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Pharmacy’s repeat prescribing targeted for NHS savings

The Scottish government should make changes to the pharmacy contract to ensure pharmacists do not have an incentive to over-order repeat prescription drugs, Audit Scotland has warned, in an attempt to save the NHS £26 million a year.

The Scottish government should make changes to the pharmacy contract to ensure pharmacists do not have an incentive to over-order repeat prescription drugs, Audit Scotland has warned, in an attempt to save the NHS £26 million a year.   

NHS boards and patients in Scotland had reported "a number of problems" with pharmacy repeat prescription services that were contributing to drug waste, according to an Audit Scotland report.

Some patients were receiving all their drugs, including painkillers, some of which would normally only order when required, it said.    

The report, published last Thursday (January 24), called for the government to make changes to the pharmacy contract by removing "the incentive for pharmacists to over-order repeat drugs" caused by paying pharmacists for each item they dispense.

Audit Scotland estimated that the NHS could save £26 million a year without affecting patient care by reducing medicine waste, reducing the use of drugs considered less suitable for prescribing and increasing generic prescribing.

NHS Boards should also work with GPs to ensure they only prescribed more expensive versions of drugs to patients who clinically needed them, it said.

But the watchdog commended GPs for cutting spending on prescribing by 11 per cent in 2011-12, despite the volume of prescriptions rising by a third since its last audit in 2004.  

Pharmacy had played a "vital role in controlling the costs to the NHS of drugs prescribed by GPs," said chief executive of contract negotiator Community Pharmacy Scotland Harry McQuillan.

"It is community pharmacy, using existing efficient practice, which manages the buying of these medicines on behalf of the NHS – contributing to a saving for the taxpayer of many millions of pounds," he said.

"We agree... that there is scope for more improvement," he added. "Through the Chronic Medication Service, through reviewing less suitable medicines and through increased use of generic medicines, community pharmacy contractors will play a vital role, working with our partners in primary care and beyond. It would be good to see that contribution recognised by the auditor general." 

The Scottish Liberal Democrats revealed earlier this month that the disposal of unused drugs was costing Scotland's NHS half a million pounds a year.


Chad Harris, Community pharmacist

You don't value something that is free!
Until we introduce a charge of some kind for every item this will continue, no matter how many MURs you do.
Oh, btw, people lie! MUR on one man, all ok, fully compliant, blah blah blah... dropped dead few months later, family returned bag fulls of sealed drugs. Was barely taking anything! He just gave all the right answers to the pharmacist doing the MUR!
And if a senior retired GP was hoarding, what hope for anyone else...?!

Hassan Argomandkhah, Community pharmacist

A simple 50p charge for each item and removal of all exemption categories except children, will produce.
1) less waste by patients not ordering unwanted items.
2) Less chance of ordering by error in pharmacies, as patients will not collect something they don't need and pay for it.
3) No more nonsense of script switching by PPD.
4) No more scrutiny of patients exemption entitlement which can be awkward.
5) Less penalising of current paying patinets as they will have a 15 fold decrease.
6) Potentially more money to NHS, as everyone is paying plus no need to check/ investigate exemption claim.
7) However I can not see any government have the courage to introduce such measures as they want to be elected, and it may not be popular by certain voters.
8) But most of this can also be acheived if pharmacy was paid for looking after patients (per Capita payment for each registered patient) rather than strive for higher numbers of items. Afterall this is how GP practices get paid. Payment will be linked to quality indicators and the pharmacy / pharmacist providing better services that meet those qualitities will be rewarded more.

Leon The Apothecary, Student

I have a little story relating to this actually, see what you think.

Unfortunately, I was tasked with the return and disposal of medicine for one of our patients who had passed away. This patient was particularly noteworthy to me, because would only except a certain manufacturer's brand of their painkiller, sometimes giving him a few emergency supplies as they frequency left it to the last minute to request a prescription from their doctor ~ as you do.

Now, I had three bin-bags full in front of me and what do I find? That's right, all those painkillers that I had spent a lot of effort ordering especially for. A month's worth? No. Several month's worth? Not even close. Try somewhere along the lines of 2 years of hoarding and that would be accurate along sealed inhalers, and a worrying about of schedule 2 controlled drugs.

