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CCGs stop pharmacy repeat prescription orders to save cash

The CCGs estimate the schemes could save £10 million a year

Clinical commissioning groups are blocking pharmacies from ordering repeat prescriptions on behalf of patients in a bid to save money, C+D has learned.

Three clinical commissioning groups (CCGs) in the north west of England and East Anglia have implemented schemes to stop pharmacies from reordering prescriptions, to save around £10 million a year in wasted medicines.

Local pharmaceutical committee (LPC) chair Graeme Batten told C+D last week (August 12) that he had “real concerns” about whether the scheme would address medicines waste, and warned it would have a large impact on pharmacies and patients in the area.

In Merseyside, NHS Southport and Formby CCG, and NHS South Sefton CCG, are piloting the new system. They estimate it will save the local NHS £2m a year in “wasted medicines”, and will “improve the safety of repeat prescriptions”.

From September 1, patients at 19 Sefton GP surgeries will not be able to order repeat prescriptions from their pharmacy, and will have to order their own repeat prescriptions directly from the practice. The CCGs say that “special arrangements” will be in place for vulnerable patients who require blister packs.

The new system will affect over 47,000 patients, and all of the 76 pharmacies in the Sefton area – and will mean that pharmacists will be forced to collect repeat prescriptions from surgeries themselves, on behalf of their patients.

"Inconvenient for some"

Susanne Lynch, head of medicines management at both CCGs, admitted the new system “may be inconvenient for some”. But she stressed “it does address some very real medicines safety issues as well as safeguarding precious NHS funds”.

Mr Batten, Sefton LPC chair and a pharmacist at the Crescent Pharmacy in Thornton, Merseyside, told C+D that pharmacists had been given little notice that the scheme was being implemented, “causing a lot of angst” for local contractors.

“The party line is that the pilot will cut down on waste and encourage GPs to do medicines reviews, and reduce the workload of pharmacies. But the impact on contractors is going to be quite great," Mr Batten told C+D on Friday (August 12).

“We support the principle of waste reduction and we want to work with [the CCG]. It would have been nice to have had some consultation [in order to] to get it to work well from the beginning."

Mr Batten said that with "a little more time" some of the logistics could be resolved. "But it’s going to be difficult getting it off the ground. I have real concerns that patients will be affected,” he added. 

67 Comments
Question: 
What money-saving schemes are in place at your local CCG?

Jackie Robinson, Marketing

Jackie...pharmacy

They will lose millions on staff going off ill due to the extra workload....so much for the paperless NHS

Folajimi Awofisoye, Locum pharmacist

Pharmacies have been providing additional services for patient's "convenience" for the past decade or so, we need to start seeing these services either being paid for or taken over by the patient , this will give pharmacies more time to do whats important, especially if the cuts are still going to come. There is afterall nothing like a free meal.

Sarah Roberts, Community pharmacist

Ordering drugs that have not been requested by the patient is fraud and nothing less.

 

Joseph Oseghale, Locum pharmacist

I think the fact that CCG's have not consulted the pharmacies,LPC and other AHP groups is not proper. Repeat prescribing policies and standards could have been agreed and monitored before getting to this stage. Other issues to consider are patient safety, how would Practices cope with demand. It may also affect the Clinical pharmacist in GP practices as the pressure builds as they may be pressured to deal with the influx of repeat request. 

A Long Serving Pharmacist, Community pharmacist

Some people need us to order their repeats as they have no access to the internet and some sugeries do not accept telephone requests for prescriptions. Provided this is monitored and we ask each time what the patient requires I can see no problems. Other people, even when asked to select what they need will tick everything anyway and order it all. These are the ones who bring bag sack loads of unwanted meds for destruction. There are failings in both systems. If pharmacies submit the prescription request we are making it easier to manage the workflow, and can order in sufficient time to get the prescriptions ready. But we risk being accused of overordering - even when we ask the patients to tick their own repeat forms. If we let the patients manage their own medication it often leads to ordering at short notice and one item at a time, which makes more work for everyone (GP staff, pharmacy staff and the patient's repeat visits). This workload is hard to plan for too. A system needs to be agreed between pharmacies and GP surgeries on a one-to-one basis and protocols set up to allow regular items to be ordered regularly by the pharmacy and prn items to be ordered by the patient. A blanket ruling on repeat prescriptions assumes that the whole country is the same and that all pharmacies overorder. That is grossly unfair to those of us who try hard to manage the repeat system correctly.

