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British Lung Foundation
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Pharmacist over-ruling GP

A few months ago, our rural practice started having a fortnightly visit from a pharmacist from elsewhere.

She appears to be reviewing everyone's medication and has called me several times asking me to change/stop medications. The latest being carbocysteine which my GP suggested might be beneficial.

I am assuming this is a cost-cutting exercise and I was wondering if it is widespread or just local to me in Scotland.

I might add that I find it a bit annoying that someone I have never met is trying to change/stop my medication. It is making me feel that I am a burden on the NHS although I try to take as little medication as possible despite my condition worsening rapidly.

15 Replies
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Grrr, how outrageous. I would have a word with your GP greatauntali. Next summer when I'm more healthy I'm going to try to take less carbo but still get my supply from the pharmacy so I can stock pile it just in case they ever try to stop it. I'm always very careful to only order what I need each month. The alternative is to buy NAC from Holland and Barrett.

Good luck. P

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Oh how bizarre! I would get in to see your GP and ask what is going on. Or you could contact the practice manager. x

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Honestly you are entitled to be annoyed..sounds like a cost cutting exercise, they probably hired some management firm..I don’t think a pharmacist’s diagnosis of your treatment should prevail above medical advice. I would raise it with anybody you can think of, if you wish, from the BMA to your MP..

Good luck!!

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WOW, that is really something. The only time they should be able to do that is if the find two of the medications you are taking are conflicting with each other in one way or another which could be dangerous but then that should have been caught when first prescribed.

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The doctor is the only one who should change your drugs. When I had a severe reaction the chemist just referred me to my doctor. However its your consent to change that counts also.

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I think this is becoming quite common. My GP was asked by two consultants, both at RBH and my local hospital, to prescribe me a liquid form of an anti-fungal medication. However he phoned me to say he'd written the prescription, but the pharmacist connected with the surgery (who is on the local prescribing committee of the CCG) had told him the tablet form was much cheaper and he should prescribe that instead. The GP told me he felt "under pressure because of budgetary constraints" to prescribe the tablet form. I pointed out that (a) the liquid form had been specifically requested by both consultants, in writing, because it is more effective than the tablets, and (b) I didn't want a pharmacist overruling decisions made by my lung specialists! The GP reluctantly agreed but he seemed quite intimidated by this b****y pharmacist and his cost-cutting obsession, grrr. Sometimes a little power goes to these people's heads.

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I can only go by my own experience but I too early on was put on carbocysteine by my Doctor which was later stopped by my pharmacist I can't remember exactly why now but either because after a while it is not thought to be so effective or and this rings more of a bell it was not suitable for emphysema which I have and could even be harmful. Whatever the reason I accepted her judgement as it was her job to keep on top of all drugs and changes and effects whereas the General Doctor although informed had a lot more to think about and hence less time to keep up to date with all the different drugs etc. I also seem to remember that I paid for the carbocysteine myself and that actually they were not very expensive so whilst I am like most of us distrustful sadly now on motives in the NHS fearing cut backs I do believe in this case it may not apply - but can only offer my own experience.

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That is interesting. I have emphysema so maybe she is acting in my best interests. She did ask whether or not I thought it was effective and told me to stop taking it for a few days to find out. Having done as requested, I think it probably is effective.

Where do you buy carbocysteine? I have been taking the liquid form.

I agree that GP's cannot be expected to be up to speed on all available medications and their potential side-effects.

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As most inhalers are designed to have long term benefits I don't see how stopping for a few days can give any indication as to the effectiveness of them!

Pharmacist calls me in regularly for a review BUT if they want to change any drug then I refer them to the GP - let them battle it out between themselves, I don't have the knowledge to make a decision.

Pharmacists get a government payment for each drug review they do! It's all about the money they can make from us!

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In the states everyone uses this.

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It's NAC

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I found carbocysteine not very effective as I do not cough much nor bring up much mucus I could buy it over the counter in spain and mine was a powder to mix with water as said just my experience if she has given you the option then up to you what you think. Good luck whatever xx

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Update : Yesterday, I called the pharmacy to order my month's supply of medication and discovered that carbocysteine was no longer on my repeat list ! The local pharmacist reinstated it but I find it wrong that the outsider should have removed it when all I had said was that I would try to do without it to see if it made any difference.

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Hi 'greatauntali' :-)

What is the difference between carbocysteine & NAC? I'm interested because I've found NAC very effective in controlling mucous & exacerbations since starting it beginning of march after being 'provisionally' diagnosed with emphysema!

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I had not heard of NAC but on checking, it would appear that they are similar. The carbocysteine that I have is in liquid form but I believe that others take capsules.

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