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Rising demand causes Well to close online prescriptions registrations

The multiple has closed registration for its online pharmacy services temporarily
The multiple has closed registration for its online pharmacy services temporarily

Well had to temporarily stop taking on new patients to “clear the backlog” that built up amid the COVID-19 outbreak, while other online pharmacies have also seen a surge in demand.

The “sudden surge” in demand for its online prescription service meant that Well had to temporarily stop taking on patients for the service, Gill Stone, regulatory and NHS standards lead for the multiple’s digital pharmacy arm, told C+D last month (April 24).

Well has also removed advertising for the online service from its bricks-and-mortar pharmacies and will be “opening up a waiting list for new patients to join the service”, Ms Stone said.

“Clearly, at this time, patients are seeing online services with home delivery as a solution to their lockdown concerns” she added.

Well is requesting that any isolating patient in need of medication first “ask a relative, friend, neighbour or local volunteer service – where possible – to collect their medication on their behalf”.

However, the multiple does “have the capacity to deliver to the shielded and vulnerable patients as identified by the government,” Ms Stone explained.

Echo: Moved to 24-hour operation

Echo – a repeat prescription app owned by Lloydspharmacy parent company McKesson – has also seen prescription nominations increase “significantly since the start of the coronavirus situation”, a McKesson spokesperson told C+D last month (April 24).

However, prescription turnaround times have “remained steady”, as the company has moved to “24 hours of operation, six days a week”, grown its fulfilment team by 50% and tripled its patient care team, they added.

Data from NHS Digital shows that Pharmacy2U, Echo, and Well’s online services currently have some of the highest numbers of patient nominations for prescriptions. 

Figures updated on May 1 reveal that Pharmacy2U topped the list of active nominations for England with 490,774 while Echo had 182,032 and Well 86,188.

Pharmacy2U: 10-day wait time

A COVID-19 statement on the Pharmacy2U website tells customers it “may take up to 10 days” for orders to be processed, due to the increased demand.

C+D contacted Pharmacy2U for comment, but it did not provide further detail than the information on its pandemic webpage.

41 Comments
Question: 
Has your number of EPS nominations increased recently?

Matthew Edwards, Community pharmacist

On the upside I have had so many disillusioned online pharmacy patients come to me that I am happy to show how sensibly a bricks and mortar can out perform them

Lucky Ex-Locum, Superintendent Pharmacist

I wonder how many of those new nominations are actually necessary or fall into the 'fat and lazy' 'paranoid' or 'high sense of own importance' categories rather than 'vulnerable' which is what the service should be reserved for.

Leon The Apothecary, Student

Are you saying that the "fat and lazy" are not allowed to use online pharmacies? Are online pharmacies only for the vulnerable?

That's not very inclusive thinking, in my opinion, nor should it be a consideration for a professional.

Interleukin -2, Community pharmacist

I think pharmacists understand what he meant. He meant no harm nor malice to any particular group or demographic. You are trying to stir trouble. Save your energy.

Lucky Ex-Locum, Superintendent Pharmacist

Frankly, given that vulnerable people are dying for lack of medication because they can't get them delivered and there are people who are registering for online deliveries who are perfectly capable of getting to a pharmacy, then yes, that is precisely what I'm saying and I don't think professionalism or lack thereof has anything to do with it. If you couldn't get your vital meds because you were housebound but some slob down the road who couldn't be bothered to get off his backside to fetch them (and from experience, I know this happens - we had to ask a staff member  to deliver a few days ago and when they got there, there were two cars in the drive and two people who could have come and fetched it but wouldn't.) was receiving a delivery, how would you feel?

The one thing I'll concede to you is that fat people should be self-isolating anyway so they may well need their self-inflicted diabetes medication to be delivered.

John Cleese, Production & Technical

Who has died during the pandemic because they couldn't get a medicine delivery? You're treating this as a zero sum game; you seem to think that for every non-vulnerable person who chooses a home delivery, a vulnerable patient dies.

And "Interleukin -2", it was "Lucky Ex-Locum" who was trying to stir trouble.

Lucky Ex-Locum, Superintendent Pharmacist

I was in no way trying to stir trouble, and as Interleukin-2 was pointing out, anyone who is actually a practicing pharmacist would understand what I meant. It has ALWAYS been the way that the pharmacy delivery service has been abused by those who cannot be bothered to fetch things for themselves, always to the detriment of those genuinely in need. This Covid volunteer service will be exactly the same as is the online pharmacy delivery service. There are those among us who believe that life owes them a living and will take anything which is on offer, provided it has that magical word 'free' attached to it. Anyone with a grain of common sense would understand it is not a 'one in one out' scenario but if even one person dies because they didn't get their meds in time (and I'm referencing other articles I have seen which have raised this as an issue) that is one too many. I don't personally know of anyone who has died in this way but I acknowledge this as a possibility.

