GPs block pharmacies from managing repeat prescriptions

East Lancashire CCG said it intends to stop unnecessary medicine waste
East Lancashire CCG said it intends to stop unnecessary medicine waste

Certain pharmacies in east Lancashire can no longer order medicines on behalf of most patients, C+D has learned.

"Some GP practices in the area have decided to manage repeat prescriptions [themselves], and prevent indirect ordering through... community pharmacies," Lisa Rogan, head of medicines management for NHS East Lancashire, told C+D last week (June 15).

According to a poster (below) produced by east Lancashire clinical commissioning group (CCG), this is to ensure “safe and responsible” issuing of medication and “prevent unnecessary medicine waste”.

The CCG suggests that rather than order from their nominated pharmacy, patients order regular medication online, by ringing their GP practice prescription request line or by dropping prescription requests in at their GP's reception.

“The CCG supports [GPs] to do this as [this approach] has been found to improve efficiency, reduce the risk of errors and reduce waste,” Ms Rogan told C+D. “It also provides an extra opportunity for contact between patients and their surgery.”

Ms Rogan added that a “small number of patients” may continue to require support ordering their medication. “In such instances, their community pharmacy may be the most appropriate option.”

“It has been agreed with pharmacies and the surgeries that in such instances, the surgery will continue to accept orders for these patients via the pharmacy,” Ms Rogan added.

“Patients aren’t happy with extra workload”

Andrew Grierson, pharmacist prescriber at Wyvern Pharmacy in Accrington, Lancashire, said it is “early days” to “really understand the impact” of the change.

“Patients have accepted it, but aren’t happy with the extra workload,” Mr Grierson told C+D. “We’ve helped some people who we know would have trouble remembering to order, by phoning or texting them every four weeks as a prompt.”

Mr Grierson added: "Some GP surgeries have worked with us really well to use repeat dispensing, but there are some that don't intend to offer it."

“The main problem is this actually increases the number of medicines that are dispensed when not needed,” Mr Grierson stressed. “If it’s run right, repeat prescription schemes are efficient and can save money.”

“The few [pharmacies] who over-order or who don’t follow CCG guidance have tarred us all with the same brush,” he said.

In October 2016, a C+D investigation revealed that almost four in 10 CCGs plan to scrap their pharmacy repeat dispensing schemes. Read the full investigation results here.

41 Comments
Question: 
What do you think about pharmacies being blocked managing patients repeat prescriptions?

Olukunmi Popoola, Community pharmacist

The closest surgery to us has done the same thing as well. I did go in and ask for an exemption for a few of my patients who I know will not be able to order their medication themselves. This was granted for about 15 of my customers.

On the whole I would say customers hate the new system as they were used to the previous system where they called us 7 days before they ran out.

Another thing is this. Any issues with issued prescriptions have to be dealt with by the customer as opposed to when we ordered them. We followed them through before. Customers hate this.

My requests for emergency supply has shot through the roof as customers are forgetting to order their repeats on time and many try to order them when it is too late and they still have to wait 2 working days. I could liase with the surgery most times and get some repeats out on the same day when I could order repeats for customers

Lastly this new system has been going for 6 months now where do I get published information that it has helped reduce costs and over-ordering?

Bilal Nazir, Community pharmacist

This has happened all over Bradford for the past 6 months. The way GPs have dealt with increased workloads is to simply prescribe prescriptions for two months and in some cases even three months! You can imagine the affect this has had on item numbers and coupled with the funding cuts it's a real struugle to push forward.

