Attn westcountryvillan or anyone else with an answer

[9goals2hattricks3pen]

Note in another post you have commented it is absolute carnage in your pharmacy. What I don't understand is why. It's certainly true of our village pharmacy. People have been commenting on local websites about having to wait for up to an hour. There is a small green outside and on there yesterday they were sitting on chairs brought from home. Today there are notices on the window with details of restricted opening hours including 'closed until 2pm today so we can prepare prescriptions for the weekend'

I assume the number of prescriptions being issued has not increased so why is it carnage?

Am I missing something simple. Shortage of staff?

Is there something a pharmacy has that has suddenly become in great demand?

Or is it the great British public that has gone mad?

I guess the West Country is an even better place to be right now.

[WBA1955]

My wife is asthmatic and she has a prescription every month for inhalers. She had a email on Tuesday saying the steroid is out of stock for seven days. This alarmed her as she is almost out, so she phoned Pharmacy to you and they gave her a code to collect some.
She phoned our local chemist and they said they had some in stock.
Our lad went up to collect it and they said the delivery will be tomorrow. He went up yesterday and they said they still haven't got any. He is now awaiting a phone call.
They tell my wife not to order in advance and after she waits they tell her they are out of stock.
Mind you our chemist is like the Cheese Shop in Monty Python.

[westcountryvillain]

Thanks for the question 923 - broadly prescriptions are roughly 75% repeatable medicines (usually but not always every 28-days) with the remainder being for short-term treatments to deal with infections or short-term worsening of a long term condition. Patients or in some areas pharmacies order repeats and they are processed at the surgery & sent to a nominated (by the patient) pharmacy.

When the prescription reaches the pharmacy it's checked by a pharmacist to ensure it is clinically appropriate and run through the computer to create a stock order (usually delivered the next day) & the white label with all the instructions. When the stock arrives the labels are stuck on and it goes through a final check process for accuracy.

Unfortunately - doctors surgeries typically tell patients their prescription is at the pharmacy without telling them the next part about when it is likely to be ready for collection which should be about 2 working days after it's been received all being well.

Pharmacies are private businesses largely funded by the NHS for the dispensing services provided - the margins are extremely tight, so much so that the taxpayer gets a cracking deal and in England a 7% funding cut plus the recent addition of a 5-year deal of no new money (so with inflation at 2% it's a cut of 10% over 5 years assuming operating costs go up by that amount). The govt has told companies to automate using central warehousing which is now commonplace but actually adds time to turn a prescription around. There is minimal spare capacity in the system as we would not be a viable business - I work for a larger multiple, each shop averages about £35 profit per day.

Still with me I hope?

Doctors now have more or less shut up shop, cancelling appointments and doing a lot over the phone & that has sped up the prescription creation so they get more done in a day, sent straight to us. That's the first bottleneck, the 2nd bottleneck is many people have ordered their repeats far too early (think panic buying) and there is no easy way to identify the more urgent from the less so.

The asthmatics despite being well controlled and not having ordered medication for some time have also piled in, I don't blame them as people are worried.

We are overwhelmed with work, it has created long queues and lots of queries which take time to deal with, not to mention the cretinous abuse from ignorant selfish me me me types, many of whom have no place else to be anytime soon under the current rules.

Our workforce is also affected by the virus too, I am about 25% under-resourced and the workload is 15 to 20% higher - so most pharmacies are closing their doors in order to catch-up operationally so more is ready to hand out when the doors are open.

Sorry it's a long response but hope it makes sense!

Keep safe and play nice with your pharmacy - it's unbelievably hard for them.

WCV

[mickd1961]

What an informative post WCV.....thank you for the detail.

I’m on two very long term drugs,Amiytripteline for a stress related problem and Esomaprazole for stomach acid.

I can pick the latter one up over the counter now ( Nexium ) but it costs almost double but in present circumstances I’d do that rather than hassle the local surgery as in Chaddesley Corbett it’s reminiscent of Royston Vazey the village where The League of Gentleman was set!

