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Webinar delegates ‘stunned’ by reluctance to dispense free scripts

Sid Dajani: Pharmacists should use their “professional discretion” in these situations

Royal Pharmaceutical Society representative Sid Dajani was "staggered" that just 16 per cent of readers would dispense to patients who claimed to be unable to pay if a government system deemed them ineligible for free scripts


Delegates at a C+D webinar were “shocked” that less than one in six pharmacists would dispense to a patient who claimed to be unable to pay but who the pharmacy’s IT system branded ineligible for free prescriptions.

Under government plans due to come into force by 2018, pharmacists will be required to electronically check prescription exemptions “at the click of a button”. Only 16 per cent of 153 respondents to an online C+D poll, which ran from March 20 to 23, said they would still dispense medicine for free to a patient who claimed they were exempt if the pharmacy's IT system told them otherwise.

Fifty-two per cent of respondents said they could not be sure how they would act until they knew the repercussions, while 32 per cent said they would not dispense the medicine.

Sid Dajani, a member of the Royal Pharmaceutical Society’s English Pharmacy Board, said he was “shocked, stunned and staggered” by the poll results. He urged pharmacists to use their “professional discretion” in this situation, and called for superintendents and pharmacy organisations to provide the sector with guidance on the issue.

Pharmacists were “not tax collectors” and those who said they would not dispense the medication for free were “in the wrong profession”, Mr Dajani stressed at the C+D webinar on prescription charges, sponsored by Actavis, on Monday (March 23). “[Patients] must always have their medication, otherwise what’s the point of pharmacy?” he argued.

NPA board member and contractor Nick Kaye said that, as an independent pharmacist, he had “slightly more freedom and flexibility” to dispense free medication to patients without an exemption than his colleagues working for large multiples.

But it was “worrying” if some pharmacists would not dispense a free prescription for fear of “repercussions from their employer”, he added.

Fellow webinar delegateTania Francis, partner at health and social care law firm Hempsons, said the government’s plans would leave pharmacists “stuck between a rock and a hard place”, as there could be legal implications both if they disobeyed the system and if a patient came to harm as a result of not receiving their medication.

“Even assuming the practicalities can be ironed out, it seems unlikely [the government has] thought it through,” she added.

The government said in December that it estimated its plans for pharmacists to electronically check for prescription fraud would save the NHS £150 million a year. Last month, a C+D investigation revealed that the Department of Health had failed to carry out an impact assessment or consult with pharmacy bodies before announcing the plans.

Would you dispense free scripts to an ineligible patient?


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Debbie Graham, Public Relations

I live in NI and don't pay for scripts (it was costing more to collect and police than revenue generated) However we are looking at re introducing fees - and I agree that we should. Would it not be a better system for the Govt to tax us all an extra £10 per year (man, woman, child, old, young etc) to pay the overall bill - and then not leave it down to pharmacists to make the call?

Dodo pharmacist, Community pharmacist

Under the new system, I would imagine that if the computer says that the patient is not exempt, then the pharmacy will have no choice but to charge the patient the Rx charge because it will automatically be deducted from the pharmacy's payment. There will no no grey areas, it will be a straight pay if not listed as exempt. I am surprised at Sid Dajani's stance because I normally agree with him on everything, but I think with this system we will have no choice but to charge all non exempt patients.

Sultan Dajani, Community pharmacist

We don't know the system Chris and I'd be surprised if there's no flexibility because it would need to be 100% accurate and updated every second. One could equally charge and issue the blue receipt to get a refund later but I'd argue the flexibility needs to be there inc the exemption not seen box if patients are adamant they're exempt and refuse to pay. If that box disappears and flexibility is minimised then that raises another issue beyond supporting patients - Violence in Pharmacies! PS I always charge all non-exempt patients unless of course items are cheaper to but OTC

Really? Wow, Superintendent Pharmacist

I am glad that there is a lot of discussion as its good for pharmacy to discuss these things and try and get things out there. However, isn't the question quite misleading? Asking someone what they would do in a situation where we don't know what the procedures and regulations are? We are arguing like children about the unknown! The real result of these conversations are; 1. There needs to be engagement with the pharmacists on the ground before anything like this is introduced. 2. Systems need to be in place to manage the issue of the system not working/updated. 3. This is going to take time and I would want a decent fee for this!

