Legislation: HMR Flashcards
WHO PROVIDES NHS HEALTHCARE AND HOW IS IT FUNDED?
Funded by the government
Funded by taxation (and is therefore available to all)
WHO PROVIDES PRIVATE HEALTHCARE AND HOW IS IT FUNDED? WHO IS IT AVAILABLE TO?
Provided by private businesses and individual practitioners
Funded by the patient-insurance
Available to all that will pay
EXAMPLES OF PRIMARY CARE.
EXAMPLES OF SECONDARY CARE.
EXAMPLES OF TERTIARY CARE.
GP
Dentist
Community Pharmacists
Optometrists
Hospitals
Specialities; e.g neurosurgery, transplant
THE NATIONAL HEALTH SERVICE (5TH JULY 1948)
- The NHS Act established a ‘comprehensive health service to secure the improvement in the physical and mental health of the people . . . and the prevention, diagnosis and treatment of illness’.
- Aim to provide healthcare based on need, not the ability to _.
- Originally free at the point of delivery.
- Now charges for some services including _.
- The NHS Act 1977 repealed the whole of the 1946 Act.
Pay
Prescriptions
MEDICINES RELATED ACTS
- Arsenic Act 1851
- Pharmacy Act 1868 – poisons list.
- Poisons and Pharmacy Act 1908
- Therapeutic Substances Act 1925 (Manufacture)
- Pharmacy and Poisons Act 1933
- Pharmacy and Medicines Act 1941 (composition)
- Penicillin Act 1947
- Therapeutic Substances (prevention of misuses) Act 1953. (manufacture and supply)
1925 THERAPEUTIC SUBSTANCES ACT
- Medicinal products (MP) were increasingly coming from a chemical origin rather than a plant source
- Anti-syphyllis drug Salversan contained 606 toxic _.
- Therapeutic Substances Act (TSA) provided a form of licensing which included:
- Inspection of manufacturing sites
- Personnel suitability
- Record keeping
- Labelling requirements introduced
Impurities
1961- THALIDOMIDE
- Marketed as a safe _ tablet and antiemetic.
- Prescribed for morning sickness in _.
- Increased incidence of babies born with phocomelia (hands & feet attached directly to the body, or reduced limbs)
- Drug withdrawn from the market
Sleeping
Pregnancy
COMMITTEE ON SAFETY OF DRUGS
- _ agreement by the Ministers of Health to look at the safety of new drugs.
- The Committee on Safety of Drugs consisted of: scientists, physicians, toxicologist, statistician and pharmacists checking for “reasonable safety of a drug’s intended purpose”.
Products already on the market were granted a provisional Licence of Right.
Voluntary
MEDICINES ACT 1968
Regulated:
- Manufacture
- Distribution
- Importation (limited control on medicines for _)
- Did so by licence and enforced by MHRA (Medicines and Healthcare products Regulatory Agency).
- Advised by Medicines Commission
HOWEVER, much of this 1968 act has now been revoked.
Exports
THE HUMAN MEDICINES REGULATIONS 2012
- Regulates
- Manufacture
- Distribution
- Importation
- Sale and supply
- Labelling and advertising
- Pharmacovigilance
Does so by licence
Licensing authority is either or both of the ministers [Secretary of State and the Minister of Health, Social Services and Public Safety].
———–> MHRA
ALSO DEALS WITH:
- Supply of Medicines to the public
- Labelling and Containers
- Sales promotion (advertising)
- Preparation of BP & other books of standards
Enforcement lies with:
Secretary of State
General Pharmaceutical Council (GPhC)
“Drugs authority” – Local Council
[Registration of Retail Pharmacies still lies with the Medicines Act 1968]
WHAT ARE THE THREE MAIN AIMS OF HMR?
Quality
Safety
Efficacy
(of medicinal products)
WHAT IS A LICENSING AUTHORITY?
Either or both of the ministers [Secretary of State and the Minister of Health, Social Services and Public Safety].
WHAT IS ADVERTISEMENT IN RELATION TO A MEDICINAL PRODUCT?
Includes anything designed to promote the prescribing supply, sale or use of that product.
WHAT DO SPECIAL PROVISIONS FOR PHARMACIES DO?
Exempts the need for manufacturing licence when extemporaneous dispensing.
CLASSIFICATION OF MEDICINAL PRODUCTS
- GSL (medicinal product covered by authorisation that states it should be available on general sale).
- POM (medicinal product covered by authorisation that states it should be available only on _).
- P (medicinal product that is not a prescription only medicinal product or a medicinal product on general sale- covered by authorisation that states it is to be available only from a _).
Prescription
Pharmacy
WHAT IS THE DEFINITION OF A MEDICINAL PRODUCT (MP)?
- Any substance or combination of substances presented as having properties of preventing or treating disease in human beings, or
- Any substance or combination of substances that may be used by or administered to human beings with a view to:-
- Restoring, correcting or modifying a physiological function by exerting a pharmacological, immunological or metabolic action, or
- Making a medical diagnosis.
MEDICINAL PURPOSE; WHAT DOES IT MEAN?
Medicinal Purpose means any one or more of the following
(a) treating or _ disease
(b) diagnosing disease or ascertaining the existence, degree or extent of a physiological condition
(c) Contraception
(d) Inducing anaesthesia
(e) Otherwise preventing or interfering with the normal operation of a physiological function whether permanently or temporarily and whether by way of terminating, reducing or postponing or increasing or accelerating the operation of that function in any other way.
