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?

I totally agree with this, when I say to some patients that they’ll need to ring round the pharmacies to see who might have it or a suitable alternative they refuse and argue that we should do it. It’s their medication and their life. I don’t have any special hotline to the pharmacies. If they don’t have time to make the calls to procure it then I definitely don’t. People seem to forget that we have lots of patients on our list and they are not the only person for us to deal with! I do understand it’s a pain and that people are busy, but it’s just the situation and that part of sorting it out really can’t be the GP’s job along with everything else.

Better to phone them.

This is the 21st century.

Yes, and a population that wants everything as cheap as possible! Pharmacies are short staffed, because the dispensers and counter staff spend years doing training for jobs, with more responsibilities, but no more pay than the staff on the supermarket tills.

DD went to work in a pharmacy, that only had permanent pharmacists. They hadn’t been able to recruit any dispensers or counter staff for 2 years - it ran only on locums, which are more expensive and not committed to the job. Turned up late, hid in the back so they didn’t have to serve customers, didn’t want to do the cleaning and didn’t observe standard operating procedures. Some days, the staff were too busy dispensing prescriptions, ringing GPs, ordering stock and serving walk ins, they didn’t have time to answer the phone!

If you want a better service, be prepared to pay for it - and don’t complain at the counter staff, because none of it is their fault. That’s why they leave - they are not paid enough to put up with abusive customers.

It is frustrating, but that’s not the fault of the pharmacy staff or the doctors.

Like most things the fault lies elsewhere if you think outside your immediate need.

Haven’t you noticed the shelves are getting more empty? Why would this also be the case for medication. We were warned. It’s happening.

My partner's medication (testosterone) was out of stock for over five weeks. He just about got by as he's only supposed to inject half an ampoule and had been storing the other half in a sterile vial.

It was only when he was about to run out and asked if they could prescribe him the topical gel that the GP said "oh, well, we can, just order the generic version of your usual medication".

The mind boggles that they didn't mention that as a possibility despite him having gone cold turkey for over a month as far as they were concerned.

i get you OP and i work in the nhs. It’s a nightmare where i live rurally and we are almost never at the doctors. My dd was ill recently and the gp ‘pharmacy’/ dispensary was out of a routine suspension antibiotic. fair enough, but had to drive to the nearest town 25 mins away, park then walk to boots with a grumpy and ill dd. Then was in queue for ages to be then told it was out of stock there 🙄Had to then flee across the high street to make the lloyds before closing and luckily had it in stock. Otherwise it’d be an hours drive to the next town and since evening already, a days wait with a sick child to get it. Not sure what the answer is but if i’d known where to go before it would’ve been so helpful. I suppose i could’ve called round but didn’t think to do this as it’s not exactly an advertised service that pharmacies do and i was hurrying and in flap to collect Dd/get prescription before the GP shut. It was only for amoxicillin so not exactly rare(but i guess high demand).

I have zero access to information about availability. I do check with our in-house pharmacist before prescribing HRT, to see what they can get this week, but I have no access to any databases etc.

Hey All,

I saw this thread and though I might be able to add some help. I did admittedly make this account to share this so apologies if not allowed. But I also had problems getting my ADHD medication so I made a website to help locate it in branches near me and have now made this a public tool :)

Website : https://pharmacystockchecker.com/

Currently this is limited to ADHD medication but I'm open to expand/make same website for different categories of medication but currently don't know any others there are a shortage of, if anyone has any recommendations for this please let me know.

Cheers

@Britneyfan do you have no cognizance whatsoever that some of your patients may also have demanding professional jobs. We don't all have time to sort out cock up after cock up twixt practice and pharmacy when sorting this stuff and prescribing available drugs is what you are actually paid to do.

I have no sympathy over your receptionists not making sensible decisions. If you pay peanuts you get monkeys and if you want to train monkeys you have to induct them properly.

FFS do stop whining darling but apropos another thread you know better than yiur daft patients don't you.

GPs are self employed profit making entities. Patients, like GPs are tax paying contributors to a service that is free at the point of delivery. A service, or not as has been the case for many years, that is funded by the people for the people.

Atrocious.

@RosesAndHellebores it really actually isn’t a GP’s job to sort this out.

And it’s not a cock-up in the slightest, unless in the sense that yes Brexit and everything that has emanated from it (which includes this issue which would not be happening without Brexit) was a cock-up… but that’s nothing to do with GPs or pharmacies. The GP has made no error here.

In this situation the GP has provided a valid prescription to the patient; sourcing the medication to fill that prescription or finding an appropriate alternative that is in stock is absolutely down to the patient and the pharmacists. Once that’s been done that’s when it becomes our job again (to provide a new prescription). If you’re too busy to do it that’s ok, and indeed I sympathise with the frustration of this issue, which I’ve experienced myself as a patient, but it still doesn’t make it my job, and if I am spending time doing that, it’s time I’m not doing the job I’m actually paid for.

It’s clear that you have an axe to grind with the health service generally. As you well know in the other thread I never said anything of the kind about knowing better than my “daft patients” as you put it.

medicine shortages won’t be lessened by prescribing more. Giving 3 people 1 months supply is better than giving one person 3 months supply. That should be done a repeat dispensing basis not repeat prescribing. Stops wastage at no extra cost and smoothes demand for Medicine in short supply.

