Rules for the sale, supply and administration of medicines for specific healthcare professionals
Published 1 January 2014
Applies to England, Northern Ireland and Wales
© Crown copyright 2014
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This publication is available at https://www.gov.uk/government/publications/rules-for-the-sale-supply-and-administration-of-medicines/rules-for-the-sale-supply-and-administration-of-medicines-for-specific-healthcare-professionals
Overview
The Human Medicines Regulations 2012 contains exceptions to the general rules on selling, supplying and/or administering medicines for some groups of healthcare professionals.
This guide covers the specific medicines that certain healthcare professionals can sell, supply and/ or administer.
These exceptions do not cover the prescribing of medicines as this can only be done by an independent prescriber such as a doctor or dentist. They are also different from the rules of a patient group direction (PGD), which is a multi-disciplinary group made up of a doctor, pharmacist and a representative of a professional group.
There are 3 ways that medicines can be sold and supplied in the UK. These are:
- on a prescription referred to as prescription-only medicines (POMs)
- in a pharmacy without prescription, under the supervision of a pharmacist (P)
- as a general sale list (GSL) medicine and sold in general retail outlets without the supervision of a pharmacist
Podiatrists (also known as chiropodists)
You are permitted to sell/ supply specific medicines with some restrictions, and you can purchase them wholesale.
Sale/ supply of prescription-only medicines (POM)
You can sell/ supply specific POM medicines with some restrictions. These are:
- amoxicillin
- amorolfinehydrochloride cream: maximum strength of the amorolfine in the cream must not exceed 0.25% by weight in weight
- amorolfine hydrochloride lacquer: maximum strength of amorolfine in the lacquer does not exceed 5% by weight in volume
- co-Codamol
- co-dydramol 10/500 tablets
- codeine phosphate
- erythromycin
- flucloxacillin
- silver sulfadiazine
- tioconazole 28%
- topical hydrocortisone: maximum strength of the hydrocortisone in the medicinal product must not exceed 1% by weight in weight
Conditions
The medicines must be:
- sold/ supplied by registered chiropodists/podiatrists
- pre-packed
- sold/ supplied during professional practice by those with a certificate of competence in the use of the medicines
These medicines may also be sold or supplied by a pharmacist if the order is written by a suitable qualified chiropodist/podiatrist.
Sale/ supply of pharmacy (P) medicines
You are permitted to sell, supply P medicines with some restrictions. These are:
- potassium permanganate (for external use):
- ointment of heparinoid and hyaluronidase 9.0% borotanic complex
- 10.0% buclosamide
- 3.0% chlorquinaldol
- 1.0% clotrimazole
- 10.0% crotamiton
- 5.0% diamthazole
- 1.0% econazole
- 1.0% fenticlor
- 10.0% glutaraldehyde
- 0.4% hydrargaphen
- 2.0% mepyramine
- 2.0% miconazole
- 2.0% phenoxyporpan
- 20.0% podophyllum
- 10.0% polynoxylin
- 70.0% pyrogallol
- 70.0% salicylic acid
- 0.1% thiomersal
- terbinafine
- griseofulvin 1%
- ibuprofen
Conditions
Except for Ibuprofen, these medicines must be:
- sold/ supplied by registered chiropodists/podiatrists
- pre-packed
- sold/ supplied during professional practice
Sale/ supply of general sale list (GSL) medicines
You are permitted to sell, supply any GSL medicine as long as it is pre-packed and supplied from a premise that can be locked from the public.
External GSL medicines must be supplied in during the course of your professional practice.
Administering medicines
You can administer:
- bupivacaine
- bupivacaine with adrenaline
- lignocaine
- lignocaine with adrenaline
- mepivacaine
- prilocaine
- adrenaline (Epinephrine) Inj BP
- methylprednisolone
- levobupivacaine Hydrochloride
- ropivacaine Hydrochloride
Conditions
You must:
- be a registered chiropodist/podiatrist
- hold a certificate of competence in the use of analgesics
You must not combine these medicines yourself, you can only use readily mixed combinations of these medicines if you need them.
General advice
Chiropodists use some chemicals in their practices. These are mainly:
- liquid phenol
- pyrogallol
- monochloroacetic acid
- salicylic acid
Since these are primarily chemical in action they fall outside the definition of a medicinal product. However, if you place them on the market with a medical claim, they will fall within that definition and you will need to follow the legislation. There is currently only one phenol product on the market like this.
As a chiropodist you can use chemicals that do not make a medical claim in your practice. You are expected to use chemicals safely and follow other relevant legislation such as the control of substances hazardous to health (COSHH).
Midwives
Midwives do not need a prescription or a PGD to supply and/ or administer certain medicines.
Sale/ supply of GSL, POM and P medicines
You can sell or supply all GSL and P medicines. You can also sell and/ or supply prescription-only medicines containing:
- diclofenac
- hydrocortizone acetate
- miconazole
- nystatin
- phytomenadione
Conditions
You can only sell/supply these POM medicines as part of your professional practice.