And you know, this wasn't the first time this scenario has turned up and I'm confident that it won't be the last time either. There is a definite wastage within the system that personally seems really simple to be improved upon and linked to other services we provide. MURs for example would be an excellent engagement opportunity to really look at what patient actually needs.

Even when it comes to aspects such as polypharmacy. Medicine should be kept to the bare minimum rather then piling on another pill ~ a refinement to a regime if you will. There's many examples that I can think of just off the top of my head. Definite scope for medicine management to develop.

Sarah Roberts, Community pharmacist

When the ex senior partner of the local surgery died , his family returned 5 carrier bags of drugs ,all untouched that amounted to at least 12 months worth of medication. He had been ordering them personally monthly and would object if there was any delay in supply. He had a cardiovascular disorder and I would think that all of the prescribed medication was important. If he wasn't taking them with his knowledge and experience what hope do we have?

Ianto Jones, Community pharmacist

The actual Ordering of the prescription should be done by the patient.... not ringing the pharmacy to place an order on their behalf. The pharmacist should ONLY be picking up the prescriptions from the surgery and perhaps delivering to deserving patients... Its about time the patients take controll of their own medication...

Underrated Professional, Locum pharmacist

What about patients who do order themselves every month for the past 5 years eg 4 ventolin inhalers, 30 belladonna plasters , 3 seretide 250 inhalers, 48 Proctosedyl suppos just to name a few ( by the way different patients). I have told surgeries to remove from patients records to no avail. GPs sign blindly!.....I got a patient being prescribed Influvac monthly for 3 years now, I can't be bothered to phone anymore....

Vishant Patel, Community pharmacist

Having just started the process of transfering patients to EPS release 2, some are asking whether we will be ordering on their behalf. This won't change for us but I know why some people believe that pharmacies should order, dispense, deliver and take the meds for their patients (the last bit is a joke).

I believe that patients are taking these medicines for their benefit, so they should take some responsibility for ordering them unless due to extenuating circumstances they can't do so.

Snowfire 42, Locum pharmacist

Repeats should only be ordered when patient requests it, not automatically ,every month,

Sue Per, Locum pharmacist

One other point this article overlooks is the fact that uncollected "repeat- order" medication is returned to stock, and the prescription presented for payment, thereby accruing further profit, and some might also call it petty fraud. This realization has been too late in coming!!
Rocket science i suppose!!

Robert Jones, Other pharmacist

Fraud is fraud and thereby illegal irrespective of the degree.

Sue Per, Locum pharmacist

Correct Robert, so where is the fraud squad. On the snooze i suppose.

Chris Locum, Locum pharmacist

If the patient fails to collect it is not our fault. If they had to pay the true cost as in other healthcare systems, they might not forget. If something changes most pharmacists get in touch with the surgery. Waste in the system is high enough without non collection of medicines which can be returned to shelves.

If community pharmacy had to rely on this as some kind of 'profit' it is in a more financially precarious state of affairs than is good for us or patients !

Sue Per, Locum pharmacist

Chris, if you read the article carefully, it clearly states ordering medications not required, particularly "PRN's "and the root cause is the automatic repeat ordering, where one is unlkely to detrmine the need one or two months in advance.Secondly if the items is not collected, and is returned to stock, then the prescription cannot be presented for payment, just as one wouldn't if the prescription tax is greater than the item value.This scheme of automatic ordering was devised not for the patients benefit, but to ensure that a prescription was not lost to a rival pharmacy, purely commercial reasons!!. Finally community pharmacy is not in a financially precarious state, as is indicated by ever increasing values and desire to open. otheriwise you would be witnessing a "fire sale" of the same.

Lord Sugar, Community pharmacist

This is hardly PETTY fraud!

Pankaj Sodha, Community pharmacist

And this was one of the reasons why I set out to design Pillmanager
App available on iPhone and android and PC.. I suggest the authorities visit and see the win win win product for patient , pharmacy, and the NHS

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