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Reinventing the wheel... badly

The new urgent medicine supply scheme from NHS England requires more thought and revision.

Rusty wheel from the industrial revolution

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In October 2016, as part of its reform of the community pharmacy contract, NHS England published details of a new service — the national urgent medicine supply advanced service (NUMSAS)— which will involve patients being referred by NHS 111 to community pharmacies for urgent repeat medicines (The Pharmaceutical Journal online, 16 October 2016).

The scheme does not appear to recognise fully the value of what pharmacies will be doing to reduce pressure on other parts of the health service.

For years, pharmacists have worked within existing regulations to help patients caught without their medicines (e.g. when they forget to request or pick up repeat prescriptions), including supplying prescription medicines without a prescription under emergency situations. There are also a number of schemes set up around parts of the UK. For example, in Scotland, pharmacies can give emergency supplies of prescription medicines under a national patient group direction (The Pharmaceutical Journal online, 3 December 2005).

The national scheme in England establishes a new way for patients who have run out of their medicines to get their regular prescription medicines by calling NHS 111 and then being directed to a pharmacy which has chosen to be part of the scheme. If suitable, patients who normally qualify for free prescriptions will be able to get their repeat medicines under this scheme at no charge while others will pay the normal prescription charge.

Problems

The scheme does not appear to recognise fully the value of what pharmacies will be doing to reduce pressure on other parts of the health service.

On one hand, NHS England wants to create a better route for patients to obtain repeat medicines from their surgery in an emergency situation without additional cost — under current emergency supply rules the pharmacy charges for the medicine privately. But on the other, it does not want to encourage patients to do this routinely; it wants them to continue to engage with the prescriber, normally their GP. These objectives are hard to reconcile but if the scheme is going to succeed, patients need to be made aware of it.

Since the scheme was started in December 2016 in six clinical commissioning group areas (Brighton and Hove, Guildford and Waverley, Blackpool, Fylde and Wyre, Nottingham City, and Cambridgeshire and Peterborough), it has expanded rapidly and NHS England predicts there will be participating pharmacies in most parts of England by Easter 2017. For a scheme that is supposed to help increase access to medicines for patients without clogging up GP surgeries, there has been little promotion from NHS England to the general public.

NHS England should have considered whether a simpler system, which does not involve NHS 111, would have worked better

There is another problem: community pharmacists will have to redirect ‘walk-in’ patients to call NHS 111, or supply under current emergency supply rules (which would incur an extra charge to the patient). This could lead to more inconvenience if a pharmacist has to turn away patients and ask them to ring NHS 111 before returning to collect their medicine. NHS England should have considered whether a simpler system, which does not involve NHS 111, would have worked better.

The financial rewards associated with the scheme have been deemed modest by contractors — £10.00 for the consultation, £1.50 for the first item dispensed, £0.50 for additional ones — for what could be a complex process, including a large amount of administrative work. Supermarket pharmacies, which are more likely to be open late in the evenings and on Sundays, may benefit most from offering the service. Some contractors may weigh up the costs and benefits and decide not to provide the service for the amount on offer. If many of them see the scheme as too onerous, patients may have to travel far to get their medicines, thereby defeating the purpose of the scheme in the first place.

There is another practical issue to address. Given the NHS’ aspirations to become paperless, it is astonishing that this newly introduced scheme involves handwritten elements and documents being sent by post. It needs to move to electronic communication as soon as possible. Also, perhaps pharmacies would also be more inclined to take part if the administration of the scheme could be done through existing pharmacy software without the need to switch in and out of different systems.

It is hard to envisage that community pharmacies across England will be jumping at the chance to provide this service

Other things to consider

If NHS England’s aim is to give patients easier access to their regular medicines without adding burden to GPs, then there are other things that need to improve. For example, more widespread use of electronic repeat dispensing would help ease pressure on GP surgeries because it enables pharmacists to dispense repeat medicines over a longer period without prescribers having to approve repeat prescriptions each time. It will help overcome some of the access issues for patients whose repeat prescription has to be authorised by a GP, including the requirement for a patient to ask for a prescription several days in advance and sometimes having to pick them up from the surgery.

To expand electronic repeat dispensing requires GPs’ agreement. Despite the potential time savings for GPs and their staff, estimated by NHS England to be 2.7 million hours if 80% of repeat prescriptions were managed electronically, some have been reluctant to embrace the service for reasons ranging from not having the time to set up the system to believing that they may lose control of patients if they visited the surgery less.

Currently, it is hard to envisage that community pharmacies across England will be jumping at the chance to provide this service. The new scheme requires a number of revisions if it is to achieve its objectives of improving patient access to regular medicines and reducing the burden on GP surgeries. NHS England should encourage greater use of electronic repeat dispensing and look at the current local emergency supply schemes to see what can be learnt from them.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20202420

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