28-day drug prescribing is wasteful…

In Pulse today, it’s been announced that compulsory 28-day prescribing is wasteful. Thanks guys, I’ve known that for years.

Unless you have a condition that is relatively simple to treat, with just a couple of drugs, prescribing every 28 days simply doesn’t work. In fact, it can’t be 100% effective even then, as tablets can be dropped and lost, and some which have to be taken whole can arrive broken, thanks to dismal quality control in the generic drug market (I had a batch of my heart drug, Candesartan, that was actually so far below the declared strength I had to double the dose).

I have 16 drugs, 4 of which I could order every 28 days with no problems, but subject to the above caveat (it took me years to convince my GP that having 28 tablets  didn’t automatically mean I’d take 28), because the dose is fixed. The consumption of the rest of them varies considerably, and depends entirely on how ill I am.

It follows, then, that much of the time, if I were forced to submit a repeat request every 28 days, I would be doing so when some drugs weren’t actually needed, and eventually I’d wind up with quite a stockpile of one or two (this could be potentially dangerous for some people with mental health problems).

I’ve faxed my repeat list for decades now, ordering drugs when needed, and not before. A few years ago, they insisted that I use the online system. This used third-party software, cobbled up by a company with zero idea of a patients’ needs, or that fact that many would find such a process entirely alien, but there was no attempt made to make it user-friendly for the less computer-savvy.

So I set up my account, and ordered everything (regardless of what I currently had in stock). 28 days later, tried to log in again; it didn’t recognise me. Now I’ve been online for about 15 years, and a computer user for 20, I don’t forget login details. If they’re complex (as this was (needlessly so, my NHS and/or NI numbers would have got the job done), they’re copied and pasted to a Word document (thus eliminating typing errors), as was the case here, so I knew they were correct. Still wouldn’t let me in.

There was a total absence of the usual Forgotten your password? link, just a note to contact the surgery – yeah, like that’ll help. I shut it down, never went back, and reverted to fax, which I still use. On average, I have re-order every 7 to 10 days.

It does make life more complicated than just ordering everything every 4 weeks whether I need it or not which, of course, I could still do by fax (but not unless forced), and occasionally I do run out, but I haven’t done that for a while, as I now lay out the unused boxes where I can see them, rather than stash them out of sight, so I have a visual check when I’m getting low. I’ve also set up reminders in Outlook, and ensured I have a reserve supply of those drugs I mustn’t be without.

It makes a little more work for all concerned, including me, but it ensures I get only what I need only when I need it, no surplus, no waste, and no crisis caused by inadvertently running out, because I’ve dropped a couple of tabs in the kitchen sink, or on the floor, where they’ve rolled irretrievably under the fridge. Or they’ve pinged out of their blister** and bounced off to oblivion.

And now I have proof I’m doing it right. Though to be fair, the primary concern was the rise in dispensing fees, with wastage coming second.

**Talking of which, what genius thought blister-packed tablets and capsules were ever a good idea? Not only are cuts from the foil a regular occurrence, the amount of waste generated is colossal – a carrier-bag full every 3 weeks or so. It’s absurd. Extrapolated across the country it’s an obscene amount of un-recyclable junk. And, of course, it jacks up the price of the drugs, too.


7 thoughts on “28-day drug prescribing is wasteful…

  1. Pingback: 28-day drug prescribing is wasteful… | Mental Health, Politics and LGBT issues | Scoop.it

  2. I agree about the waste – here in Scotland we order our repeats and get 2 months worth! Admittedly I need most of the drugs so not a lot goes to waste, just the general ones falling down the sink and under stuff. What I do find absurd is my painkillers are only on a monthly basis or a weekly one! Now, I am MsT’s and Oramorph as well as some other painkillers, and I understand that I can’t stockpile them – but having to order Oramorph weekly and diazapam as well weekly, is driving me mad as it means a weekly trip to the chemist. Some of my drugs are not prescribed at the same time as others so you can sometimes be putting in repeats once or twice a week during a month!
    As for blister packs, don’t get me started on them! Our recycling depot will take the instructions from every pack of drugs but will not take the cardboard! So, we have to save the cardboard up in another container and take them to the local tip to put in the cardboard recycling bin!
    I got some antibiotics a couple of weeks ago and they came in the glass bottles – I nearly fell over with shock! What a pleasant surprise, AND the chemist will take them back to recycle. Joy of joys, are some drug companies finally finding that the glass or plastic bottles really did work better? Or are they finding that they too are spending more money on so much packaging! I think that the latter is true.

  3. I agree that it doesn’t work. If you are on life-long drugs then they should be prescribed for at least 3 months and that makes it easier to adjust doses and less hassle having to re-order so quickly. My partner and myself have long-term health conditions and it is so annoying being tied down to 28 days. He’s forgetful and sometimes leaves it late to get his epilepsy tablets and I have to vary my doses according to my pain levels. It’s a farce!

  4. I have some drugs that are dispensed for two months, some for one month, and some for four weeks. The three days difference between a month and four weeks can build up and cause problems, and my surgery don’t ring and ask ‘why you are ordering one drug more frequently?’, they just don’t put it on the form, so it’s only when it’s delivered that you realise it’s missing, and that you’ve only two days worth left.

    And the absurdity of putting painkillers in small boxes so that they collapse in heaps in the cupboard, instead of a nice big box that holds 100 tablets. If I was going to kill myself would having to open three boxes instead of one stop me? No. oh for the good old days when Doctors prescribed for three and even four months, and the pills came in easy to open bottles.

  5. The problem I get with this system (in addition to those already mentioned) is with asthma pumps. My surgery think you’re asking for gold so are ridiculously strict with the timing. With my condition,I get more problems through winter,the cold affecting me more. So I have to stockpile through the summer to last the winter. This alone makes a mockery of the system.
    I’ve been using these for years,discussed the problem with my GP,highlighted the 28 day to monthly problem,but nothing changes. You’d think that,with long term conditions,they’d dispense medication automatically , but alas no.

    • It’s down to the bean-counters at NICE, in large part, but individual GPs vary wildly too. I used to have a GP who’d dispense drugs in pretty much wholesale quantities. Doesn’t happen any more.

      I’ve been buying my own antibiotics for 8-9 years, thanks to the NICE-inspired paranoia. The literature is quite clear, COPD needs treating fast and aggressively, yet my GP arses about with sputum tests and then dispenses a week’s worth of a drug that disagrees with me. Life’s too short.

      Now I can start treatment within minutes of realising I have a flare-up, and have it gone in 3-4 days. This year NICE has finally come round to this point of view, but unless you can trust the patient, give them a stock of drugs, and take the GP visit out of the equation, it’ll never work.

      I used to be at the surgery ever 4-6 weeks with a flare-up. Since I’ve been self-medicating I’ve needed professional help just 4 times.

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