236602.
www.gmc-uk.org/doctors/registration_applications/evidence_of_qualifications.asp
Dentists
The GDC has a similar feature on its website (see link below) that also details the contact
information of the equivalent competent authority within the relevant EEA member state.
Alternatively the GDC can also be contacted directly on 0845 2224141.
www.gdc-uk.org/dentalprofessionals/applyforregistration/documents/
list of eea competent authorities.pdf

EEA and Swiss Prescriptions Practical Advice
The following factors should also be considered before deciding whether or not to
dispense the prescription:
Is the prescriber registered with the GMC and GDC in the UK?
If this is the case it will mean that they will automatically be considered to be an appropriate
prescriber authorised to write prescriptions in the UK. A GMC-registered doctor with a
licence to practise, or GDC-registered dentist can have a registered practice outside of the
UK or EEA and still be considered an appropriate prescriber. They may not prescribe any
Schedule 2 or 3 CDs privately unless their practice address is based within the UK and they
use the standardised CD private prescription form.
Is the country from which the prescription originates part of the EEA or Switzerland
(see overleaf)?
If the prescriber is not registered and practising in the EEA member country or Switzerland,
or registered with the GMC/GDC then the prescription is not valid.
Is the prescriber registered in the EEA country or Switzerland?
The GMC/GDC equivalent regulatory body in the relevant EEA country or Switzerland can
be contacted to confirm registration status. Not all member states of the EEA have formal
registration systems for prescribers as in the UK so it may be difficult for you to check
whether the prescriber is a registered healthcare professional.
Is the prescription written in English and is the name of the medicine
easily identifiable?
The Medicines and Healthcare Products Regulatory Agency (MHRA) has confirmed that
there is no legal requirement for the prescription to be written in English. A prescription
written in any other language could be accepted provided it complies with the legal
requirements stated above.
The NPA advises that pharmacists should only dispense a prescription written in a foreign
language if they are fully competent in that language and can fully understand the contents
of the prescription. Pharmacists are not expected to have the prescription translated into
English. If the pharmacist cannot understand the language it may be difficult to interpret
the prescriber’s intentions and dispense the prescription legally and safely.
It cannot be guaranteed that support staff, or even the patient, can accurately interpret the
prescription either.
Is the medicine which is prescribed licensed in the UK?
The legislation allows EEA and Swiss prescribers to legally prescribe medicinal products
which have a valid marketing authorisation in the UK.
Is the prescription for a branded European product?
Substitution is not allowed, so unless the specific branded European or
Swiss product also holds a valid market authorisation in the UK it is
NOT possible to supply the foreign unlicensed product or its generic
equivalent against that prescription.
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Could the prescription be fraudulent?
Consider the item prescribed and whether it is an item that could be misused or abused.
Is there anything suspicious about the patient/representative presenting or the prescription
itself? Is the quantity prescribed reasonable? Is it possible to verify that the patient has
received the prescribed item previously, for example, does the patient have an empty
container or medication record card?
Is the prescriber contactable?
The prescriber may need to be contacted to verify the prescription or to check details on
the prescription. If so, are there any prescriber contact details on the prescription? Dialling
codes for other countries are detailed below. If the prescriber cannot be contacted to check
the necessary information, the pharmacist will need to decide whether it is appropriate to
dispense the prescription.
What will happen if the prescription is not dispensed?
The legislation does not oblige a pharmacist to dispense an EEA or Swiss prescription.
Pharmacists should consider the patient’s best interests and the consequences if it is not
dispensed. Patients may need to be referred to other services.
Is the prescription written by an EEA/Swiss veterinarian?
Legislation permitting veterinary prescriptions written by EEA/Swiss veterinarians to be
dispensed in the UK is currently under consultation and is expected to be finalised soon.
Currently the dispensing of an EEA/Swiss veterinary prescription is not permitted.
Professional discretion
It remains the pharmacist’s professional decision whether or not to dispense an EEA or Swiss
prescription. The pharmacist will need to take all reasonable steps possible to ensure that
dispensing is in accordance with the prescriber’s intentions and that the patient will be able
to use the dispensed item(s) safely and appropriately.
A pharmacist may refuse to dispense the prescription if it cannot be confirmed that the
prescription is genuine, legally valid, or clinically appropriate. It would be good practice to
record reasons for refusing to dispense such a prescription via the PMR record, intervention
book or the prescription-only medicine register.
