NHS needs it's own Amazon.

[Bollindger]

I often wondered why this has never been done.
If medical supplies were brought and stored and dispatched on an Amazon style system, that any health care facilities could access , the NHS could save Millions, even down to light bulbs and cheap paracetamol, after all if Tesco can do Paracetamol for 50p so could the NHS. Also Amazon can deliver overnight, so that would mean Hospitals would have to carry less stock.

@Tink1989 - don’t forget to add in that certain medical professionals prefer to use certain things that will be unique to a certain manufacturer. Try saying tough luck to a surgeon. I dare any of you!

@Tink1989 - oh sorry you did say that. Must read slower!

@Plumtreebob
ha yes! they have their favorites. my sons dad is a med rep and some of the stories I hear from him regarding equipment and consultants is quite comical

So true.

Procurement is the ‘leaky water pipes’ of the NHS! Millions are wasted every year.

Thinking about this more. If I want to order 500 packs of paracetamol - the contract price and wholesaler have been negotiated down to the lowest possible price so essentially I just go to the wholesaler’s website select what I want and the quantity send off the order and it will be here in the afternoon or next morning. No delivery charge added, just the contracted price per item (mostly there are a few exceptions).

In your proposed system the NHS central ware house is going to need tons and tons of warehouse space to store the stuff they have ordered, a huge customer service department to deal with the volume of orders and queries, pickers, vans to and drivers to deliver, petrol to fill up the vans etc etc. I’d be surprised if this turned out to be cheaper at all.

Even if a supplier has a delivery charge for orders under a certain value I doubt a centralised system would work out cheaper overall.

The one I always remember is Velcro at £13.99 when the identical one on Amazon was £2.50

Thanks for your professional opinion OP, next time I need a new cystoscope I'll just pop into town and use the petty cash tin to save some money.

The £8.99, now £9.35 you pay for a prescription on the NHS has zero relation to how much that medication costs the NHS to buy & supply to you. It’s not a price but a charge.

So you can’t compare what you pay in a chemist for a prescription for paracetamol to what you pay in Tescos for paracetamol over the counter.

So the NHS actually spends more on medication than it recoups through prescription charges. The charges are set as the same £ no matter what you are prescribed regardless of whether it costs the NHS as a 50p per month drug or a £13,000 per month drug.

So the charge is a universal charge set to be fair and equal so that people needing very expensive drugs don’t pay more than those who only need cheap drugs. It means everyone with a chronic illness is treated equally and has the same out of pocket costs- which with a prepaid certificate are capped at £108.10 per year of unlimited prescriptions.

@EdieJay - I would argue working culture is the “leaky pipes of the NHS” - lots of turnover due to bullying and stress, people on long term sick leave due to stress, lots of territorial “that’s not my dept”, people coasting along not doing anything causing more stress on everyone else. Before people jump at me I know lots of people in the NHS work very very hard, but from experience there are numerous battle axes who do eff all and are coasting until retirement. Nothing is ever their job etc.

@Maybeebebe
I'll caveat this with I don't work in NHS procurement, but another complex public organisation and collaborate with others. The detail is different but principles are there.

Dr tells me to get paracetamol
2 options

Option 1: I get from Chemist
dr writes a script (in same appt where they tell me I need it)
Storage
people to put on shelves
People to dispense
people to pay

Cost to me either 8.99 (or whatever it is now) or free if eligible
How much does this cost the NHS?

Unsure on exact figures, but factor in staff time, systems/software/licenses, training, leases, building maintenance, utilities, hardware for all aspects including procuring the contract to supply the item, managing that contract, prescribing, the admin behind it all, processing of data, the pharmacy and pharmacy staff too.

Option 2: I get from Tesco
dr has told me to get it
storage
people to put on shelves
People to dispense Checkout 'checks' age/amount
people to pay

cost to me £0.50
How much does this cost tesco?
That's a bit different as Tesco will procure differently and the cost is intertwined with their other operational costs. At 50p a box Tesco are making a profit where the NHS are not.
Also, the NHS is saving the cost in terms of prescribing the over the counter medication to you (and the checkout staff are paid significantly less than the doctor and pharmacist)

Again very simplified and generalised. Obviously there isn't staff and software specifically for paracetamol, but there is a significant saving to be made from stopping the prescribing of over the counter medicines.

As is pretty obvious in my posts, I work in manufacturing.
So that means we have a system to handle orders.
@Bollindger would you care to guess just how often that system has issues?
We have a contract with the software provider that costs an absolute fortune that means that their extremely skilled IT specialists drop everything to get us back online.
And no, we didn’t buy cheap. It’s from a world leading provider - but, these systems are complex.
Those systems run throughout our business. For example, releasing production orders. We’ve put a lot of money into disaster recovery programmes - we can still produce with almost none of the system working.
But the customer order end? We have to pay a lot to have 24/7 instant support.

How much of the NHS budget are you prepared to pay for that?

Or when the order system goes down, are you going to say, “sorry, no paracetamol today”?

Amazon, and any other business, stores the absolute minimum necessary, Storage is not free.

