Patient experience is at heart of decision to prescribe a special

When the Royal Pharmaceutical Society (RPS) updated it’s guidance on the procurement and supply of specials1, the focus was on putting the patient experience at the very heart of the process.
The APSM supports this approach, believing that the emphasis on cost in recent years has sometimes clouded this underlying principle of a special provision.
Says the RPS Guideline, the starting point is to establish the optimal treatment for the patient, this means that if a suitable licenced medicine is not available a Special must be offered to meet the patient’s special circumstances and urgency of need for treatment.  This basic decision to supply a Special therefore, cannot be based on cost or convenience.  

Case Study:
A GP prescribed an anti-inflammatory drug in a dispersible tablet formulation for a child with arthritis. A week later the mother returned to the GP because the child was still in pain despite giving the medicine as directed. The GP found out that the child had been given 50mg dispersible tablets and parent told to dissolve these in 5ml of water then give the child 1ml to provide a dose of 10mg. Dispersible tablets are designed to provide the full 50mg dose. When dispersed in water a lot of the product fell to the bottom of the glass, so taking 1ml out of the total volume resulted in a variable dose. On testing, this ranged from between 2mg and 8mg and the 10mg required was rarely achieved. Had the child been given a properly formulated Special, their pain could have been more adequately controlled. (Adapted from Tomlin S, et al. Making medicines safe for children – guidance for the use of unlicensed medicine in paediatric patients. Berkhamsted: MGP Ltd, February 2009)



1.    Professional Guidance for the Procurement and Supply of Specials 2015.  RPS.

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