EEA member countries and their international dialling codes:
Austria +43 Hungary +36 Poland +48
Belgium +32 Iceland +354 Portugal +351
Bulgaria +359 Ireland +353 Romania +40
Cyprus +357 Italy +39 Slovakia +421
Czech Rep +420 Latvia +371 Slovenia +386
Denmark +45 Lichtenstein +423 Spain +34
Estonia +372 Lithuania +370 Sweden +46
Finland +358 Luxembourg +352 Switzerland +41
France +33 Malta +356 Other
Germany +49 Netherlands +31
Greece +30 Norway +47

Emergency Supplies
At request of a prescriber
The pharmacist supplying the prescription-only medicine (POM) must be satisfied
that:
• The sale or supply has been requested by an appropriate prescriber, who by reason of an
emergency is unable to furnish a prescription immediately
• That the prescriber has undertaken to furnish a prescription to the pharmacy within 72
hours of the sale or supply
• That the POM is sold or supplied in accordance with the prescriber requesting it
• That the POM is not a Schedule 1, 2 or 3 CD
• An entry will be made in the prescription-only medicine register on the day of the sale or
supply or on the following day.
Record keeping requirements
The pharmacy staff should record in the prescription-only medicine register:
• the date on which the POM was sold or supplied
• the name, quantity and, except where it is apparent from the name, the pharmaceutical
form and strength of the POM sold or supplied
• the name and address of the prescriber who will be providing the prescription
• the name and address of the person for whom the emergency supply is for
• the date on the prescription
• the date on which the prescription was received
• the nature of the emergency.
At request of a patient
Emergency supplies at the request of a patient may be considered if:
• The pharmacist who is selling or supplying the POM has interviewed the person requesting
the POM and is satisfied that:
- there is an immediate need for the POM and that it is impracticable to obtain a
prescription without undue delay
- the POM has previously been prescribed by an appropriate prescriber for the
person requiring it
- the dose is appropriate for the person taking it.
• the quantity supplied is no greater than enough to provide 30 days treatment,
except where the medicine is:
- a permitted controlled drug*, where the maximum that can be supplied is five
days treatment
- a preparation of insulin, an aerosol for the relief of asthma, an ointment or a
cream, which has been made up for sale in a container elsewhere other than
at the place of sale or supply, where the smallest pack that is available to the
pharmacist for sale or supply may be sold or supplied
- an oral contraceptive, where a sufficient quantity for a full cycle of treatment
may be sold or supplied
- an antibiotic for oral administration in liquid form, where the smallest quantity
that will provide a full course of treatment may be sold or supplied
- an entry is to be made in the prescription-only register on the day of the sale or
supply or on the following day
- that the drug is not a Schedule 1, 2 or 3 CD.
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Labelling requirements
The POM must be labelled to show:
• The date on which the POM is sold or supplied
• The name, quantity and, except where it is apparent from the name, the pharmaceutical
form and strength of the POM
• The name of the person requiring the POM
• The name and address of the pharmacy from which the POM is being sold or supplied
• The words “Emergency Supply”.
Pandemic
In the case of a pandemic situation being imminent or declared, the pharmacist need
only be satisfied that the person has been prescribed (but not by a dentist or EEA/Swiss
prescriber) the POM before and that the dose is appropriate.
Eligibility
*Phenobarbitone or phenobarbitone sodium can be sold or supplied for the treatment
of epilepsy (except for EEA/Swiss patients, see below). Other Schedule 1, 2 or 3 CDs are
not allowed. Emergency supplies of Schedule 4 and 5 CDs are permitted. The maximum
quantity of a CD permitted to be supplied is five days worth of treatment. For EEA and
Swiss patients, see below.
The following may not be supplied to patients requesting an emergency supply: ammonium
bromide, calcium bromide, calcium bromidolactobionate, embutramide, fencamfamin
hydrochloride, fluanisone, hexobarbitone, hexobarbitone sodium, hydrobromic acid,
meclofenoxate hydrochloride, methohexitone sodium, pemoline, piracetam, potassium
bromide, prolintane hydrochloride, sodium bromide, strychnine hydrochloride, tacrine
hydrochloride, thiopentone sodium.
EEA and Swiss patients
Supplies can be made at the request of the EEA or Swiss doctor or dentist, or at the request
of a patient treated by them.
Emergency supplies are not allowed for Schedule 1, 2 or 3 CDs (including phenobarbitone
for epilepsy). Supplies of Schedule 4 and 5 CDs are permitted for five days treatment.
