Question for a pharmacist

[TheOrigRights]

I get a repeat of my ADs every two weeks.
I order the repeat online via my surgery who authorise it and send it directly to Tesco, who text me when it's ready.

We are instructed by surgery not to put in a repeat request more than 48hrs before it is due.

Normally this has worked very well, but last time when I had not received a text from Tesco I went in the store and asked about it, explaining that I had no more meds.

After some time they told me they were having trouble getting it and advised me to go to a different pharmacy. I did that, they didn't have it either, they phoned another one and they didn't have it.
In the end the pharmacist gave me the capsule version of the same thing. So I got it, but I was anxious and wondered what on earth I'd do if no one locally had it (I have a child at home and can't drive all over the place in search of medication).

My question is this. Does a pharmacist have a responsibility to inform someone (the surgery who issued the prescription or the person who it's for) that they are unable to fill it so that alternatives can be found in good time?

I am not sure how to manage the situation of not knowing if it will be filled in time. Is it up to me to chase or them to follow up?

Do pharmacists note that some meds e.g ADs should not be abruptly stopped?

I think your surgery is being unreasonable. I put my prescription requests in ages before. Although, that still doesn't stop the pharmacy from keeping me waiting sometimes or not giving me enough medication

I called the pharmacy. There is a national shortage of my meds.
He didn't listen to me when I tried to ask what the protocol was. Would he tell someone (the surgery, me?) if he was unable to fill it?

Anyway, he's contacting my doc to ask for it in capsule rather than tablet format.

It seems to be that there should be some line of communication or exchange of info if a medication is in short supply so that GPs are not prescribing those meds. But I know nothing about it.

Hi, a close relative of mine is a pharmacist and I have also been a patient in a similar position to you before as well.

Firstly, I agree that your GP surgery's policy for ordering repeats is unreasonable and leaves no room for delays like this. I would complain about this to the practice manager and detail your experience. If you get nowhere, your local Healthwatch might support you further.

In terms of whose responsibility it is, I think it's a joint responsibility, but GPs and pharmacists are only human (and generally very overworked humans at that) so sometimes they miss things or are not up-to-date with manufacturing issues etc. If there is no production of your medication at all, the GP should have known and not prescribed you it. Then the pharmacist should have known and contacted the GP practice to ask them to prescribe a different one.

However it doesn't seem like that's what's happened here. It seems there is a shortage but some pharmacies still have a supply line. That means that the GP was still fine to prescribe it really and that the pharmacist was fine not to ask the GP to prescribe something else. I think good practice would be for the pharmacy to have contacted you to let you know that they didn't have it and advised that you take the prescription elsewhere and explained your options. However the likelihood is that the pharmacy haven't even looked at your prescription prior to you attending the store to ask about it, because they will be working through a big backlog of prescriptions to fill. In my relative's experience, and in my experience as a patient, this is easily around a week or so. So in fairness to the pharmacist, they couldn't have contacted you about it when they hadn't even seen the prescription.

These issues are symptoms of the chronic lack of enough staff in GP practices and community pharmacists where staff are expected to work very long hours, permanently running with a backlog of work that leaves no time or room to deal with situations like this effectively. That's why it's important that you can order your repeats with enough time to manage situations like this, not being run down to two tablets left or whatever.

Thank you Meadow, that's really useful.

I really do understand the pressure health professionals are under and that's why I want to understand the system so I can follow up with the appropriate person rather than rock up at Tesco and start crying when I feel overwhelmed and I feel they're having a go at me

There are reasons I don't have too many tablets at home at one time.

There isn't a set guideline with regards to this.
A good pharmacy would have preempted the issue or at least called you to see if you had much left as soon as they had an issue getting it but having been a pharmacy technician myself, sometimes things got missed being chronically short staffed (it's mainly why I quit the profession).

If your prescriptions are electronic then I d been wondering if your surgery can post date them so they ll appear two days before you run out so there's time in future to solve the problem before it becomes an issue.

I've seen practice policies that state please request repeats at least 48 hours before they are needed.