As a reply to Leon, obviously, within the capabilities of the pharmacy and it's operations, all are equal, but what happens during a situation such as we have now where the capabilities of most pharmacies are stretched to breaking point (again, from experience, I know this to be the case - my local GP owned service has restricted deliveries to over-70s and housebound only which I believe is a decent model) and we have requests from a 35 year old who is on furlough but is a little bit worried about catching something and also an 85 year old with brittle asthma but we only have the capability to deliver one thing (hypothetical I know, but if you have a grain of pharmacy in you, you'll understand what I mean) then you have to make a choice who is more deserving. I'd like to think that you have the humanity to make the correct choice. You are exactly right though in that we are too lenient and have most definitely made a rod for our own backs.

John Cleese, Production & Technical

This question was put to you: "Are you saying that the "fat and lazy" are not allowed to use online pharmacies? Are online pharmacies only for the vulnerable?" - your reply was "yes, that is precisely what I'm saying".

You then said "fat people should be self-isolating anyway so they may well need their self-inflicted diabetes medication to be delivered".

You then posited that an able-bodied person who chooses a home delivery option is someone "who believe[s] that life owes them a living and will take anything which is on offer, provided it has that magical word 'free' attached to it."

If all that's not trying to stir trouble, then I don't know what is!

My opinion is: if there is a system that people can take advantage of, that's partially the fault of the system. Don't moan about your delivery problems if you know you've got people taking the mickey - prioritise the vulnerable, calmly. Ask people WHY they need a delivery when you are likely to be overwhelmed, then you can make DECISIONS. We're great as a profession at moaning about our workload or our circumstances, having made no attempt to manage them at all.

Lucky Ex-Locum, Superintendent Pharmacist

OK, maybe it looks to you like I'm spoiling for a fight, but frankly, unless you've worked in pharmacy you don't get the frustrations we feel. I'm fed up of getting requests for deliveries (and yes, I'm aware that this has morphed from an online angle to a deliveries one) from people who are perfectly capable of getting their medication for themselves but just can't be bothered. If I substituted the word 'fat' (and yes, I am fully aware that obese people may have other issues going on) for just 'lazy' how would you feel about that? I don't think a pharmacy delivery service should be for people who can't be bothered to get off their backsides and look after themselves, it should be reserved for the genuinely needy. It's a similar thing to what's hapopening with supermarket deliveries at the moment whereby genuinely at risk people can't get food because the system has been taken over by selfish 'worried well' or downright bone idle (and most people now have more time on their hands than they know what to do with).

If you read the last paragraph where I replied to Leon, I think you'd see that I said more or less exactly what you said in your last paragraph. However, as I've said before, until you've worked in a retail pharmacy, do not lecture us on what we should and shouldn't be doing.

As for your quotes - it's very easy to take selected passages and quote them to make comments look worse than they are - if you'd taken the whole passage, you would realise it has a different meaning to what you clearly are intent on twisting it to mean. I'm saying that vulnerable people are suffering difficulties because certain sections of our community see it as their right to have things delivered into their hands so they don't have to lift a finger.

I sincerely hope you are never in the position where you desperately need something, are unable to leave your own home but can't get what you NEED (not WANT) because of selfish, lazy people and if you think that is stirring trouble, then so be it. I'm a firestarter.

John Cleese, Production & Technical

When you put it like that, then I think we're on the same page. If delivery capacity is not limited, then there's no issue, and able bodied (and even lazy) people have the right to choose a convenient service if that's what they want. However when the system is saturated then there are choices to be made - most likely, by the service provider, because "people are people".

I have lots of experience in retail pharmacy, and I also prefer evidence over anecdote. However I think we've reached our common ground here :)

Lucky Ex-Locum, Superintendent Pharmacist

I believe we have. Fun locking horns with you Mr Cleese!

Leon The Apothecary, Student

It's more effective to post a conflicting opinion than to ask a question. We're hardwired to correct someone we perceive to be wrong!

I would argue if allegedly patients are dying because the pharmacy in question is unable to handle the workload, then that is the failure of the business to realise the limitations of what it can realistically provide or the capability to prioritise its workflow to avoid patient risk.

Your example is a reasonable situation we all have come into contact with and touches upon the point I am making. You are saying that one person is more deserving for another just down to capability. Deserving becomes subjective, and we stray away from clinical. From your example, both patients would receive a delivery, so they are both suitable, in your mind.

You mentioned that this patient "wouldn't" come to collect it, but you decided to send a staff member to do so.   Would it be fair to allow the patient in question to make an unwise and informed choice in regards to their health? For things like these, it is my personal opinion we are too lenient for situations like this. Or perhaps we are simply unpracticed at it?

I am confident that you would bend over backwards for your patients, and to a certain extent, are we simply creating a more difficult situation for ourselves in the long-term? It is a different perspective to yours, certainly, but I hope you don't disingenuously discard it because it differs from your own.

Lucky Ex-Locum, Superintendent Pharmacist

Don't have a problem with you at all, Leon. I quite enjoy our little disagreements actually. Are you a student btw or are you like me? I'm not a superintendent any more, not lucky any more (back to locuming until I can get out) but haven't changed my details because it now seems that C and D want to know everything about you before they'll let you change anything.

