Repeat prescriptions are the core of every pharmacy business. They contribute to prescription numbers at the end of the month and they also give an indication of future dispensing figures, which can provide an idea of how busy the pharmacy will be. There are a lot of benefits to this, including knowing if staff levels need to be increased and whether a pharmacy is able to plan for service provision.
When reading about the three clinical commissioning groups (CCGs) in the north west of England and East Anglia implementing schemes to stop pharmacies from reordering prescriptions, I considered this to be a knee-jerk reaction that casts pharmacy in a negative light.
I would be more inclined to look at the system that allows medicines to be prescribed excessively in the first place. Every pharmacy has a different way of ordering, every surgery has a different way of processing, and every prescriber has a different way of prescribing. There is a lack of unity, a lack of information, and a lack of communication.
Medicine wastage is often highlighted as a reason for pharmacists needing to change how they work, but is part of the responsibility also with the prescriber? When you see zopiclone on a monthly repeat, you begin to wonder how much effort has really been put into a patient’s treatment regime – considering it is intended for short-term use to treat insomnia for up to four weeks.
The CCGs have not considered the hard work pharmacy does in syncing medication so a patient doesn’t have to come in every other day. Or how adherence issues are identified, how items that are not available are requested with alternative suggestions already written down for approval. There is an awful lot pharmacy does to make the process work successfully for the patient. Pharmacies are champions of medicine supply.
Many other questions spring from the CCG's plans. How would blister packs work? How would it affect care homes and house bound patients? How are “special measures” decided? How are medicines synced for 28-day cycles? There are many fatal flaws in their intrepidness.
If ordering through pharmacies was stopped overnight, my predictions are simple:
- Pharmacy phone lines would be swamped with patients who have run out of medications, attempting to arrange an urgent request, to which we’d have to say: "Unfortunately we have no control over ordering your medicines any more."
- Surgery phone lines would be swamped constantly – even more than they are currently – with patients demanding why their prescription hasn’t been sent to the pharmacy yet.
- Many patients would go without for various degrees of time, from a few days for the ones who are constantly after their scripts, to weeks for the housebound patient who “didn’t want to be an inconvenience".
If this is to go ahead, the ordering system as a whole will need an upgrade. We need to see at what stage a script request is at, delays that have occurred and the reasons why, and dates when it will be ready for collection/release onto the spine. We’d also need clear lines of communication with surgeries to deal with the inevitable stream of queries pharmacy would get.
Go back to the drawing board, the idea is incomplete at best.
Benjamin D’Montigny is a locum dispenser working in the south of England