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Pharmacy jobs threatened by CCG halting repeat prescriptions

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Warburton's, Fleetwood; one of O'Brien's six branches. Credit: © 2017 Google, image capture: July 2016

Two pharmacy staff are at risk of redundancy following a clinical commissioning group (CCG)'s decision to block pharmacies from ordering repeat prescriptions, C+D has learned.

Fylde and Wyre CCG announced on October 31 that it will stop pharmacies from ordering repeat prescriptions for most patients, in a bid to save an estimated £1.6 million in waste medicines.

Six-branch chain O’Brien’s in Fleetwood and Fylde, Lancashire told C+D last week (November 15) it will have to consider making two members of staff redundant when the new prescribing policy comes into effect in local GP surgeries, unless another role can be found for them.

The staff who manage the service have full-time roles, dealing with 3,000-4,000 patients a month, superintendent pharmacist Lisa Cottam said. But the combined impact of halting repeat prescription ordering alongside the funding cuts in England means “we just can’t afford to keep these staff”, she said.

Announcing the policy change last month, the CCG said it had already been implemented in two GP practices, with more to come on board “in the coming weeks”.

Patients who a pharmacy feels “would struggle to cope with the change will be exempt”, the CCG said.

“Practices will work with any particularly vulnerable patients and their families to ensure they are not negatively affected by the changes,” it added.

Guidance causing “confusion”

Ms Cottam said the lack of clear guidance on the definition of a “vulnerable” patient is “creating confusion for pharmacy staff and the patients”.

Some patients who had been told they could no longer receive repeat prescriptions from their pharmacy have requested MediPack trays instead – moving onto another free service for which the pharmacies are already “maxed-out on capacity”, Ms Cottam said.

She is also concerned that when patients try to order medicines from GP surgery reception staff, they “won't necessarily have the same training” on identifying patient’s medicines needs as pharmacy staff, she said.

“This level of support for these patients will need to come from somewhere, or it will burden other aspects of the NHS services,” she said.

Practice staff “concerned”

Ms Cottam said a manager at a local GP practice where the change had not yet happened was “quite concerned about the additional workload”.

They were “already stretched” and “not getting any additional funding”, she said. “They’ve been quite happy with us offering the service”.

CCG aims to improve patient safety

As part of the CCG’s announcement last month, its clinical lead Dr Jacky Panesar said: “We have seen that when patients order their own prescriptions, this is safer and reduces waste.” She claimed that the prescribing policy change “will make sure more and more people understand their medication”.

Waste costs the NHS “hundreds of millions of pounds every year” through “over-ordering, stockpiling and unused medicines”, Dr Panesar added.

43 Comments
Question: 
Are CCGs planning to stop pharmacy repeat prescriptions in your area?

Steven Ash, Pharmacy technician

Apart from the fragile, elderly and vulnerable patients. I believe patients need to take more responsibility for their medication and not rely on the pharmacy. I will be so happy if this is enforced.  Please make it happen :-) 

Anant Patel, Superintendent Pharmacist

Work in an independent attached to a surgery. The CCG implemented this change last year here. It freed up quite a lot of staff time not having to chase rx that had been ordered. Some patients moved to pharmacies closer to where they live as we no longer order for them but overall rx numbers are slightly up. 

Jonny Johal, Pharmacy Area manager/ Operations Manager

Am I right in say that every CCG that has stopped pharmacies ordering prescriptions have seen savings? I personally have seen regular over-ordering, and then when the medicines come back for disposal, the staff laughed at how wasteful the patients have been! If you play the system, this sort of consequences will become inevitable.

I have worked for a multiple whose pharmacists report on a weekly basis the number of collected prescriptions, because there was a target. I suspect that system is still in place in that multiple.

Sunny Jim, Pharmacy Buyer

Go to any multiple, you’ll see endless bags of Rxs not collected . I’ve even seen area managers tell pharmacy managers to put rxs through even though they not been collected ..,,

Leon The Apothecary, Student

Random idea. Third party system?

Reeyah H, Community pharmacist

The patients will carry on ordering and storing unnecessarily. Nothing is going to solve. Unless of course the receptionists are going to pop down the patient’s houses and check. Meanwhile, whoop for us. Less work! 

