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?

@RosesAndHellebores

“It's interesting that if one pays for the meds on-line, with a prescription there is never, ever a problem. Not even for dd's ADHD meds.”

People seem to have the misconception that if you order a (NHS) prescription online, using a company such as Pharmacy2U, then the prescription is received and dispensed wholley by that company.

However, , before the prescription can be dispensed, P2U (and others) send the prescription to the gp surgery, a receptionist or prescription clerk adds the prescription to the patients records, and processes the request for the gp to sign. The gp then approves and signs it off, at which point it electronically whizzes its way back to P2U (and others) to get dispensed and sent to the patient.

At riverlee, I think you have missed the point that if I purchase a drug on-line with a prescription, when I pay the full price there is never a problem fulfilling the prescription.

But if you are very unwell, in pain, have mobility problems, no transport, it is really daunting to have to track down an alternative source of medication. Especially now that it is almost impossible to get through to your surgery or get a message to your GP.
I spent 2 whole days online and on the phone a few months ago because my consultant wanted my GP to prescribe one of my medications instead of the hospital. My GP was happy to write a prescription, but after trying 4 different pharmacists and doing a lot of internet research and phoning round, eventually a pharmacist in another town looked it up and explained to me that only hospital pharmacies are allowed to stock that particular drug.
I then spent a further week relaying that message back to consultant's secretary, numerous phone calls to the hospital pharmacy and finally another expensive taxi to and from the hospital to get the drug. It would have been quicker, easier and cheaper to have been able to get both my hospital prescriptions during one return trip instead of two. It is tiring and stressful.

Why so rude? are you so offensive in RL or just behind a keyboard? & your link doesn't work "page no longer exists"

I live around 6 months of the year in France, i ve never had medicine shortage nor do i know anyone who has, the issues in the UK are far worse than anywhere else.
CV shortages have long gone here.

Even the UK Parliament has acknowledged that HRT shortages are now a UK only issue and supplies are good in Europe.

Even the 'Mail, hardly an EU fan, has led with stories of UK women going to EU to get HRT.

@GPTec1 absolutely. We too spend much time in France and the difference between the two systems and standards of service is vast. France, King of bureaucracy in almost everything is so much smoother.

I did not use the word daft not infer it. I’m not sure why you’re insisting on trying to read my mind but you’re getting it wrong.

With respect, you have no idea how prescriptions for ADHD medications or anything else works from the clinician end. It’s not possible to do a prescription for “x or y or z”. And I understand everyone including private patients, are currently struggling to get hold of ADHD medication due to the stock issues. Possibly there is some financial benefit to a pharmacy of dispensing a private prescription over an NHS one which might explain this? I don’t know as I don’t work in private medicine. Also it has only appeared as an issue in the last month or so (regarding ADHD medication supply). You may well have that delight to come as the shortage is likely to last for several months.

I understand everyone is frustrated with the NHS and that includes the people who work in it (although you seem to see that as “whining” when mentioned). Although I would argue that we do not work in retail and therefore measuring by the perceived quality of “customer service” is an unreasonable expectation of the NHS, I too would like to see a more efficient system and I agree that France appears to have a far superior set up all round for both patients and clinicians.

All is not entirely rosy in France, either, according to this story in Euronews dated 10/10/23.
https://www.euronews.com/next/2023/10/10/trying-to-find-solutions-worsening-drugs-shortage-is-leaving-pharmacists-and-patients-in-t#:~:text=Shortages%20of%20common%20older%20medicines,are%20currently%20unavailable%20from%20suppliers.

It highlights factors such as manufacturers' unwillingness to produce older medicines that make them less profit and the outsourcing of manufacturing to places like India and China, where it is cheaper, thus increasing profits.

Yes it would be better and it would stop pharmacy staff being abused by customers when they come to collect and their medication is out of stock.

@RosesAndHellebores So are you talking about private prescriptions?

@Riverlee yes. It's never a problem.

Just to say that I was totally coincidentally told today about a company who is developing AI for pharmacists so they have data on medications. Presumably it could also be accessed by GPs if it works.

So maybe we'll get a solution after all!

What difference would it make whether it was a private or NHS prescription? All pharmacies are private companies and can dispense private prescriptions regardless of whether they also dispense NHS ones.