 

 

 

Patricia Westhead, Dispenser Manager/ Dispensing Assistant

perhaps they should look at how often surgeries send medications which have not been ordered, sometimes they had been stopped months previously

 

Johnathan Smith, Community pharmacist

I now record items that have not been ordered, and they still appear on the prescription. Also how about people who get 56 days supply every month. 

Simon MEDLEY, Community pharmacist

84 isnt unseen round our way,,,, more if your the family member of a gp !  ( years supply of o.c )

 

Tim B, Locum pharmacist

Its about time that you all stopped exploiting the laziness of patients who cannot be bothered to managed their own medicines

Danny TheRed, Community pharmacist

Outside my local pharmacy next to the GP surgeries I overheard two older ladies grumbling about the new system, an older gentlemen interceded and said the following 'you know why it is... When you order from the Dr you only get you want, when the chemist orders you get everything whether you need it not'. We are aware of the multiple culprits and yes they have alleged processes in place to stop this happening but too often there isn't the the time or staff to adhere to the SOP which in itself is little more than a device to protect the body corporate. In my pharmacy every request is initiated by the patient, phonecall, email or face to face but the work that creates is immense and that is before we spend time chasing surgeries for items they have missed off, every request has an audit trail. So when I heard this news it made my day, it will force the surgeries to up their game and it will be them getting it in the neck and not me or my team, too often surgeries will say we didn't order an item even though their PMR shows the item requested. I predict chaos as some surgeries cannot cope with repeats at the moment.

 

 

 

 

 

Abid P, Primary care pharmacist

Let us see how GPs will get on with those "one item" a day ordering that some patients enjoy doing so much. Don't see why pharmacies cannot order 7 days in advance. It's the automatic ordering i have a problem with. Not sure why all the ordering has been taken away from pharmacies. Seems like overkill. Think GPs have enough control over the NHS purse strings as it is. Is this a powerplay?

Farm Assistant, Community pharmacist

There are two issues here. The first is why should pharmacists do this for patients in the first place? We don't get paid for it and the vast majority of the public who use this service are just lazy. I used to locum where they had to walk past the surgery from the car park to reach the pharmacy and they still could not be bothered to drop off their own repeat. The second issue is managed repeats which everyone one knows is just pure fraud. How certain multiples have been allowed to get away with this theft for years is beyond belief. Oh sorry I forgot the profession is policed by a certain body who only does what its masters tell it to do.

Leon The Apothecary, Student

It secures repeat business, a patient is less likely to go elsewhere if their medication is prepared and made up for them.

Jatin Morjaria, Community pharmacist

Maybe an electronic repeat management service- something akin to ETP but being accessible to pharmacies, patients and GPs highlighting items that are being ordered,flagging items that are "likely" to be overordered and thus creating an audit trail, accountability, ownership whilst stream lining the process making it more efficient and reviewable(by all concerned) be the answer?? It can go a step futher by calculatig the savings to educate and evaluate the decisions made whist ordering the repeat?

Interleukin -2, Community pharmacist

IT stuff like that costs money mate...they are trying hard to save some

Leon The Apothecary, Student

I like Jatin's idea. A system that is visible over a network by the GP, Nominated Pharmacy and Patient.

Barry Pharmacist, Community pharmacist

This is the end of the line for automatic re-ordering by unscrupulous individuals that drag us down. If it applies to everyone and is not manipulated by unscrupulous GPs with a commerical interest in a particular pharmacy then let it be 

Valentine Trodd, Community pharmacist

Brilliant news for once! No more moaning buggers saying we didn't put in their repeat for them. Please accelerate the roll out - I can't wait! Will give those witches in the surgery something to think about, haa, haa... 