John Cleese, Production & Technical

Incase anyone hadn't noticed, demand for pharmacy services has increased quite a lot in the last few weeks.

https://www.chemistanddruggist.co.uk/news/covid-19-increase-dispensing-volume-npa-reports

https://www.chemistanddruggist.co.uk/news/boots-hires-more-500-drivers-meet-covid-19-delivery-demands

https://www.chemistanddruggist.co.uk/news/multiples-redeploy-staff-branches-alleviate-covid-19-pressures

"Public should be informed that the wait time at your local pharmacy will be 10 minutes" - hilarious!

Leon The Apothecary, Student

We have given ourselves a rod for our own back when it comes to time expectations, in my opinion. It has become a common expectation to not have to wait for medication. 

Lucky Ex-Locum, Superintendent Pharmacist

It takes longer than ten minutes in the chip shop! Is that what we've descended to? (no slagging off of chip shops intended - they are fast food, we ain't fast healthcare because fast healthcare leads to dead people)

Sunil Gupta, Community pharmacist

"It may take up to 10 days." 
But don't worry your community pharmacy will sort things out when we leave you without medication. 

Lucky Ex-Locum, Superintendent Pharmacist

What about acutes? Would someone have to wait 10 days for, say, trimethoprim? I can't imagine (in fact, having worked closely with GPs, I know) that GPs have the nous to check about this and change the nomination before they ping off the prescriptions so acutes will be going to online as well and patients will be suffering.

John Cleese, Production & Technical

Similar situation to what would happen in the old days if the GP printed a paper script for an acute, and put it in the Boots bag instead of the Lloyds bag. After 11 years of EPS2 (15 years since EPS1!), GPs should have the "nous" by now, or at least a national guideline issued to all of them to remind them of the correct procedure.

Lucky Ex-Locum, Superintendent Pharmacist

They wouldn't read it anyway. They never do.

John Cleese, Production & Technical

Whoops! C+D forgot to mention in this article that Echo is also advising patients to order their prescriptions 10 days before required. (https://www.echo.co.uk/blog/coronavirus-covid-19-and-echo) They also forgot to mention that Superdrug have temporarily stopped new patient registrations, and Boots online pharmacy are limiting incoming prescriptions. Bit unfair to take it all out on Well and P2U - they're all under increased pressure.

Lucky Ex-Locum, Superintendent Pharmacist

Poor dears. Welcome to the pressure club.

Are the GP surgeries in on this as well though, or will all of those 10-day earlier requests come back to say they were ordered too soon?

Leon The Apothecary, Student

I suspect they want the additional three days to work the request into the hub's own systems and then send the request at day three. Makes perfect sense to me.

C A, Community pharmacist

"will all of those 10-day earlier requests come back to say they were ordered too soon?"

 

What do you think? The "good" ones may post-date the rx, leading to confusion and delay because it feeds into the "online" like it was ordered late, the "bad" ones will just discard the request because it's too early and NHSE advised not to process scripts early or allow stockpiling (or some such)

 

That said, patients don't alway make it easy. I had someone in to collect on Saturday (02/05/20), and they ordered their script at the start of April...

Joan Richardson, Locum pharmacist

EPS niminations are bound to increas as GP surgeries will not let you enter just to collect a prescription unless it is an emergency.

I have been forced to nominate a pharmacy against my will as I prefer the prescription in my hand to take wherever is convenient at the time.  The dispensing of said prescription has been a debacle and it is only the fact that I know pharmacies are struggling at the moment that has prevented me from losing my temper.  I only hope that I can get the nomination removed before my next prescrition is due.

Leon The Apothecary, Student

Joan, you don't need to nominate a pharmacy. Just have your doctor's upload it to the Spine, then present yourself with your NHS number at the Pharmacy of your choice, where they can access the EPS tracker, and download your prescription.

Some good CPD for you there?

Lucky Ex-Locum, Superintendent Pharmacist

Are you genuinely a student? If so, you have much to learn.....

Lucky Ex-Locum, Superintendent Pharmacist

My wife requested a script from our GP in an emergency, so rather than picking it up for me to do, they asked for it to be sent to the pharmacy and guess what? - they didn't send it! A pharmacy staff member then spent about 20 minutes of their valuable time tracking it down, going to the surgery to pick it up (ok it's next door but even so), defeating the whole object of the exercise, and then another 15 minutes to dispense, so over half an hour of time wasted, massive queue build up behind me and me stood in a probably infected pharmacy (we've had covid cases in the surgery) potentially taking the infection home to a vulnerable person (kidney disease) just because the surgery didn't send the script over as requested, and IT WAS THEIR BLOODY REQUEST!!!! Pharmacies are struggling but coping. GP surgeries have all the time in the world because they aren't seeing patients yet are still crap!

Oh, and my surgery doesn't do EPS because they a) are a dispensing practice and b) have their own pharmacy.

C A, Community pharmacist

I thought NHS Digital had nearly 100% of surgeries live with EPS now?

Lucky Ex-Locum, Superintendent Pharmacist

Not dispensing GPs or ones with their own pharmacies. They are holding out for as long as possible because they can only lose out by being EPS live. Remember this is GPs we are talking about - they don't dance to any tune other than their own. 

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