Catherine Hingston, Community pharmacist

This has been happening for months in Sheffield...At the pharmacy end there is much less paperwork and time spent trying to contact patients about what meds they may or may not want. Gives us more time to do our job. All our regular patients are still with us. We are still able to order Rx for vulnerable patients (I know in Rotherham that has been tricky) To be honest I love that patients have to be in charge. To assume that there will be be a reduction in waste is simply stupid. There are so many patients out there that order, in the belief that the GP thinks that they are then taking their medicines and on the other hand central staff that know what the meds are. We still get issues with meds being missed...nothing changes

Locum Pharmacist, Locum pharmacist

As a locum I also prefer it when patients order their medication themselves. With the old system there were always a few patients whose medication wasn't ordered and I would be forced to 'loan' some medication in advance in anticipation of a prescription. Now that patients are ordering themselves at least this widespread questionable practice will decrease and we can simply provide an emergency supply where appropriate as a private service. Also, it's one less thing for patients to complain about:)

Mark Ashmore, Superintendent Pharmacist

Catherine's experience exactly mirrors situation in Oldham. It has freed up a lot of staff time to our advantage.

Alchemist 1948, Locum pharmacist

The CCG are convinced that by bringing patient ordering in-house they will eradicate pharmacy overordering. What they have failed to account for is that in their own research 1/3 errors were due to GP prescribing errors, 1/3 were due to pharmacy errors and 1/3 were due to patients'errors. You can fully understand that in this scenario that the view from a GP surgery receiving ordered prescriptions via a community pharmacy is that 66% of errors are from the pharmacy (33% pharmacy + 33% patient).

How do you deal with patient over ordering ?

Deliberate over ordering by a pharmacy is fraud and should be dealt with directly.

What about GP surgery prescribing errors ?

I am pretty certain that this method will not solve these. Once again the value of community pharmacy interpreting and solving the myriads of errors is ignored. The NHS is under severe financial stress but surely by constructive collaboration between health care professionals we can achieve so much more then it would be a win for patients, a win for pharmacy and a win for the NHS

saed kolasinac, Student

colin...u sound envious of P2U

Farmer Cyst, Community pharmacist

V. gd comment Saed. Hope to see more of your opinions in future. 

Arvind Sami, Locum pharmacist

It'll be fine, I'm sure the receptionists will know, which ones are the blue ones, and the the oval ones, and that other one, for you know...the blood pressure... I think

Locum Pharmacist, Locum pharmacist

Lol pharmacy staff have had to suffer through this repeat ordering system and angry patients, now it's their turn.

Best Farma, Ecommerce

EPS is so clever. The premise was to become paperless.(Endless amounts of paper now printed at the pharmacy instead of surgery).

The workload would be greatly reduced at the surgery(It has simply been shifted to the pharmacy)

 

And this cost billions of pounds by the way. Remind me again the point of all this.......

Bal Singh, Locum pharmacist

Oh well, if only the local LPC was able to get together and reassure the CCG that emergency supplies will not be given to cover shortfalls, as surgeries are in charge of it all now.

Deliveries will be next day only, and I will be sure to inform everyone that it is best to leave 48 hours for delivery, to allow for managed workload, stock, and delivery. Medidoses we should really advise against, due to waste....and the lack of evidence of increased concordance from use.

Barry Pharmacist, Community pharmacist

This isn't GPs blocking it's CCGs / MMT leads. They think it will say them money. It might in some cases but it won't make the savings they seek. However it's actually a good thing for pharmacy I feel not to be answering the phone every few minutes. The NHS - not EMIS needs a portal for patients to order Rx. I thought that was what EPS was all about!

 

Faisal Ali, Manager

As a manager of a store with very low numbers on automatic repeat service (~13%) and a very high PCS %, I can see how this would massively reduce our workload on the phones in particular- taking in requests, checking off recieved items vs requests and then chasing up items/ scripts not recieved, then explaining to patients about why certain items can't be issued etc etc etc. However its all part of the service the pharmacy team provides and its why patients like ordering through us.

Surgeries will really struggle with the additional workload, as with every business nowadays, they are tight with staffing and budgets as it is and I can't see the investments required being made. 

I like patients to have control over odering thier own medicines as I feel it does reduce medicines wastage- skeptical about some of the figures CCGs are throwing around though. Main advantage of a FRPS is greater management of workflow.