A.S. Singh, Community pharmacist

I agree with this completely, pharmacies like boots asking patients to repeat their meds every month. But surgeries up and down the country have got used to pharmacies dealing with their repeats and most do not have the staff in place to deal with extra prescription requests normally dealt with by the pharmacy. Who will pick up the slack when it fails the elderly too?

Why doesn't the government focus on the real money holes such as the expensive generics that companies charge the NHS millions, like doxepin and hydrocortisone. Again I feel its a case of watching the pennies while loosing the pounds

Shaun Steren, Pharmaceutical Adviser

It is not pennies, it is £100,000 month just in one trial area alone

A.S. Singh, Community pharmacist

£100k compared to £700m is pennies. See how much waste goes into NHS admin staffing as well while you're at it. £100k is a drop in the ocean...

A C, Locum pharmacist

£100k x 160 odd CCG areas

 

Shaun Steren, Pharmaceutical Adviser

What a moronic view of NHS funding. Avoiding waste is not a zero sum game, it is cumulative. Smaller savings add up to huge sums that support the individually large savings. One hundred thousand pound per month in one CCG area could pay for a huge amount of care for severely disabled children - an area that has seen significant cuts. Is it any wonder we have such a lowly standing within the NHS with comments like this. 

CAPT FX, Locum pharmacist

Moronic view, eh what a term to use against a fellow professional. I suppose next people will be using toilet epithets to put across basic facts. There is nothing moronic about the observation because the point here is that we have a 21st Century Health Service whose priorities are so misplaced that they will spend £700m to save £100k, literally. The examples are many and trying to state them and argue their strengths and weaknesses is a waste of time because people in Charge of the NHS are still generations away from thinking logically like this. This why NHS watchers from around the world say this is a First World facility that is being run by not third but fourth world minds. I suppose the men who preside over the running of the Department of health use such choice words as "moron"  in their deliberations and is it surprising that we have moronic results that permeate through every aspect of this sorry edifice.

Shaun Steren, Pharmaceutical Adviser

Care to argue the actual point being made? Or do you think by presenting ephemeral theories you can deflect from evidence and clear reasoning. Counter the very specific position of the Luton CCG, I would be most interested to hear this.  

Interleukin -2, Community pharmacist

People are allowed to disagree with even you you know....

Mr CAUSTIC, Community pharmacist

no prescription should be requested without the patient requesting it. i ask the patient to contact us 7 days before their script is due .yesterday i had a new patient come in and ask us to get his scripts in future. he said he was changing from his previous pharmacy as they kept ordering his drugs when he had not asked them to. i asked him if they rang him before ordering the scripts from the surgery and he said no. This was a multiple and if it is repeated country wide one can see how much money is wasted. Perhaps the nhs should look into the practices of the largest pharmacy groups to confirm what other people have said below. I have always been surprised at the amount of waste drugs returned to me from other pharmacies when a relative has passed away. A note should be made when the patient has requested a script and contact is made. we produce a repeat request on the computer and do not use patient request slips.so there is an audit trail on the computer. I disagree that £1 should be charged for all scripts but think a 10P charge for all the current exempt groups ( not children) would be suitable. Nobody will waste 10p on something they do not need regardless of income. The surgeries will do what the patient requests and  if an elderly patient says i need everything do you think the receptionist is going to go through and ask about every individual drug. The patient may be hard of hearing,have poor sight,have an accent that the staff do not understand and so on. They will take the line of least resistance. The other problem is that if the patient goes direct and orders 6 items and then comes inot the pharmacy to collect them 4 days later and the surgery has only done 5 it will waste our time ringing up to sort it out. With my system we have a copy of our faxed request and 3 days later we refax if the script has not arrived. if an item is missing we refax with a stamp on the original saying some items have not been received and highlight them. 

Reeyah H, Community pharmacist

With all due request, it's simply not possible to ring up EVERY PATIENT before ordering! Which is why this rolled out nationwide. It's about time the patients bothered to actually do anything apart from moaning. 

Leon The Apothecary, Student

I'm reminded of the Code of Ethics for Pharmacists and Technicians. We should be encouraging patients to be involved with their healthcare. 

Alchemist 1948, Locum pharmacist

look at the impact 5p has had on carrier bag usage

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