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Bulk prescriptions create big problems

“Those dreaded bulk prescriptions are the absolute – and I cannot stress this enough – bane of pharmacy businesses”

Dispensing six months of medication at a time makes no business sense, says Benjamin D’Montigny

With prescription items going up and up on a yearly basis, you would assume there was plenty of work to go around, keeping pharmacy businesses strong and profitable. However, many places I have visited in my role as a locum dispenser seem to struggle with low monthly figures and it makes me wonder why. One of the recurring reasons seems to be prescribing habits.

These habits change from region to region and county to county, but the same issue keeps recurring. Of course, I'm talking about those dreaded bulk prescriptions. The ones for up to six months’ worth of medication in one go. They are the absolute – and I cannot stress this enough – bane of pharmacy businesses.

Any prescription for more than 28 days is terrible for a number of reasons. Firstly, it creates a lot of problems with stock levels. Every six-monthly prescription means a pharmacy needs to adjust its stock levels to an additional 600 to 1,200 per cent to ensure there is enough to go around. The stock required for five such patients is the difference between 30 boxes and just five.

Not only is this a costly practice of having a large amount of quintessentially dead money sitting on our shelves, but it also takes up a lot of the finite space in our dispensaries, not to mention that it is a prime trigger for stock shortages.

Secondly, there is a question of potential wastage, which is something I have mentioned multiple times before and is, unfortunately, a byproduct of an inefficient prescribing system.

Medication changes occur for a phantasmagoria of reasons, as you all know well. Should the patient’s medication change during the course of the six-month prescription, we now have a large amount of medicine that we have to waste. Unfortunately, our laws prohibit us from using these returned medications and reintroducing them back into the system, regardless of their condition. Caught at the early end of a prescribing cycle, we'd be looking at almost six whole boxes going to waste, which can be quite a cost to the NHS with no benefit to show for it.

Pharmacy is a business; a business that cares for people’s health, but a business nonetheless. And a core aspect of a successful business is profitability. One of the main sources of income for pharmacies is item figures: the more, the better.

A six-monthly prescription effectively denies a pharmacy of five items for the same amount of work. It turns a 12,000-item-a-month pharmacy into a 2,000-item-a-month pharmacy.

That is a devastating loss. With that loss comes loss of employment for staff, loss of improvement funds for the business and, ultimately, leads to the end of that pharmacy. And who loses out then? The patient.

The solution

So what is the solution? I believe we've already been given the answer and that is through repeat dispensing. The question is, though, how do we get GPs on board with this time-saving, wastage-preventing, superiorly efficient and effective system?

I have had the opportunity to work in a pharmacy that ran an almost perfect system of repeat dispensing, which was the primary source of prescriptions. The lack of effort required to keep things going was alien, and feedback from the local surgery was fantastic – moving from a somewhat chaotic maintenance of day-to-day issues to a refined simple system.

Prescriptions being ordered late or delayed was a thing of the past. Holiday scripts were easily prepared, having a number of months already in hand. A huge weight of pressure was removed from the local doctor's surgery, with the time spent much more effectively seeing patients.

It is a system I have always been eager to emulate and – at the risk of overstepping my boundaries as a locum dispenser – I actively encourage wherever I go. I would appeal to everyone who reads this to push the system as well.

Benjamin D’Montigny is a locum dispenser working in the south of England


How do bulk prescriptions affect your pharmacy?

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Gerry Diamond, Primary care pharmacist

28 days scripts certainly reduce the opportunity for medicines wastage, and elderly patients have at least several changes to medication from gps, hospitals and opd clinics. Also, adherence is easier to monitor. Indeed there are regional variations such as in Manchester seven days scripts don't happen whereas they exist in Blackpool.

London Locum, Locum pharmacist

Same old prescription factories. Remember when they said 'services' were the future? What a chuckle I had that day.

Mr D'Montigny has hit the nail right on the head. Our local surgery started 56 day prescribing 1 year ago. At that time we just relocated investing heavily in the business for the long term. Our business has been 'bleeding'to death and no one in the land seems to care. The so-called temporary safeguarding arrangements do not go far enough and work only for the first year. The ccg have no teeth to force the Gps to change. We carried out an audit which showed £30,000 a year more waste but no one seems to listen. The repeat dispensing presriptions are issued on 56 day intervals so makes no difference. This seems like Idi Amin rule in Uganda in the 70s!

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