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‘It's not pharmacists' job to police prescription exemptions’

"Pharmacists should not be the gatekeepers to healthcare”

Forcing community pharmacists to perform the burdensome administrative task of checking prescription exemptions will distract from patient care, argues pharmacist Laura Lockwood

The history of pharmacy extends into ancient times, when the cultivation of plants played a key role in the compounding of cures for ailments. Pharmacy has a rich history and should, by rights, have evolved into a well-understood profession that is respected for its expertise in medicines.

Today however, we find ourselves facing the very real possibility of becoming the “prescription police” – so nicknamed by the Royal Pharmaceutical Society in May – expected to assess patients’ exemption status in the government's crackdown on prescription fraud.

The proposed system, already being piloted in community pharmacy, requires pharmacies to check patients’ exemption status against a digital database before dispensing prescriptions. While considerable cost-saving to the NHS is a potential positive to the proposal, what about the cost to community pharmacy?

If we allow ourselves to take on this new role, when will it end? Colleague time is already spread thinly as the workload in pharmacy increases. An ageing population is demanding more prescriptions, there is an ever-increasing number of services to deliver – often without the staff capacity to do so – and now we have to deal with the Falsified Medicines Directive. Adding to the burden of work serves only to reduce the time dedicated to more meaningful areas.

To the NHS Business Standards Authority, a simple check of a prescription might seem like the smallest addition to our standard operating procedures, but what about the outcome? Are we to take more time away from other work to discuss a patient’s exemption status, when a patient becomes distressed at an “unknown” message on the screen?

We should not be the gatekeepers to healthcare, nor should we assess exemption in any greater detail than we already do. As healthcare professionals, why are we expected to take on an administrative task that should be done centrally?

As a community pharmacist, I have had one or two occasions where patients have admitted that they have been fined for prescriptions, usually due to expired pre-payment certificates. I have not had to get involved, nor do I feel it is appropriate for me to discuss exemption status – unless a patient has questions about the process.

We should be maintaining the image of healthcare, not giving the impression that we are policing prescriptions. Patients need to feel comfortable enough to have open and honest conversations, so that we can use the best of our skills to improve their quality of life.

Patient-centred care and improving the health of the general public were key factors that attracted me to become a pharmacist years ago. Making changes to support medication regimes, assisting those in need and empowering people to make healthier choices are the foundations of the work we do.

As a profession, we pride ourselves in our accessibility and our non-discriminative approach to healthcare. If we continue to accept these administrative tasks – which jar with our history – then we continue to lose focus on who we are and why we do what we do.

Laura Lockwood is a community pharmacist based in north England

8 Comments

Paul Summerfield, Community pharmacist

Having read the article, I disagree with the argument that we should not be checking exemptions.

We are one of a number of gatekeepers to the NHS and we must help to protect the public purse. There have been a number of times since I qualified that I have reported matters to NHS Protect in relation to false exemption claims and I have no problem in doing so. I also remind patients that they have to ensure that they are claiming the correct exemption or face a fine. Having used the exemption checking system, available online, it is not burdensome or time-consuming. It helps to educate patients and the exemption checking tool can be used for this. 

I would never refuse to dispense a prescription to anybody but I would, and do, point out that if the patient was incorrect in their choice of exemptions category then it falls squarely on their shoulders if they are fined. That is why I always get the patient to complete the relevant sections on the reverse of the prescription unless they are age exempt. 

I look forward to the comments that will follow.

 

Community Pharmacist, Community pharmacist

Drop the fee ....Did this in Wales years ago as it's unfair and a task that pharmacies should not be burdened with.

N O, Pharmaceutical Adviser

""Drop the fee ""

Do you mean the item charge??? If yes, then that debate will never end. I believe the Rx charge in England pays for all the free prescriptions in other 3 countries!!! or atleast the salaries of the so called Fraud Detection Team !!

Chris Locum, Locum pharmacist

Unfortunately, we are viewed as gate-keepers or shop-keepers. The ongoing problems with shortages might give the view pharmacists are the prescription police in one sense or another...

SP Ph, Community pharmacist

If I recollect correctly, there was a major debate on this topic on another thread, where a technical person was fiercely supporting the use of this new technology. He was proposing there was no extra load and it is as equivalent to what we do at the moment, i.e if no evidence seen then cross the box.

What I think those people who support the system being implemented at the Pharmacy Level dont understand many facets of what can happen if this goes out of hand.

For one, when they propose there would be no conversation with the patient, then why do we ever do this exercise? Example: I tick H at the back of the script. The system says wrong or unknown. So what are we supposed do now? As per the technology expert on that thread we do nothing but tick the evidence not seen box. If that is the case then why are we even checking the exemptions online? And this at the time when we are overworked, less staff, less funding for the existing roles and more paper work, why another useless exercise with no proper funding and no different outcome to the existing exercise??

Just another ploy to employ people elsewhere while there are joblessnesses in the Pharmacy sector!!! Pathetic

Alexander The Great, Community pharmacist

When we submit EPS scripts MANUALLY every day, im guessing my staff will tick the wrong box in around 5% of cases. I dont see why we have to do this when the NHSBSA can scan the reverse of scripts in seconds and get this error rate to a near 0%. Not only will they do it quicker (saving me costs), but it will reduce error rates and letters fining patients on our error.

Kevin Western, Community pharmacist

and all that is without the false finacial penalty that is imposed if we, the patient,or our IT system get it wrong... I wonder how many "false " prescription charges are generted every year? I bet it adds up to  a huge chunk of what we are paid to administer the system.

We live in  "a digital age" we keep being told.... let someone else's digits sort it out

Leon The Apothecary, Student

There's a good portion of time spent within a dispensary that has to be dedicated to administration, and this particular task regarding exemptions should squarely fall within the remit of the NHS Business Standards Authority because to be blunt those of us in a dispensary neither care nor are interested in the financial status of a patient because it fundamentally goes against what we do in the NHS.

The risk being of course that a pharmacist is forced into a position where they are forced to choose between the morally correct choice of supply of medication vs the financial welfare of the NHS. In all senses, it is simply perverse.

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