To think GPs should be able to check medication availability

[jeaux90]

I'm absolutely fed up of ordering medication to turn up at the pharmacy to be told the manufacturer is out of stock.

If they have access to the system why isn't the GP checking this and prescribing the alternative? Surely machine learning/AI would help here or are the systems not integrated?

I mean in the whole era of technical progression why are we running between Boots and the GP to get things re-prescribed?

For context this has happened with my HRT, my DD14 ADHD medication, antibiotics etc etc over the last three months.

AIBU to expect an integrated supply approach to prescriptions?

Me too.

Dont think the NHS do integrated though.

Totally agree. It is utterly ridiculous that systems aren't all linked so the GPs know what is available.

One of our dc was really unwell, got a prescription to be told put of stock and it was 'returned to spine' whatever that means and we had to just trawl round chemists to find it 🙄.

Chemists are like the Post Office, outdated slow and need a bomb up their arses to get into the 21st century. I'm not sure chemists have even heard of bar codes but surely they could be used to assist in delivering some kind of organised service.

Nothing in the NHS is integrated.

That'd be nice, issue is it's not even just the NHS having to have compatible systems; different pharmacies use different suppliers and although GPs do get updates on brands that are out of stock for prolonged periods etc (which they have to read and remember in their own time) it'd be a real challenge consolidating it all currently. I do agree it would be easier, I'm sure GPs would also agree with that, it's more work for them too after all redoing scripts.

So frustrating running around pharmacies looking for a particular medicine.

This just shows ignorance into how it works though. There isn't one singular supply chain that all pharmacies use, stock availability can also change rapidly. I agree it's a pain and you'd hope there would be a system in place, but it isn't lack of will of pharmacies. Most will phone another and see if they have it if you ask nicely.

Yeah but that's now how it works, the manufacturer isn't the supplier.

Boots, Lloyds, independent pharmacies - none of these are part of the NHS.

They are separate commercial entities with their own stock control systems

So the GP surgery won't know what the nearest Boots pharmacy has in stock, and the staff at Boots won't know what the nearest Lloyds has in stock

To have one system for fulfilling NHS prescriptions would involve setting up a parallel state-run network of pharmacies.

Or the state taking over pharmacies from the commercial companies. At what cost?

And in that case what would you do about private prescriptions?

I'm not blaming the pharmacist or the GP. They all do a demanding job, I'm blaming the systems.

When you look at all the machine learning and AI we already use in banking, mobile networks etc it's not hard to get this supply chain issue resolved surely?

And honestly you look at just how dysfunctional IT is across the different trusts and NHS digital it boils my blood. They could be doing a much better job making peoples lives who work in the NHS much easier if they wanted to, making us as users spend less time chasing down new prescriptions....I feel for our elders having to chase around for medication.

This is tax payers money, I'd like some of it to be spent on technical efficiency.

Not the point. If the different pharmacies have access to the manufacturer information why doesn't the NHS? Then they can prescribe what is available/an alternative.

GP surgeries procure their own IT systems as do pharmacies, they're private businesses albeit they get funding from the NHS to run certain services. I agree IT systems across the NHS suck, hopefully you're lobbying the government about it and writing to your MP if you feel that strongly about it- everyone working within it would be very grateful.

You can choose which pharmacy your prescription goes to if you don't have a physical piece of paper prescription. Phoning around pharmacies to check they have exactly what you need is pretty standard. I don't think GPs have access to what every pharmacy has available, or to anticipate which pharmacy you're getting it from. I suppose if it's one connected to your surgery then it would make sense. But.. well... Haven't got an answer for that. NHS infrastructure is fragmented and awful.

@jeaux90 are you suggesting that banks have perfectly integrated IT systems where one bank will talk to another when it comes to helping customers. Although I suppose they have the money to keep throwing at new systems.

That would only tell the NHS what medications have been withdrawn or where supplies are unavailable fof a length of time. And GP surgeries get notification of this, as a PP has noted

The manufacturers' stock systems won't tell you whether a medication is in stock at your local pharmacies.

