View from the ground, by Dr Rachel Hooke

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Pesky repeat prescriptions can be the bane of the lives of patients, doctors, and pharmacists.

For busy working patients, the temptation to stockpile supplies can be very strong as the last thing they want is to run out of medication. Ordering repeat prescriptions has been made easier by online requests and electronic communication with the patient’s regular pharmacy; however, they still need to obtain their tablets, whether that’s by visiting the pharmacy or being at home for a delivery. Depending on their schedule and other commitments, they may carry this out erratically.

Retired patients may have more time but do not necessarily have internet access and may not be able to get to the pharmacy. Home deliveries can be delayed or the date changed abruptly, possibly leading to a few extra days before the patient actually receives the medication. To account for this, patients learn to allow more leeway and ring up earlier to put in their requests. Again, this can lead to stockpiling. 

Holiday time can make things even worse. Normally, 1 month’s or even just 4 weeks’ worth of medication is prescribed at a time. For patients, this means that if they are going away even just for 2 weeks but at a time that will take them past when they would run out, they will need to do some judicious jiggery-pokery with the timing of requests to ensure they have enough for their holiday while still ensuring a supply for when they get back. Otherwise, patients risk returning from holiday assuming they can obtain the next lot of medication, only to find that it has not been prescribed and no-one has bothered to contact them to explain why. The receptionist must then interrupt the duty doctor to obtain an urgent prescription. 

All this can mean that patients request their repeat prescriptions a week or more before the next batch is due to make sure they stockpile enough not to run out. Practice staff will get wise to this, suspect over-requesting, and put a curb on it. Anecdotally, some patients are even asked to account for how many tablets they have got left altogether and end up with a very tight margin on which to manage.

Pharmacies can get caught in the middle, trying to mediate between patients and their surgeries. Some patients may not take kindly to pharmacy staff telling them to contact their practice when they feel that they have already been given the run-around. Alternatively, the patient may have put the request in to the practice assuming it will be transferred electronically to the usual pharmacy. They allow a couple of days, as instructed, before visiting the pharmacy to pick it up but when they get there, they find that the medication has not been made up because the pharmacy has had an issue in the past with no-shows. The patient is asked to wait for 10 minutes for dispensing. Then it becomes apparent that half of the medication is not on the shelf nor in stock and needs ordering from the supplier, which will take another day. The patient is unable to call back at the pharmacy for another few weeks, by which time the tablets have been put back into general circulation and dished out to someone else.

It goes without saying that being without vital medication can cause effects ranging from the inconvenient to the catastrophic. Vaginal bleeding, withdrawal symptoms, hypomania, risk of stroke, seizures, anaphylaxis, or Addisonian crisis are just a few possible consequences. We do not want waste in the NHS, but nor do we want patients to suffer badly and need even more expensive treatment. What is the answer?