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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To think GPs should be able to check medication availability

342 replies

jeaux90 · 12/11/2023 10:11

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?

OP posts:
jeaux90 · 12/11/2023 11:39

@Peablockfeathers

You don't need to integrate all systems they just need to federate or share data points.

Ask yourself why other industries are way more efficient.

We have this weird need to get protective about the NHS I too want to see it thrive but the way it operates is a waste. It creates stress, not just for the users but for the employees too.

My pharmacist is lovely, he's exhausted and could barely talk yesterday. It's a mess.

OP posts:
BinturongsSmellOfPopcorn · 12/11/2023 11:40

You’ll get what you need less than half the time .. the suppliers have it, they just don’t have any “in stock” and needs to be ordered in for the next day.

Have you any idea how many thousands of medicines there are? All in multiple.doses and formulations and pack sizes? Many with short shelf lives. They cannot possibly keep everything in stock all the time just in case it's needed.

OddBoots · 12/11/2023 11:40

I get the whole GPs and pharmacy being outside of the NHS but if there are alerts about national shortages (rather than local stock) then there MUST be a way for that info to be added to Spine (as we have learned it is called) so the GP can see that when they click on the medication to prescribe it.

jeaux90 · 12/11/2023 11:42

GRex · 12/11/2023 11:38

It isn't practical to integrate stock across all privately owned pharmacies. In spring my GP warned me a particular antibiotic may be out of stock, and asked what pharmacy I use, then said he'd have admin check stock and he would put through the prescription for whatever it was the pharmacy had, so wait until after X time to pick up. A time before that when something ran out the pharmacy checked systems and said we could collect from X place or ask the GP to issue Y, we decided to just collect from the other place. Stocks running out aren't ideal, but it happens, best thing is to just stay calm and ask for help from the pharmacist and GP to find you some solution that will work.

I'm sorry but this is not a solution.

This is a sticking plaster.

Other industries are way more efficient.

We need to stop making excuses. The government need to invest in a better more federated way of working across the NHS, GPs and pharmacies.

Do you think supermarkets, medical research, logistics work like this? No, they don't.

OP posts:
NeverDropYourMooncup · 12/11/2023 11:42

I wouldn't particularly like AI getting within a country mile of prescriptions. It would go from a stock check to making prescribing decisions (and refusals) without a trained human's involvement.

jeaux90 · 12/11/2023 11:44

@Musicaltheatremum wow!! That's shocking. I mean it's an indication of how mad it is when I got excited about automatic transmission of prescriptions where I live.

OP posts:
BinturongsSmellOfPopcorn · 12/11/2023 11:44

For a new employee in the NHS to actually be able to work from offer to being on site. 6 months.

In my industry its 20 days.

The NHS could be faster, but I doubt you're comparing like with like. Many NHS employees will be on 3-month notice contracts. Many need DBS checks, health checks, vaccination checks - if they don't already have up to date Hep B, for example, the vaccination schedule for that alone is considerably over 20 days.

jeaux90 · 12/11/2023 11:46

NeverDropYourMooncup · 12/11/2023 11:42

I wouldn't particularly like AI getting within a country mile of prescriptions. It would go from a stock check to making prescribing decisions (and refusals) without a trained human's involvement.

No. It was just mean the alert is sent to the GO as they approve so they can intervene and make an alternative prescription rather than us running between pharmacy and GP.

How do you think fraud alerts are created in banking? It's AI/ML and been around for years.

OP posts:
jeaux90 · 12/11/2023 11:47

BinturongsSmellOfPopcorn · 12/11/2023 11:44

For a new employee in the NHS to actually be able to work from offer to being on site. 6 months.

In my industry its 20 days.

The NHS could be faster, but I doubt you're comparing like with like. Many NHS employees will be on 3-month notice contracts. Many need DBS checks, health checks, vaccination checks - if they don't already have up to date Hep B, for example, the vaccination schedule for that alone is considerably over 20 days.

You are just making my case for me here. In my industry we have to have background checks etc too. It's still 20 days.

OP posts:
Chersfrozenface · 12/11/2023 11:48

Do you think supermarkets, medical research, logistics work like this? No, they don't.