Brian Austen, Senior Management

The problem that has caused this to happen was pharmacies ticking against every medication on behalf of patients, in many cases not even bothering to ask the patient what they actually need! How do you think GP surgeries feel when the get repeat request from pharmacies, even though the patient died a month earlier? When asked the pharmacy said it was an oversight. They also said the same thing when it happened with 2 other patients.

Valentine Trodd, Community pharmacist

This just doesn't add up...
The only thing that appears to be changing is the pharmacy will no longer be ordering repeat prescriptions for patients - a 'service' they presumably receive no payment for.
The patients are entitled to have their prescriptions dispensed where they choose, so again presumably, if they are happy with O'Briens they will continue to use them.
So, unless O'Briens are over-ordering on behalf of the patients, their bottom line won't be affected. The only knock-on effect is some staff time will be freed up. It was OK to pay them to do a job the pharmacy was receiving no payment for - so how can they suddenly 'not afford' to keep the staff? Can't they simply re-train them to do the blister packs (which they won't receive any additional payment for either) that they apparently can't afford to take any more on because they are 'maxed-out'? It's just providing one free service instead of another! That's the trouble of course... too many free services.

Ilove Pharmacy, Non Pharmacist Branch Manager

Over ordering - the elephant in the room. 

Leon The Apothecary, Student

In addition, even more so these surgeries will have a greater need for hiring staff to deal with the increased workload that will entail.

C A, Community pharmacist

It's a convenient excuse to futher reduce staffing levels to compensate for the funding cuts...

Locum from yorkshire Pharmacist, Community pharmacist

It's very chaotic. Some surgeries insist on 56 day rx. Some GP s will only do 28 days.
Some surgent staff cannot master EPS yet the NHS continues to push it down pt throats (pun intended).
Is this an evidence based national decision or what. ?
Evolution or chaos?

Ilove Pharmacy, Non Pharmacist Branch Manager

nail on the head. I'll bet my mortgage director dividends/salary will be unaffected.

Shaun Steren, Pharmaceutical Adviser

Valentine, stop using logic, you are making their argument look ridiculous.

Gerry Diamond, Primary care pharmacist

Hello, I co-ordinated stopping patients except the most elderly and vulnerable ordering scripts through chemists last year in our practice in Blackpool. I have locumed in that chemist in Fleetwood down the road a couple of years ago. The practice budget is now £60,000 less than last year, and our main pharmacy in the health centre had had no job cuts due to our ban on chemist reordering or any other for that matter. Indeed the staff and pharmacist were really thankful as the work flow has changed freeing staff up to do other duties in the pharmacy., receptionsist do not have any extra work load as we do a lot of electronic RDS, and I cannot see any negative impac on chemists or staff jobs. A bit of an exageration in my experience....good luck x

Ilove Pharmacy, Non Pharmacist Branch Manager

You're right but You woun't get a Sun newspaper type headline with that. 

A Hussain, Senior Management

The pharmacy in the health centre will already benefit from an employee of the surgery sending them prescriptions I'm sure.

Hardworking manager, Superintendent Pharmacist

Hi Gerry,

Having worked at your closest pharmacy I note they do not offer a managed repeat service and therefore would not have noticed many changes to workload. I would be really keen to hear how your pharmacies that are offering this service are utilising the staff. I note Lloyds have just listed that they are now charging for deliveries. Of course this is something we have considered but wish to try and maintain our level of care as much as possible. we have so far made few cuts to any staffing or services since the funding changes, feedback welcomed!

Gerry Diamond, Primary care pharmacist

Not true. I have visited all of the pharmacies and have daily contact with its staff and they are even helping me out with the xmas church fayre next week. So yes I do know how it has impacted on local pharmacy staff and they are all glad to see the back managed ordered repeats and the incessant phone call from patients reordering. Ta

Hardworking manager, Superintendent Pharmacist

Hi Gerry, you must have an awful lot of free time during the day to visit all the local pharmacies that you deal with on a daily basis. No wonder you are not concerned about additional workloads on your practice. Our practice pharmacist barely has time for lunch. I have yet to meet a dispenser who isn’t looking forward to the loss of phone calls, and running about doing a ‘social care’ role now this service is in place where we are. It’s a shame all GP surgeries don’t have a practice pharmacist with as much spare time as you, all this work could easily fall to them to be managed. You would habe no issue with it. Your closest Pharmacy has also lost other local funded services so I am amazed they have faced no changes to staffing levels whatsoever. Regards. 

