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?

The problem is that you want every shortage to be published to GPs when it just isn't practical.

But the GPs use a computerised system to issue prescriptions which includes "research" functions re dosage, side effects, etc., so why can't shortages been "pinged" into the existing system so that it flags up when a GP tries to issue a prescription for it? The system could be updated regularly, in fact, daily, to keep up to date.

It seems madness that other posters have mentioned bulletins of shortages issued to GPs that they have to read and remember - that's a classic example of antiquated working practices.

Because as Melj explained a couple of posts above yours, most of the local out of stocks are transient and are about shortage medicines not being in the right place. The national out of stocks are managed by, but are largely out of control of, the Department of Health. Visibility of the whole supply chain would take a massive nationalisation effort which will not happen, is absolutely nothing whatsoever to do with the NHS, and would probably cause more problems than it solved.

@Badbadbunny its not as simple as that. I used to find chemist X may not have a medicine, but a local independent further away, who used a different wholesalers, may have it in stock. I used to ring around chemists on occasions, and it’s amazing how many people didn’t want to go to further away chemist y, which may have it in stock, rather than the local chemist x. They then demanded the dr prescribed an alternative.

Because a "shortage" may only last 12 hours and "shortages can appear and disappear within the same working day depending on the pharmacy. If every pharmacy was constantly "updating" their availability then they'd spend more time doing that than dispensing items and it still wouldn't be helpful if an item is available at Boots but not at Tesco so the GP prescribes it as it is available if the customer can only get to Tesco ... It's not as helpful as you imagine it to be except in the case of long term out of stock items which are already covered in the SSPs

We get daily deliveries, if we run out of something at 1pm we can (usually) have more by 10am the following day and as we are open 9-9 then that means the item is unavailable for 9working hours and half the time the customer doesn't even come for their prescription until the following afternoon anyway so any immediate shortage does not actually affect them at all and if every pharmacy was doing that every day then we'd a) never get anything done and b) GPs would get so much conflicting information they would invariably ignore it anyway.

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.

When you get the collection text the medication is physically in a bag behind thd pharmacy counter

By the time you've received a text about availability and contacted the surgery and GP has signed off a prescription for x and you:ve got to the pharmacy, x may be out of stock. Availability changes all the time.

It is a nightmare. I understand why the problem exists but it’s so unsatisfactory and I find it hard to believe that every country has this problem.

The worst is when you have to make another GP appointment because the medicine you’ve been prescribed isn’t manufactured anymore/is out of stock everywhere. What a waste of everyone’s time.

Brexit definitely hasn’t helped.

There is a supply issue with Adhd meds . I spoke to meds prescriber at camhs who said they are hoping to be over the worst mid December . My Ds’s prescription sat at usual chemist for about 10 days . I took my prescription into Boots managed to get them that day ordered in . Pharmacist assistant was quite surprised they could get them so I just dropped lucky I think rather than knowledge .

@Chersfrozenface so why can't the text be sent before the bag is packed?

I think I'd rather go back to collecting paper prescriptions from the surgery and phoning round for myself.

We have, in the past when there was a shortage, asked a GP friend what antibiotics could be prescribed for a specific illness and called ahead to our local pharmacy to find out what they had in stock (rural area and we needed them asap)

When we got to the GP we’d ask for that specific antibiotic, explaining that it was the only one in stock, when they were prescribing.

worked as a one off and I agree that the back and forth over stock is really annoying. Anything that I can get privately online I do, as it’s not worth the back and forth, queuing, driving around that getting them in person causes. I’d rather pay extra and have them delivered to my door

Because until the pharmacist/ pharmacy assistant checks the system and the physical stock, they don:t know whether they actually have the medication to hand over to you. (The packing and labeling, the last step, takes, what, a mi ute?)

I agree with SaltyGod. The NHS and those in and around it have totally lost sight of the fact that the time of the people generally is as important as their own.

You're conflating two totally different things.

When your prescription is complete (IE received, dispensed, checked, ready to collect) we send a text as we are putting it on the shelf to wait for you to arrive. It's the same as getting the "Your parcel is ready for collection at the ABC parcel lockers" text when you're waiting on an Amazon parcel to be delivered.

What you want is for us to receive your prescription on Monday afternoon, see we have none of the item, get the pharmacist to check what the viable alternatives are based on your other medication, send you a message saying "We don't have X, but we do have Y &Z", have you get a new prescription for Y or Z, get it processed and sent by the GP for us to dispense.

The time it takes to do that would mean potentially we have used up the Y&Z stock on other prescriptions by the time yours arrives so we go through the whole rigamarole again, or we have to "reserve" Y and Z for you, therefore taking two medications out of stock for anyone else until the GP decides which to prescribe (and they may not prescribe either) which may then mean another patient who needs Y has to go to their GP for a new prescription for A or B instead ... Meanwhile we were only out of X on Monday and more X arrived on Tuesday morning or was OOS but when we called the supplier they told us that it would be back in stock on Wednesday morning and we could have it by Wednesday afternoon.

