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?

OK, got it

As the system heds in, the assistant might even offer a token number and explain how that works.

The pharmacists anc assistant where I go are very good anc hrlpful.

Had my hospital appointment this week and my consultant has kindly made sure I have enough of my hospital only meds for 3 months. 2 different things all ready for me in the pharmacy about half an hour after my appointment finished.
Today I went to collect the items the GP pharmacist said he would prescribe and would be ready for me yesterday. No sign of anything, everyone denying all knowledge.
So, I will run out of my medication while I am visiting my family 6000 miles away. I leave in 6 days. I don't know what else to do. I will have to try and find a doctor, pay for a private consultation and hope for the best.

(I have been trying to get the GP Px for the last 3 weeks).

We have had telephone triage since covid but didn't before. Before anyone jumps on this when I say triage Receptionists don't decide who is worthy of an appointment, we just take a brief idea of the problem and the GP triages. My surgery is a bit behind in lots of things but it's getting there - slowly

@IrresponsiblyCertainAboutSexualDimorphism I think I did. Technically it's doable it's how you enforce it through procurement is the issue.

That was what I was asking you to explain. How exactly do you think it could be enforced through procurement?

I spoke to the pharmacy yesterday. The GP has provided three prescriptions on repeat dispensing. This evidently means that the pharmacy can fulfil the 2nd as soon as the 1st has been dispensed and then the 3rd when the 2nd has been dispensed. Therefore I have received a four month supply in three weeks and in 7 days I shall have the full 6 month supply.

This makes an absolute mockery of 56 day prescribing and is totally inefficient. It would make far more sense to raise one prescription for six months. That would mean it had to be dealt with once rather than three times. This is why I have no patience for the perpetual whine of overwork arising from the NHS. It is totally illogical.

I wish I could have 6 months supply.

I’m not sure this is how it’s supposed to work.
A batch prescription is an instruction to give a patient a medication at defined intervals. Otherwise we might just as well prescribe 6 months at a time

@PaddingtonsHat indeed. So provide a 6 month prescription and cut down the admin for staff and inconvenience for the patient. If the system worked properly I would have greater respect for it.

This makes an absolute mockery of 56 day prescribing and is totally inefficient. It would make far more sense to raise one prescription for six months. That would mean it had to be dealt with once rather than three times. This is why I have no patience for the perpetual whine of overwork arising from the NHS. It is totally illogical.

How does it make sense for pharmacies to get one third of the dispensing fees income, they used to get? Where would they store all the prescriptions of 6 months drugs, three times bigger than they are now? They are usually only small shops, with no space to expand.

The NHS has a number of factors to consider in the optimum length of prescriptions - like:

1. an increased number of overdoses, if people have more drugs. It’s about balancing the risk.
2. 20% of medical litigation relates to drugs - if prescriptions are for 6 months, that means they wouldn’t be reviewed for 6 months. It’s about balancing the risk.
3. the elderly particularly in care homes may well be on poly pharmacy - their prescriptions wouldn’t be reviewed for 6 months either
4. waste increases with the prescription length - people put the drugs in a cupboard and forget about them
5. people on expensive drugs, would have to throw away say 4 months of drugs instead of a few weeks, if there were a sudden drug change
6. pharmacists cut in fees as above
7. pharmacists needing more storage space as above
8. I imagine the NHS would need greater funds available to ease cash flow - say a person is on a drug, costing £15,000 a year, the NHS has to pay cash upfront for a 6 month prescription of £7,500, instead of having to find the cash for 2 months at £2,500 upfront. It would need to be able access 3x as much cash to pay for its drugs?
9. Ditto pharmacies would have to pay 3x as much for the drugs, and fund that while they wait to be reimbursed by the NHS; and possibly the drugs manufacturers too, waiting for the pharmacies to pay their suppliers?

It might make more sense for you personally @RosesAndHellebores , but the NHS has complex priorities to balance for a whole range of people, including the vulnerable. If all the independent pharmacies go out of business, what happens to the people who need their advice? GPs are snowed under already. Pharmacists know more about drug interactions than GPs.

I'm really starting to doubt you have spent 20 years in the tech industry, unless it's in sales or marketing maybe.
The problem you're describing is very easy to solve technically speaking and doesn't need AI or any other fancy buzzword.
The problem isn't technical, it rarely is these days. Some of the problems you'd need to solve, and there are many, are persuading the pharmacy system suppliers to build an API that would allow other systems to query their stock.

And then persuade the pharmacy businesses that they should allow GP's to query their stock and why would they, perhaps they benefit from people coming to their business regardless of whether they have stock or not.

And then persuade the GP system manufacturers to build against the multiple pharmacy systems stock APIs.

All of that work has to be paid for and, as is the trend these days, that won't be a nice upfront sale that will likely be on a cost per use basis so someone would need to commit to paying for all of this, including maintaining it all for a number of years.

