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?

People need to take responsibility for their own medication. Why should the pharmacy spend hours hunting for one medication when there is the potential for tens of medications to be low stock at any one time. It also costs money to transfer stock between stores.

@melj1213 respectfully, I think the point you are missing is that the patients nominates a pharmacy of their choice. Therefore, because the patient nominates a particular pharmacy, that pharmacy makes money from fulfilling the prescriptions rendered by that patient. Therefore, the pharmacy is responsible for providing an acceptable standard of service. My former pharmacy was not providing an acceptable service. Therefore they lost my families business. 10 x 90p every two months plus the loss of vicarious purchases, probably a tenner a visit.

DH and I are both over 60. We are both still working. Our prescriptions are free. It's absurd. All those £9.35 x 5 every two months that could be invested in decent systems across the board.

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

Why don't you just check your computer system? Would be a lot quicker than physically walking to the shelf and looking for it.

My mum has difficulty getting certain eye drops from her pharmacy. Yet I can order them on Amazon for her just fine.

You buy* *prescription medicines from Amazon? Is that safe? Are the suppliers registered as pharmacies?

Worse is that my OH is on monthly chemotherapy tablets, which come along with various other drugs. They're ALL issued automatically by the oncology dept, even the ones he doesn't use and the ones he takes less than the prescribed dose/days. All agreed with oncologist, he's not just not taking tablets on his own say so. But every sodding 4 weeks, he gets the FULL bag, even of drugs he's never taken and more worryingly, two VERY expensive chemo drugs, one being a weekly drug that he gets 3 of but only takes 2, and the other for 21 days but he only takes 10/11. He's building up quite a cupboard of drugs he didn't ask for and doesn't need to take. But pharmacist won't take them back nor issue less. Oncologist says it "too much hard work" to alter the prescription. We're talking one of the chemo drugs costing over £1k per tablet, and the other £300 per tablet. No one cares about the wasted money! He's tried, tried and tried again to get them to stop issuing more than he needs, but neither oncology nor the pharmacy show any interest in saving the waste!

It isnt though because that's not how our dispensing system is set up, we need to know ahead of processing a prescription whether an item is out of stock so it can generate the order and create an "owing" flag on the prescription so we can find it to dispense the owed item when it comes into stock.

At any given time there can be up to 4 dispensers all dispensing medications and if they're all dispensing paracetamol and there's only 3 boxes on the shelf then someone is going to be left without, so we get prescriptions, pick the items from the stock we have and then dispense them. If there's something missing we can then order it as part of the dispensing process.

Additionally our dispensary is a single room with drawers along one wall - it takes a maximum of 30 seconds to locate an item, see how many we have in stock and take it to be dispensed - as opposed to going into the system, finding the item, checking the amount it says we have and then dispensing it only to then find out that as the item is a "P" item so can be sold as well as prescribed we have sold the item OTC and the till system only reconciles sales to stock levels overnight after we close we haven't actually got any in stock and then have to order it anyway.

@Badbadbunny I am sorry about your DH. It's the sort of thing that makes my blood boil when the NHS continually whines about lack of resources.

These are all GP/doctor problems. Pharmacies cannot decide what they dispense, they do what is on the script. You can refuse to take the medication you don't need before you leave the pharmacy. We cannot get a refund on drugs we have ordered though so it'll just sit on the shelf and hope someone else needs some before it expires o

Nope, the hospital pharmacy won't let us leave any of the drugs and won't take them out of the bag before handing them over the counter. We've tried all ways to get them to stop, but they won't. The best they can do is say they'll take it back and destroy it! They claim there is no way of them being re-issued to anyone else. He's been on them nearly 3 years and has asked several different pharmacists in the hospital pharmacy, and all have said the same.

Most Adhd medication are controlled drugs becuase of this pharmacists have to dispense exactly what is on the prescription they can't swap to generic or change anything as it's recorded exactly.
There is a national shortage at the moment of most adhd medication.

From the pharmacy side, we can't just decide not to dispense something - we have to fulfil the prescription as it is written. IDK if there are restrictions or set prescribing guidelines for the oncologist to follow that means the prescription can't be changed easily so I can't talk from their side, just from the pharmacy side.

We buy medications to fulfil prescriptions we receive then submit the prescriptions at the end of the month to be reimbursed the set fee per drug from the NHS ... If we don't fulfill the prescription properly then we don't get paid.

The problem with your case is they're prescribing more than your OH needs but if the pharmacy dispense any amount that is not the amount on the prescription then they don't get paid. So even though he only takes 2 of X and 10 of Y, if the prescription says 3X and 15Y the pharmacy has to dispense or else they cannot claim the cost back as if they only dispense 2 then the NHS sees this as an unfulfilled prescription and won't process the payment.

Especially if it is an expensive drug the pharmacy can't afford to lose that money every month as the options are: dispense an unneeded but expensive drug that they will be reimbursed for or don't dispense it and don't get paid for it, but they then have the drug sitting in the pharmacy indefinitely (as they have to order it to fulfil the prescription dispensing).

