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?

So your system involves mandating that manufacturers should make available real time data about what stock they have and in which wholesalers?

Who is going to make manufacturers do this?

And you have been repeatedly told that this already exists with SSPs for serious manufacturing shortages.

The problem is you seemingly want to extend this to every shortage ever even if the shortage is "It's 8:58pm, the local OOH has prescribed X drug. We have run out of X drug but have a delivery due at 9am which will contain X so the patient will have to wait 12hrs for the non-urgent and not life saving medication to become available"

From the post I read that it's postmenopausal women are the ones that don't have any patience and the lack of medication is the pharmacies fault. Those seeking HRT medication have the poor behaviour.

@Britneyfan as a GP how much time do you waste having to re do prescriptions because you didn't know the manufacturer was out of stock and the patient has to refer back to you?

Unless your disability and/or age means you can't use a phone to call the local pharmacies and say "I have a prescription for MST prolonged release, 20mg do you have any in stock?"

The problem is that some pharmacies hardly ever answer the phone. Such as the one I use regularly. Definitely because they are understaffed and busy coping with taking in and dispensing prescriptions, giving advice, inoculations, drug consumption, packing repeat prescriptions...

@melj1213 sorry but this is not true all the time is it. Notified of some, not all.

This is the issue.

Pharmacies have had so much piled on them, especially during COVID, that we no longer have enough staff to do all of the services required for the people in the pharmacy, never mind answer the phones, and yet we are also supposed to find the time to personally source medications we can't get hold of for patients because they don't want the hassle of dealing with their own medication ...

Whose databases would GPs need access to?

The manufacturers in the UK and abroad? Thd wholesalers? The pharmacy chains, independent pharmacies, supermarket pharmacies?

Mainly because the public is heavily against having integrated systems.

And the vast majority of pharmacies are private, not NHS.

@Chersfrozenface because this isn't about the individual pharmacies it's about the data the GP should have access to from the manufacturer.

Worst case with pharmacies they don't have it in and they get it within a day or so, I mean that's annoying of course.

The point I'm making is at source, you order your normal medication the GP approves it and it gets sent to the pharmacy. You go to the pharmacy they tell you there is a problem with supply from the manufacturer. You then have to go back to the GP for an alternative.

It's the front end process I'm saying should be better. I mean it all should!

@Chersfrozenface to the manufacturers so the upwards supply chain.

Except it is.

Any SSP as determined by the NHS is passed to everyone including GPs. Any short term or supply chain issues are not notified as they are, as by the nature of their name, short term issues that will be rectified within a short time frame that may even be less than 24hrs, therefore it doesn't require an entire overhaul of NHS contracts and having everyone signed up to a new centralised system that requires every private company in the NHS supply chain to provide their private information to any health authority that requires it ...

The point I'm making is at source, you order your normal medication the GP approves it and it gets sent to the pharmacy. You go to the pharmacy they tell you there is a problem with supply from the manufacturer. You then have to go back to the GP for an alternative.

But that "supply issue" might be "We have none in stock and our delivery didn't turn up today because the driver got stuck in traffic due to motorway closures and the next delivery won't be until tomorrow but we have only ordered 20 and due to the delay we now already have 30 prescriptions waiting to be fulfilled so it will be 3 days at least till we can dispense X ... But if you can speak to the GP and get them to change your prescription to Y then we have it in stock and can give you the medication today."

Even assuming the manufacturers have somehow been persuaded to share their commercially sensitive information with every GP in the land, how would knowing what they have in their goods out warehouse be helpful in understanding
a) what they will have tomorrow
b) what the pharmacies can get hold of by this afternoon?

As a GP I'd love it if there were one system that I could check for this. But I understand from talking to my pharmacist colleagues that there are various different systems, different suppliers etc. For me to use a system it would have to add no more than 30 seconds to the consultation and be a 'one-click' thing.

@melj1213 but that isn't true if it was why do we end up like other posters with medication prescribed that are out of stock with manufacturers? Why?

you didn't know the manufacturer was out of stock

FFS, how many times does this to be explained? There are dozens of steps between the manufacturer and you holding the dispensed prescription in your hand. And it is not a case of manufacturer has a pile of the things, the individual pharmacy rings them up, and they deliver it the next day.

Supply chains are global. A single medicine might be manufactured in 10 different factories around the globe. Each will have different stock levels. They then send those to wholesalers or shippers, of which there are thousands - again with different stock levels and capacities. At some point a lot of these meds have to go through one or more national borders and customs systems, which can cause unknown delays - for the UK this is a lot worse since Brexit. Then to national wholesalers and distribution warehouses (especially for the chain chemists). Then to individual pharmacies. All of which deal with several different suppliers and multiple GP practices. So if GP prescribes drug A, even if your miracle supply chain data system means they know for absolute certain it is in stock at pharmacy B when they prescribe it, they can't possibly know whether a patient from GP C (who got a prescription days ago but hasn't yet filled it) will snaffle the last box before the first GP's patient gets there.

