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?

I think you misunderstand how repeat dispensing works ... The pharmacy don't "order" any prescriptions.

The GP essentially pre-authorises a batch of prescriptions - up to 12months worth - so that when the previous prescription is collected and processed the next one will be released to the pharmacy to dispense so that it is ready to be collected at the next dispensing interval. In the pharmacy I work in there is an automated system so that a prescription will be "released" as soon as the previous one is processed but then is essentially post dated to 10 days before the next dispensing interval so that it cannot be processed too early (eg if you collect your prescriptions every 28 days, as soon as you collect Rx1 the system releases Rx2 to us so we can see it but it is "locked" on the dispensing system until day 18 of the next cycle) - if we try to dispense it early then the system will flag it and not dispense but we can see it on the system so if there is something we need to order in specially or that there has been a supply issue with we can do so early so that we have maximum time between ordering and collection.

This means pharmacies can manage their stock - if they know 6 people have Rxs that are due for collection on the 15th of the month who all need Atorvastatin, they can ensure that they have the stock to fulfil those Rxs on the 14th so that they are ready and waiting to pick up and go when they're collected on the 15th.

In the pharmacy I work in we have an alphabetised file with every repeat dispensing Rx filed away. When the Rx is released to us, when the previous one is collected, it is printed, we check if anything needs to be special ordered and then it is filed away. We go through it every Monday and any Rx that has a due date within the next week is taken out and processed/dispensed ready for collection.

That way we have the maximum amount of time to order the items but we don't actually assemble the prescription in its bag until the week it is due for collection.

That's not what's happened here. Repeat dispensing means a 6 monthly script will stay at the pharmacy to be dispensed in installments every 8 weeks with the amount you should take for those weeks. When you collect your next bag, the staff will note what date you're next due and your script will be pulled out to dispense. The reason it's been done early this time is that they pharmacy will have received the script with their usual bundle and dispensed it now as they have no idea how much you already have at home, and just dispensed what they have been sent.

The Pharmacy are not daft and will not request a new script immediately after you have collected as they know that it won't be accepted that early as it's not due. All scripts have due dates.

@melj1213 @YouAndMeAndThem what you are describing is what shoukd happen. However, I collected a two month supply on 24.10. The pharmacy texted me this morning to say my prescription was ready for collection. I telephoned because it seemed an error. The person I spoke to told me that as soon as a prescription is dispensed and collected, they dispense the next one. This was the second of a batch of three. I asked if they would dispense the next when I collected the second and they said yes because the GP had raised three and as soon as one was collected, they dispensed the next one.

It is utterly absurd. However I shall collect on Saturday and the next time they tell me to, presumably in the first week of December. I should then have enough stock to last until the end of May/beginning of June. Then we can do it all over again.

It makes a mockery of the reasons for 56 day prescribing which is another ludicrous topic altogether.

If you don't believe me I shall happily pm you the name of the GP practice and the name of the pharmacy (a moderate chain) and you can check for yourselves.

That's insane. We don't even keep a dispensed bag of.meds on the shelf for 6 weeks before putting it back into stock. What a weird way to run a pharmacy.

Then that's probably one pharmacist misunderstanding the system, not how RD is meant to work.

@notmorezoom if it is one pharmacist, do the GP's, or their admin people, not realise the frequency with which prescriptions are being signed off. Also, as my prescriptions are given to me wrapped and sealed, it must cause a huge issue for the pharmacies vis a vis storage.

It just feels like another example of NHS related systems not working. Don't get me on the topic of wastefulness re free prescriptions for over 60s, or everything free for those with hypothyroidism. DH and I earn well, even when we retire, shortly, our pensions/income will be far higher than the average. Waste, waste, waste.

I got my phone call (from the practice pharmacist) to negotiate my prescription and managed to get an agreement for the required amount. I will have to see what is in the bag when I get there.
I am on vagifem pessaries and my gynae told me that I can use 3 per week because my symptoms were so severe. This is written in my notes.
The (male) pharmacist has decided I can't have sufficient for that so is only giving me enough for 2 per week.
I have never met this person and I am not comfortable going into the detail of my problems. Luckily I can probably buy a box of Gina now that it is available OTC. It is yet another thing to have to work around.

@JustCheckingforMe its unlikely that the pharmacist has decided that, as they have to dispense what’s prescribed.

What’s more likely is someone has prescribed your Vagifem and used the default amount which is 2 pessaries weekly. The amount specified by your gynae in a letter hasn’t been actioned into your repeat prescription.