Administering POM medicines
You can administer injectable POM medicines that include:
- adrenaline
- anti-D immunoglobulin
- carboprost
- cyclizine lactate
- diamorphine
- ergometrine maleate
- gelofusine
- hartmann’s solution
- hepatitis B vaccine
- hepatitis immunoglobulin
- lidocaine
- lidocaine hydrochloride
- morphine
- naloxone hydrochloride
- oxytocins, natural and synthetic
- pethidine hydrochloride
- phytomenadione
- prochloperazine
- sodium chloride 0.9%
Conditions
You should only administer these POM medicines as part of your professional practice. You must also only administer lidocaine and lidocaine hydrochloride when attending to a woman in childbirth.
Student midwives
Student midwives can only administer these injectables (excluding the controlled drugs) and must be supervised at all times by a registered midwife.
Occupational health
Only doctors and registered nurses can supply or administer medicines as part of an occupational health scheme. However a registered nurse can only supply or administer POM medicines as part of the scheme if they have written instructions from a doctor.
Optometrists
You are permitted to sell/ supply all GSL and P medicines. In an emergency you can also sell some POMs that are not for injections. These are:
- eye drops that contain no more than 0.5% chloramphenicol
- eye ointments that contain no more than 1% chloramphenicol
- substances that contain:
- cyclopentolate hydrochloride
- fusidic acid
- tropicamide
You must only do this as part of your professional practice. Pharmacies can sell or supply these POMs to patients if a registered ophthalmic optician has given a signed order.
Commonly used P medicines
Optometrists commonly use P medicines containing:
- antazoline (up to 1%)
- azelastine hydrochloride (up to 0.1% for the treatment of the signs and symptoms of allergic conjunctivitis
- dibromopropamidine isethionate
- fluorescein sodium
- levocabastine (up to 0.05% for the symptomatic treatment of seasonal allergic conjunctivitis)
- lodoxamide (up to 0.1% for ocular signs and symptoms of allergic conjunctivitis)
- phenylephrine hydrochloride
- propamidine isethionate
- rose Bengal
- sodium cromoglicate (only for the treatment of acute seasonal allergic conjunctivitis or perennial allergic conjunctivitis and subject to a maximum strength of 2% for eye drops or 4% for eye ointment - products containing this substance are also subject to restrictions on maximum quantity, which may be sold or supplied as a P medicine and are not more than 10ml for eye drops and 5g for eye ointment)
- various tear supplements and ocular lubricants
- xylometazoline hydrochloride
Additional supply optometrists
These optometrists are accredited by the General Optical Council they can sell, supply or write an order for an extended range of medicines in an emergency and as part of their professional practice containing:
- acetylcysteine
- atropine sulphate
- azelastine hydrochloride
- dicofenac sodium
- emedastine
- homotropine hydrobromide
- ketotifen
- levocabastine
- lodoxamide
- nedocromil sodium
- olopatadine
- pilocarpine hydrochloride
- pilocarpine nitrate
- polymyxin B/bacitracin
- polymyxin B/trimethoprim
- sodium cromoglycate
A pharmacy can sell/ supply POMs if the order is signed by an additional supply optometrist.
Wholesale supplies to registered optometrists
Registered optometrists can stock the exempted P and POM products.
They can also get stocks of P medicines and some POMs to administer to their patients. These POMs are:
- amethocaine hydrochloride
- lignocaine hydrochloride
- oxybuprocaine hydrochloride
- proxymetacaine hydrochloride
An additional supply optometrist can get thymoxamine hydrochloride if it becomes available.
Paramedics
Paramedics can administer certain medicines on their own initiative to sick or injured persons who need immediate treatment. These medicines are:
- diazepam 5 mg per ml emulsion for injection
- succinylated modified fluid felatin 4% intravenous infusion
- prescription-only medicines containing one or more of the following substances but no other active ingredient:
- adrenaline acid tartrate
- adrenaline hydrochloride
- amiodarone
- anhydrous glucose
- benzylpenicillin
- compound sodium lactate intravenous infusion (Hartmann’s Solution)
- ergometrine maleate
- frusemide
- glucose
- heparin sodium (NB: administration is only allowed for the purpose of cannula flushing.)
- lignocaine hydrochloride
- metoclopramide
- morphine sulphate
- nalbuphine hydrochloride
- naloxone hydrochloride
- ondansetron
- paracetamol
- reteplase
- sodium chloride
- streptokinase
- syntometrine
- tenecteplase
As a registered paramedic you can keep stocks of these injectable medicines as well as administer pharmacy medicines as part of your professional practice. Paramedics can also get stocks of P medicines to administer in their business. The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) website has a wider list of medicines you can administer. Usually you can only access these when working with an ambulance trust or body permitted to receive wholesale supplies.