Posted on Monday January 18 2016 by RIG Healthcare
Part 1) Comparing commonly used medications and scheduling of medicines
Hello everyone, or perhaps I should say G’day. One of my long term dreams was always to leave the land down under and live in the UK for a time. I wanted to experience life, work as an aussie pharmacist in the UK and culture in a different country, and to travel as much as possible. So with a lot of planning and a little luck, I found myself in England on a two-year ‘working holiday’ VISA. Although I’m a registered Pharmacist in Australia, I was well aware this registration is not recognised here in the UK. So, not wishing to spend all two years of my VISA re-training to be a Pharmacist, I chose to pursue work as a locum Pharmacy Dispensing Assistant. I was lucky enough to secure a locum pharmacy position in an NHS hospital in England, and have been happily working there for several months.
Naturally, many people ask if I’m bored working as a locum Dispensing Assistant, but this has never been an issue for me. Truthfully, I find it fascinating just comparing the practice of Pharmacy in England with Australia, and almost every day I come across an interesting similarity or difference to reflect on. So over the course of three blogs, I’d like to share these observations and comparisons with you.
My first thought, and often the first question asked by interested colleagues is: “Does Australia use mostly the same medicines?” From my first day, I was eagerly scanning the dispensary shelves looking for familiar names vs new ones; and so far I’ve observed that many commonly used medications and treatment strategies are the same or very similar. After only a short time dispensing, I was feeling right at home issuing paracetamol, enoxaparin, docusate and senna, the sorts of items commonly prescribed in my previous hospital workplaces in Australia.
While many frequently used medicines are exactly the same, I often observe that a different medicine from the same class is favoured in each country. This seems to be supported by dispensing data from the English National Health Service (NHS) and Australian Pharmaceutical Benefits Scheme (PBS). For example, esomeprazole and pantoprazole appear among the top-10 PBS drugs dispensed in Australia; while omeprazole and lansoprazole are in the top-10 drugs dispensed in England. Similarly, perindopril is a top-10 drug in Australia whereas ramipril is in the top-10 for England. Sometimes, I’ve found that England’s chosen medicine in a class isn’t even registered in Australia; for example bendroflumethiazide (Australian prescribers tend to use hydrochlorothiazide, or indapamide). But on the whole, it is very easy to quickly learn these medications once the class is known.
I have only encountered a small number of medications where both the name and class are totally unknown to me. The most common example is nefopam, a non-opioid analgesic which is not registered in Australia. Overall, however, I think Australian Pharmacy professionals could very easily apply their knowledge of medicines to English practice, and vice versa.
Understanding English medication scheduling, on the other hand, has been a big challenge, and I’m still quite ignorant in that area. My general impression is that England has a broader range of schedules with more subtle differences between them, especially for ‘controlled drugs’ (CDs). Some CDs seem to require secure storage, but don’t have prescription requirements for the quantity in words and figures (e.g. morphine syrup). Some have prescription requirements, but don’t require storage in the safe (e.g. tramadol). For me, the Australian medication scheduling system feels a bit more straightforward (except for very rare exceptions when a medication can be in two classes depending on dose … that’s still a bit confusing). However the vast majority of ‘scheduled’ medicines in Australia fall into four clear categories (Pharmacy only, Pharmacist only, Prescription only and Controlled drugs) and the requirements for each are quite distinct.
So, although not working as a locum Pharmacist in the UK, I still enjoy seeing an in-depth view of English Pharmacy practice. I think it helps my work that many medications and schedules are already familiar, but I also enjoy the challenge of learning about the new ones. I would definitely recommend this experience to any other interested Australian Pharmacy professionals.
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Read more in this series of blogs - An Aussie Pharmacist in the UK