This is especially relevent if it comes in larger pack sizes than is prescribed - if your OH is prescribed 3X but they come in boxes of 12 and a box costs £1200, then if we prescribe the correct number the pharmacy will be reimbursed for the full £1200 that they had to spend to get the 3X for the prescription (and then for the next prescriptions we submit for X we don't get any more money until we go past the 12 we have already been paid for) but if they only dispense 2X then the NHS will not reimburse the pharmacy any money as it is an incomplete dispensing and so the pharmacy is left £1200 out of pocket.

I didn't know this. I've never heard this in community pharmacy but maybe different in hospital.

YABU

GP’s prescribe the medication but they do not dispense it- the pharmacy do (unless you have a dispensing surgery, which are rare outside very rural areas), so unless it is a well known national shortage then it is unlikely your GP would know of individual supply issues.

The pharmacies are separate, independent businesses. They have have agreements with suppliers and wholesalers, and each pharmacy may have slightly different ways of operating- e.g. may hold different levels of stock, keep higher stocks of different medication based on what is used by their customers. Supplies/shortages will change from day to day/week to week.

Your GP will know if there are widespread difficulty with a particular medication-e.g. there is a national and well known shortage of certain diabetic medications. There is guidance stating no new patients should be commenced on them. The GP should know that. They will have no idea of what any/all local pharmacy stocks are of any given medication, nor what the wholesalers delivery times are. Add in that patients can take your paper copy of your prescription to any pharmacy, it would be very hard to ensure there is never an issue.

There could potentially be an AI solution (though presumably this would mean thing each surgery to a particular pharmacy, which is a potential issue in itself), but it won’t be a quick solution, I’d have thought.

If she is on methylphenidate - short acting version doesn't yet seem to be affected by stock shortage.

Out consultant rang us two months ago to warn of medication shortage alert had been announced and to get back to them ASAP if we had issues sourcing medication

I live in a city so lucky and most independents seem to be better at sourcing than chains

Because government IT systems are years behind private sector

It's so sad seeing what must ɓe the Brexit effect. We don't have these issues in my adopted country. Nothing constructive to add. But I agree, if they could see availability they could choose an alternative

Do they put them in dosset boxes/trays or something? That's the only reason I can think that they would insist they can only take them back to be destroyed as they are no longer in the correct original packaging so they can't be reused for other prescriptions as the pharmacist's can't check they are the correct item.

The pharmacy I work in as long as an item doesn't leave our possession we can take it back and return it to our stock to re-dispense; so if you stand at the counter and open the bag in front of us and immediately hand it back we can take it back and put it on the shelf but if you take it, leave our sightline (even if you just turn away from the counter so we can't see the bag)and come back even 10 seconds later we have to destroy the item as we don't have complete "chain of custody" so can't 100% guarantee that the item hasn't been tampered with and with medication we aren't allowed to take any risk.

The IT systems are actually private and not "government".

Well ours is reliant on government staff to build / update and let me tell you it’s ancient. So if it’s private then it’s private based on tiny budget compared to top company IT budget

No, it really isn’t. The data is in the hands of private companies.

@IrresponsiblyCertainAboutSexualDimorphism

So even if NHS IT is private or all the companies that supply the drugs are it doesn't stop federated data nor does it stop enforcement of that as a pre-requisite to supply.

The procurement process for supply can mandate this.

Honestly it really isn't that hard!

If our government said right, any supplier has to provide these data points, and we then have the ML algorithm in place it is not beyond the realms of possibility.

They just can't be arsed. Don't have the budgets or are not incentivised that way...possibly all and many more.

All they have to do is look to industry which have solved a lot of these problems.

So who is going to pay all these private companies to provide this data because they aren't just going to let it happen. Also how up to date can they be? Like are they updating real time cause even our system in pharmacy doesn't update until close of day and everything gets electronically sent! There's also the fact that the individual pharmacy stock file can be incorrect due to a number of reasons, we don't have time to ensure that that is always 100% correct.

As I have said before, patients need to take responsibility for their own medication. If.you don't like the system, order it online.

If our government said right, any supplier has to provide these data points, and we then have the ML algorithm in place it is not beyond the realms of possibility.

So you want a monopoly system?

And when all the private companies go "no thanks, take this as notice to terminate your contract," and the NHS is left with zero GPs to prescribe or zero pharmacies to process the hundreds of thousands of prescriptions issued every day, then what?

Even if some GPs and pharmacies sign up, others won't and that will just heap more pressure on the NHS GPs and pharmacies who will inevitably close as they can't cope with demand and can't make the financials work (many pharmacies make a loss on providing NHS services and break even by providing other services/products, many GPs are the same) so the IT system will be entirely irrelevant as there will be no GPs or pharmacies to implement it with.

The NHS can make it part of the contract that pharmacies sign up for at the next contract renewal point.

This thread really shows how little the general public understand about the processes in GP and Pharmacies thinking they know better than those who actually do the job.