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Repeat dispensing schemes are a burden on patients too

"This new system is an incentive to cheat"

Forcing community pharmacists to jump through hoops to head off accusations of waste places extra costs on patients like Paul Laxton

I am a 71-year-old patient who requires five medications a day, to prevent a recurrence of a stroke, and also to alleviate my severe osteoarthritis.

To help me manage these conditions, I have had monthly deliveries from my excellent community pharmacy in Wallasey, Merseyside, for six years. The pharmacist there has not gone as far as one local GP practice – which requires patients to collect a paper prescription in person every month — but he is now obliged to get someone to telephone me monthly asking what I require.

Accusations are ‘madness’

He and his staff know well enough what medication I need, and that if there were any change, I would tell them. Yet he has to employ someone more or less full time to telephone his customers and ask them, item by item, to state whether they still require drug x, y or z.

The extra precaution is to head off any accusation from the local clinical commissioning group (CCG) that my community pharmacist is not doing his job properly. This is madness.

I often go away from home, sometimes for three weeks or more. My family is mostly abroad and I have annual commitments in the United States. So this new system causes inconvenience all round. It is also an incentive to cheat: encouraging a patient to have an emergency stock at home in case the medicine police start causing trouble.

Sledgehammer to crack a nut

No one is in favour of wasting money in the NHS. But this is the equivalent of using a sledgehammer system to deal with a nut – irresponsible patients who either hoard medicines to feed their chronic hypochondria or just for fun, or who get understandably confused about things.

I very much doubt if it will result in any significant saving. And in the case of patients who, for a variety of reasons, find they have not taken their medicine for a period, the money would have been spent anyway, even if they were diligent.

On a couple of occasions I have taken a packet of pills back as surplus to requirements. But once a medicine is dispensed, even if it is still sealed, it cannot be taken back into stock. Now that's waste, caused by regulation.

Like all bureaucratic systems, checking up on medicines use is based on a lack of trust. And the cost is placed on the pharmacist and the patient.

Read C+D's investigation on how much CCGs plan to save money by scrapping repeat dispensing schemes in community pharmacy, and how many have already rolled this out in their area. 

14 Comments

Shaun Steren, Pharmaceutical Adviser

The gentleman has 'annual commitments' in the United States, so is more than capable of making a single phone call each month to order his medication. So it might be fair to deduce that it is not capability that is holding this patient back, but a willingness to give up some of his time to the 'bureaucratic' process of ordering ones own prescription.

I await the now ubiquitous virtue signaller to chime in and purposely mistake the expectation of self-responsibility with an uncaring disposition. This letter has a suspiciousness to it, not relating to the author in anyway, but the sense that a level of encouragement is operating in the background. Who would encourage such a thing? It wouldn't be somebody who profits from 'managed' repeats, would it? 

Jupo Patel, Production & Technical

Shaun, There are no profits anymore and that's why pharmacies are all shutting down and salaries are plummeting(though this does not explain the consisitent falls of the past 10 years before these 'cuts') maybe you haven't heard. Just don't mention this to all those people still purchasing shops at record prices. 

Frustrated Pharmacist, Community pharmacist

Sounds like it's ghost written by Boots...

Since when did our patients start reading the C+D and writing letters in?

It seems to me, the more you do for patients, the less empowered they become. It breeds a dependence and a helplessness. This is neither good for us nor the patient. It also leads to an erosion of the patient's personal responsibility - they expect you to take full responsibility for their well being. The whole system of managed repeats, blister packs and deliveries has lead a situation where I've never even met many of my customers! In my opinion, it would do no harm for many of my patients to pick up a script now and then and visit the pharmacy. I have one lady patient just turned 100 who comes in weekly and many in their 90s and they are much the better for it. Of course the exception to all this would be the GENUINELY housebound patients. I can't help but think many are housebound when it suits them.

Jupo Patel, Production & Technical

You forget the likes of Boots keep C&D in the style to which they've become accustomed.

Andrew Martin, Primary care pharmacist

This the least common sense article I have read on here. Why isn't the patient taking responsibility for their own medications?

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Because we provide a service to help the patient. It also protects the pharmacy business. Have you seen the ads for 'Pharmacy2U'? THAT'S where all your prescriptions and money will go if you can't manage a patients prescriptions.

Jupo Patel, Production & Technical

You'll make less money if the patients took responsibility for their repeats. FACT.

Clive Hodgson, Community pharmacist

But if "managed repeats" are universally outlawed it would have a profound (adverse) effect on the P2U business model as well as reducing Community Pharmacy workload and most probably reducing medicine wastage by a considerable amount. Not a bad result.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

All they need to have is your ETP nomination and then every script you or anyone else orders goes to them. They don't give a stuff who orders scripts. I've worked in pharmacies where people bring repeats in for the pharmacy to take to the GP and the pharmacy isn't even the nominated one. That's plain stupid to me but that is the level of service people expect from any pharmacy.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

And I think pharmacies generally (yes there may be a few loose cannons out there) are more responsible than patients at ordering. Most patients left to their own devices just order everything off their repeat regardless of whether they need it or not. I've seen it happening because I've worked on both sides of the divide.

Jupo Patel, Production & Technical

You're right but I'd suggest employee and locum pharmacists care less and less as their pay goes in the oppsite direction to their workload. The threats of being sacked or losing your job(regularly repeated by contractors on here and of course by multiples) carry less and less weight as pay aligns with that of aother retail jobs with infiniteley less stress and responsibility

Clive Hodgson, Community pharmacist

Exactly. There seems to be no valid reason at all why this patient cannot organise the prescription repeat requests for themselves.

Why did his Pharmacist take on this task in the first place?

Jupo Patel, Production & Technical

They make money by managing the repeats. SIMPLE

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

This is the most common-sense article I've read in here in ages. 

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