Definitions
Appropriate prescriber
An appropriate prescriber can be a: doctor, dentist, supplementary prescriber, a community
practitioner nurse prescriber, nurse independent prescriber, optometrist independent
prescriber, pharmacist independent prescriber, EEA or Swiss doctor or dentist.

Drugs in Sport
This section is for information purposes only
The use of drugs by athletes can raise many ethical issues. Sports men and women may
require drugs for genuine medical reasons; however, many drugs can enhance performance
in sporting events and their use, intentional or otherwise, can result ultimately in a lifetime
ban from competitive sport. Even the use of permitted drugs may pose problems due to
unwanted side-effects.
The World Anti-Doping Agency (WADA) sets the international standards for doping control
through the World Anti-Doping Code and the Prohibited List of Substances and Methods.
A table outlining the current (2012) WADA Prohibited Lists are shown below.
WADA Prohibited List – January 2012
I Substances and Methods Prohibited at all Times (In- and Out-of-Competition)
S.0 Non-Approved Substances M.1 Enhancement of Oxygen Transfer
S.1 Anabolic Agents M.2 Chemical & Physical Manipulation
S.2 Peptide Hormones, Growth Factors M.3 Gene Doping and related substances
S.3 Beta-2 Agonists
S.4 Hormone and Metabolic Modulators
S.5 Diuretics and other Masking Agents
II Substances and Methods Prohibited In-Competition
All the categories under Section I, plus:
S.6 Stimulants
S.7 Narcotics
S.8 Cannabinoids
S.9 Glucocorticosteroids
III Substances Prohibited in Particular Sports
P.1 Alcohol
P.2 Beta Blockers
The regulations regarding these prohibited drugs are detailed and complex.
Further information can be found on the WADA website: http://list.wada-ama.org/.
UK Anti-doping (UKAD) is the National Anti-Doping Organisation (NADO) for the United
Kingdom. UKAD has produced, in collaboration with other NADOs, a useful resource called
Global Dro. This online information resource allows athletes and other persons, including
healthcare professionals, to check whether a medicine contains a drug(s) which is on the
WADA Prohibited List.
The website is simple to use and can be accessed through www.globaldro.com
Athletes competing in London 2012 Olympic and Paralympic Games will be expected to
obtain all their medical supplies through the Games Polyclinic Pharmacies in the Athlete
Villages. Pharmacists working outside the Games venues, who are asked to advise on
the use of prescribed or over-the-counter (OTC) medicines for competing athletes at the
Olympic and Paralympic Games should refer the athlete to their team doctor or to the
Games’ on-site pharmacies.
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Identifying UK Equivalents of Foreign Medicines
Identification of UK equivalents of foreign branded medicines can be a challenging process.
Language barriers, bad handwriting, lack of information, and the same names being used
in different countries for different products, are all areas that can cause problems for
pharmacists trying to advise customers about UK equivalent products.
This information below highlights the common pitfalls that can result in incorrect products
being identified as equivalents with the aim of reducing the risk of inappropriate products
being suggested (thereby reducing the risk of potential for patient harm).
Before trying to identify the ingredients in a foreign branded medicine, pharmacists should
gather as much information as possible from the patient or their representative:
Which country was the drug originally prescribed or supplied in?
This is essential information as the same brand names are sometimes used in different
countries for products containing very different ingredients.
Which strength was being used?
This is a useful parameter in ensuring the correct drug is identified.
What is the medicine being used for?
The indication of the drug acts as a double-check in identifying the drug. It is also helpful
to see if the patient/representative has an old packet or blister strip of the medicine to aid
identification. If no prescription or original pack is available, the patient can be asked to
write down how the product is spelt to help ensure accuracy.
Where can information be found about the ingredients of foreign branded
medicines?
Information about foreign brands, including their ingredients, can be obtained from the
following sources:
• NPA Information Department telephone service: available Monday-Friday 9- pm,
Saturday 9-1pm. Email: information@npa.co.uk
• NPA Information Services Database (IRIS): available to NPA members 24/7at www.npa.co.uk
• Martindale: The Complete Drug Reference. Martindale does not state the strength of the
preparation.
How can the ingredients of foreign brands of oral contraceptives be identified?
An online database is maintained by the International Planned Parenthood Federation –
available online at: http://contraceptive.ippf.org/(zqfgvqr4rqjun045xdpebp45)/introduction.
aspx (registration required).
Are there any country specific websites available listing the licensed products for
that country?
The following country-based websites may be useful when trying to identify foreign
branded medicines, especially during times when the NPA Information Department is closed.

