1. Name of the patient.
2. Name and address of the herbal practitioner.
3. Directions for use of the remedy.
4. Liquid preparations for local or topical use to be clearly marked: For external use only.
Statutory Instruments: Medicine (Labelling) Regulations 1976 No. 1726. Medicines (Labelling) Regulations 1977 No. 996.
Most GPs work in groups of self-employed individuals, who contract their services to the local Primary Care Trust (PCT) – see below. Those in full partnership are called principals, but an increasing number now work as non-principals – that is, they are employees rather than partners in a practice. Alternatively, they might be salaried employees of a PCT. The average number of patients looked after by a full-time GP is 1,800 and the average duration of consultation about 10 minutes. GPs need to be able to deal with all common medical conditions and be able to recognise conditions that require specialist help, especially those requiring urgent action.
Until the new General Medical Services Contract was introduced in 2004, GPs had to take individual responsibility for providing ‘all necessary medical services’ at all times to their patient list. Now, practices rather than individuals share this responsibility. Moreover, the contract now applies only to the hours between
8.00 a.m. and 6.30 p.m., Mondays to Fridays; out-of-hours primary care has become the responsibility of PCTs. GPs still have an obligation to visit patients at home on weekdays in case of medical need, but home-visiting as a proportion of GP work has declined steadily since the NHS began. By contrast, the amount of time spent attending to preventive care and organisational issues has steadily increased. The 2004 contract for the ?rst time introduced payment for speci?c indicators of good clinical care in a limited range of conditions.
A telephone advice service, NHS Direct, was launched in 2000 to give an opportunity for patients to ‘consult’ a trained nurse who guides the caller on whether the symptoms indicate that self-care, a visit to a GP or a hospital Accident & Emergency department, or an ambulance callout is required. The aim of this service is to give the patient prompt advice and to reduce misuse of the skills of GPs, ambulance sta? and hospital facilities.
Training of GPs Training for NHS general practice after quali?cation and registration as a doctor requires a minimum of two years’ post-registration work in hospital jobs covering a variety of areas, including PAEDIATRICS, OBSTETRICS, care of the elderly and PSYCHIATRY. This is followed by a year or more working as a ‘registrar’ in general practice. This ?nal year exposes registrars to life as a GP, where they start to look after their own patients, while still closely supervised by a GP who has him- or herself been trained in educational techniques. Successful completion of ‘summative assessment’ – regular assessments during training – quali?es registrars to become GPs in their own right, and many newly quali?ed GPs also sit the membership exam set by the Royal College of General Practitioners (see APPENDIX 8: PROFESSIONAL ORGANISATIONS).
A growing number of GP practices o?er educational attachments to medical students. These attachments provide experience of the range of medical and social problems commonly found in the community, while also o?ering them allocated time to learn clinical skills away from the more specialist environment of the hospital.
In addition to teaching commitments, many GPs are also choosing to spend one or two sessions away from their practices each week, doing other kinds of work. Most will work in, for example, at least one of the following: a hospital specialist clinic; a hospice; occupational medicine (see under OCCUPATIONAL HEALTH, MEDICINE AND DISEASES); family-planning clinics; the police or prison services. Some also become involved in medical administration, representative medicopolitics or journalism. To help them keep up to date with advances and changes in medicine, GPs are required to produce personal-development plans that outline any educational activities they have completed or intend to pursue during the forthcoming year.
NHS GPs are allowed to see private patients, though this activity is not widespread (see PRIVATE HEALTH CARE).
Primary Care Trusts (PCTs) Groups of GPs (whether working alone, or in partnership with others) are now obliged by the NHS to link communally with a number of other GPs in the locality, to form Primary Care Trusts (PCTs). Most have a membership of about 30 GPs, working within a de?ned geographical area, in addition to the community nurses and practice counsellors working in the same area; links are also made to local council social services so that health and social needs are addressed together. Some PCTs also run ambulance services.
One of the roles of PCTs is to develop primary-care services that are appropriate to the needs of the local population, while also occupying a powerful position to in?uence the scope and quality of secondary-care services. They are also designed to ensure equity of resources between di?erent GP surgeries, so that all patients living in the locality have access to a high quality and uniform standard of service.
One way in which this is beginning to happen is through the introduction of more overt CLINICAL GOVERNANCE. PCTs devise and help their member practices to conduct CLINICAL AUDIT programmes and also encourage them to participate in prescribing incentive schemes. In return, practices receive payment for this work, and the funds are used to improve the services they o?er their patients.... general practitioner (gp)
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... herbal medicalMHRA section of the website... medicines and healthcare products regulatory agency
The BHMA is recognised by the Medicines Control Agency as the official representative of the profession and the trade. Its objects are (a) to defend the right of the public to choose herbal remedies and be able to obtain them; (b) to foster research in herbal medicine and establish standards of safety which are a safeguard to the user; (c) to encourage the dissemination of knowledge about herbal remedies, and (d) do everything possible to advance the science and practice of herbal medicine, and to further recognition at all levels.
