28-day Prescribing

[helvella]

It is now over ten years since the issues with "old formula" Teva levothyroxine which saw the publication of the MHRA/Committee on Human Medicines report which expressly advise avoiding 28-day prescribing.

Yet we still see all too many members forced into getting repeats every 28 days with all that entails.

helvella - 28-day Prescribing

For many years now, there has in the UK been a near-universal imposition of 28-day prescribing.

There is, quite simply, no rational basis for this policy in relation to long term medicines on repeat.

helvella.blogspot.com/p/hel...

[Sparklingsunshine]

I'm on 28 day prescribing, except for HRT which is 3 monthly. Its a pain going to the chemist every month. And my medication is eligible to be requested on different dates which means I'm ordering it in dribs and drabs.

Most of it is stuff I've used for years. It seems a waste of NHS time and resources doing it like this frankly. Its always been 28 day prescribing at my surgery.

[helvella in reply to Sparklingsunshine]

Yes - an utter waste.

And it is particularly bad if they are very on the ball and don't allow even slightly early ordering of repeats.

[Judithdalston in reply to Sparklingsunshine]

Yes I’m on lots of meds, all 28 days ( except insulin) but not the same day each month…levo is the first one to need replacing and often needs chasing up as pharmacist orders the others ‘early’. Most months something is missing!

[TiggerMe Ambassador in reply to Sparklingsunshine]

I heard something remarkable from the receptionist (when I asked for at least 2 x 28 days at a time as I had to travel to collect them as they were unwilling to supply and could the 2 renew on the same date).... she said she would happily put in the request but expected it to be ignored as they get paid per prescription so it's not in their interest!! What an utter nonsense when they need extra staff to deal with long queues endlessly waiting for scripts

I did get my double dose but on alternate months for each script 😳

[helvella in reply to TiggerMe]

The pharmacies get paid a dispensing fee.

Fee per prescription item (p) 127

(And much more comprehensive information about all sorts of special issues.)

cpe.org.uk/funding-and-reim...

The definition of "prescription item" is not always entirely clear.

[TiggerMe Ambassador in reply to helvella]

Maybe that's why they agreed as they just send the script... maybe this is the way round it by getting your prescribing/ dispensing surgery to send the script elsewhere and they'll give you more?

It makes even less sense if it is per item rather than per script...?

[helvella in reply to TiggerMe]

Two entirely different medicines on one prescription will attract two dispensing fees.

But if, say, you get 100 + 25 microgram levothyroxine, I think that might count as a single item but am not sure.

And 3 packs of 100 levothyroxine probably count as one item.

It would be great if any pharmacist members could clarify?

[helvella in reply to helvella]

I've found the words used.

Two things that are treated as one item are "elements". The example used was where you might get one-and-a-half packs (because of how it is packaged). That is two elements constituting one item.

[tattybogle in reply to helvella]

My prescription (every 2 months) is always:

4 boxes of 50mcg levo (usually Accord) ,

and 2 boxes of 25mcg levo ( usually Wochhardt)

The pharmacist usually asks me to confirm it is for "2 items" so mine seem to view each size of tablet as 'an item'

[Hidden in reply to tattybogle]

Almost all my meds are now packaged in boxes of 56 - as opposed to 2 x 28

[Horsecrazylady79]

When I was having mine dispensed in a dosette box, I was warned that due to changes in how they charge, I would have to start paying £5 per med, a time if I wanted to carry on having it in the dosette box, the pharmacist then told me the way around that was if I had my monthly (28 day) repeat broken down into weekly scripts!! She said I could still get them delivered 4 weekly, but to ask the GP for for 4 separate scripts breaking each medicine down into a weekly script, then the company that did them wouldn't charge me! 😳 I was gobsmacked! I live in South Wales and we haven't paid for our scripts in years so to say I was surprised at this would be an understatement, I was on quite a few more meds than I am now and there was no way I could afford it! My GP was shocked too, and agreed to the weekly scripts, until they merged with a bigger surgery and they refused to carry on doing it.