Are there any country specific websites available listing the licensed products for
that country?
The following country-based websites may be useful when trying to identify foreign
branded medicines, especially during times when the NPA Information Department is closed.
Australia: Australian Government-Department of Health and Ageing
www.pbs.gov.au/browse/medicine-listing
Belgium: EudraPharm
http://eudrapharm.eu/eudrapharm/
Canada: Health Canada
www.hc-sc.gc.ca/dhp-mps/prodpharma/databasdon/index-eng.php
Czech Republic: EudraPharm
http://eudrapharm.eu/eudrapharm/
Denmark: EudraPharm
http://eudrapharm.eu/eudrapharm/
Estonia: EudraPharm
http://eudrapharm.eu/eudrapharm/
State Agency of Medicines
http://193.40.10.165/register/register.php?keel=eng
European medicines
EudraPharm http://eudrapharm.eu/eudrapharm/
Finland: EudraPharm
http://eudrapharm.eu/eudrapharm/
France: EudraPharm
http://eudrapharm.eu/eudrapharm/
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Greece: EudraPharm
http://eudrapharm.eu/eudrapharm/
Hong Kong: Department of Health
www.drugoffice.gov.hk/eps/root/en/consumer/search_drug_database.html
Hungary: EudraPharm
http://eudrapharm.eu/eudrapharm/
Iceland: EudraPharm
http://eudrapharm.eu/eudrapharm/
India: MedGuideIndia
www.medguideindia.com/
Ireland: Irish Pharmaceutical Healthcare Association Ltd -
Medicines Information Online
http://www.medicines.ie/
Italy: EudraPharm
http://eudrapharm.eu/eudrapharm/
Japan: Japan Pharmaceutical Reference
www.e-search.ne.jp/~jpr/jpr_db/eindex.html
Latvia: EudraPharm
http://eudrapharm.eu/eudrapharm/
State Agency of Medicines
www.vza.gov.lv/index.php?id=375&sa=375&top=334

Lithuania: EudraPharm
http://eudrapharm.eu/eudrapharm/
State Medicines Control Agency
http://extranet.vvkt.lt/paieska/index.php
Malta: EudraPharm
http://eudrapharm.eu/eudrapharm/
Netherlands: EudraPharm
http://eudrapharm.eu/eudrapharm/
Medicines Data Bank
www.cbg-meb.nl/CBG/en/human-medicines/
geneesmiddeleninformatiebank/default.htm
New Zealand: Pharmaceutical Management Agency
www.pharmac.govt.nz/Schedule
Norway: EudraPharm
http://eudrapharm.eu/eudrapharm/
Poland: EudraPharm
http://eudrapharm.eu/eudrapharm/
Pakistan: PakMediNet
www.pakmedinet.com/
Portugal: EudraPharm
http://eudrapharm.eu/eudrapharm/
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Romania: EudraPharm
http://eudrapharm.eu/eudrapharm/
Slovakia: EudraPharm
http://eudrapharm.eu/eudrapharm/
South Africa: South African Electronic Package Inserts
http://home.intekom.com/pharm/
Spain: EudraPharm
http://eudrapharm.eu/eudrapharm/
Sweden: EudraPharm
http://eudrapharm.eu/eudrapharm/
United States Food and Drugs Administration
of America: www.accessdata.fda.gov/scripts/cder/ob/default.cfm

CAUTION: IDENTICAL NAMES
Identical brand names can be used in different countries for products with different
ingredients. The US Food and Drug Administration (FDA) has issued guidance on medicines with
US brand names that have identical names to drugs marketed in other countries, but which
have different active ingredients. Information on those drugs, as published on the FDA website
is reproduced below. FDA website:
www.fda.gov/Drugs/DrugSafety PostmarketDrugSafetyInformationforPatientsandProviders/
DrugSafetyInformationforHeathcareProfessionals/PublicHealthAdvisories/ucm173134.htm
Extra care should be taken when asked to identify/confirm equivalents
of the drugs detailed in the following table.