Membership is open to all interested in the future of herbal medicine, including herbal practitioners, herbal retailers, health food stores, wholesalers, importers, manufacturers, pharmacists, doctors and research workers.
The BHMA produces the British Herbal Pharmacopoeia. Its Scientific Committee is made up of senior herbal practitioners, university pharmacologists and pharmacognosists. Other publications include: BHMA Advertising Code (1978), Medicines Act Advertising guidelines (1979), the Herbal Practitioner’s Guide to the Medicine’s Act (F. Fletcher Hyde), and miscellaneous leaflets on ‘Herbs and Their Uses’.
The BHMA does not train students for examination but works in close co-operation with the National Institute of Medical Herbalists, and with the European Scientific Co-operative on Phytotherapy.
Chairmen since its inception: Frank Power, 1964-1969; Fred Fletcher-Hyde, 1969-1977; Hugh Mitchell 1977-1986; James Chappelle 1986-1990; Victor Perfitt 1990-.
During the years the association has secured important advantages for its membership, particularly continuity of sale of herbal medicines in health food shops. It continues to maintain vigilance in matterss British and European as they affect manufacturing, wholesaling, retailing, prescribing and dispensing.
See: BRITISH HERBAL PHARMACOPOEIA and BRITISH HERBAL COMPENDIUM. ... british herbal medicine association
Sheila E. Drew BPharm PhD MRPharms. Deputy Head of Technical Services, William Ransom & Son plc.
Fred Fletcher-Hyde BSc FNIMH. President Emeritus, British Herbal Medicine Association. President Emeritus, National Institute of Medical Herbalists.
Simon Y. Mills MA FNIMH. Director, Centre for Complementary Health Studies, University of Exeter. Hugh W. Mitchell MNIMH (Hon). President, British Herbal Medicine Association. Managing Director, Mitchfield Botanics Ltd.
Edward J. Shellard BPharm PhD DSc(Hon) (Warsaw Medical Academy) FRPharmS CChem FRSC FLS. Emeritus Professor of Pharmacognosy, University of London.
Arnold Webster CChem MRSC. Technical Director, English Grains Ltd.
Peter Wetton BSc LRSC. G.R. Lane Health Products Ltd.
Hein Zeylstra FNIMH. Principal. School of Phytotherapy, Sussex. ... british herbal medicine association, scientific committee, 1995
Misleading claims and the use of such words as “organic”, “wholesome”, “natural” or “biological” cannot be accepted on product labels. The Licensing Authority treats herbal manufacturers no differently than manufacturers of allopathic products for serious conditions.
The Advertising Standards Authority does not allow quotation of any medicinal claims, except where a Product Licence (PL) has been authorised by the Licensing Authority.
All labels must include: Name of product (as on Product Licence), description of pharmaceutical form (tablet, mixture etc), Product Licence No., Batch No., quantity of each active ingredient in each unit dose in metric terms; dose and directions for use; quantity in container (in metric terms); “Keep out of reach of children” or similar warning; Name and address of Product Licence Holder; expiry date (if applicable); and any other special warnings. Also to appear: excipients, method/route of administration, special storage instructions, and precautions for disposal, if any.
Where licences are granted, the following words should appear on the label of a product: “A herbal product traditionally used for the symptomatic relief of . . .”. “If symptoms persist see your doctor.” “Not to be used in pregnancy” (where applicable). “If you think you have . . . consult a registered medical practitioner before taking this product.” “If you are already receiving medical treatment, tell your doctor that you are taking this product.” These warnings are especially necessary should symptoms persist and be the start of something more serious than a self-limiting condition.
Herbal preparations should be labelled with the additives and colourings they contain, if any. This helps practitioners avoid prescribing medicines containing them to certain patients on whom they may have an adverse reaction.
Labels of medicinal products shall comply with the Medicines (Labelling) Regulations 1976 (SI 1976 No. 1726) as amended by the Medicines (Labelling) Amendment Regulations 1977 (SI 1977 No. 996), the Medicines (Labelling) Amendment Regulations 1981 (SI 1981 No. 1791) and the Medicines (Labelling) Amendment Regulations 1985 (SI 1985 No. 1558).
Leaflets issued with proprietory medicinal products shall comply with the requirements of the Medicines (Leaflets) Regulations 1977 (SI 1977 No. 1055).
See also: ADVERTISING: CODE OF PRACTICE. BRITISH HERBAL MEDICINE ASSOCIATION. ... labelling of herbal products
Information from the NHS Resolution website... practitioner performance advice
(a) The practitioner must supply remedies from premises (apart from a shop) in private practice ‘so as to exclude the public’. He is not permitted to exceed the maximum permitted dose for certain remedies, or to prescribe POM medicines.
