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Surgeons operate and physicians prescribe. However, some paediatricians know less about drugs, their prescription, and the legislation governing medicines than their surgical counterparts about anatomy and operative technique. For the first half century of its existence, the British Paediatric Association did not have a Medicines Committee. Yet it is now becoming clear that thirty years after the thalidomide disaster and the ensuing Medicines Act (1968), children remain disadvantaged compared to adults in the development of new drugs and in the scrutiny of old drugs.1 ,2 The two recent Crown Reports add to the complexities of prescribing for children but also represent opportunities for innovation to improve the quality of the service we can offer families.
Background to the Crown Committee
The Government established a review of prescribing, supply, and administration of medicines in 1997 chaired by Dr June Crown. The review grew out of a desire to make greater use of the skills and experience of the various professions working in primary and secondary care and to determine in what circumstances non-medical health professionals could undertake new roles with regard to the prescribing, supply, and administration of medicines. There already exist situations where a doctor signs a prescription even though the assessment has been undertaken by a non-medical colleague, for example, gaiters recommended by a paediatric physiotherapist to aid walking. This is unsatisfactory in clarity of responsibility and accountability.
The first Crown Report and group protocols
The first Crown Report published in April 19983 was concerned with the supply and administration of medicines by group protocols. A group protocol is a specific written instruction, drawn up locally by doctors and pharmacists, for the supply or administration of named medicines by other health professionals in an identified clinical situation. It applies to a group of patients who need not be individually identified before they present for treatment and may include …