Brand Name
Aldactone
Alphadine*
Antagon*
Calan
Cervidil
Cloderm
Diasorb
Dilacor
Flomax
Hexalen*
Naqua
Norpramin
Rubex
Urex
Vivelle*
U.S. Active
Ingredient
spironolactone
povidone-iodine
ganirelix
verapamil
dinoprostone
clocortolone
pivalate
activated
attapulgite
diltiazem
tamsulosin
altretamine
trichlormethiazide
desipramine
doxorubicin
methenamine
estradiol
U.S. Indication
water pill
disinfectant
fertility
heart conditions
labour induction
dry, itchy skin
diorrhoea
heart conditions
enlarged prostate
ovarian cancer
water pill
depression
cancer
urinary tract
infection
hormone
replacemement
Foreign Active
Ingredient
potassium
canrenoate
ranitidine
astemizole
ranitidine
vinpocetine
gemeprost
clotrimazole
loperamide
digoxin
verapamil
barnidipine
morniflumate
hexetidine
furosemide
omeprazole
ascorbic acid
furosemide
norgestimate,
ethinylestradiol
Foreign
Indication
water pill
*These products have different dosage forms, so that use of the wrong drug seems relatively unlikely,
although the difference in active ingredients should be noted.
For further information on identifying UK equivalents of foreign medicines or any other query please contact the
NPA Information Department on 01727 891 800/0844 736 4201 or email: information@npa.co.uk
March 2012
ulcer
allergies
ulcer
stroke symptons
labour induction
fungal skin
infections
diarrhea
heart failure
heart condition
blood pressure
anti-inflammatory
antiseptic
mouthwash
water pill
ulcer
vitamin c
deficiency
water pill
birth control
Foreign Country
Austria, Czech
Republic,
Germany,
Hungary
Greece
Mexico
Brazil
Japan
Italy
Germany
U.K.
Serbia
Brazil
Argentina
Italy
Greece
Portugal
Spain
Ireland
Australia
Austria
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First Aid for Pharmacists
What telephone number is dialled for an ambulance; has the 999 number been
replaced?
The numbers 999 or 112 can be used to call for an ambulance.
Who can be contacted for first aid advice on poisons/overdoses?
NHS healthcare professionals can contact the UK National Poisons Information Service on
0844 892 0111. The National Poisons Information Service does not accept enquiries from
the general public, who can seek help from NHS Direct on 0845 4647 or, in Scotland,
NHS 24 on 0845 242424.
Are pharmacy staff insured when providing first aid to members of the public?
NPA Insurance Professional Indemnity policy holders are covered for providing first aid to
members of the public. Other policy holders should check with their insurance provider.
Should records be kept of any first aid provided to members of the public?
The NPA recommends that pharmacies should keep a record of any first aid given to
members of the public. No specifically designed books are available but a blank note book
(available from NPA Sales) with the following headings can be used:
• Full name and address of person(s) who suffered the illness or injury
• Date, time and place of accident
• Details of the injury or illness, and what first aid treatment was given if any
• What happened to the person immediately following the incident (for example, did they
go home, to hospital, or return back to work)
• The nature of any advice given by the pharmacy staff
• The name and signature of the person who dealt with the incident
NB: This book is different to the statutory accident book which pharmacies need to retain
for accidents and first aid incidents relating to employees.
What should be included in a pharmacy first aid box?
There is no mandatory list of items that should be included in a first aid kit. Under the Health
and Safety at Work Act, it is left to employers to decide what is needed in a workplace first
aid box from information gathered during the health and safety first aid risk assessment.
First aid provision for members of the public should be accounted for as part of this process.
Guidance, including a list of minimum stock items for a low hazard environment, can be
found on the Health and Safety Executive (HSE) website:
www.hse.gov.uk/firstaid/faqs.htm#first-aid-box.
NPA Sales are able to supply a range of first aid kits.
First aid boxes should be checked regularly to ensure that all items are within their expiry
date. Any used items should be replaced as soon as possible after use.
Are there any other items that should be made available alongside the first aid
box?
Other items that stores may wish to consider keeping with the first aid box are:
• Scissors
• Adhesive tape
• At least one litre of sterile water or normal saline (0.9%) in sealed, disposable containers
for eye irrigation if mains or tap water is not readily available

• Disposable aprons
• Spillage kits, used to help clean up body fluid spills, are another useful item and should be
kept close to the first aid kit.
These are available from NPA Sales.
What medicines should be kept in the first aid box?
No medicines should be kept in the first aid box. If, for example, staff or customers request
paracetamol tablets to treat headaches, or antiseptic cream to apply to cuts and grazes, these
can be supplied as an over-the-counter sale.
Who provides first aid training courses for pharmacy staff?