But why prescribe in a 28 day format if they don't have to ... I always assumed they had to prescribe like this? My HC and Pred are the only ones that are prescribed in a greater quantity and that's only because as an Addsions patient you must always have a 3 month supply to hand at home. It would make much more sense and less work for pharmacists to dispense in say 3 or even 4 month batches, surely?

[helvella in reply to Horsecrazylady79]

I'm pretty sure the Welsh govt. would not have intended that when "free" prescriptions were introduced.

Sounds like someone, somewhere, manipulating a loophole.

However, it does appear that there is some "four prescriptions" rule regarding getting dosettes without charge.

[crimple]

helvella, I am very lucky to receive both my Levo and Lio on one scrip sent to pharmacy and delivered in the post. far more efficient than my local Boots which never had sufficient Lio in stock. My scrip is for 2 months and if I send an email they will bring it forward for holidays, they have done that twice this year.

Being a bit of an Environmentalist it would be interesting to see the carbon footprint of those who go to the surgery in their cars to drop off their scrip, then go back to collect scrip and then go to pharmacy and have to go back for items that are missing or need changing and this saga going on every month all over the country. So the carbon cost must be pretty bad and then the time involved in writing scrips or at least signing them every month instead of 2 months.

Has anyone ever looked at the percentage of time receptionists spend dealing with scrips?! The whole system is utterly bonkers.

[helvella in reply to crimple]

My big reservation with online pharmacies is that the more we go down that route, the fewer pharmacies there will be. And we need them when the issue is urgent. For example, an infection which needs immediate antibiotics.

We've also seen service deteriorate from good to poor over time with some online pharmacies.

And I still have an open MHRA complaint about one specific online pharmacy which I believe is acting improperly.

[Sparklingsunshine in reply to crimple]

To be fair a lot of people order meds online these days and the scripts are sent electronically, to avoid paper waste. But not everyone can avail themselves of this, those without the internet, older people etc still have to physically go to the surgery to get their prescriptions re-ordered.

I used to use an online pharmacy for the convenience but the service was patchy at best, and often poor. I could never seem to speak to anyone on the phone and just got frustrated with the whole thing. I now use an excellent independent one and walk to get my meds. I dont have a car so walk everywhere 😊

[crimple in reply to Sparklingsunshine]

sparkling sunshine, great that you can walk to your pharmacy and that it is good. I only have Boots or Lloyds attached to GP surgery. Boots could never comply with my specific meds and at the surgery the queues are out the door for the pharmacy and blocking patient waiting area, good way to spread disease!

[Sparklingsunshine in reply to crimple]

I feel your pain lol The Lloyds near me that I used to use were hopeless, the meds were never ready, even when you ordered days in advance. Then you faced a half an hour long wait in the shop, rapidly losing the will to live. Too many customers and not enough staff.

I'm quite blessed with pharmacies where I live, a max 20 minute walk in any direction will lead to one. I tend to avoid the big pharmacy chains though as I've found they are less accomodating

[crimple]

helvella, yes I do agree regarding loss of pharmacy shops when you have an urgent scrip. I used to spend hours walking back and forth to my Boots for the specific Lio that I need (Sigma Pharma) I was very nearly left short over a Xmas/ New Year and woudl get a couple of weeks at most. I found it all to anxiety inducing. They don't treat diabetic patients like that when it comes to insulin.

I have complained about my online Pharmacy not sending a PIL, they empty 2 manufacturer labelled bottles of 90 pills into one small brown bottle, so I dispense my weekly dose of 21 tablets into separate bottles, to keep track of what I have taken. I have twice asked for a PIL, they sent it but just when I asked.

When I have finished fire fighting on other fronts I might pursue the matter.

Can you PM who it is you have a complaint with?

[helvella in reply to crimple]

Just in case you have not seen this:

MHRA - Patient Information Leaflet

The MHRA requirements regarding Patient Information Leaflets.

helvella.blogspot.com/p/mhr...

[crimple]

Thanks helvella, yes I was aware and will take up the matter when I have time. The levo box always has a PIL. Thanks again for all that you do for us on this site.