Jagdeep Johal, Community pharmacist

Just look at other countries like America and Canada where people are either covered by health insurance or not. Their systems run smoothly

michael mustoe, Community pharmacist

The question is not correct - it should read ... would you dispense a prescription to someone who the computer system identified as ineligible for free prescriptions. The answer MUST be yes if you are a healthcare professional, rather than a robot who operates only according to set rules. We are trained and paid to exercise care and put the interests of the patient first, not the interests of the taxman!!

N O, Pharmaceutical Adviser

Very true and I am sure the taxman agrees with you. But, unfortunately the contractor may not agree with you, unless you give an undertaking that these charges can be deducted from your wages. After all we have trained to put patients first always and who cares if we don't earn enough on the way to achieve it.

London Locum, Locum pharmacist

I'm staggered at the 86% who would refuse to dispense. Pharmacist usually love working for free.

Z ZZzzzz, Information Technology

Just think. If there was no script charge we would not have had to suffer the SJ show for the best part of the past 24 hours. That must be worth at least £500m of anyone's time. If anyone could obtain the total cost of collecting and policing this archaic system, (all costs including staff pension provisions, office costs, etc etc) and still reckons the net return is more than £0 and not negative, then perhaps I might support some form of script charging. Until then I won't. Bet we don't get the true figures as I expect it costs more to police etc than the amount collected. If it were cost effective I would expect someone in the dept would emphasis that every year they put the charge up.

N O, Pharmaceutical Adviser

Actually, it looks to me that, these charges are in place so that the Govt. can pay these policing people at the fraud detection dept. Imagine if the script charges are waved then there is no need of a whole department and this in turn would result in a big embarrassment for the Govt. So this so called tax is not making any difference to NHS at all, in my opinion.

Sultan Dajani, Community pharmacist

agreed :0)

Gareth Rowe, Community pharmacist

I'm in Wales so don't know exactly how the English system will work but I could have a good rant about the concept. If the pharmacist has the capacity to check a patient's exemption and they are not exempt, I don't think there should be any expectation at all that they should supply. All be it that the government will take the money anyway, they are not eligible so could it not constitute some kind of fraud? I have become more and more frustrated by the expectation that pharmacy should make up everybody else's shortfall for free 'because they are medicines'. Supermarkets don't give away food for free (we need food to live), banks don't give free mortgages (accommodation to live) clothes shops don't give away clothes for free etc etc. A few years ago I spoke to my (then) RPSGB inspector about an ambiguously written MST script and was told if I do supply it I could be reprimanded by the Society for incorrect supply but if I don't supply it I could be reprimanded for not fulfilling my duty of care to the patient because the patient needs it!! Perhaps this issue can spark the sorting out of this kind of folly. If we are going to be left with moral issues gives us the same 'professional judgement' latitude that medics have, or, make the guidance black and white but make sure the public and other healthcare professions know the rules we have to play under. Sorry, I did rant a bit....

mohamed nanji, Community pharmacist

My experience of what happen at the pharmacy i was working few years back. A lady came with prescription for migraine for co-dydramol and paid charges, then exactly 2days later came for propranolol and assumed she could return the co-dydramol which did not work. When the staff has her for new charges and explained she could not return co-dydramol, she started to cry that her family budget could not allow her to spend any extra funds for any thing else or her children would suffer. So we paid for her. So Pharmacist find it difficult many a times.

Sultan Dajani, Community pharmacist

I know it's very hard. That's honourable and very kind but I'd have tried to calm her down, explained it's a sickness tax imposed by the government so she doesn't think it's your fault; loan her a few till payday, ask if anyone could lend her the money over the phone with a CC or checked to see if she had any Rxs over the past month and deduct them from a 3-month PPC. This tax heaps unfairness on illness and it's worse when you feel you have to pay for your patients!

I didn't realise that simply saying "its not my fault" vetoes the requirement of responsibility. I completely agree that it is an unfair tax, but I don't think telling a distressed patient so in the pharmacy setting is really the way to go about changing things.

Sultan Dajani, Community pharmacist

I wasn't saying its a solution but many think the tax is due to us because they see it going in our tills. Communicating to patients why there's a problem and helping them to understand the issue means they don't blame us and hopefully they'll be yet another informed voice to the right target.

quite frankly, I don't really care who the patient blames. I'm more interested in whether or not they get their essential medicines. Telling a distressed patient about the tax system isn't particularly helpful when all they want is their inhaler.