Perhaps you can, as you say, add it as a requirement into procurement contracts, and you can I'm sure but the price for the contract will go up and you still can't force the pharmacy systems to do the work on their systems unless they have a good reason to do so. So do you pay for those private businesses to update their systems as well?

This is all do-able, if you have the money to spend and there aren't other priorities to spend the money on.

@quisquam I appreciate all of that, and as it prevails perhaps GPs could please sort out 56 day prescribing and make sure it works effectively. At present it does not and my time is as valuable as that of the average GP.

It would also be good if GPs dealt holistically with patients. My levothyroxine dose has not changed in 30 years and that particular drug is as cheap as chips and must cost more to prescribe than the drug itself.

The NHS also refused to fund my osteoporosis injectable drug because I don't quite meet Nice guidance despite my rheumatologist recommending it as the most optimal mechanism after 2 vertebral breaks. Therefore I have 2,400 reasons to feel pissed off. The NHS won't pay for what I need but takes the tiddle about prescribing what it will pay for. Therefore I expect it to get right my prescriptions that it will fund and that is not negotiable.

I have worked since 1981 and don't feel I have got vfm and at the end of the day it's the public's money that is not being efficiently used. Rainbow crossing anyone! Notwithstanding the £8k to get my dd the MH suppprt, diagnosis and treatment she needed to recover and manage an MH condition. Without that she would have dropped out of 6th form, not gone to Oxford and would not now be teaching, fulfilling her potential and supporting society. And paying tax!

The system in its current form stinks and is absurd. It isn't working and it isn't good enough. I am sick and tired of the embedded incompetence.

So building an API isn't technical? one that can work across multiple software's, hardware and internet security systems?

Then there is the limitations that many pharmacies and surgeries don't have fibre internet, don't have the correct hardware and that we are talking about agreements between family, national and international companies.

As i said earlier, its like expecting your local corner shop to be able to tell a customer the stock levels of all UK and European supermarkets AND all other corner stores.

This is a pharmacy issue. They don't understand RD.

@notmorezoom. Actually it's a patient issue. The NHS requires 56 day prescribing. It is therefore the responsibility of the NHS and its agents to ensure the pharmacists do understand. It is an indicator that the NHS is not working and it is the funders (the public) who are being messed around. It must cease and it is the principle reason why I iobject to tax being increased for the NHS. Until the NHS understands it is to provide an efficient well delivered service to its patients it doesn't deserve more resources to waste

No, this is one pharmacy who doesn't understand a perfectly straightforward system. I'd suggest move pharmacies.............

@notmorezoom why should I have to move? Why can't the CCG or ICG ensure the pharmacies know what they should be doing to ensure their rules are followed. Why is it always the patient who should be inconvenienced because NHS bureaucracy is ludicrous.

Those who make the rules need to take responsibility for them and the consequences suffered by the patients. I am minded to say customer because the NHS is free only at the point of delivery but I have never met an HCP, u less it is one I am paying, who is cognizant of the concept of customer service.

Vive la revolution.

🙄

Think I'll bow out of this conversation now - you're clearly always right...........

@notmorezoom noted but how interesting. Do you not think that those who make draconian rules need to ensure their bureaucracy that underpins them is correct?

I'll always argue and advocate when I know I'm right. I'll always reflect when another is able to demonstrate I may be wrong.

Once again, for those who weren't paying attention the first 1,936,286 times - the pharmacies are private businesses and not part of the NHS.

No it's not like telling a corner shop to know the stock of all other corner shops.

It's about letting the corner shop have access to it's wholesaler's stock availability so they can order stock at the click of the button. And, it already happens today, same way it happens with car dealerships and loads of other businesses.

It's how online platforms like ebay and amazon work.

Live links are put into place which allow the "buyer" to check stock across multiple sellers. The sellers don't give access to their entire database, they give limited access which is basically just selling price, delivery timescale and whether it's in stock - 3 bits of data which aren't really confidential.

A similar system could allow the GP to know stock availability generally.

I'm sure pharmacies already use a similar system for their stock ordering - I'm pretty sure they can click on a supplier's database link to order stock for next day delivery, and if none are available, they can click on a different supplier.

I think we've already established that pharmacies themselves don't seem to always have good internal stock control systems, so it makes sense to give the GP direct access to the wholesalers' systems (which are already online). Although, not sure at all why individual pharmacies don't have their own stock control so they know what's in stock rather than having to walk to the shelf to see if there are any there - seems a very antiquated way of working!

Yes, we all know that. But suppliers in most other business areas make data available to their customers, i.e. car garages, corner shops, online selling platforms, etc. It's not a problem in the real World outside the shambles of the NHS.

I want actually talking about the data there, I was responding to the immediately preceeding posts about a pharmacy not dealing correctly with repeat dispensing.

However: "pharmacies themselves don't seem to always have good internal stock control systems, so it makes sense to give the GP direct access to the wholesalers' systems"

How would that help? The patient can't pick up their prescription from the wholesaler.