Kevin Western, Community pharmacist

"Surgeries will really struggle with the additional workload, as with every business nowadays, they are tight with staffing and budgets as it is and I can't see the investments required being made".... the important difference being that if you have to hang on 45 minutes waiting to get through to a surgery, or they dont get it right, and you shout at them, they will kick you out and you have to go and get registered elsewhere so you dont shout at them...so they dont care so much

Locum Pharmacist, Locum pharmacist

I agree 100%. Patients have become far too reliant on pharmacies due to the repeat ordering system and are too casual about emergency supplies in that they start demanding them. Plus if they ever have an issue with the GP surgery, they want the pharmacy to call them up rather than contacting them themselves. 

This is not all patients of course but definitely enough to put me off pharmacy ordered repeats.

Faisal Ali, Manager

Not sure what point you are trying to make in response here.

Currently in my branch we share the workload of taking in requests with the surgery. The vast majority of surgeries on my patch do not take in requests over the phone now in any case. patients mainly order from thier surgery via email or physically handing in a repeat slip. Older patients prefer phone so use the pharmacy.

We currently work synergistically to manage this process and ensure patients recieve the required medicines promptly.

My point being shifting this workload primarily onto surgieries will result inevtibly in delays and most likely a reduction in the level of service all around.

P W, Pharmacy technician

Why pharmacy should take responsibility to re-order patient medications? We are not prescribers, aren't we ? Are we not busy enough with MURs, NMSs, vaccines, ES, and !we not SHORT-STAFFED

I know this may sound not right, but: why should I care about surgery workload if nobody cares about workload in my workplace?

...there is another argument, as patients claim "I have signed for the service, so YOU DO IT". And honestly? I can do it, I can reorder it; it is not a problem for me at all. So I try to confirm with patient medications they are currently on (read: medications they take on daily basis) 50% won't be able to recall name of medications they supposed to be  "adhered" to. Aren't they spoiled enough already? Therefore I ask: which medication I should order... patients will reply: all of them. And what do I do? - I literally order them all, and I do not care if they need them of not.... I do it... because I have to do it… as I have not got other choice. The company I work for will not understand why patient wrote complain. I have failed: I made them unhappy. “do everything to make them happy!”… I am doing everything I can… including:: I am wasting NHS resources… I am person who helps to kill health system on a daily basis! System I always wanted to be part of. Its not very pleasant to do it; isn’t it ?

 

Drugs given to 95% of patients are free of charge... patients not responsible for their own health; as doctors will prescribe... pharmacist will dispense... etc, as tablets will solve each problem. Everybody are scared of providing easiest and the free of charge advice (medication)… “loose weight, stop smoking/ drinking, change your diet” etc.

Aren't you surprised when patients prefer to waste half a day to go to surgery to get Rx for paracetamol which they can buy for 1 pound? Do we really believe that this system works efficiently ?

Patients in this country has been spoiled; they will never take charge on their own health... I wish everybody were ask to pay... 1 - 2 pounds per each item... this would change EVERYTHING. !wastage would drop by 50%! at least!

If patients wants medications and is capable of posting repeat prescription to surgery or using internet service to reorder drugs ? – why they can not do it themselves ? its easy… isn’t it ? Patients have to take a LITTTTTTLE BIT of responsibility for THEIR OWN health! And be grateful that they live in such country which provides those drugs free of charge.

 

I request medications 7 days before patients are due to receive new supply -  surgery wont be able to prescribe it on time...  if medications are not prescribed for other reasons (patient review is due with GP etc.) surgery won't even inform us about it. Who will be blamed when the patient will come to pharmacy with intention to collect their new supply ?