I'm a nurse and since covid, we are the last to know re stock issues. I have sometime contacted the manufacturer and this has been denied only for 2 weeks later to send an email to say they have stock issues
2) many pharmacies in my experience have advised there are stock issues when there isn't. Often, the wholesaler which is alliance hasn't ordered enough stock so there is a delay. I was prescribed cream for my child and was told there was an issue and there wasn't. Went to another chemist and they had plenty

I was thinking the same - it makes no difference. If there’s a shortage of adhd meds, then a company dispensing private prescriptions don’t have a magical supply.

) many pharmacies in my experience have advised there are stock issues when there isn't. Often, the wholesaler which is alliance hasn't ordered enough stock so there is a delay. I was prescribed cream for my child and was told there was an issue and there wasn't. Went to another chemist and they had plenty

The fact that another pharmacy has an item in stock does not mean there aren't issue with stock levels arriving from the wholesalers ...

I work in a pharmacy, if we are out of stock of X item and have ordered it from the wholesaler but they are showing either OOS or informing us of delays to the deliveries that mean we won't get more for 2/3 days then from our pov there is an "issue with the suppliers" as we cannot get the item as we usually would, leaving us short ... Meanwhile the pharmacy down the road has 20 units of X already on their shelves so they haven't needed to order any X from the wholesaler recently. This means they are therefore unaware that the wholesaler is having issues delivering the item this week, because their circumstances mean they are not affected by the issue that has developed since they last ordered X.

So both pharmacies can be telling the truth when one says they're having supply issues and the other says they have no issues, even when the same item is involved from the same supplier due to the different circumstances within each pharmacy.

Those with private scripts for ADHD are having similar difficulties with stock

Yes but you're not buying ADHD drugs online I assume..........

I was prescribed cream for my child and was told there was an issue and there wasn't. Went to another chemist and they had plenty

Yes, and this is an example of how shortages and supply chain issues work on the ground. The lack of cream in the first pharmacy has not arisen from a total U.K. out of stock situation, but from a temporary out of stock in a wholesaler (of which there are several, with depots up and down the land), or possibly even a driver shortage which reduces frequency of deliveries.

The near-total out of stocks of ADHD and HRT medicines is a somewhat different issue.

Online pharmacies with a higher turnover that can afford to hold larger stocks, and may have different trading relationships with the wholesalers and manufacturers, are more resilient than a little high street pharmacy, but they are still badly affected by the major stock outs.

It does make a difference if it’s an NHS or private prescription.

The NHS sets out a price, when it reimburses a pharmacy for prescribing a drug - and pharmacies may be having to pay its suppliers more for a drug, than the NHS is reimbursing them. The pharmacy makes a gross loss then on each prescription, before anyone gets on to covering their shop overheads like wages, rent, business rates, utilities, etc.

It happened earlier this year with Atorvastin, a well known statin and the 80mg tablets. The NHS covered the price of say 40mg tablets; but not 80mg tablets:

https://www.chemistanddruggist.co.uk/CD137198/Four-figure-loss-Pharmacy-contractors-rage-at-atorvastatin-crisis

DH and everyone at his cardiac rehab were affected by this, as they were all on the maximum dose of statins - 80mg of Atorvastin! They were having to take prescriptions back to the GPs to get them changed to 2 x 40mg….

Also pharmacies estimate it costs them £2 to dispense a prescription, whereas the NHS reimburses them around £1.73 - they are making a loss on every prescription regardless of what drug it is.

I assume pharmacies can charge what they like for private prescriptions, so they can ensure they make a profit on the cost of the drug itself and the act of dispensing the prescription!

Anyway, comparing online businesses to independent pharmacies in a high street shop is like me complaining I can’t get the book I need to read for my book club, from my high street Waterstones (the size of a corner shop plus a first floor), but I can always get it from Amazon! The Amazon distribution centres near us are the size of multiple football pitches! The rent for an ordinary sized shop on our high street was £35,000 pa 5 years ago! Business rates will also be sky high.

Obviously it makes a difference to the price Pharmacies receive but it doesn't make a difference to whether the wholesaler has it in stock! Unless you are suggesting that Pharmacists are just pretending that an item is out of stock at the wholesalers because they can't make enough money on it which would be incredibly unethical. It isn't like amazon at all.

