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?

Nice bit of ageism there @melj1213 . I suppose it doesn't apply to pregnant women or those on universal credit? I'm over 60. I don't waste mine or any institution's funds. I do however take exception at the NHS and its constituent parts that perpetually waste the money with which I and millions of others fund it.

@C8H10N4O2 well said.

Boots online stock checker is very helpful

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

Tried that once because I had three weeks' left and had a bunch of long days at work where I'd be nowhere near the Pharmacy between 8am and 10pm.

'You didn't collect after a week so we sent the prescription back to the GP. You'll have to make an appointment to see them to get another prescription now'.

I didn't have a message to say that it was waiting for me, either.

There is a huge difference between what the HCPs are saying happens and what actual patents are experiencing. I was standing at the counter showing the dispensing assistant (in the chemist) the 2 items in the bag that I hadn't ordered and asking about one I had ordered that was missing. The lady behind me in the queue, who was earwigging, said she was a gp receptionist and it must be my fault for ordering the wrong drugs. It is gaslighting and it is infuriating.

Do people have to have certain vaccinations in your industry?

@melj1213

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 neededthe 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've no doubt that some people lazily tick all the boxes. BUT, from my experience, the GP surgery admin/receptionists can also be lazy and tick all the boxes when the repeat request was only for selected items. Likewise, if the pharmacy manage the repeats, they can sometimes tick all the boxes when only selected items have been asked for by the patient - after all, they make more profit by dispensing more, don't they! Certainly happened to us many times.

Worse is my OH's cancer drug package which apparently can't be changed, not even by the oncologist, so every month he gets drugs worth thousands that he doesn't need and doesn't take! Every consultant appointment he mentions it, but they just shrug it off as though it's not important. One of the drugs is over £1k per tablet - he gets issued 3 each month but only takes 2. He's asked them not to issue it for a couple of months so he can use up some of his stock, but they won't do it as apparently it's "too hard" to keep changing the monthly drugs package!

I can't think of any drug that costs £1k per tablet. I think you are mistaken.

Not uncommon for cancer drugs

I run a GP practice. The GPs dont have access to information about stock. They have to follow guidelines (first line choice) and then local systems have their own prescribing policies and after that they are forced to consider the cheapest option, They are responsible for choosing medications that will make you better not for ensuring a chemist (an independent business) can supply it.

When it comes to stock, there are several issues. Some like Boots cut costs by only ordering by request so you have to go back again. The government wont always refund the full cost so when they tell you its out of stock, it might just be they wont dispense it because it costs them money.

We get a list of 100 drugs with supply problems every week via email - how can anyone cope with that. Brexit (both supply and regulatory issues) is still ongoing. We have massive shortage of HRT and the morphine used in end of life, for example.

It is very uncommon for one tablet to cost that much, including cancer drugs. Which one are you talking about btw?

I haven’t read all the responses so I hope somebody has responded that manufacturers do have the ability to update the dm+d if they so wish. GP surgeries may be slow to run updates, though.
GPs are already overworked and the NHS overstretched, so they can’t be expected to know everything.
Sometimes the error is a change of pack size etc
Or there can be issues at one of the three big distributors: AAH, alliance or phoenix.
Pharma is big business so they may even restrict things in some markets if they can direct supply elsewhere for strategic reasons.

plenty of things that affect availability beyond the GPS control.

Ixazomib (Ninlaro). Part of standard treatment for Multiple Myeloma. Alongside Revlimid which costs a few hundred per tablet (which they also over-prescribe!).

Per NHS webpage "The list price is £6,336 per pack of 3 capsules"

https://www.nice.org.uk/guidance/ta870/documents/final-appraisal-determination-document#:~:text=2.3%20The%20list%20price%20is,online%2C%20accessed%20November%202022).

That is the "list price" which is the official price the company charge for the tablets (and probably do in the US). The NHS will be paying a lot less though and the actual cost will be kept secret (as stated the discount is commercial and in confidence).

Well, yes, obviously, but it's still a very expensive drug, however much discount the NHS has negotiated. His consultant is the one who said it costs over £1k per tablet, and I presume she knows what she's doing!! It's hardly going to be a few pounds per tablet is it??

This website suggests the US price is $13k for 3 tablets!! https://www.drugs.com/price-guide/ninlaro

The consultant won't know the cost the NHS is paying actually. They will be talking about the list price too.
No, it won't be a few pounds per tablet if the list price is over 1K per tablet although the discount could be huge. It depends on how often the tablet needs to be taken and how effective if it. If it was once a year and cured cancer, for example they could charge 1K easily but if 1 per day and not so effective, if could be a fraction. NICE decide how much the NHS will pay and won't recommend if the drug costs over the threshold.

But look at something like Humira. The NHS was not paying the US full price for it - mainly because Abbvie wanted it to come into the market here. Still cost around ten grand a year - just not the 96 thousand dollars a year per person (not counting loading phase) it would cost at US list price.

Then biosimilars came along and it was repriced at just over three and a half grand per year charged to the NHS.

I doubt the NHS pays anything like the US price for anything.

Good insights thanks. I think the thing I find interesting is there are lists of low/no availability but these are not used well because they are lists. No GP will have time to cross reference.

It could be easily automated using ML etc to flag against prescriptions though, which is the point of the thread. There is a way to technically solve these issues. When I say technical I mean via software and machine learning.

Just ask your GP to remove your 'linked chemist', so instead of the prescription being sent to a specific pharmacy that may or may not have it in stock/might have short opening hours etc. it sits on the spine and then any chemist can download it using your NHS number. That way you can call up a chemist beforehand and ask if it's in stock or not. And if it isn't, you can just try another.

The system of sending it straight to a linked pharmacy is great if all pharmacies are equal in stock and opening hours but it doesn't work like that in practice and many people need their medicine there and then. For example antbiotics, if 'your' chemist hasn't got any do you really want to be waiting potentially days for it over a weekend? Or painkillers, if you're in agony, and you can't access them. I much prefer having control over where and when I take my prescription.

Sort of relevant, Wales has announced they are rolling out electronic prescriptions. How does that work for the "I've run out of medication" brigade especially the Friday afternoon panicked telephone calls?

@TroysMammy The dr can still issue paper prescriptions as well as eps. However, the difference is that with eps, once dr signs it off, it can be sent straight to a pharmacy (although doesn’t always goes straight away).

Used to hate the Friday panic-ers who made it our fault that they hadn’t submitted their request, and on more than one occasion got told it was their fault if they died, got pregnant etc.

You still haven’t explained how you’re going to make the manufacturers and wholesalers make their information available to every GP in the land.

Thanks. I hope they don't get wind that the GP can still issue paper scripts as I know that some patients will take advantage. We used to get patients who would book an appointment with a GP just to get their script there and then without having to wait 3 working days. When we started online ordering and reduced the time the script line was on more people would come to the surgery to drop their request off instead of registering to use the convenient ordering service.

We've occasionally been blamed for their oversights too.

A genuine question...

Once Wales has electronic prescriptions, what happens if my nominated pharmacy doesn't have the medication in stock?

Very often when I go into the one I use regularly, either I'm told or someone else in the queue is told that an item isn't in stock, and given the choice of taking the paper script to another pharmacy (there are another two within walking distance).

How will that be possible without a physical piece of paper?

You need full phone triage for GP appointments. We've done it for 8 years, I'd never work at a practice that allowed untriaged GP appt booking.

The prescription can be released back to ‘the spine’. Ie, virtual storage of prescriptions. Another pharmacy can then download the prescription. Ask the original pharmacy or surgery for a ‘token number’, which makes the process easier.