I will be blamed, because surprisingly now responsible for EVERYTHING and I become little bit tired for listening those shouting people who do not realise that I haven't got 2 minutes spare to go to the toilet... but I am still smiling and pretending that everything is OK

 

Couple of days ago: one of my patients returned unopened 3x Ventolin, 3x Tiotropium - as "GP and nurse told her to return it". On the same day we received a fax Rx (urgent one!) for Ventolin and Tiotropium... 

We all want to save "OUR NHS" wright? so let's start saving from today... and let surgery do their job which is taking responsibility to prescribe appropriate medications at an appropriate time. And pharmacy staff will take charge of their part of patient care. Let’s be honest this “reorder system” has been so willingly applied in our practise; as all those big pharmacy chains want to earn MORE AND MORE… so “lets reorder everything”! there is never enough…

 

Lets request at least 1 pound per each dispensed item. No exceptions.

 

 

“…I haven’t got my tablets… what should I do…

“we dispensed three month supply for you !two weeks ago”, “I will try to reorder you medications urgently; but at the same time I would like to ask you to contact surgery yourself and give them explanation what has happened – as they will assume that your medications has been requested by mistake as they are not due for next 3 months”

“…No! I am not going to do it… because you are responsible for it! I have signed for repeat!... I am not gonna take it then, and if I am gonna die… its gonna be your fault”

Sounds familiar ? 

Best Farma, Ecommerce

It's all smoke and mirrors anyway. People scuttling around trying to make the Billions scammed off the NHS by IT experts look like value for money.

Valentine Trodd, Community pharmacist

Nail on the head... they don't have the same agenda to keep the customer happy at all cost. In my experience, sad as it sounds, most surgeries don't care.

Kevin Western, Community pharmacist

This has been happening here for over a year now and its fascinating that the over ordering hasnt gone way (despite the CCG's assurances about the skill of surgery staff)  ... but I can now say not me and assume all is correct... and when the rx doesnt turn up... not me, strangely, since it always was in the past.... and we dont spend hours every morning answering the phone to take requests...... 

I reckon it has made little difference to items or wastage , increased patient frustration with surgeries and freed up a bit of time.. go for it!

we simply ordered what the patient rang up and asked us to - none of this I want everything - or order for next time when you pick up a script, so over ordering was minimal anyway.

A Hussain, Senior Management

Kevin, you describe exactly what is happening in my situation here.  If anything there is even more waste.

Rekha Shah, Community pharmacist

Similar proposal being consulted on by CCGs across NW London too. I will be keeping a watchful eye on increase in NUMSASS across this area if proposals get implemented. Agree it's short term thinking and we can all see the upcoming issues with patients running out of some of their meds each month as ordered the wrong generic name etc - however so long as pharmacy is not expected to fill this gap, it might well be extremely welcome reduced  (unpaid) workload which can be utilised towards other income generating work 

Shamir Patel, Community pharmacist

When this happened in our local areas, the emergency supplies sky rocketed with patients forgetting to order their meds. We now refer the patient to 111 and hopefully get the NUMMAS fee.

Sau Sheung Yuen, Pharmacy Area manager/ Operations Manager

Shamir, ethically, are you using your patients as a human shield? The emergency supply regulations are here for the patient's benefit.

Farmer Cyst, Community pharmacist

Not supposed to direct the patient to 111 specificially to get an emergency supply - naughty boy ;-) 

Grace Lewis, Editorial

We'd be interested to hear more about your experience Shamir. Where are you based?

Grace Lewis, News Editor

Valentine Trodd, Community pharmacist

Good on ya - less hassle for me.

Seal Patel, Community pharmacist

First the cutbacks, then this!! Pharmacies will lose a lot of incomes here

Stephen Eggleston, Community pharmacist

Interesting that they will still allow it for patients who "require support"(i.e. mds patients, as they know to block this would cause chaos) - isn't managed repeats just a form of repeat dispensing? And surely all patients will benefit from support, to varying degrees? Helping patients with their medication is an end-to end process and builds rapport - it's not just about sticking a label on it and shoving it in a bag!

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