Preventing
ACCORDING TO THE HMR ACT 2012, WHO WOULD BE CONSIDERED AN APPROPRIATE MEDICINES PRESCRIBER (FOR POM’S)?
(a) doctor;
(b) a dentist;
(c) a supplementary prescriber;
(d) a nurse independent prescriber; and
(e) a pharmacist independent prescriber.
EXCEPTIONS:
- Community Practitioner Nurse Prescriber (Certain laxatives, Mebendazole, Nystatin, etc)
- Optometrist Independent Prescriber (Any POM for ocular conditions but not CDs)
- EEA health professional (Any UK MA POM except CD’s Sch 1, 2 and 3)
- Physiotherapist Independent Prescriber (Some CDs e.g. Fentanyl (Transdermal) )
- Podiatrist Independent Prescriber (Some CDs e.g. Diazepam (Oral) )
HMR 2012; AMINISTRATIONS
Allows for continuation of:
- Commission on Human Medicines (CHM)
- British Pharmacopoeia Commission (BPC)
- Expert Advisory Groups (EAG)
MEDICINES AND HEALHCARE PRODUCTS REGULATORY AGENCY
Executive agency of Department of Health and Social Care (DHSC)
- Mission - The MHRA’s mission is to enhance and safeguard the health of the public by ensuring that medicines and medical devices work, and are acceptably _.
Responsible for:
- regulation of medicines
- medical devices and equipment used in healthcare
- the investigation of harmful incidents.
- Looking after _ and blood products.
Safe
Blood
ACTIVITIES OF MHRA
- Assessing the safety, quality and efficacy of medicines, and authorising their sale or supply in the UK for human use
- Overseeing the UK Notified Bodies that audit medical device manufacturers
- Operating _ card scheme (medicines + devices)
- Operating a proactive compliance programme for medical devices
- Sampling and testing of medicines, including imported.
- Regulating clinical trials of medicines and medical devices
- Ensuring compliance with statutory obligations (inspection and enforcement)
- Promoting good practice in the safe use of medicines and medical devices,
- Managing the General Practice Research Database (GPRD) and the British Pharmacopoeia (BP).
- Information provision to public and professions – informed choice
Yellow
WHAT IS MEANT BY THE TERM ‘DEVICES’?
The term ‘medical device’ covers all products, except medicines, used in healthcare for the diagnosis, prevention, monitoring or treatment of illness or disability (e.g. dressings, orthotics, cathters etc)
COMMISSIONS ON HUMAN MEDICINES (CHM)
- Advised by Expert Advisory Groups (EAG’s)
- Minimum of 8 members
- Appointed by Ministers
- Chair appointed by Ministers
- Proactively give info to Ministers
- Advise Ministers when asked
- Meet once each month.
CHM FUNCTIONS
Advise the appropriate Ministers about:
- The execution of duty imposed by the HMR 2012 regs or Clinical Trials Regulations (CTR).
- The exercise of any power from HMR 2012 and CTR.
- Medicinal Products.
- Generally advise about safety, quality and efficacy of medicinal products.
- Promote collection and investigation of ADR’s (Yellow Card scheme).
- The CHM provides independent expert advice to the regulatory agency the MHRA
WHAT DOES THE CHM ADVISE MINISTERS ON?
The safety, advising on applications for both National and European marketing authorisations:
- Considering further representation against our provisional advice in respect of national applications
- Advising on the need for, and content of, risk management plans for new medicines
- Advising on the impact of new safety issues on the balance of risks and benefits of licensed medicines - eg adding warnings, restricting or suspending use of a medicine
- Advising the licensing authority on changes to legal status of marketing authorisation, efficacy and quality of medicinal products.
BRITISH PHARMACOPOEIA COMMISSION (BPC)
Functions:
- Preparation of British Pharmacopoeia
- Contains substances which are or may be used in the practice of medicine or surgery (not vet), dentistry or midwifery
- Separate compendia for Veterinary medicine/surgery.
- Preparation of other appropriate compendia
- Preparation of cumulative list of rINN
- European Pharmacopoeia
- At intervals as it thinks appropriate.
WHAT DOES THE BPC BOOK CONSIST OF?
Comprises descriptions for substances which may be used in the practice of medicine & the manufacture of medicinal products
Specifies the standards for medicinal products
EXPERT ADVISORY GROUPS (EAG)
- Appointed by either BPC or CHM.
- Ministers may instruct BPC or CHM to appoint an EAG.
- Range of Expert Advisory Groups (EAG) undertake detailed examination of issues prior to referral to CHM or BPC, e.g.
- New medicines licensing
- Risk management plans.
- Members of EAG’s do not have to be members of CHM or BPC.
- Chair appointed by CHM/BPC.
- Independent and transparent.
WHAT ARE SOME EXAMPLES OF SOME CURRENT EXPERT ADVISORY GROUPS?
HIV/Anti-infectives
Biologicals/vaccines
Oncology
Diabetes
Paediatric medicines
Clinical trials
ENFORCEMENT
- Primary responsibility with Appropriate Minister who may delegate some functions
- Ministers solely responsible for:
Licensing
- MHRA – licensing MPs in UK
- EMA – licensing under EC Council Directives
- Hospitals
- Practitioners premises