Supermarket logistics work on the basis of separate chains.

If your local Asda doesn:t have Heinz beans in stock, its system can't tell you whether the Tesco up the road has them.

CormorantStrikesBack · 12/11/2023 11:52

jeaux90 · 12/11/2023 11:47

You are just making my case for me here. In my industry we have to have background checks etc too. It's still 20 days.

But the NHS doesn’t do the checks themselves. It’s the DBS service. Which is not controlled by the NHS. So either your industry isn’t doing DBS checks as their background check(so won’t be as thorough) , or it takes longer than 20 days (on average).

the hold up with the dbs checks is normally at the police force vetting stage. So maybe they should be quicker. 🤷🏻‍♀️. But then they don’t get enough funding to employ more dbs check staff. But it’s not the nhs fault.

as for the original question. All the pharmacies are private companies. Lots of different firms. The GP doesn’t have access to their stock control.

melj1213 · 12/11/2023 11:52

ExtraOnions · 12/11/2023 11:18

Our surgery has an in-house pharmacy. It’s hopeless

You’ll get what you need less than half the time .. the suppliers have it, they just don’t have any “in stock” and needs to be ordered in for the next day. This isn’t just a one off .. I was there last week where someone needed the medicine urgently for her brother who had terminal cancer, told her it would be next day (hopefully), she made a bit of a fuss .. and (surprise surprise) they found some round the back.

The whole place is filled with bags waiting to go out, and still seems to run on paper

This clearly shows a total lack of understanding of how pharmacies work.

Pharmacies cannot hold infinite amounts of infinite supplies of infinite medications that could possibly be prescribed on any given day "just in case".

Therefore we hold larger amounts of stock of the most common lines - amitriptyline, atorvastatin, amoxicillin, flucloxacillin, bisoprolol, omeprazole, penicillin, prednisolone, metformin, co-codamol, naproxen etc - and smaller amounts of other drugs we use often but not necessarily daily to ensure that we aren't wasting it (eg due to it expiring before it gets dispensed) but even on "fast line" items there can be a rush on them at certain times so we just don't have the stock that day but, unless it's a Saturday, the pharmacy I work in gets daily deliveries whereby as long as we order an item before 7pm it will be with us by 5pm the following day.

I work in a pharmacy within a supermarket, in the evenings (after 5pm) and at weekends there is only us and another supermarket pharmacy on the other side of town who are open, so we get every prescription from the OOH centre and/or everyone coming in after work or on Saturday with a paper prescription because it is most convenient. Unfortunately if we only have 20 boxes of flucloxacillin and 21 people are prescribed it at the OOH centre, the last person either has to go elsewhere or wait until the following day when our next delivery will arrive. We can't just magic medicine up from nowhere, we aren't pharmacists from the 19th Century who mixed up their own concoctions on site.

In the case of the person in your example, it might be that they didn't have anything sitting on the shelf but they had an item that had been dispensed for someone else but they made the decision that her need was greater and/or hedged their bets that the other person wouldn't come in for the medication that day (either due to the time or because it had been sitting waiting to be collected for a few days/weeks/months) and essentially took it off the other person to give to her. This is not best practice and sometimes even palliative care medication isn't time critical and can wait 24hrs but if not then the pharmacist will make an informed decision as to the best course of action to take, which may be taking medication from one person to give to another because they are physically there at the moment.

Of course the pharmacy is filled with bags and runs on paper - we get hundreds of electronic prescriptions sent to us each day to fulfil (as well as the walk ins, referrals, private prescriptions, online doctor orders etc) and we have to print out the prescription, put it in a basket with the items we have physically taken off the shelves as per the prescription, dispense them on the computer system, have a dispenser check the information on the sticker matches the item it is being attached to and then have the item checked by the pharmacist before they sign off to hand out. If someone isn't waiting to collect it there and then we have to file them away for collection and the easiest way to do so is to put it on a numbered shelf and then write the number on the prescription and file it away until someone comes to collect it. There's no way we could do this if every prescription was only available on a screen as opposed to a physical piece of paper that we can take to each location and can only be in one person's possession at any one time.