Email your surgery prescriptions team and ask them to amend the amount prescribed as per gynae instructions.

The gp can send a batch prescription, so send six over at once which are meant to be downloaded at monthly/two monthly intervals. So the gp may not be aware when they are being dispensed by the pharmacy.

My gp always used to prescribe the correct amount. There seems to be a new system now where the practice pharmacist deals with everything. I don't know. I didn't want to go into it all. It is impossible to see or speak to a gp these days.

@RosesAndHellebores you don't at all understand how it works. We'll issue 6m of meds every 6m. How the pharmacist handles that is up to them. I don't think you understand quite how many scripts go through an average practice....

@notmorezoom no I don't understand because it had not been explained by any stakeholder. However thank you for the inference that I am stupid. I am not, not all the scummy patients are you know.

However, understanding present or not, the system isn't working is it, if I am getting a six month supply, supposedly managed by 56 day prescribing, every six weeks.

Surely, the answer is that GPs and pharmacists need to make the system work for the patients. Where I live it is not working. When I queried it with the practice, the practice pharmacist phoned me up to cross examine me about how I was taking my meds and inferred my stocks were building up because I was taking them incorrectly. I know how to take my meds and the inference was offensive. Notwithstanding the fact they expected to be able to call and speak with me at their convenience, didn't ask if I could speak and assumed I was free. An absence of mutual respect at practice level.

Why the assumption that the fault always lies with the thick old patient? We aren't all thick and the malfunctions of the system do not translate to respect for patients' time. It's not the patients' fault that so many GPs are overwhelmed with prescribing. That's the fault of CCGs/NHS England who introduced blanket 28/56 day prescribing in the first place. Which is fine if the system works but nobody seems interested in making it work from the perspective of the patient.

3 x 2 months is a reasonable compromise between not dispensing too much in one go to avoid waste, but not doing scripts too often to save workload.

@notmorezoom I agree. I would be perfectly happy with a six month supply, prescribed and collected once. I am not happy with collecting that supply in three goes, particularly when those goes do not join up with the 56 day prescribing mantra. You chaps, GPs and pharmacists, need to sort it out and think of the needs of the patient - and their time, which is no less important than yours.

The reason 56 day prescribing came in is because so many people were basically stock piling meds and creating enormous waste.

One pharmacist incorrectly dispensing doesn't mean the whole system is broken.

@RosesAndHellebores I would suggest using a different pharmacy. One of the online ones might work better for you.

How about you just don't collect the prescriptions until you need them then, regardless of when the pharmacy makes them up for you?

If your pharmacy decides to disregard the guidelines around how to repeat dispense responsibly then that does not oblige you to collect the items immediately, nor is it reflective of the wider pharmacy network, especially as multiple people have shown that the repeat dispensing system is not supposed to work that way so your pharmacy is more likely to be the outlier doing things wrong as opposed to all pharmacies behaving that way. If they want to make your prescriptions up now despite not being due for 2/3/4 months then let them deal with the logistics of storing it rather than taking on the mental load of the job they have not forced you to take and then complaining about it.

The pharmacy I work at has a 4month rolling colour coded storage system because rxs have a 6month validity so in theory you can submit a prescription today and not collect it until May so this is the best compromise we have found to work so we aren't constantly undispensing then redispensing the same rxs if someone doesn't collect for a while. Every time we put a completed Rx on the numbered shelf in the collection area we write the number on the bag and prescription in a certain coloured marker based on the current month. We have a 4 month rolling marker system so at the end of each month we go back and pull any bags marked with the colour from 3 months ago before we start using it again for the next month, undispense them and note on the patients record that the Rx was uncollected and undispensed. There's rarely more than maybe 20-25 bags removed every month, and many of those are often short term medications like antibiotics that patients never collected or items that patients didn't even know their doctor had prescribed.

I have had this happen myself, I've gone to the GP for a blood test, heard nothing back from them immediately (they ask you to wait a week to call for routine blood results) before returning to work two days later, at which point a colleague mentions "Hey we got your prescription for iron tablets through earlier, they're on the side as we knew you'd be in today so didn't file them away" ... Which is the point I find out that my iron levels are low again and I have been prescribed iron tablets off the back of my blood results, but when I call to check the rest of the result levels, nobody even mentions the prescription to me.

And yet people still do it by requesting prescriptions for things they no longer take, knowing they will not take it. It always shocks me when people bring items back from elderly relatives who have passed away/gone into a care or nursing home, at the sheer volume of items especially when it's the same thing that has been dispensed again and again but never actually taken.