Obviously it makes a difference to the price Pharmacies receive but it doesn't make a difference to whether the wholesaler has it in stock! Unless you are suggesting that Pharmacists are just pretending that an item is out of stock at the wholesalers because they can't make enough money on it which would be incredibly unethical. It isn't like amazon at all.

I don’t know. Correlation does not make causation. As I said, DH and his cardiac rehab group could not get their prescriptions of Atorvastin 80mg tablets, but they could get 40mg tablets a few months ago. They assumed it was drug shortages.

This week, I was looking in depth online at why pharmacies are in financial trouble and I came across the articles on pharmacies asking the NHS to reset the tariff for Atorvastin 80mg tablets higher, because they were making a loss on them - which the NHS did eventually. The articles do not go into whether there were supply issues as well at the time.

DD had quit working in pharmacies by then, although I remember her complaining for months about the shortages of HRT. I asked her why there might be shortages in the ADHD drugs, and her first thought was increased demand in the West? Trump complained how American drug companies charged Americans more for their products, than they did what he called the “socialist” NHS. If I were an American drug company, I’d prefer to sell my ADHD drugs to Americans, where demand is rocketing by the sound of it, than at a lower price to the NHS. However that is pure speculation, I have no idea who makes the ADHD drugs, prescribed here.

I have not read all the pharmaceutical guidelines and professional ethics for pharmacists, but imo it would be short sighted of any profession to force its members to operate at a loss - no business can sustain ongoing losses for long, if it’s owners have any sense. They have to close. So patients who insisted their pharmacist dispense their prescriptions at a loss, would ultimately end up with no pharmacy at all. What good have professional ethics done the customers then? Look at Lloyd’s closing their branches in Sainsburys, and iirc Boots is set to close 300 branches as well.

There have been stock shortages for atorvastatin though so they were correct that was the reason they were told to get a prescription for 2x 40 mg tablets. The price the NHS pays changes every three months and is supposed to be based on what pharmacists can buy the tablets in for but sometimes the price goes up very quickly (sometimes due to a stock shortage) and the price paid by the NHS is out of sync with the actual cost.

Of course business can't make a loss so if they can't get the tablets for the price then they make a fuss (as per your link) and the NHS raises the price they will pay outside of the usual three month schedule. They don't lie and tell customers that there is a stock shortage if there isn't!

I'm not sure of your point regarding branches closing and pharmacists "professional ethics".

I know I've commented ad nauseum on the thread but here's a cracker.

On 24th October my nominated chemist sent me a text to complete my prescription. Never mind that when I set up the repeat I informed the GP in writing that I didn't need any drugs. I received 56 levothyroxine 100mcg, 28 lebothyroxine 25mcg and 118 Adcal D3.

Today I got a text to say my prescription was ready for collection. I thought hmm and phoned the chemist.

Evidently I have been put on repeat dispensing. This means that every time I collect a prescription another request is sent to the GP within a couple of weeks. If I collect the new stocks on Saturday, another request will go to the GP. The GP has set up three repeats so within about six weeks I can collect 168 levo 100mcg, 84 levo 25mcg and 354 Ad Cal. Enough for six months. It is bizarre.

I thought the whole point of 56 day prescribing was to limit stocks and ensure economic provision.

The pharmacist said I needn't collect until I am down to one week's supply. Presumably the bagged stock is taking up huge storage as every time I go in meds are packed in a plastic bag. Nobody shares this info, one just gets random texts.

This is neither efficient nor cost effective. Why does the surgery not send my prescription automatically to the pharmacy 56 days after sending the last one. Notwithstanding the mockery this makes of the ludicrous 56 day prescribing. One prescription would be far more efficient, especially as these meds are as cheap as chips. I suppose that would need a bit of sentient thought though.

And GPs wonder why patients are losing their patience.

That's not what repeat dispensing is. RD is when you ask for meds I send (e.g. 3 x 2 months worth), so each 2 months you can go back to the pharmacy without us having to reissue and we can only reissue every 6 month. Bearing in mind that for maybe 3-5 doctors in the surgery we routinely have 200 scripts per day to sign and so there's a real safety imperative in reducing them. The next lot of 3 x 2 months only comes when that lot have run out.

@notmorezoom yes I get the 3 x 2 months point. I don't get why the pharmacy orders the next lot as soon as the current lot is collected. Should they not order it 56 days later. If so, that isn't happening here.