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Are community pharmacies moving away from providing blister packs?

Following Boots’ decision to explore “alternative ways to support” patients to whom it provides multi-compartment compliance aids (MCCAs), Lloydspharmacy, Well, Rowlands and some independent chains have told C+D where they stand on this issue.

Last month, C+D reported that Boots was considering “patient-led” alternatives to MCCAs, in line with Royal Pharmaceutical Society (RPS) guidance indicating they are not “always the most appropriate option for all patients”.

 

Read more: Boots exploring alternative options for patients using blister pack service

 

However, Boots' stance has attracted criticism in the media, with patient advocates and experts in elderly medicine questioning the move.

Which pharmacy companies are opting to stick with MCCAs, and which are choosing to move to alternative systems?

 

What is the RPS’s stance on MCCAs?

In a statement published today (June 22), the RPS said that while MCCAs are “often viewed as a solution” to people experiencing obstacles when taking their medicines, “the limited evidence base suggests a lack of patient benefit outcomes and sometimes they can cause harm”.

The RPS pointed to other solutions to help with medicine use. 

It argued that where patients are capable of safely self-administering their medicines, they should do so, “and where they are unable to do so, there must be appropriate training for carers so that they are able to administer medicines from original packaging”.

Lloydspharmacy and Well stick to blister packs

 

Lloydspharmacy – the second biggest multiple after Boots in terms of number of branches – is “not moving away from blister packs”, a spokesperson told C+D last week (June 15).

However, the spokesperson was unable to share more details about the decision at this stage.

Well Pharmacy also has no plans to stop offering MCCAs. The multiple’s superintendent Ifti Khan told C+D today that the pharmacy’s role in providing “support in helping to take medication is essential”.

“We provide a number of aids to assist patients with taking their medication, including medication administration charts and medicine compliance aids, such as blister packs.

“Our pharmacists will discuss and agree with patients and patient representatives the most appropriate aid to suit individual needs,” Mr Khan added.

 

Rowlands offers “tailored prescription service”

 

Rowlands pharmacies have been using PilPouch – a pouch-based dispensing device – to help patients taking multiple prescription medicines since 2017.

A spokesperson told C+D on Monday (June 20) that “the tailored patient prescription service sees a patient’s personal prescription packaged in a box of clearly labelled pouches”.

 

Read more: Rowlands chief: Introducing automated MDS dispensing was a challenge

 

“Each pouch of medication within the box outlines the specific day, time, dosage and further medication safety details,” they explained.

The pouches “dispens[e] the medicine in the order in which the patient should take it”, the spokesperson added.

 

Independent chains not ditching the service

 

Speaking on BBC News last night (June 21), Association of Independent Multiple pharmacies CEO Leyla Hannbeck said that while her members are not “withdrawing the service… they are under a lot of pressure because this service is not funded at the moment”.

Knights Pharmacy superintendent Peter Horrocks said that his branches assist a “significant number” of patients with compliance aids.

“However, with rising costs across the sector, the NHS needs to address the lack of funding for this service alongside the often lacking social care package an individual requires to maintain their independence,” Mr Horrocks added.

 

Automation and checks at Day Lewis

 

Day Lewis will also continue to offer blister packs to patients, executive director Jay Patel told C+D yesterday.

The chain is “currently rolling out [monitored dosage systems] automation to its pharmacies”, he said.  

Each MCCA “is produced using a Synmed ultra machine” and “screened using semi-automated checking software imbedded into the robot”, he revealed.

However, in order to ensure full patient safety, an accuracy check will be carried out on each MCCA.

Day Lewis pharmacy teams undertake a “qualitative review of the need and effectiveness for blister packs in each case”, on top of analysing whether it is appropriate for each medicine to go into a blister pack, Mr Patel said.  

 

Weldricks: MCCAs “not a panacea”  

 

Meanwhile, Weldricks Pharmacy has been considering individual patients’ needs in assessing whether to provide MCCAs, director of operations David Vanns told C+D last week (June 17).

The pharmacy continues to provide MCCAs to “patients who are struggling to take their medication, for example due to poor ability to manage multiple medicines”, he said, as they are a way for patients “to maintain their independence, avoid the need for carers and alleviate the anxiety of managing medication”.

“However, [MCCA] trays are not a panacea to support every patient struggling with their medicines,” he continued.

If a patient has a carer, for example, it “can disempower both the patient and carer in understanding and managing the patient’s medication”, Mr Vanns explained.

“In circumstances such as these, original pack dispensing is the safer and preferred option,” he said.

“The key to ensuring the patient has the right support is a robust assessment under the Equalities Act to determine what reasonable adjustments the patient needs to safely access their medication,” Mr Vanns added.

Mr Vanns pointed out that MCCAs “are very time consuming for community pharmacy to supply” and are reliant on adequate workforce capacity to be supplied, which at present is challenging due to “the current workforce issues we are all facing”.

“[MCCA] provision must also be undertaken safely”, Mr Vanns stated, “and overworked and under-funded pharmacy teams must manage their [MCCA] patient numbers to ensure service provision remains safe for everyone”. 

He advised pharmacy teams to “proactively manag[e] their [MCCA] patient numbers while seeking engagement with new technologies to increase capacity in the system”.

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