 

Gerry Diamond, Primary care pharmacist

I am very good at time managent, as I have also an MBA and organise myself very effectively. lolx

Wolverine 001 , Pharmacist Director

This is all to do with the multiples auto repeat ordering service - independents in gerneal only order on a phone call another form of communication.  The vast amount of meds ordered especially with MDS trays is staggering.

A lady passed away on our estate recently and i was asked to help remove the tons of medcines waste.  All MDS trays piles of insulin and paracetamol, how can the Dr's acctually provide prescriptions for this.  Until the Big Boys stop this service more CCG's will adopt this policy.  

max falconer, Superintendent Pharmacist

Spot on! CCGs don't get the difference between auto-ordering (eg Lloyds and Boots)=waste of meds and submitting orders instigated by patients= time saved for practices. Then I suppose they are populated with personnel who would struggle in the 'real' word of medicine & pharmacy.

Simple solution prohibit auto-ordering nationally!

Faisal Ali, Manager

Excellent comment Max.

My patients prefer to order through me as A) I can take requests over the phone (most surgeries don't), B) they can specify whether they would like it delivering/ collect and C) my team can answer any queries with regards to the medication being ordered as they have knowledge of the actual meds as opposed to a receptionist (how many times has an elderly patient asked- which ones do I take for blood pressure?).

The surgery team love us taking in requests as it reduces their workload massively. My elderly patients don't order online, they don't email, so the only option for them to order meds would be to physically walk to the surgery. It's so fustrating that unfortunately as you say, some people just don't get the real world implications.

Wolverine 001 , Pharmacist Director

If this was done nationally then the standard BIG BOY response will be "we adhere to our strict SOP's and protocols" blah blah...... These multiples are the scruge of pharmacy - upon opening of our new medical centre I questioned the local Tory MP of her view on the cuts and honestly this was her reaction "Well why do you sell sandwiches and shampoo - surely this makes a profit""

All these MP's use pharmacies - when you walk into a BIG BOY store you can see why they think what they do - 200K per week on retail sales why should they subsidise a pharmacy with establishment payments etc 

Paul Dishman, Pharmaceutical Adviser

 

It's fascinating reading the quote from the GP practice manager that they're already stretched and aren't getting any extra funding to implement this change.

No wonder they've been happy with pharmacists doing the job for free!

VAL MADDEN, Hospital pharmacist

I am a retired pharmacist . The pharmacy who organise my repeat meds only order what is requested by the patient . No waste and a great service .My grandaughter has eczema and fluctuating needs for her emollients and steroid creams , however her pharmacy organise the maximum amount for her month regardless if whether the previous month has been collected and are not happy when her mother says it is not needed .This system is wasteful , may lead to more profit for the pharmacy concerned but is not sustainable for the NHS . Patients need to have some responsibility for their medication requests , they largely know what they need .

Stephen Eggleston, Community pharmacist

Pharmacy-based repeat ordering systems provide a "closed loop" in that the patient orders through the pharmacy who, when the script is received, can often be called upon to rectify any problems ahead of the patient calling in to collect. Orders are initiated by patients, so it grieves me that Pharmacy is used as the whipping boy for over-prescribing - because an order is not wasteful until someone issues an unrequired prescription - so maybe the ire of the CCG should be aimed at the prescriber 

Leon The Apothecary, Student

I'm still vexed at how both pharmacy, surgery and patient do not have one system that can manage prescriptions. 

Clive Hodgson, Community pharmacist

Stephen, as you should know, the problem is not when orders are initiated by patient but by Pharmacy. The so called "managed repeat" system where patient input is often non existant. At best wasteful and at worse fraudulant.

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