Sultan Dajani, Community pharmacist

It's not blame, it's informing the patient

Stephen Eggleston, Community pharmacist

"Loan her a few till payday" - if you mean Emergency supply - that's illegal as I presume from the post she has not had the medication before. And if she doesn't come back? Pharmacy pays for the medication (illegally?) supplied - so not just out of pocket but up in front of the beak! I think as someone who sits on the RPS (our professional body) you might like to consider your words before putting them out there for all to read. I think you might need to accept that, although you may be shocked that only a small number would supply without collecting the charge, that is our reality. And, I believe, there is an element of our funding covers exemption checking and therefore, by association, the collection of appropriate fees

N O, Pharmaceutical Adviser

In the parts of the country where Sid practices, it is quiet common to lend meds without scripts as an emergency supply and deducting them when the script arrives. Am I right Sid. I know many such Independents and some Multiples in direct competition with these Indis following this practice on a routine basis. How about running an audit of the PMR systems on a random basis to prove my point wrong (doubtful it will be) after the National Audit on emergency supplies. The most common thing patients say on a Saturday or when the surgery is closed --- ""Oh I don't pay for my script. The regular Pharmacist always lends me some to tidy over and then takes it off when the script comes from the surgery"" Possibly this what Sid intends to suggest we do with those who say they don't have money and we look for an alternative cash source for the patient, as he has ruled out giving the meds free without the charge of £8.20.

Sultan Dajani, Community pharmacist

It's not an emergency supply if the Rx exists surely?????? Sometimes it's a loan of a few tabs till they come back pay the charge and collect the rest and no one is asking the pharmacist to pay for the meds or falsely declare anything. I guess it boils down to how far you'd go to help your patients and make sure they stick to their care plan.

London Locum, Locum pharmacist

You live in cuckoo land.

Sultan Dajani, Community pharmacist

Better cuckoo land than Neverland you're in chap

London Locum, Locum pharmacist

You even resemble a fat cat banker at an enquiry in the pic. Never let a patient a get in the way of profit eh.

Sultan Dajani, Community pharmacist

Nice blinkered view you have from Neverland mate

Stephen Eggleston, Community pharmacist

Confused here Sid. Are you saying that, if the patient has a prescription but cannot afford to pay for it, you would part supply against that prescription and hold the balance until the prescription is paid? Firstly, that could be interpreted in a way that isn't always positive - I'm not sure what the regulations say about not supplying the whole quantity if there is no supply issue but I feel sure it would view that as a separate issue from the patient being unable to pay. And if the patient doesn't come back? Also as someone else said, "loans" do not exist, legally. It's either supply against a prescription or an emergency supply - if you lend against a future prescription, you need to make all relevant emergency supply records One thing is clear -some pretty robust guidance is going to be required so the we don't fall foul of the law while trying to help

Sultan Dajani, Community pharmacist

I don't charge for part supplies and it's not a loan ie with added interest. I'd also argue it's not illegal because the NHS isn't being short changed here, I'm also not paying for it and it's totally ethical because I'm helping the patient out knowing they'll always pay within a few days. I have one whose script sometimes falls just before months end on occasions and I trust him because he's genuine. I've never done it for anyone but the regulars I know and it happens rarely and only as a last resort when other ideas fail. Internal processes may not allow others but where I work I want to do what I can to provide a Clinical service without the tax hindering me unless all else fails.

N O, Pharmaceutical Adviser

""" it's a loan of a few tabs""" ------ Can you show me where to find this terminology in the rule books. The RPS guideline makes it clear that these practices are illegal. The NHSBSA makes it very clear that any part issue of a script (issuing 5 tabs when Rx says 28,) unless a owing note is created, is against the Meds Act. What if the patient never comes back? How are you going to claim the script or account for the supply (loan)? ....."""""help your patients and make sure they stick to their care plan""""........ Why it always boils down to the Pharmacist ?? Is NHS/ DoH/ Govt. not responsible for this act ?? If they make the rules then they should take these issues in the first place, rather than leaving it on us to decide what is the best course of action surely.

Really? Wow, Superintendent Pharmacist

Calm down, Sid should probably not have used the word loan, its a part supply where a prescription exists.

Sultan Dajani, Community pharmacist

Thanks Niall, point taken and absolutely the right terminology. N O each pharmacy will have their own internal processes of keeping track and auditing and each pharmacist can decide how far they go in their professional life, what they do or what they won't do. My experience is of grateful patients, no loss of earnings, no outstanding part-supplies and job done from my side of things. Equally I'm happy if you don't care


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