We also need there to be a physical prescription (or token) as prescriptions are legal documents so we have to have them for the items to be checked off and for the patient to fill in the back of with their exemption/payment and signature. We also have to physically send prescriptions to the NHS at the end of the month so we can be paid correctly for the items we have dispensed.

CormorantStrikesBack · 12/11/2023 11:54

I mean I guess the govt could buy all the pharmacies if they wanted and make them all nhs. But seeing as the govt are going in the opposite direction and privatisation of various nhs depts and services I can’t see it happening

Peablockfeathers · 12/11/2023 11:54

jeaux90 · 12/11/2023 11:39

@Peablockfeathers

You don't need to integrate all systems they just need to federate or share data points.

Ask yourself why other industries are way more efficient.

We have this weird need to get protective about the NHS I too want to see it thrive but the way it operates is a waste. It creates stress, not just for the users but for the employees too.

My pharmacist is lovely, he's exhausted and could barely talk yesterday. It's a mess.

GP surgeries and pharmacies aren't run by the NHS is the glaring point you're missing.

Sceptre86 · 12/11/2023 11:54

Your understanding of pharmacy is poor. GPS do receive lists of medication that is out of stock longterm. Other shortages can change almost daily. @BinturongsSmellOfPopcorn has explained it really well.

Didoreththeterf · 12/11/2023 11:57

The problem really isn't with NHS IT systems.
The problem is with the supply of the medication.

I presume it is because of Covid and/or Brexit, but its only over the last few years that commonly used medications have been increasingly unavailable.

Investment in publicly owned manufacture of generic pharmaceuticals to ensure continuity of supply would be a more effective solution than fannying about with IT systems to track the shortages.

jeaux90 · 12/11/2023 11:59

@Peablockfeathers pharmaceutical companies don't own all the pharmaceutical research companies but they have a federated way of working.

Just like manufacturing does.

Technically I'd like to understand why there isn't more efficiency when I see way more efficient ways of working in different sectors.

Is this just funding and lack of will to change. I think it probably is.

OP posts:
JessicaBrassica · 12/11/2023 12:04

A lot depends on the gp. My gp knew there was a shortage of one of my medications. She prescribed the medication and an alternative in case the pharmacy didn't have it.

jeaux90 · 12/11/2023 12:23

JessicaBrassica · 12/11/2023 12:04

A lot depends on the gp. My gp knew there was a shortage of one of my medications. She prescribed the medication and an alternative in case the pharmacy didn't have it.

Yes it's hit and miss though. With my gp they knew about one shortage and automatically provided the alternative but not the other two. Unfortunately this impacts my ADHD DD14.

OP posts:
IrresponsiblyCertainAboutSexualDimorphism · 12/11/2023 12:31

jeaux90 · 12/11/2023 11:59

@Peablockfeathers pharmaceutical companies don't own all the pharmaceutical research companies but they have a federated way of working.

Just like manufacturing does.

Technically I'd like to understand why there isn't more efficiency when I see way more efficient ways of working in different sectors.

Is this just funding and lack of will to change. I think it probably is.

What exactly do you think the NHS can do? Do you understand that the NHS is not the Department of Health? Do you understand that all the parts of the supply chain, apart from the bit that happens after medicines are received in hospitals, is private sector?

The NHS is shambolic in many respects, but the problems you’re experiencing are out of the NHS’s control.

melj1213 · 12/11/2023 12:35

jeaux90 · 12/11/2023 11:59

@Peablockfeathers pharmaceutical companies don't own all the pharmaceutical research companies but they have a federated way of working.

Just like manufacturing does.

Technically I'd like to understand why there isn't more efficiency when I see way more efficient ways of working in different sectors.

Is this just funding and lack of will to change. I think it probably is.

@jeaux90 You're just not getting the issue ... Unless it becomes a government controlled monopoly you cannot control supplies from individual manufacturers to individual suppliers supplying to individual pharmacies.

There are essentially three different shortages:

Manufacturing shortage - the item just isn't being made by manufacturers. This can then be subdivided into long and short term shortages

Supply shortage - the item isn't available via specific suppliers

Availability shortage - the item isn't available via specific pharmacies

A shortage can be due to any one (or a combination) of those three reasons and you cannot legislate/fund/change how private businesses run.

