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Readers split over scrapping pharmacy repeat prescriptions

Exclusive
CCGs claim reducing repeat prescribing will save the NHS millions

C+D readers are split over whether a scheme to prevent pharmacies from ordering repeat prescriptions should be rolled out across the country.

Three clinical commissioning groups (CCGs) in the north west of England and East Anglia have implemented schemes to stop pharmacies from reordering prescriptions – with the hopes of saving the NHS around £10 million a year in wasted medicines, C+D reported on Monday (August 15).

Pharmacists commenting on the C+D website were divided between those who hoped for a wider rollout of the scheme across the UK and those who branded it a “step backward”.

“No prescription without request”

Community pharmacist Michael Franks agreed with the CCGs that “no prescription should be requested without the patient requesting it”. “I ask the patient to contact us seven days before the script is due,” he said.

Pharmacist Reeyah H said they are “100% for” nationwide rollout of the scheme. “[I'm] sick and tired of moaning patients who have become so lazy, and the workload for staff,” they wrote.

A community pharmacist posting as Barry Pharmacist praised the CCGs’ decision as “the end of the line for unscrupulous individuals that drag us down”.

“If it applies to everyone, and is not manipulated by GPs with a commercial interest in a particular pharmacy, then let it be,” he posted.

Community pharmacist Kalpesh Shah said he “completely” agrees with the scheme, which would affect multiples used to “asking patients to repeat their medicines every month”.

However, he questioned who will “pick up the slack” of the extra prescription requests currently handled by pharmacies. “Surgeries up and down the country have got used to pharmacies dealing their repeats and most do not have staff in place to deal with extra prescription requests,” he posted.

“Totally against the idea”

Other readers were more vocal in their concerns. Dispensing assistant Sam Isted said his pharmacy had already tried to “implement this change” and he is “totally against the idea”.

“I work in an area where roughly 80% of the population are elderly patients who do not have access to the internet or are unable to get to the surgery,” he posted. “Surely patient safety should come [before] any money saving scheme?”

A community pharmacist posting as R Patel said the scheme was going to be “such a disaster for some independent pharmacies, as “the [GP practice] pharmacies in these pilot areas will pick up all the scripts”.

“Yet again, bad practices by some pharmacies – mainly the big multiples and large groups – have created this problem,” they added.

Pharmacy staff member Robert Miller labelled the scheme a “step backwards”. “The present arrangements [are] working well. This change will put pressure on surgeries and inconvenience patients,” he wrote.

Locum pharmacist Hadi Al-Bayati said he “agreed that more [responsibility] should be put on the patient", but added that he is “curious what [a] surgery's policy will be if you can’t get there to order [the medicine] and don’t have a computer”.

He questioned whether GP practices would be forced to “staff a prescription ordering service” to deal with the extra demand.

The Twitter response


Read a retired pharmacist’s view on the dangers of repeat prescribing

Result

Do you think all pharmacies should be prevented from ordering repeat prescriptions?
Yes
57%
No
43%
Total votes: 281
17 Comments
Question: 
Do you think repeat prescribing in pharmacies should be stopped in all pharmacies?

Paul Summerfield, Community pharmacist

I agree with stopping this completely. It will make patients take responsibility for their own medication but equally important it will stop a push, by some contractors, to "lock" patients in to the pharmacy by converting the prescription from walk in to lock in. What ever happened to patient choice? 

I will back this 100%.

Seal Patel, Community pharmacist

I 100% agree with this, I can accept some patients are not able to order their medications but Im sure there would be plans put in place for these particular patients.

Let patients be responsible for their own medication, let the surgury take the burden of "why havent I got this medication", when items are missed of signpost them back to the surgury, when patients come in for emergency supplies during surgury hours ask them to speak to their surgury, when a patient rings up regarding issues with quanity etc ask them to contact surgury,

 

Anonymous Anonymous, Information Technology

Do you really think I care one jot about ordering patients' meds???! We order what the patient asks of us and when there's a problem (usually caused by the surgery) we take the flak! Let the CCG find a more expensive way of doing what we already do so that we can spend our time doing what we actually should be doing rather than admin work and sorting out the surgeries' problems! Good luck to them!!

PHILIP CLARK, Pharmacy

What is wrong with this profession of ours? We are acknowledged medicines management experts and yet we do not formally trumpet the benefits of Pharmacies dealing with repeat prescription orders. Patients, especially the elderly, are notorius for forgetting which meds to order, ordering the wrong thing, and building up stockpiles. I am convinced that, once again, the majority of Pharmacists are doing the right thing and providing an excellent service to our patients. The bad apples are, as usual, getting all the headlines and influencing policy which will affect us all. I want someone in the Pharmacy heirarcy to ask the CCG's how many extra hospital admissions have had to be made, and at what cost, due to inappropriate or missing medications.  Also, how have they arrived at the conclusion that Pharmacy is to blame for the waste and not the patient?  Seems to me we have the rough end of a very big stick, ONCE AGAIN!

Shaun Steren, Pharmaceutical Adviser

Can you explain the 100k per month saving by LCCG? I have not seen the data or methodology, have you? 

b t, Manager

Once again we see how unethical behaviour by multiples and their lackeys, their area managers, have led to a culture of staff being coerced into ordering unneccessary items and then banking them as extra profit.