One lady came in a few weeks ago with three Tesco bags for life full of medication for disposal that they had removed from her elderly aunt's house when she went into a care home. There were hundreds of boxes of the same item, diligently dispensed on a 2 monthly basis (based on the dates on the dispensing stickers) going back 2.5 years, none of which had been opened but all of which had to be destroyed. This lady was not on repeat dispensing but was just requesting all of the medications on her repeat request list every 2 months, like clockwork, but then only taking 2/3 out of the 7 medications she requested ... She actively had to request those medications from her GP, yet knew she wasn't taking them, which not only wasted the items but also wasted the GP and pharmacy's time processing and fulfilling prescriptions she was never going to use.

@melj1213 because the oharmacy has a notice up saying that if prescriptions are not collected within 7 days they will be sent back. I imagine there will then be a massive Ball ache getting it sorted again with more work for the GP.

It isn't my job to make the system work but it is a reasonable expectation that it does work and works efficiently. So much time is being wasted.

I imagine the issue of the three bags above related to an elderly lady who didn't understand what she was doing. A prime example of where a F2F appointment with a proactive GP would have helped.

They don't send them back to the GP though so they will not need to do anything, they send them back to "The Spine" which is essentially the Cloud for prescriptions. You "imagine" there to be a lot more problems than there actually are because you have no idea how the system works and are basing your opinions of the entire system based on, what sounds like, one very dysfunctional pharmacy.

This just means that the prescription is undispensed from that specific pharmacy and returned to the system so any other pharmacy can dispense it if they want.

So if your pharmacy returns things after 7days then all that would happen is that after a week the prescription goes back the Spine and they undispense the physical item in their store but the prescription is still available for either them, or any other pharmacy, to re-dispense at any point before it expires 6 months after issue.

Pharmacists dispense the prescription that’s sent to them. They don’t usually deviate. If they’re not happy with the dose, they should speak to the gp first.

She presumably didn't want her GP to know that she wasn't taking the medicines. It is difficult to prevent that.

This isn't the pharmacist in the chemist. This is a phamacist in the surgery who will create the prescription and send it to the dispensing chemist up the road. I dont think the gp is involved.

Oh I have not doubt that that was the case, and you can't control what people do with their meds once we dispense them but I have to say that the vast majority of "wasted" medication is returned by over 60s who do not pay for prescriptions, where they just keep reordering things they don't need or won't take. Perhaps it's because they don't see the cost of the waste since their prescriptions are free so they don't realise just how much money is lost for every medication they take without using?

You never get someone just ordering meds they are never going to use when they have to pay for their prescriptions at £9.65 per item, in fact I often get people who pay for prescriptions come to pick them up and ask us to take items off because they don't need it and don't want to pay for it, or where the item dispensed is cheaper to just buy OTC - for example there was a 30yo prescribed 56 ferrous sulphate tablets at a cost of £9.65 for the prescription charge ... You can buy a bottle of 60 of the exact same thing OTC for £3.10 so she opted to pay £3.10 instead of £9.65, but why didn't the GP just tell her to buy them in the first place?

The amount of medicine wasted by that one person was about £3k worth, all in, from the last couple of years. That's £3k that the NHS paid for medicine that was never going to be used, and potentially meant that someone else who actually needed the medication, and would take it, was left short/waiting and that's just one person, multiply that by how many others who are doing the same and the NHS would save millions on waste alone.

I am really careful to only order the repeats I actually need. I still get items I didn't order and not the ones I did order. It all seems very disorganised. Even if I carefully open the bag on the counter in the pharmacy, they cannot take anything back. I wish I could get it organised to get 56 days worth of everything, all on the same day, but it seems impossible. My consultant has just prescribed a new painkiller and I am trying to figure out how to co- ordinate things so I don't end up with another repeat date.

Oh come on, patients are often encouraged to tick the box for automated prescription management by both pharmacists and GP practices which encourages build up of drugs, especially in older and more vulnerable patients who will often assume the doctor/pharmacist knows best.

These threads always go the same way. Multiple posters self describing as part of the system - be it as medics, pharmacists or admin all "explain" how it works, all explain something different because there are massive variations depending on where, when and who you are. There are variations in what should happen and actual practice.

The net result is the same though - somehow its always the patients in the wrong. The system is just dysfunctional if it creates so much waste and so many problems for patients and staff alike.

Nobody is winning here on any side of the situation and blaming problems on stupid patients isn't going to fix anything, its just going to perpetuate waste and problems for all parties.