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Xrayser rails against the pharmacy urgent supply pilot

"It’s so frustrating that we have to go through this rigmarole for basic stuff"

Does the government really want us to fail, asks Xrayser

The expression "designed to fail" could have been invented for the Department of Health, as the announcement of the Pharmacy Urgent Care pilot last month demonstrated how differently clinicians and politicians view services.

A clinician sees a new local service that improves patient care and outcomes, and works to spread the learning and improved practice nationwide. A politician sees a new local service that improves patient care and outcomes, such as a minor ailments scheme or a CCG-funded emergency supply scheme, and instigates a committee to design a poorer version of what already works so well.

It’s a fact of life that patients run out of their repeat medication. Their pharmacy can make an emergency "supply", but in reality this is an emergency “sale” – as the patient pays the cost of the drugs, and asking payment for expensive drugs like rivaroxaban or a combination inhaler just isn’t practical.

The only answer is to “loan” drugs against a future prescription, which is neither satisfactory nor legal, for the patient to call 111, where it costs the NHS £100 to write an out-of-hours prescription.

So our CCG, like many, recognised that a local service to reimburse the drug cost and pay the pharmacist a service fee is more cost-effective, improves patient care and encourages medicines adherence. Importantly, there are no restrictions on access into the service, because most patients come to their 'pharmacy first' thanks to all those campaigns.

But what do we get offered by the Department of Health (DH)? A pilot, for a service that already has proof of concept from all over the country, and a requirement to refer all patients first to 111, so that a call handler can then refer them back to me. That's going to work great at 5.30pm.

Yes, the pharmacy flu service started as a trial a few years ago and now seems embedded, so maybe I'm just impatient. But it’s so frustrating that we have to go through this rigmarole for basic stuff, when the real sustainability and transformation for the NHS and patients is for pharmacies to handle long-term conditions.

The Royal Pharmaceutical Society has absolutely got it right. When our hypertensive or diabetic patients need another prescription, why do they need to go back to their surgery? Medication reviews – we’re already doing them, and it wouldn’t take much for medicines use reviews to be added to the patient record via PharmOutcomes or write-access on the summary care record.

Blood pressure or serum glucose checks are easily within the capability of a trained healthcare assistant, and an increasing number of pharmacists are graduating with the prescribing qualification, so will be able to titrate the dose.

This is the direction we must travel, with benefits for patients, the NHS, and for pharmacy. So instead of designing to fail, we cannot let the DH fail to design this service.

15 Comments

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

It's a similar situation with the MUR scenario. It's something we have ALWAYS done (called 'Advice') but once DoH got their dozy claws into it it became the shallow money-oriented thing that it is today, the cause of so much misery to honest pharmacists.

Valentine Trodd, Community pharmacist

an emergency "supply", but in reality this is an emergency “sale” – as the patient pays the cost of the drugs

Not in my neck of the woods Xrayser. If I asked for payment for an emergency supply I'd probably have to administer CPR to the patient on the spot. And if a 'loan' against a future prescription isn't legal (which we all know it isn't, of course) then why does my PMR have an option to process an 'Emergency Supply - script to follow'? Are the software providers guilty of aiding and abetting? Should my head office toss this software out the window as it is blatently encouraging unlawful behaviour? And shouldn't the GPhC be interested in this? All I can say is, that if I didn't do 'loans' last month a lot of people in local care homes would have not had a very happy Christmas - despite the fact that prescriptions were ordered a month ahead. Ah well, just another day in the magical land and alternate reality of Pharmacy...

C+D Xrayser, Community pharmacist

You're right of course - in order to do the correct and ethically appropriate thing for patients, prescription medicines are regularly loaned in most pharmacies. Because it's the "right" thing to do doesn't mean it is in accordance with our contract or the medicines act. NHSE have an opportunity to address this - as our CCG has - by allowing us to exercise professional judgement and by paying for a fully legal "Emergency Supply". Will they? Let's hope that is the direction of travel.

Valentine Trodd, Community pharmacist

Quite right. I just hope when the inspector comes knocking and sees the number of 'loans' we do that he's as understanding!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

If the inspector comes you haven't actually done anything illegal PROVIDED you have recorded your 'loan' in the private prescription book. The only thing you haven't done is take payment and you can charge what you like (or nothing at all if you want) for an emergency supply or private prescription. The illegal bit is when they bring the script in but you don't supply another item against that because that is breach of contract.

N O, Pharmaceutical Adviser

""why does my PMR have an option to process an 'Emergency Supply - script to follow'?"""

This is designed for situations when a GP calls in to say please supply xxxx of yyyy etc. and I will send the script tomorrow (or within 3 days) But, in reality none of this happens and as you rightly said, it is highly (mis)used for the Loans.

Valentine Trodd, Community pharmacist

Nope, cause it got options for...

-Emergency supply - Prescriber Request - UK

-Emergency supply - Prescriber Request - EEA

-Emergency supply - Patient Request (SALE) - which I've never used!

-Emergency supply - Script to Follow

 

I'm probably not allowed to say what PMR it is - begins with a 'P' ends in 't', with a user interface that looks like something from 1982.

 

N O, Pharmaceutical Adviser

Well, then possibly, you rang the surgery and they confirmed there is a prescription waiting but either not signed yet or there is no way you or the patient can collect it in time for you to dispense the URGENT (pun intended) medication (may be even paracetamol). So, as Xrayser said, in the best interest of the patient, you dispense the medication. My CCG has this service as mentioned by Xrayser and it runs smoothly.

Valentine Trodd, Community pharmacist

Nope. Called the surgeries and in most cases we got the standard reply that 'Oh, we didn't receive a request for that one... I'll put it to the doctor', yada, yada, yada. When I know well they did get the request - cause it was all recorded on the PMR. Absolutely not interested. "But the care home is due to go out today and we need the script". "I'm sorry, all I can do is put it to the doctor and he's very busy". What am I supposed to do? Not provide the medication over the Christmas because the surgery can't get it's act together? Absolute disgrace. I don't know whether it's incompetance or understaffing - probably a combination of both - but getting the correct prescriptions, on time from the surgeries in my area is becoming next to impossible. I've spoken to the practice manager and complained to the CCG and have gotten the standard lip service. I really feel between a rock and a hard place.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

The duty of care lies with the GP not with us. I always tell people to go to their surgery and tell them this. It works every time. It's amazing how often a surgery will find a script that they swore blind they'd sent already.

Valentine Trodd, Community pharmacist

I wish it was that simple... I don't think a pharmacist would get away with claiming the duty of care lies with the GP. Surely it's shared? After all number one principle in our code of ethics is:

1. MAKE THE CARE OF PATIENTS YOUR FIRST CONCERN

What's more most of the problems I have are with blister pack patients or patients in homes, so they are incapable of chasing scripts themselves. So, get the home to do it, you say? Again, fine in principle, but it doesn't work - most of them just don't care enough to put in the effort. After all, if a patient goes without meds it's either the doctor or pharmacy at fault right? They reckon they've done their bit. Furthermore, my head office insists we provide a full 5* service to care homes - any reports back of troublesome pharmacists are not very well tolerated!

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Are you B**ts or L***ds btw?

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

I deal with 12 carehomes at the moment and their surgeries are going over to this idea of pharmacies not being able to order repeats - problem solved!! There's a silver lining to every cloud!

Jupo Patel, Production & Technical

The line must be drawn somewhere or you'll forever be a doormat. And a poorly paid one at that.

Soon-To-Be Ex-Pharmacist, Superintendent Pharmacist

Steady on Jupo - I'm agreeing with your posts more and more!!

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