And if there is a manfacturing problem, GPs already know. As has been explained to you repeatedly.

@notmorezoom as a GP do you see these SSPs on medication not available from manufacturers?

Exactly. Why should the GP.trawl through multiple suppliers data to check this? That is the Pharmacies job, but as pharmacies are private and owned by different private entities, they have different suppliers so you have to try different pharmacies to get your stock. The GPs get data re properly out of stock things but it's exceptionally hard to keep up with it all.

@BinturongsSmellOfPopcorn then why are we being prescribed those that have had SSP notifications?

There are GPs on this thread saying they wish they did know!!

So the manufacturers would have to be persuaded to allow access to their databases. Would they be willing to do this?

What about different data protection laws and regulations? Given that 90% of UK medicines are imported, and of that number 45% come from the EU.

Would their databases have flags on products they weren't shipping?

And the GPs would need an IT system that could work with the various databases, presuming access were allowed?

Because you're still on this medication, and it may become available somewhere at sometime so if you have a script for it, when it goes become available you can go and get it immediately. If you didn't have a script at all, then you have the whole rigmarole of going to the GP for the script in the first place.

As a mum of a diabetic child what I find frustrating is after a week when I haven’t heard anything from the pharmacy I phone up to find everything is out of stock. I wish they would send out a text and let me know.

Ive had to go around several pharmacies before trying to get all the medication, which as I work full time I just don’t have time for. It’s very frustrating and worrying and his medication is vital.

We do get the SSPs. We avoid prescribing those items.

What usually happens is a patient goes to the pharmacy for an item they usually have on repeat without issue, which has been routinely prescribed electronically so no paper token.

The pharmacy says we haven’t got that. Can’t get it until <whenever>. Patient thinks oh I can’t wait that long or don’t want to wait that long. Goes back to GP for another prescription. GP surgery says what’s the problem, patient says I need another prescription as Boots/Well/Lloyds etc haven’t got it in stock. Surgery says here’s the barcode - you can use this to shop around any pharmacy and as long as they have the barcode they can download and dispense the script.

Patient says no I can’t be bothered to do that (basically). GP receptionist then has to task the GP or NP who then have to spend time represcribing an alternative which may or may not be available. Or there may not BE an alternative so they just have to shop around, which many don’t want to do. Some aren’t able and of course we’ll help but I’m finding an increasing number of patients have the expectation that we’re like Amazon Prime or a supermarket and they can get things instantly with no effort from themselves.

It’s your medication, for YOUR health. Take some responsibility for it and make some effort to source it.

(I’m not talking about completely unavailable meds)

It’s an everyday issue, I get interrupted multiple times a day with requests to provide alternative scripts for patients as pharmacies don’t have what I prescribed in stock. It always has been that way but it’s has been worse since Brexit and especially over the antibiotic, HRT and ADHD medication shortages - this last has been the absolute worst so far, although the HRT crisis has lasted the longest so far (I’m hoping the ADHD meds crisis will be more short-lived). People screaming at me because there is no stock of their ADHD medication, totally refusing to understand the actual situation and making it all out to be somehow my fault…

Mind you it was like that at the beginning with the HRT stuff too until the message got out to women of HRT-needing age that there is a national stock shortage… but people on ADHD medications are often much younger, frequently have other mental health issues, and because they are controlled drugs they can’t order that much in advance so it’s an immediate crisis as they run out tomorrow as opposed to next week with time to try and sort something out in between.

It helps A LOT if the patient has first taken the initiative to call around various pharmacies first to check if they have the medication in stock elsewhere, and if not then asked them what potentially suitable alternatives they DO have in stock and where.

If I have a sensible patient who calmly tells me well I’ve rung around and nobody has my 70mg tablet in stock which is annoying, but this particular pharmacy has some 30mg and 40mg tablets of it right now, then it only takes 2 minutes of my time to sort out a new script for them. No big deal other than the additional difficulty and stress to my brain of rapid task-switching from something else I was in the middle of due to the interruption, and making sure I do go back to finish what I was in the middle of doing before (could be a cancer referral etc) before being interrupted again. That would also be less of an issue TBH if we had half sensible receptionists who took messages and then asked me them again the end of a session rather than interrupting me between patients but I can’t seem to get that message through. And it requires patience on the part of the patient waiting for an alternative prescription, which is in short supply these days, and so the receptionists feel pressured to interrupt me to sort it out right now this second without understanding that I might be in the middle of doing something much more important in the grand scheme of things.

However when I have a patient ringing up sobbing down the phone and threatening to kill themselves because they can’t get their ADHD medication from their usual pharmacy who hasn’t spoken to any other pharmacies then you can imagine it can take up to half an hour to sort out just that one patient. So it depends! But it can definitely be time consuming.

But actually I think much more than the time wasted the worst bit of it is the increased likelihood of abuse from patients over all this, and the emotionally draining and exhausting effect that has on me during a busy and already very demanding working day.