The thing is, when I take my car in for a service, and they need extra parts, they can just login to their difference suppliers and can, literally, whilst I'm sat there, give me prices/timescales for different options, i.e. £x from supplier A but it'll be tomorrow, or £y from supplier B and it'll be delivered that afternoon. I decide the option and they click the button and it's ordered. The garage doesn't have full access to their suppliers' databases, they have limited shared access to certain elements of their database, and it's live, so if it's on their system as available, it's available and then the system makes it unavailable as allocated so no one else can buy it.

Like all things to do with the NHS, there's too much of it being "too hard" or "we've always done it this way".

The sheer amount of time and effort wasted with all the too-ing and fro-ing between pharmacy and the GP surgery when a drug isn't available is mind-boggling.

@melj1213 you are over-complicating the logistics. Receive script. Mrs H needs Levothyroxine 100mcg, Amitryptillin 10mg, Levothyroxine 25mcg, Adcal. Ah, we don't have the Levo 25mcg. So send a text saying: Levo100mcg, Amit 10mg, Adcal ready to collect. No Levo 25mcg avail at this time.
Incomplete order stays on the system and patient notified 2, 3, 4, 5, etc daysnlater when it's in. Patient can therefore wait without makingbtwo trips.

Amazon lets me know when an order is partially fulfulled and when the outstanding item is due.

What you are describing is lazy, sloppy and old fashioned.

It's called customer service.

I had this problem over the summer. Told GP I couldn't get hold of it and was told to keep trying elsewhere. There's 4 chemists within walking distance and none had it

I went away and got hold of it there.

Wasn't too impressed that I was told to just keep wasting my time visiting different chemists

@TigerRag someone in power needs to calculate the cost of GDP of lost patient/working time.

But that's what we do at the pharmacy? You seem to want the GP to have access to every pharmacy's running inventory which is impossible as GPs and pharmacies are not owned by the NHS, they are private companies with NHS contracts.

When we receive your prescription at the pharmacy we look on the shelf, if we don't have it in stock we go to our main supplier, if we can get it from them we order it, if not we go to our secondary one and order from there. Both of these suppliers have a 12hr turnaround - if we order before 12pm it arrives the following morning, if we order by 8pm it arrives the following afternoon. If it's not available from either supplier we have a "Special order" service which can take 3-5 working days as it tends to be more complex/rare/expensive items as well as an ability to buy direct from the manufacturer of there are extenuating circumstances. All of those options are entirely dependent on the individual pharmacy's contracts.

I work in a supermarket pharmacy we use suppliers A or B and have Special Order X ... We cannot use any other company as it is a decision made by Head Office to have contracts with those suppliers only. Boots meanwhile use Suppliers B and C, Special Order X and Y; and the local independent pharmacy uses Suppliers A, C, D and E, Special Order X, Y and Z and can also order direct from the manufacturer in special circumstances because we all have different contracts as they are all private companies with NHS contracts

If only!! Most GPs rely on the pharmacist dispensing some sort of generic version as it's cheaper. There are so many of these, that it would be impossible for a GP to check (or know) availability.

They're monopolising it. It's all about being able to charge more money for the drugs, there is no manufacturing crisis, there is a share holders demanding bigger dividends crisis.

I say this as a parent of an infant who had specialist prescribed formula that could often be unavailable - and as a result we became very friendly with our local hospital.

Why can't the electronic prescription be sent to the patient like a gig ticket. The patient can then phone round all pharmacies and present it at the one with stock?

I agree it’s ridiculous but OP, even if the gp system could check manufacturer or supplier availability, that doesn’t mean there’s availability at any particular pharmacy.
In practice what you (rather annoyingly) need to do is contact your pharmacy before putting in the repeat. It’s a pain but this is how I mostly avoid the problem

I'm not specifically saying about ordering early I mean the ones who ring on a Friday afternoon saying they need a script because they have run out of their medication because they haven't ordered at all.

Because by sending it to the pharmacist on a monthly basis the pharmacy can get a feel for its regular customers and preorder stock knowing Mrs Jones needs her inhalers and insulin every month.

Like all things to do with the NHS, there's too much of it being "too hard" or "we've always done it this way"

The difference is how your garage fulfills its contract as to specified new parts, isn’t controlled by law!

If the GP writes a prescription for 80mg of a particular statin twice a day, that is what the pharmacy has to supply. If they can’t get 80mg tablets, but can get 40mgs, the pharmacy is not allowed by law to supply 2 x 40mg statin tablets twice a day instead.

Likewise, if the GP prescribed the brand drug by name, the pharmacy cannot supply you with a generic, just because they are out of stock of the brand drug.

It’s for your own good, because the GP may have good reason for prescribing the brand drug, and it’s not the pharmacist’s job to question the GP’s clinical judgment (unless it’s obvious there’s been a mistake).

Nobody tells a garage, they can’t supply Pirelli tyres, because Michelin are in short supply.