Some waste is unavoidable. To truly know how efficient the NHS is compared to its potential, you have to compare its administrative efficiency with that of other nations health systems. The most recent study on this (2021) ranked the NHS #4 overall for health system in 11 high income countries and also #4 in administrative efficiency. Which is above average for spending vs good health outcomes- or value for money (the average was a 10 country average because the US was so bad, it was statistically an outlier and including it to calculate the average would have artificially lowered the bar).
www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly

@RagingWoke - I agree with you. I don’t know anyone going to the Dr for a prescription of something that costs 50p to buy but £9/10 on prescription.

@Discovereads - oh of course the MOD, I had genuinely not thought of that!

To be fair, paracetamol is still prescribed for chronic pain management to patients who need it in higher quantities than you can legally buy over the counter. One person I know is on the maximum dose possible and have it on a prescription they fill every 3 months…so for free (as they are over 60) they get 7 boxes of 100 tablets, so 700 of the 500mg tablets. They’re 90 odd so for them liver damage isn’t an issue so much as quality of life for their final years. But prescription saves them money as they get them for free.

@Discovereads - I’d argue that wasn’t OTC really, in the same way you can only buy a weaker form of codeine OTC but need a prescription for stronger stuff. I know this is quantity rather than potency but I’d say same principle applies, that patient needs a prescription to access the medication they need.

It has happened for years!

Of course, if government ministers insist on buying, for example, £millions worth of Covid supplies that don't work from their mates, it does tend to jam up the space.

Paracetamol doesn't really cost the NHS more than it costs anyone else, even with overheads taken into account. The prescription charge is a flat rate for everything the NHS provides. You aren't paying for the medicine. You are paying an NHS charge for providing you with a medicine - whatever the medicine is.

The real failing of this system is that it works fantastically for most people. But it is based on decisions as to what they will stock / provide that are not always clinical, but based on cost effectiveness. That means that if you need a something that isn't "on the list" you can't get it on the NHS, even if 200 doctors agree that you need it!

For example, I have severe dry eyes. It may not sound all that serious, but if you have ever suffered from dry eyes then you will know that it can be awful. You can't see properly, it can impact on work and driving etc., causes great discomfort and pain. But the majority of medicines (it cannot be cured) are not available on the NHS. For effective treatment you are looking at anything between about £3 and £20+ per item. That may not sound like much money, but for poorer people even £3 is money they can't afford. It is estimated that at least 40% of the population over the age of 40 have dry eyes to some degree. Some people get it so mildly they will never really notice it, but for others there will be varying levels of severity and impact.

There are a few drugs available that are more effective in severe cases, but they can only be prescribed by specialists and good luck on the wait for an appointment. Equally there is a treatment which will give very long lasting results for some conditions and dispense with the need for medicines etc. But it costs £500 per eye, so the NHS refuses to license it for their use, even though they admit that in cost terms it is more cost-effective than the alternatives. You can only access the treatment privately, and again, many people can't afford that.

@Discovereads absolutely in that scenario prescribing is effective. It's the prescriptions where the patient didn't need an excessive dose and a OTC option was suitable where the savings can be made.
This has already happened but it doesn't stop people expecting it, same with the childrens medicines scheme being abused because it's 'free'.

And there's pain patients who desperately need stronger medication and can't get it... not a supply issue but equally frustrating.

@RagingWoke
I do apreciate your taking the time and making it so clear

Unsure on exact figures, but factor in staff time, systems/software/licenses, training, leases, building maintenance, utilities, hardware for all aspects including procuring the contract to supply the item, managing that contract, prescribing, the admin behind it all, processing of data, the pharmacy and pharmacy staff too.

Most of these are the same for all businesses though,
apart from the data processing (club card?) and the extra training required for their staff (although I can also buy my paracetamol from the chemist directly)

I'm sorry if this comes across as a bit (or a lot!) whiny

but there are people who are on free prescriptions who will ask for it

@Maybeebebe It is probably such a small % that it is a drop in the ocean of NHS procurement. I am not even sure what your point is at this point? The NHS is not comparable to Tesco.

Not at all, it's a really complex area.

So, essentially the shops are working for profit and the NHS is not (broadly speaking). Costs to a shop are factored in to their prices and they have the staff there anyway, scanning a pack of paracetamol isn't an extra cost whereas there is a tangible cost to the NHS for the prescription.

There are studies and articles with figures available but the potential saving to the NHS of stopping unnecessary prescriptions of OTC medicines is significant.

As tax payers we all want to see the public funds used effectively which is exactly what the aim of reducing these prescriptions is. And also why NHS is subject to public procurement regulations.

I deal with ordering stock for my section of the dept as well as doing my actual job (funnily enough we have this recruitment problem at the moment and can't retain our stock assistants). I barely get chance to eat my lunch let alone to walk into the local shopping area to try and find 15cm rulers that will be cheaper than the 8p each I can get them delivered to me via banner. Seems like it would be an expensive and inefficient waste of my time.

I've been to our trusts warehouse- it's massive and is very much akin to the Amazon model you propose. They keep stock there that all sites use so if we require it we can have it same day/next day. We also have a lot of temperature controlled stock- frankly it would be stupid and expensive for stores to keep that for us as they have to be monitored and as our dept is niche they don't need to hold them for other sites- better all round that they come straight to us.

I'm not sure where you're getting stock being a massive problem from. It's certainly the least of our worries. We can get stock, staff to actually use it is another story entirely. Unless Amazon sells humans?

Brilliant!