(b) The practitioner must exercise his judgement in the presence of the patient, in person, before prescribing treatment for that person alone.
(c) For internal treatment, remedies are subject to a maximum dose restriction. All labels on internal medicines must show clearly the date, correct dosage or daily dosage, and other instructions for use. Medicines should not be within the reach of children.
(d) He may not supply any remedies appearing in Schedule 1. Neither shall he supply any on Schedule 2 (which may not be supplied on demand by retail).
He may supply all remedies included in the General Sales List (Order 2129).
(e) He must observe requirements of Schedule III as regards remedies for internal and external use.
(f) He must notify the Enforcement Authority that he intends to supply from a fixed address (not a shop) remedies listed in Schedule III.
(g) Proper clinical records should be kept, together with records of remedies he uses under Schedule III. The latter shall be available for inspection at any time by the Enforcement Authority.
The practitioner usually makes his own tinctures from ethanol for which registration with the Customs and Excise office is required. Duty is paid, but which may later be reclaimed. Accurate records of its consumption must be kept for official inspection.
Under the Medicines Act 1968 it is unlawful to manufacture or assemble (dispense) medicinal products without an appropriate licence or exemption. The Act provides that any person committing such an offence shall be liable to prosecution.
Herbal treatments differ from person to person. A prescription will be ‘tailored’ according to the clinical needs of the individual, taking into account race as well as age. Physical examination may be necessary to obtain an accurate diagnosis. The herbalist (phytotherapist) will be concerned not only in relieving symptoms but with treating the whole person.
If a person is receiving treatment from a member of the medical profession and who is also taking herbal medicine, he/she should discuss the matter with the doctor, he being responsible for the clinical management of the case.
The practitioner can provide incapacity certificates for illness continuing in excess of four days for those who are employed. It is usual for Form CCAM 1 5/87 to be used as issued on the authority of the Council for Complementary and Alternative medicine.
General practitioners operating under the UK National Health Service may use any alternative or complementary therapy they choose to treat their patients, cost refunded by the NHS. They may either administer herbal or other treatment themselves or, if not trained in medical herbalism can call upon the services of a qualified herbalist. The herbal practitioner must accept that the GP remains in charge of the patient’s clinical management.
See: MEDICINES ACT 1968, LABELLING OF HERBAL PRODUCTS, LICENSING OF HERBAL REMEDIES – EXEMPTIONS FROM. ... herbal practitioner
Anyone may administer a herbal product to a human being, except by injection. Under Section 12 of the Medicines Act 1968, any remedy may be sold or supplied which only specifies the plant and the process. The remedy shall be called by no other name. This applies to the process producing the remedy consisting only of drying, crushing and comminuting. It must be sold without any written recommendation for use.
Those who have a manufacturer’s licence, or who notify the Enforcement Authority (the Secretary of State and the Pharmaceutical Society) can sell dried, crushed or comminuted herbs which have also been subjected to certain other limited processes (tablet-making, etc) but not those herbs contained in the Schedule to the Medicines (Retail Sale or Supply of Herbal Remedies) Order 1977 (SI 1977 No.2130).
This Schedule has three parts.
Part 1 contains substances that may only be sold by retail at registered pharmacies under the supervision of a pharmacist.
Part 2 refers to remedies that can be sold only in a registered pharmacy. There is, however, an important exception, as follows.
Part 3 contains a list of considered toxic herbs. A practitioner can prescribe all remedies that a shopkeeper can sell. He may also prescribe and sell remedies on Part 3 of the Schedule which a shopkeeper cannot. Such supply must be in premises closed to the public and subject to a clear and accurate indication of maximum dosage and strength. These remedies are as follows:... licencing of herbal remedies – exemptions from
Platelets may be given in transfusions for people with blood-clotting disorders. Patients who have life-threatening infections may be treated with granulocytes, a type of white blood cell. Fresh frozen plasma is used to correct many types of bleeding disorder because it contains all the clotting factors. Albumin, prepared from the plasma of whole blood, is used mainly to treat shock resulting from severe blood loss until compatible whole blood becomes available. Purified albumin preparations are used to treat nephrotic syndrome and chronic liver disease.
Concentrates of blood clotting factors and are used in the treatment of haemophilia and Christmas disease.
Immunoglobulins (also called antibodies), which are extracted from blood plasma, can be given by injection (see immunoglobulin injection) to protect people who are unable to produce their own antibodies or have already been exposed to an infectious agent, or to provide short-term protection against hepatitis A.
Immunoglobulins are given in large doses to treat certain autoimmune disorders.... blood products
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