I also believe there may be some system of batch prescribing that may be more appropriate for short interval dispensing like you are on - so that, say, 2 months' worth of prescription is in the system and you just collect it from your pharmacy every 2 weeks or whatever.

Hope things improve for you.

Hi OP, there are things you can do to order prescriptions earlier if your practice allows you, but to keep less tablets at home. E.g. you could order them say a week in advance but only collect two days before you need them. Another thing you could do to pre-empt this kind of thing is call the pharmacy in advance of when you want to collect them to ask them to get your prescription ready for collection at X time. This will mean they will sort your prescription before you arrive and then if they notice any issue in theory they should call you to let you know before you turn up. (Although once recently they didn't do this for me for a prescription that they didn't have stocks of due to a manufacturing issue, they waited til I turned up to let me know - I'm guessing this is staffing pressures.) Now that you know there may be an issue with your medication I'd keep a close eye on it for the future and perhaps badger the pharmacy more in advance to ensure they have it next time you have a prescription if you can't rely on them to contact you. It is shit though cos it's not really the patient's responsibility to be doing stuff like this. But also not the fault of staff who in community pharmacists who often work e.g. 8-8 without any real break at all.

This happened to me recently with my contraceptive pill, apparently there is a national shortage of this brand and I had to go to five pharmacies before I got it!

Nobody told me and I just found out when I turned up looking for the prescription. I had to advise the GP of the shortage and ask them to prescribe something different and more widely available. I got the impression that it was very much my problem to solve 🙄

Thanks all.
I have a text from Tesco saying they've requested capsules from my GP, but now I don't know if they'll be issued today. I did tell him I had run out, but it wasn't an easy conversation - he couldn't hear me well, and he sounded very busy.

I am actually going in person to my surgery next week (for a smear) so I shall speak to the staff in person then. It's usually better to talk face to face (mask to mask).

It has worked very well till recently so I'm not complaining, but neither do I want to get sudden withdrawal (done that, it stinks).

Actually as I know Tesco do have the capsules I'm less worried, I am sure they will give me 1 or 2 if the new prescription hasn't come through from the GP. I presume I'm on the computer.

@TokyoSushi I had a problem with contraception earlier this year, the GP prescribed me a drug that there had been a shortage of and then at the time of prescribing production had actually been totally halted so it was no longer available. GP didn't know this. Pharmacy didn't know this either, they told me there was a shortage. It wasn't until my relative looked it up for me and found out it was no longer produced. I told the GP who insisted that wasn't the case as "the computer wouldn't let me prescribe it if it wasn't available" and issued me the same prescription but without the brand name. Back to the pharmacy and I told them my relative told me it was no longer produced but the GP ignored me. Pharmacist didn't know so looked it up and found my relative was correct and suggested another similar medicine. I had to go back to the GP for the third time til they would prescribe me something else. Nightmare!

Stock issues are common problems in pharmacy at the moment. Sometimes we can't get a certain product for three weeks then are able to order say for two days and then it's unavailable again. Likewise we could have been able to order an item yesterday and suddenly not be able to order it today. Often the suppliers do alert the pharmacies but it's often a point of who is able to put the order in first. There are no protocols in terms of alerting the GP/paitent really, we usually do it on a case by case basis. Some patients will have no medication at all and some may have a back up supply that means they can wait until the item becomes available again. We can often like you have had, see if the patient can take a different form of the item, or maybe use a lower strength and alter the dose so that it fits the original prescription.

Often doctors will prescribe things that are unavailable as they don't know the stock availability of all the items. Plus the unavailability may be short-term or long-term. We do try and sort things like this out as much as possible before the paitent comes for their prescription, but time scales don't always allow for that.

My medication is one that is rarely kept in stock and is regularly in short supply I try to put the request in a week in advance. My dose was changed the other day (a Friday for extra inconvenience) and for reasons I had to start it that night. I called round 5 pharmacies before finding one that had enough in stock to cover me for the weekend and allow them to order the rest in.

In the past I have had the pharmacy manage my prescriptions so they put the repeat prescription request, I don't know if that actually allows the to prepare in advance though. I stopped when my dose started changing and they kept requesting my old dose even when I told them not to.