Interesting reading

I’ve just read our LPC newsletter and it makes particularly interesting reading this month.

They describe the pilot non-dispensing scheme and reiterate that while they don’t agree with it in principle (due to timing and why not concentrate on getting repeat dispensing up and running
instead?) they are encouraging contractors to take part in order to support the PCT in this initiative.

The newsletter also describes the LPC’s lack of progress with agreeing a SLA and funding with the local DAT for supervised consumption and that the LPC has a number of concerns with the C card scheme that I now know is being run in certain parts of the PCT.

These concerns boil down to the fact that the scheme SLA requires contractors to perform a number of tasks when clients come in asking for their free condoms, but there is no remuneration attached to this work (heard this before!).

Three day week

It’s been great to have some time off over Xmas but the work is still all here to do when we get back, not least because all the dosette boxes that we fill for one of our care homes needed filling this week (of course!) which meant a considerable amount of staff time being taken away from the dispensary to enable us to get all this work done in the three days available to us this week.

We have recently done a lot of work both within the pharmacy and with the GP practices in order to really tighten up on our dosette box procedure (but that’s a story for another time).

Happy Christmas!

As much as I enjoy my job, I’m pleased that Xmas week is nearly over. I wouldn’t say that it’s been the ‘manic hell’ that a lot of the pharmacy staff were predicting, but it has certainly been very hectic.

I think it’s made a difference that we have had a full week available to us in the run-up
to Xmas since there doesn’t seem to have been the usual smell of panic in the air!

We have an excellent Urgent Care Centre in the town next to us and so there has been no pressure on us to open over the Xmas period, and it’s great this year that the pharmacy staff will have three full days off over Xmas.

One of the dispensers told me she couldn't remember the last time that she didn’t work on Xmas eve. Anyway, I wish you all a very merry Xmas.

Agreement with GPs

The boxes of biscuits, cakes and sweets have started to pour in from the customers, which is really lovely of them but really horrible for my waist line.

We have just been talking to our local GP practices about how we will handle scripts that come in for Prednisolone EC during the current ‘manufacturers delay’.

The PCT did email a circular round to all GP practices and pharmacies to alert everyone of the shortage and suggested a number of options of how this could be handled.

After talking to our GPs we have come to the agreement that any scripts we get in for the EC version where we are unable to supply, that we will give the GP surgery a ring to check that it’s OK to substitute the plain tablets and mark the script ‘PC’ etc.

The GPs don’t want us to automatically change everyone over onto the plain tablets in case particular patients have had stomach problems in the past (yes I know there’s not much evidence for the value of EC tablets v plain tablets!).

In these cases the GPs plan to co-prescribe a H2 antagonist or PPI depending on the severity of the previous stomach complaint.

This makes slightly more work for us, but I’m happy about it because from a liability point of view I don’t want to be in the position where we alter a script and the patient experiences stomach problems (even though there is a dubious evidence-base).

Repeat intervention

Here are a few of the interventions I have made this week:

* The patient with numerous repeat medicines, which included two calcium
channel blockers. He had intended to take them both together so we contacted
the surgery to clarify which one the patient should be taking and which one
had been stopped.

* The lady who had recently had her blood pressure reviewed in outpatients
and had had her medication changed. However she didn’t know which of her
regular medicines were for blood pressure and of these, which she should
stop once she started taking the new ones from the hospital. So I advised
her to talk to her GP to make sure she took the correct ones, and stopped
the other ones appropriately (since one was a high dose of beta blocker).

* The patient recently issued a GTN spray who had been inhaling it rather
than spraying it under the tongue.

Do I come here often?

Had an interesting encounter with a rather irate gentleman this week who came into the pharmacy asking for his wife’s repeat medication.

The counter staff couldn’t find anything on the shelf for him; the dispensary staff could see that she hadn’t had anything dispensed from us for 2 months; and on ringing the GP practice, the repeat prescription was not sitting over at the surgery.

So, despite his insistence, we were at rather a loss until one of the dispensary staff wondered if he was in the wrong pharmacy. So we rang the pharmacy up the road who informed us that this lady was a regular of theirs and that her medicines were all ready for her.

So we politely explained to the gentleman that he was in the wrong pharmacy and that his wife’s prescription had been dispensed elsewhere. All well and good, until he left the shop muttering ‘Well I can see why my wife never uses this pharmacy’. Ahhhhhhhh

Record returns

The non-dispensing scheme is ticking along nicely. Most of the ‘non-dispensed’ items so far seem to be prn painkillers. I’ve also been talking to our locums who work in pharmacies which do have a few repeat dispensing patients and they have given me some great tips about where the system can potentially fall down with patients.

One ‘top tip’ is to stress to patients that once they decide they don’t need a medicine on their regular repeat, they can’t then change their mind at a later date. Therefore we have started to stress this as part of the non-dispensing scheme.

And sticking with the theme of ‘non dispensing’ and reducing drug wastage, we recently had a bit of a record with patient-returned medicines when we were given 19 unopened boxes of orlistat from one patient. I know that patients who request medicines they don’t actually need tend to do so either to ‘make sure they have enough at home’ or because they want the doctor to think they are dutifully taking their medicines.

However, we were quite amazed at how this patient had managed to accumulate nearly 2 years worth of this drug, since they should have been regularly monitored as part of a weight loss programme.

Money for nothing

We have started to take part in a PCT-led non-dispensing scheme, where we basically get paid more to ‘not dispense’ rather than to dispense. I believe that the LPC reluctantly agreed to the scheme because it is after all, new monies for pharmacy.

However I share the LPCs’ concerns that a) this is a rather busy time of year to start anything new, and b) whilst the PCT needs some ‘quick wins’ to show some savings to the drugs budget, it would be strategically better if they worked with the local GPs to get repeat dispensing up and running, since the under repeat dispensing we are required to check if patients need all their repeat medicines anyway.

There is also a firm evidence-base that repeat dispensing does reduce drug wastage.

Never-the-less we are duly taking part and are required send a list of the ‘non dispensed’ items to the PCT in order to receive payment. If nothing else, it has really made us think about the practicalities of beginning repeat dispensing in the pharmacy.

Under our terms of service, we are obviously ready to take this on but there’s nothing like actually starting it and finding out where the strengths and weaknesses of our planned procedures actually lie.

Secret C Cards

Had a really embarrassing encounter with a young man this week who came into the pharmacy and presented me with a ‘C card’. I simply hadn’t come across this before and neither had any of the other staff in the shop.

So I asked him what he expected me to do now he had shown me the card and he said that he expected to be given free condoms adding ‘This is a chemist isn’t it!’.

It was at that point that the penny dropped (I have heard of these schemes before) and on looking at the card I could see that it was from a town some distance away from ours that, prior to 1st October, had been in a different PCT.

So I explained to him that we weren’t taking part in the scheme and advised him to try one of the pharmacies in the town from where he had picked up the card.

I was just really frustrated at the lack of communication about this scheme (e.g. Was I supposed to know about this? Was there sufficient information available to patients to explain which pharmacies were taking part?), and that this young man had been responsible enough to try to discretely use the scheme and had failed!

I just hope that our encounter didn’t put him off and that he does try to use scheme again. I have since clarified that the scheme is currently just running in the aforementioned town.