You want shortages to be published to GPs - they are via the NHS BSAs "Serious shortage Protocols" (SSPs) if it is a long term/high priority medicine that has a manufacturing issue then the SSP is published and made available to everyone so they can make changes as necessary. The problem is that you want every shortage to be published to GPs when it just isn't practical.

I work in a supermarket pharmacy that is open 7 days a week and we get deliveries 6 days a week. If we run out of something on Saturday afternoon at 2pm we have a "shortage" until Monday because we do not get deliveries on Sundays. Tesco pharmacy (on the other side of town and the only other weekend opening pharmacy) may have the item but if we send out patients to them along with their own then they might also run out by 7pm so there is a shortage as they also don't get deliveries on Sundays ... But the manufacturer and the supplier have stock, as do Boots and the independent pharmacies, the problem is the other pharmacies aren't open at weekends and we can't get items from the suppliers till Monday.

On these situations we try to mitigate the issue as much as possible, eg when we receive the 21st electronic Rx for Flucloxacillin 500mg capsules on Saturday afternoon when we only had 20 boxes in stock we try to call the prescriber at the OOH clinic to inform them and ask them to prescribe X or Y alternative that we have in stock but that isn't always possible and if you have a large area with multiple GPs/OOHs options then it's not logistically possible to call them all especially when we know we will have more stock in 36hrs ...

GRex · 12/11/2023 12:44

I'm not getting your supermarket example, supermarkets run out of stuff all the time and we just pick something else or try another location. Most medication is not daily critical; I get mine on repeat a few weeks ahead of being needed and so does DH; if the pharmacist says to wait a day or two then it's no bother are all. Antibiotics can usually be substituted by the GP, as can painkillers. Letting thousands of medicines go out of date and in the bin fault at every pharmacy can't be the right answer either. Is the issue really that you can't get hold of your GP for a substitute, that you aren't organising yourselves to get medication ahead of time, or that you aren't resilient enough to handle minor inconvenience?

deplorabelle · 12/11/2023 12:51

EilonwyWithRedGoldHair · 12/11/2023 11:16

If you're on repeat prescriptions though they won't let you order 'early' - and with us it's not as if they tell you it's too early. No you go to pick it up only to find it's not there. So have to re-order, which could then leave you requesting your repeat prescription at the last minute, especially if you've had to take extra doses of your medication.

(All this could largely be avoided by prescribing three months at a time for DH - but they refuse to do that because of the risk of him wasting medication - the fact that he would die if he didn't take it and the advice for his condition is to give three months supply is, apparently, irrelevant.)

SO MUCH THIS. I have now got a postal prescription which has alleviated a lot of problems for me (giant faceless corporation no doubt screwin NHS for profit but it doesn't get told it's ordered too early) It used to be a constant cluster fuck to get my asthma medication. Due to rationing of one of the meds I was only allowed one on prescription at a time, but due to the dose I took that lasted two weeks! Ordering a week since the last script left to a "too early" refusal so I was having to put them in after ten days, but when that fell at a weekend I just experienced a break in the medication resulting in poorer asthma control, additional appointments and medication. At my annual asthma review I'd beg for them to do me just one extra prescription so I could have a spare in a drawer for when there were delays with a script. Sorry no you might waste it!

Quisquam · 12/11/2023 12:54

Everybody complains how hard it is, to get an appointment with a GP. Why give them even more admin work to do, taking more of their clinical time away from patients, when pharmacists specialise in trying to get hold of drugs for their customers? Pharmacies usually have several suppliers of drugs.

GPs can’t keep track of what over the counter treatments are licensed for what use; don’t get patients’ names right on prescriptions; prescribe the wrong doses to patients; don’t issue prescriptions on time as per their promise to the patient (all of which pharmacies have to sort out), never mind keep track of what each pharmacy supplier has in stock!

RosesAndHellebores · 12/11/2023 12:59

If the pharmacy can text one has a prescription to collect, surely they could text that x and y is available but z is not of stock, so you need to get an alternative from the GP. We also be helpful when scripts get-out of sync or pharmacies start ordering bits every fortnight, because they get paid boer script. The system is an arse and we, the public invest our time sorting out the endless cock ups.

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