Just want to say I really appreciate all the different views on this thread it's been fascinating albeit quite saddening with everyone struggling from patients, pharmacy staff and GPs.

@Britneyfan there is absolutely no point in providing a prescription that cannot be fulfilled. At the very least the GP needs to provide a prescription with x or y or z on it. It's interesting that if one pays for the meds on-line, with a prescription there is never, ever a problem. Not even for dd's ADHD meds.

The axe I have to grind is that the people pay for the NHS, along with HCPs, but it is not designed to bear in mind the customer service element. Regrettably it is providing a very poor standard of service. None of the nonsense happens when one pays and avoids the nanny knows best mentality.

You didn't actually use the word daft no, but the inference was there.

Don't disagree generally, but the advice for my husband's condition is three months at a time - because of having to take extra when needed, because if he can't take his medication for any reason it means hospital or death. He's also supposed to have an injectable version in case of emergency, but trying to get more of that is nigh on impossible. This isn't a shortage issue.

On shortages - I've heard some pretty distressing stories from people unable to get their ADHD medication, and their GP practice being misleading and unhelpful about prescribing. Maybe they couldn't have done anything, but honesty about that rather than giving false hope would surely be better (and maybe would have avoided official complaints being made.)

But its not about AI or machine learning, you need new/updated equipment, in pharmacies/suppliers/GP surgeries, that needs power, cooling and space, you then need improved internet connections, new software written, permissions to databases.... all from a mixture of multiple private/global companies, the GP surgeries, the NHS and in every high street pharmacy.

Plus these suppliers are in competition with each other, its like expecting Tesco to know, at a click of a mouse, what your corner shop has in stock at all times plus who supplies them & what they ve got.

I do not recall issues with prescribed drugs a few years ago so perhaps a better question is why the UK has these problems and other countries do not?

Half the issue is presumably pharmacies ha ing contracts only with some suppliers because of better deals struck. If we are to have an NHS then the GP part needs to stack up with the pharmacy part and this is an NHS England issue in that regulations are required for the pharmacies. Also the GPs shoukd be pressuring the ICG's to deal with it as a commissioning issue.

None of the above can be done because the GPs are not employed by the NHS, they are self employed and are profit making whilst providing contracted services to the NHS. They want the best of both worlds and their attitude very nearly scuppered the NHS back in 1947.

Either the nation has a fully state owned and integrated NHS or it transitions to a Continental provision. It works on the Continent far better.

perhaps a better question is why the UK has these problems and other countries do not?
Why comment at all if you don't know what you're talking about?

The FDA did some research pre-covid and found the most common reason was quality and manufacturing issues creating supply chain gaps. Next most common reason was raw material shortage. Covid then dramatically escalated raw material shortages and slowed imports to reduce stocks further. Every country tracks their medicine shortages, and the EMA tracks it for the EU here: www.ema.europa.eu/en/human-regulatory/post-authorisation/availability-medicines/public-information-medicine-shortages. But sure, it's only the UK that ever had any issues.

The NHS has lots of data and information about GP prescribing. Possibly better than anywhere else in the world. It is able to predict what is needed and where right down to individual GPs. The knowledge on demand isn’t the issue.

It cannot predict the supply change problems. Which sits behind the problem in a system that is designed to JIT. Community pharmacies cannot and don’t hold stock. They order it Just in Time. If the suppliers don’t have it they cannot get.

They then have to contact busy GPs to change the prescription. Usually from generic to brand, or even brand to generic. Or send the patient elsewhere to a bigger pharmacy who is better able to source it.

Even changing the prescriptions is short term. Whatever they change it to will run out.

The problem is supply not demand. Whilst the NHS can do better in managing the problem it cannot sort out the supply issues. Caused by Brexit and Covid.

I don’t think it’s reasonable to explain etc the GP to have to trawl through yet more information to find out what is available and where. They are busy enough. I’d rather be able to get an appointment tbh

*expect

Slightly off topic but still relevant.

It had already been announced at the beginning of the year that all Lloyds pharmacies on Sainsbury's sites would be closed (237 outlets, apparently).

Now the regional news site says that all Lloyds pharmacies in Wales have been closed.
(This is a Reach site and therefore a nightmare to read.)
https://www.walesonline.co.uk/news/health/lloyds-closed-pharmacies-wales-27970193

That's hardly going to help.

Well done. Now just do it for all the other big chains, and all the independent pharmacies, and all other medicine. Then pay to host it long-term and keep it up to date..................

Hey , thanks for your kind feedback ……. Not to sure what your problem is with this ? It’s helped a bunch of people get hold of medication ? Please do tell and I might be able to improve for you :)

This is the reality of people saying

”Can’t pharmacies just text/ring/order me….”

https://www.pharmacymagazine.co.uk/news/vast-majority-of-community-pharmacists-at-high-risk-of-burnout

On shortages - I've heard some pretty distressing stories from people unable to get their ADHD medication, and their GP practice being misleading and unhelpful about prescribing.

It may surprise you to know that GPs aren't really prescribers of ADHD meds; they're specialist, controlled drugs with red flags and are supposed to be initiated by specialists in secondary care eg psychiatrists. A GP may have a shared care agreement with a specialist and agree to CONTINUE prescribing. However if that medication becomes unavailable it has to go back to the specialist (ie the hospital consultant) to prescribe an alternative.

It is not the GPs responsibility to source, prescribe and stock check an alternative. However like most things in primary care it seems to have become so...