Repeat after me: ban won't work
Martin Hao and Quintus Liu, co-founders of Healthera, say the move for clinical commissioning groups (CCGs) to stop pharmacies from repeat ordering for patients is just plain wrong
Summer 2016 saw the emergence of a CCG scheme to bring an end to pharmacies ordering repeat prescriptions for their patients. Cited with the aim to reduce drug wastage and help pharmacies play their part in saving the NHS millions, several CCGs leapt at the opportunity, and subsequently instructed GP practices not to accept repeat requests from third parties. In fact since the scheme began many CCGs have either implemented or are considering such measures in a bid to achieve major cost savings; money that could be reallocated to frontline services.
Luton for instance was the first to unveil the initiative, with others, particularly those battling significant deficits, eager to follow Lutonâ€™s claimed success and target savings of Â£2.1m by 2020. While the Luton model is positioned as a best practice example, questions remain over its reported figures. Medicines wastage is an issue that must be addressed, and while patients must certainly be encouraged to take better management of their medicines and greater control of their own health, cutting community pharmacies out of the repeat ordering loop, is a rather short-sighted and inconsiderate approach.
Less than half of all pharmacies support the move (though nearly all independent community pharmacies do not), while others remain very concerned about the long-term implications. While it might be a quick win to help save CCGs money, it gives rise to negative consequences.
Affecting patients and pharmacies
Think about the process before: patients would go to their local pharmacy to order their medicines. These orders would then make their way to the designated GP practices in large batches, a process that relieved pressures on GPs and clerks. Now it breaks down the batches, thereby increasing the workload for GPs, who will have to deal with individual cases in a sporadic manner. It makes the process more complex and lengthy for patients.
Considering the relatively low penetration and awareness of the practice where repeats are ordered online, most patients now have to battle with visiting their GPsâ€™ surgeries every single time they need repeat medicines. This doesnâ€™t bode well for many people, and removes the convenience that pharmacies previously offered. For vulnerable and elderly patient, it causes additional problems, confusion and even concern over running out of medication. The option to order via community pharmacies is a convenient choice for many patients. The average waiting time for a routine GP appointment is almost hitting two weeks, and in some instances reaching up to four weeks, despite urgent attempts to reduce the times.
Yet with increase in demand, combined now with driving even more patients to GP practices for repeat prescriptions, this only heightens what is already deemed a crisis. Under new NHS plans, by 2020 patients are being promised access to GP surgeries 8am-8pm, seven days a week. GPs will be named and shamed for long waiting times; so is it right that additional, unnecessary pressure is placed on these services? Independent community pharmacies will suffer greatly â€“ as many in areas where the schemes are currently in action have experienced.
Research has shown that the pharmacies already affected by the scheme have been suffering from patient confusion and unrest, and drastically decreased prescription processing efficiency (caused by the loss of the ability to efficiently plan medicine ordering, effectively schedule staff hours and to notify their patients of prescription collection times.) The impact has no doubt been accentuated by a lack of consultation with pharmacies and local pharmaceutical committees. A scheme of this kind surely demands genuine input from all parties involved? Such an oversight results in a step backwards in terms of progress and collaboration between NHS organisations.
Collaboration is key
Reducing wastage and saving money is a goal that everyone strives to achieve. Reducing the number of prescriptions dispensed will of course save money, however there surely are more cost effective and harmonious alternatives to merely cutting community pharmacies out of the picture? What might be the alternatives?
Letâ€™s streamline repeat prescribing models; letâ€™s step up training for GPs and pharmacies on how to reduce over-prescribing; letâ€™s educate patients on their medication usage and help them monitor it, encouraging them to initiate the ordering of their own prescriptions. But letâ€™s think very carefully about an outright ban on pharmacy prescription reordering.
Independent community pharmacies must be kept in the loop â€“ simply because they are the forefront in offering patientcentred care. GPs and pharmacies all have an equal role to play in reducing the level of medicine wastage, not through an inconsiderate ban but through medication usage behaviour and data analytics. Collaboration is essential to secure longterm, sustainable efficiencies.