The GPhC will investigate ? Doubt it.

Diana Taylor, Primary care pharmacist

There is a huge difference between the regular take one a day items and the prns, creams inhalers, insulin etc. The latter should always come directly from the patient, it would save hassle for the pharmacies and money for the NHS. Just an opinion. I don't have any evidence.

Mr CAUSTIC, Community pharmacist

I did not say I agreed with the idea of stopping pharmacists ordering scripts for patients. I do not agree with it ! What I said was :-

no prescription should be requested without the patient requesting it. I ask the patient to contact us 7 days before their script is due. 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.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. 

The original can be seen in the replies from yesterday. Whoever wrote todays article obviously did not read my email or has given the impression that I agreed with the proposal when it is clear that we do the request for the patient BUT ONLY after they have made a request. They should stop Pharmacies automatically making requests without patient contact.

John Urwin, Community pharmacist

It could be argued that there is no difference in terms of prescription generation between Managed Repeats and EPSr2 Repeat Dispensing. In both cases a prescription is sent to the pharmacy without direct patient involvement.

BUT, the difference comes when the patient comes to collect their prescription. It seems there is massive waste with Managed Repeats as the bag is simply handed to the patient without any attempt to establish actual need and grave suspicions as to the fate of any declined or uncollected items.

With EPS2 Repeat Dispensing (or the older manual system) the patient should be questioned to ensure each item is required ON THIS OCCASION. It is a strict requirement of the system. Any declined items are processed as Not Dispensed and this is visible to the prescriber. This process provides an excellent opportunity to explore possible compliance issues.

I am unclear if EPS2 RD is included in the ban. I hope not as EPS2 RD has the capability of reducing workload for surgery, pharmacy and patient. I would strongly argue for EPS2 RD becoming the norm for supply of most regular medication.

Angelique Dunne, Community pharmacist

What worries me is we have all spoon fed the patients for so long they will not order in sufficient time.  What about all the "but I've run out" conversations pharmacies will need to have, not to mention all the "if I die it's your fault".

 

 

 

janet maynard, Community pharmacist

Had exactly this last week- patient told me she was going to die as I hadn't ordered her co-codamol! (though how I was supposed to know she needed them is anyone's guess- we don't run a manged repeat system!) Patients/customers are so used to us ordering scripts for them and/or lending when they forget that it will be a massive amount of work in the short term and lots of angry conversations! I see patients/customers blaming us for not ordering the scripts regardless of whether it is our choice or the surgeries or the CCGs

 

Hospital Pharmacist, Hospital pharmacist

Not necessarily, I have locumed on weekends and have been expected by pharmacy staff to provide an emergency supply to patients for which they manage the repeat slip however 'forgot' to send it to the GP surgery. What is that documented as, supply at the patients request? or at the GPs request? My guess is at the request of the multiple who wish to retain 'customers' not patient.

Sachin Badiani, Pharmacy owner/ Proprietor

If it's the pharmacy's fault, then you should record this as so.

Matthew Edwards, Community pharmacist

Not all contractors are for keeping managed repeats. As I commented on the original article its a wasteful procedure for the multiples to create extra profit.  however as an independent contractor I take phone calls, repeat forms off patients and ferry them to the surgery, this is a service my patients value and as we only order what the patient asks for at the time of request (3-4 days before the script is needed) I can't see any problem.

SydBashford Sold&Retired&DeRegistered, Community pharmacist

The changes are really to STOP:
Pharmacies ordering patients meds automatically with no patient involment.
Pharmacies ordering everything regular (for Homes) needed or not.
Pharmacies being lazy and requesting patients sign the request a whole month before.
I have never been involved in any of the above. It is a shame that we cannot accept patient requests over the phone, but to be honest, it is generally patient laziness becuase they dont want to wait for the surgery to answer, or the surgery have limited Rx phone access.
I wholeheartedly agree that something had to be done about it. It has also been implemented in Nrth Yorkshire. I Genuinly hope that the surgeries stick by the principle, and if they have to man the order line more hours, so be it.

M Yang, Community pharmacist

I've encountered a similar issue north of the border, with some health boards and individual surgeries doing similar things to reduce unneccessary prescriptions being generated. Personally, I think this is a move in the right direction. Having worked for Boots, I know from first hand experience the blanket approach was used and actively encouraged by area managers, with items being ticked off whether or not they were needed, and patients were often barely involved in the process. The result was that patients would be missing the meds they actually needed or return with bag loads of meds they didn't need. My only gripe with what the CCGs are doing is that well meaning pharmacies will no longer be able to take patient requests and ferry them to the local surgeries to be processed. The independents have good systems in place to accept requests when the meds are needed (Michael Franks gave a good example). There must be a better way than the indiscriminate approach being proposed. Surgeries typically have a decent relationship with the independents and it shouldn't be hard for them to identify which pharmacies are guilty of abusing repeat prescription ordering and tackle the problem individually.

Valentine Trodd, Community pharmacist

Contractors = for, employees = against

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