Back in the day, October 2016, a question was being asked “How much can CCGs save by ending pharmacy repeat dispensing?”
We read that “Pharmacy minister David Mowat is a man with a lot on his plate. Signing off on a reconsidered pharmacy budget for England will be number one on his priority list, so one might assume medicines wastage is further down his to-do tray.
“But on one of the few occasions when he did speak to community pharmacists, at a Pharmaceutical Services Negotiating Committee (PSNC) event last month organised to persuade him of the sector’s value, he stated that pharmacy will not “get away” from the £20 billion the NHS needs to make in productivity savings”.
A week later, NHS England chief executive Simon Stevens went a step further by highlighting “legitimate considerations” about how much community pharmacy is spending to dole out “£8 billion-worth of medicines”. If the last few years had seen pharmacy’s service provision dominate debates, it’s clear the focus is back on dispensing.
Clamping down on medicines waste is nothing new, an influential study published in 2010 conservatively estimated that unnecessary primary care and community prescriptions cost £300 million in England every year.
But what has changed is that this research, conducted by academics at the University of London and the University of York, is now routinely cited by GP-led clinical commissioning groups (CCGs) who are cracking down on medicine waste as the latest cost-cutting efficiency drive. And as Mr Mowat’s warning implied, community pharmacy has found itself very much in the cross hairs.
It was reported that Southport and Formby, as well as South Sefton, CCGs are piloting a system they claim will prevent “wasted medicines” and “improve the safety of repeat prescriptions”. The latest such repeat ordering initiative is in West Lancashire, a CCG which this month launched a new campaign to tackle medicines waste, snappily titled: “Being a hoarder is out of order!” (Pictured below).
They said “Help us minimise medicines waste. Medicines are expensive, so try not to order more than you actually need. £600,000 a year is spent in West Lancashire on wasted medicines. If this money was not wasted in this way, it could instead be spent on, for example: 50 hip replacements, 50 cataract operations, 40 heart by-pass operations, 10 knee replacements and five full-time nurses”.
So we had reached the stage of the CCG deciding, reasonably enough, that hoarding was to blame for there not being enough money for other NHS purposes. Moving on to how we received our medicines, they could be collected and or delivered, at no cost to the patient. Then, there was suddenly a charge to the patient for delivery, and finally there was no delivery because patients being unable or unwilling to pay and the chemists were unwilling to lose money.
And so we are where we are today. It all started with medicine waste, and ended with such zeal to save money that the only losers were, and are, home bound patients.
Peter Gregory, a GP and clinical lead at West Lancashire CCG, said at the time “With this campaign, we want to give [patients] the confidence to take control of how they take and order their medicines, and to only order what they need. Ultimately, it is about everyone in West Lancashire working together, residents, GPs and pharmacists, so that collectively we can help to tackle this issue of medicines waste”.
And on being warned of the “unintended consequences” that these schemes could have on patients who are “vulnerable, time poor and/or require assistance”, Pharmacy Voice has advised that schemes seeking to “unpick” the support services pharmacies offer patients to help them with their medications should be “considered and consulted on with local pharmacies, general practice and patients so that people are not adversely impacted”.
And now we have the coronavirus, about which the West Lancashire CCG stated “There are no prescription medicine shortages as a result of Coronavirus, but the difficulties facing isolated elderly, disabled, and at risk patients trying to obtain their prescriptions from their chosen chemists, hopefully by free delivery, have still not been resolved”.
Followed by, 19th March from CCG, “We are currently dealing with an exceptionally high level of demand for prescriptions and need to prioritise issuing of prescriptions to those that need them most”.
We wrote “Patients receive medication prescriptions because they need them, so to now be told the POD has a need to prioritise issuing of prescriptions to those that need them most indicates a judgement will be made that some of us need them less”.