• British Red Cross
offers a course aimed specifically at pharmacists and which covers the administration of
adrenaline/epinephrine autoinjectors.
www.redcross.org.uk/What-we-do/First-aid/First-aid-training
• St John Ambulance
also offer a range of first-aid training courses. www.sja.org.uk/sja/training-courses.aspx
• Details of over 1250 training providers approved by the HSE can be found on the HSE website:
www.hse.gov.uk/firstaid/first-aid-training.htm
Are there any websites that provide guidance on first aid?
NHS Choices provides guidance on first aid including information on the recovery position and
guidance on performing cardiopulmonary resuscitation (CPR).
www.nhs.uk/conditions/Accidents-and-first-aid/Pages/Introduction.aspx
Other useful websites include:
• British Red Cross www.redcross.org.uk/What-we-do/First-aid
• St John Ambulance www.sja.org.uk/sja/first-aid-advice.aspx
How is suspected anaphylaxis treated?
Potentially life-threatening anaphylaxis is probably the most critical first aid scenario a pharmacy
would be expected to deal with because the reaction can occur within minutes of exposure to
the allergen. The following advice is taken from the NHS Choices website:
• Call 999 (or 112) if anaphylaxis is suspected
• Remove any potential trigger if detected (e.g. wasp or bee sting)
• If the person is carrying an adrenaline auto-injector, help them to administer it
(or consider administering it yourself-see below)
• If the person is unconscious, place them in the recovery position.
Can pharmacy staff administer adrenaline/epinephrine, such as Epipen, to a member
of the public suffering an anaphylactic reaction?
Pharmacy staff can administer adrenaline/epinephrine in a life-saving situation provided the
casualty has in their possession an adrenaline/epinephrine injection that has been prescribed
for them. Any pharmacy staff acting in this way must work within their competency (i.e. be
able to recognise the anaphylactic reaction, know where to inject the drug, and be able to
administer the adrenaline/epinephrine using an auto-injector). A training course aimed at
pharmacists and covering the administration of adrenaline/epinephrine using an auto-injector is
run by the British Red Cross (see above for further information).
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Are pharmacy staff insured to administer a patient’s own adrenaline/epinephrine
to them in a life-saving situation?
NPA Insurance regards the administration of adrenaline in an emergency as first aid and
provided pharmacists are competent to administer adrenaline injections they will be covered
under NPA Insurance Professional Indemnity policies. Other policy holders should check
with their insurance provider.
Where can I find further information on first aid?
First aid at work
• Health and Safety at Work Act 1974
www.hse.gov.uk/legislation/hswa.htm
• Health and Safety Executive
www.hse.gov.uk/firstaid/index.htm
First-aid advice
• NHS Choices
www.nhs.uk/conditions/accidents-and-first-aid/pages/introduction.aspx
• British Red Cross
www.redcross.org.uk/What-we-do/First-aid
• St.John Ambulance
www.sja.org.uk/sja/first-aid-advice.aspx
• NPA Information Department
01727 891 800
Health Promotion and signposting
Pharmacists have a key role to play in promoting good health and directing people to
services during the Games. To help you with this, NHS London have produced leaflets,
posters and a central web hub on NHS Choices www.nhs.uk/london2012. Included
within this pack are leaflets and posters to enable the communication of key health
signposting and staying healthy messages at Games time. Pharmacists can also support
their customers to access health services appropriately using the ‘find a health service’
tool which can be embedded on your website, the tool can be found on http://www.npa.
co.uk/askyourpharmacist.Please ensure you and your staff are aware of the nearest walk-in,
urgent care and sexual health service to you so that you can signpost effectively if required.
You may also wish to use the Games as an opportunity to promote ‘Summer essentials’ that
will help to support a safe and healthy games:
• Over the counter remedies such as paracetemol, ibuprofen, hang over cures, plasters,
Diarrhoea and vomiting remedies, Antihistamine
• Foot care
• Anti-bacterial hand gels
• Suncream minimum 15 SPF (in particular those in 100ml containers due to liquid
restrictions in the Olympic and Paralympic venues and some live sites)
• Condoms

Information Team
Open Monday-Friday 9am to 6pm
Open Saturday 9am to 1pm
Our Information Department is
available for members to contact via
information@npa.co.uk
or by calling
01727 891 800
and more information is available
online at www.npa.co.uk.

National Pharmacy Association
Information Department
38-42 St Peter’s Street, St Albans, Herts AL1 3NP
Tel: 01727 891 800 or 0844 736 4201
E: information@npa.co.uk
www.npa.co.uk
Printing and production of this booklet has been funded by Reckitt Benckiser.
Reckitt Benckiser had no editorial control over the content of the booklet.