Boots withdrawing dossette box service

[Itsnotallaboutmoney]

www.bbc.co.uk/news/health-61881272.amp

Name changed for this as I really don’t mind it ending up in the Daily Fail for once.

I seriously cannot believe what Boots are planning. For those of us who have elderly parents (particularly with memory issues) who we are trying to persuade to allow help in the home (to no avail) this is a kick in the teeth. Whilst I understand it’s probably time-consuming etc to fill the boxes, the sheer danger of missed tablets, overdosing or the wrong combination as a duty of care from a profession surely outweighs the cost-saving element of providing this service. My in-laws both currently have memory issues and without this service, the lady who comes in to help each day would not have a clue as to what they have taken each day. My own parents at-home care service will not distribute any meds not in a pharmacy-filled dossette box. So where do the elderly and vulnerable go from here?

This morning I couldn’t imagine anything getting me more wound up than having to book a hotel stay in order for my child to get to a public examination today.. but here we are. I sincerely hope Boots have not tried to sneak this in on a day when everyone is watching the rail strike hoping no one has noticed 😡

I said the ‘most vulnerable such as’ and gave a couple of examples. I am aware there are other groups of people but I didn’t want to list everyone.
If it cannot be everyone, it should be those - like your husband - who absolutely cannot take their medication without this service.

For those pharmacists explaining why they are struggling to provide the blister pack/dossette service - what do you see as the solution? It just seems wrong to just withdraw a service many of us rely on to take our medication properly or for carers to be able to give/prompt meds? I mean why did pharmacists start providing this service and what happened before that?

Pharmacies have been absorbing the costs of these boxes for decades. Once upon a time there was a small amount of profit in them: we were paid proper dispensing fees, got weekly prescriptions and had enough staff to safely facilitate the service.

The boxes are not even recommended by the NHS, the preferred option from a safety perspective is dispensing in original packs with medication reminder charts to assist patients and carers. There is no legal impediment to carers administering medication this way and the equality act says that reasonable adjustment must be made for the patient (not the carer), but this does not need to be a dossette box.

Pharmacies are struggling with workload and recruitment issues. There is no NHS renumeration for MDS so it makes sense that the most dangerous, time consuming and least profitable service be scrapped first.

It's a damning inditement of the lack of funding for pharmacies and the care sector.

I completely agree with @TrufflyPig . It is a lot of work to fill a dosette box - i used to do the box for DM and it would take about twenty minutes for each weeks box and I would hope that with boots etc it would be a two person job (checked by a professional). The government doesn't pay for these services (or home delivery) and has to be absorbed in the costs of the pharmacy business and many can't do that any more.
Perhaps people could arrange for their gp to fill the dosettes for nothing.

Thanks @Innocenta that's very kind. I can do it - it's just a huge effort but I'm lucky I CAN really. Others aren't in my position. I can see both sides.

Except the pouches don't work as well for people with dementia.

I used to divide up the tablets into boxes myself for my mum. Now we have carers in a few days a week we need to use the dosette boxes. The carers are lovely but they make mistakes at times, which haven't have serious consequences so far, thankfully. However it's enough for me to question the reliability of them dispensing then directly from the manufacturers' boxes and it would be hard for me to ensure they're being taken (check lists definitely aren't infallible). I also doubt they're paid enough for the responsibility. We had a really hard time finding a pharmacy that offers the dosette boxes, I hope others don't follow suit as the knock on effect will be huge.

Whilst I'm on here I'm going to give reasons why I as a pharmacist dislike MDS systems, hopefully will dispel some myths about this issue too:

-There is no evidence to suggest they work on a large scale and improve compliance (I've just done a presentation on this for work, believe me I have scrutinised the data, or lack thereof). I appreciate there will be certain individuals that will benefit a lot from a compliance aid but the overall data does not support their widespread use.

-There is evidence to suggest that they pose a safety and liability risk to both the pharmacy and the patient. The governing bodies for pharmacy do not recommend removing and repackaging medication from its original containers.

-Medication compliance is a multi-faceted issue and the solution will be patient specific. Compliance aids are not a once size fits all solution. In some cases they remove a patients knowledge and autonomy over their medication.

-There is no legal reason why a paid carer or care home needs a compliance aid. They are able to administer from original packs given the correct training and following the correct process. Sadly funding is a big issue in making this happen.

-The service puts a huge strain on already struggling pharmacies, they are not renumetated for this service. It's difficult because noone wants to provide a poor service or not help those in need but if it cannot be done safely then its best to not be done at all.

Ideally paid (and arguably unpaid) carers should have the support and training they need to administer medication safely, pharmacies should have the support and funding they need to facilitate this. Sadly this is not likely to happen.