I’m disheartened that we are having to cover this old ground again today. Disheartened and disappointed with the clinical commissioning groups (CCGs), who have not thought of the complications and degradations to patients’ health and wellbeing that blocking community pharmacy’s managing of repeat prescriptions will cause.
Reducing the controlled management of medication ordering leads to a reduction in patient compliance, increased need of emergency supplies, and increased pressure on pharmacy to deal with the backlash. Ultimately the patient suffers, the GP surgery staff suffer, and the pharmacy staff suffer. It’s not the human approach.
I have already spoken strongly against this before, and my stance has not changed. If CCGs were interested in reducing medicines wastage, they could start by: enforcing prescribing that follows the correct guidelines of 28-day cycles, using repeat dispensing batches on the electronic prescription service; keeping medicines in-sync; having optimisation reviews on more than a once-in-a-blue-moon basis; and working with pharmacy to deliver the exceptional level of healthcare we strive for in the NHS.
What we have is something else – negligible uptake of repeat dispensing by doctors; drugs like zolpidem being prescribed month after month (the British National Formulary states it should only be used for 28 days, after that it’s unlicensed); and medicines being prescribed three months here, one month there, and two-and-a-half weeks over there.
Once again, the important question must be asked: why are surgeries allowing repeat medication to be excessively ordered in the first place?
East Lancashire CCG stated that blocking orders reduces the risk of errors. I would state that overburdening your clerical staff with several thousand patients’ worth of medications orders per surgery goes quite against that. To echo Andrew Grierson, pharmacist prescriber at Wyvern Pharmacy in Accrington: “Repeat prescription schemes are efficient and can save money.”
Once again, unanswered questions have created an elephant in the room: how are patient ordering exceptions chosen? Do guidelines exist, and have pharmacists been made aware of these? Are pharmacies expected to apply for exception for every single patient we identify for whom self-ordering is impractical?
Is it simply down to how the doctor is feeling that day? At what point does a patient turn from being self-reliant to requiring help? Is there a clear line, or is it only when the patient ends up falling ill due to aforementioned poor compliance? And most importantly: is this safe?
What about if I wanted someone else to manage my medicines, why should I be denied that right? Having the choice to allow an expert to organise your medication should be just that – your choice.
The blame gets shifted to pharmacies for over-ordering, but is this right? We ask on the patient’s behalf, the surgery always has the option to say “no”. May we not work together as one?
I wish those surgery support staff that are affected the best of luck, because all we in pharmacy are going to be able to do is send more and more – quite rightly – angry patients their way. Considering how impossible it is to get in contact with some surgeries – my personal best is one hour 37 minutes – I’d not personally aspire to be on the receiving end.
Benjamin D’Montigny is a locum dispenser working in the south of England