I mean, there are parts of the UK that still don't have electronic prescribing at all. I don't disagree that it's frustrating but the scale of the IT issues in the NHS dwarfs this particular problem.

They don’t have access to manufacturers stock information, only their own supplier. Different pharmacies, different suppliers. Patients can go to any pharmacy so a range of suppliers and neither the pharmacies nor the suppliers are part of the NHS.

I do t think this is the simple problem you think it is.

GPs are also private businesses with a contract to the NHS and if they are too tight arsed to spend out on enough qualified staff and good IT systems then what can the patient and pharmacy do.
A lot of this is due to Brexit - I wonder how many people now wish they had voted remain seven and a half years ago and not been conned by someone who is now being shown to be a fool and a liar

I’m a pharmacist and I agree the whole system would be so much easier if it was all linked up, but there’s so many different systems and branches with different contractors to the NHS I can’t see it ever happening unless there was a monumental increase in funding… but that’s not going to happen. Even pharmacies don’t really know when things are in and out of stock, many times it’s only when we try and order something and it doesn’t turn up we know. Also things happen so quickly, for example Avamys spray was out of stock for a couple of months, some stock came in one day last week and then the next day we couldn’t get hold of any and still can’t. Basically out of stock medication can change daily.

DS works on a pharmacy counter and he says the worst patients are those seeking HRT prescriptions.

He can’t force the manufacturers to make more or supply more.

Order online? Gets delivered to your home.

I think they should prescribe the generic medication. Had my pill changed and they asked for a brand which was out of stock everywhere local. In the end they changed to generic which has been easier to get hold of

I hear you re how frustrating this is.

Particularly ADHD meds - you can waste hours of your life trying to find which pharmacy actually has them in stock this month.

I live rurally and we've had to drive an hour to get them in the past.

Fortunately DD now lives in a city with lots of pharmacies.

Very few pharmacies ever answer the phone either, so you do have to physically go there.

It doesn't matter how good the IT system is, there isn't a way to link up and access the data of all pharmacies. The contract is also crap, hence so many GPs leaving.

Electronic prescriptions are held on ‘the spine’, which is like an electronic, cyberspace, storage system. Each prescription has its own unique number (‘token number’) and any pharmacy can download the prescription using this number. A pharmacy can return the prescription to the spine if they haven’t cashed it in.

Different pharmacies have different supply chains. I found the independents had a greater range of avenues they could access than the chain stores.

Supplies of medicines vary in a daily basis. GPs don’t have the time to check availability of stock. Also, a prescription can be written on the Wednesday, but not dispensed until a few days later. Stock availability can vary greatly then.

Doctors are informed of major stock shortages and are given guidance on alternative options.

It’s definitely worse since covid. Last time I went to pick up my medication at the nominated pharmacy they didn’t have it (HRT), suggested I go round other local pharmacies to see if they did.
Annoying for me - but, the elderly person in there at the same time was picking up medication for her seriously ill husband, and they didn’t have that either. She was literally in tears and asking what could she do, he needed it now, she was his carer, she couldn’t leave him and she didn’t drive.
I felt so sorry for them, HRT for me is important but not life threatening. It made me realise how much I took the pharmacy systems for granted.

If the different pharmacies have access to the manufacturer information why doesn't the NHS?

You're massively undestimating the complexity and number of steps in the supply chain. Pharmacies have access to their own stock list. Not even necessarily the stock of another branch down the road, and certainly not of all other companies. They don't buy directly from the mananufacturer, they don't all buy from the same wholesaler, and they don't all buy from a single supplier (Boots does, which is why they are more often out of stock than independent pharmacies). They don't all have the same things in and out of stock.

Plus the patient has a choice of pharmacy and won't always collect a prescription immediately. If the GP prescribes something that is in stock in Boot on the High Street, Bigtown today, but the customer tries to collect it from Lloyd's in Station Road, Bonnyvillage next Thursday - then all the joined up in IT the world is no help.

If there's a long-term global supply problem then yes it should be flagged on prescribing system - it already tends to be on things like NICE guidance and the GPs are sent circulars. But it's impossible to do that for fluctuating, temporary, or local problems.