I can’t get by without the first drug because without it I get pain like an electric cattle prod being used on my b o l l o x as the stress affects my prostate and this drug keeps me pain free.

The first drug is only available on prescription though so I’m left with no choice than to go down the surgery route but in truth they’d help themselves by prescribing a two or three month supply which I’ve asked for.

My guess is they like you to have a monthly supply as they make more money but at times like this it would’ve helped a bit I guess.

Good luck over the next few weeks.

[Q165]

I will second that. Thanks for the information WCV.

I have been on medication since I was a kid but have never really given much thought to the processes behind it. In fact I have become rather blasé to the whole thing. Recently I was a little confused picking up my prescriptions only to see a note upon them saying 'This is not a prescription". I asked my pharmacist about this and he told me that it was all to be done electronically now but at the moment they were experiencing some teething problems and I certainly was not the first confused customer.

It is essential that I have my medication and I will need a repeat very soon. Like most everywhere else the Surgery I use is locked. I phoned the other day concerned about how I would actually pick up my non-prescription. I was reassured that the details could be phoned through to the Pharmacy. Great news and bearing in mind what you say I just hope they are able to cope.

I am OK for medication at the moment but despite the actions of others I am going to have to get my 'prescription' in soon. I cannot take risks.

One thing I take is a controlled drug (Phenobarbital) and I was told I am one of only two people taking it from this large pharmacy. Nearly always it has to be ordered (some of the others too). Do you think there could be any delay in getting hold of some of these drugs? As I say, I am OK for now but who knows what will happen

Good luck to you.

[9goals2hattricks3pen]

Thanks for the question 923 - broadly prescriptions are roughly 75% repeatable medicines (usually but not always every 28-days) with the remainder being for short-term treatments to deal with infections or short-term worsening of a long term condition. Patients or in some areas pharmacies order repeats and they are processed at the surgery & sent to a nominated (by the patient) pharmacy.

When the prescription reaches the pharmacy it's checked by a pharmacist to ensure it is clinically appropriate and run through the computer to create a stock order (usually delivered the next day) & the white label with all the instructions. When the stock arrives the labels are stuck on and it goes through a final check process for accuracy.

Unfortunately - doctors surgeries typically tell patients their prescription is at the pharmacy without telling them the next part about when it is likely to be ready for collection which should be about 2 working days after it's been received all being well.

Pharmacies are private businesses largely funded by the NHS for the dispensing services provided - the margins are extremely tight, so much so that the taxpayer gets a cracking deal and in England a 7% funding cut plus the recent addition of a 5-year deal of no new money (so with inflation at 2% it's a cut of 10% over 5 years assuming operating costs go up by that amount). The govt has told companies to automate using central warehousing which is now commonplace but actually adds time to turn a prescription around. There is minimal spare capacity in the system as we would not be a viable business - I work for a larger multiple, each shop averages about £35 profit per day.

Still with me I hope?

Doctors now have more or less shut up shop, cancelling appointments and doing a lot over the phone & that has sped up the prescription creation so they get more done in a day, sent straight to us. That's the first bottleneck, the 2nd bottleneck is many people have ordered their repeats far too early (think panic buying) and there is no easy way to identify the more urgent from the less so.

The asthmatics despite being well controlled and not having ordered medication for some time have also piled in, I don't blame them as people are worried.

We are overwhelmed with work, it has created long queues and lots of queries which take time to deal with, not to mention the cretinous abuse from ignorant selfish me me me types, many of whom have no place else to be anytime soon under the current rules.

Our workforce is also affected by the virus too, I am about 25% under-resourced and the workload is 15 to 20% higher - so most pharmacies are closing their doors in order to catch-up operationally so more is ready to hand out when the doors are open.

Sorry it's a long response but hope it makes sense!

Keep safe and play nice with your pharmacy - it's unbelievably hard for them.

WCV

Thank you so much for taking the time to send such an informative post

I've taken the liberty of cutting and pasting the bulk of your reply (leaving our anything remotely personal and making clear it's not local) onto our village facebook site where there are many comments about local pharmacy in the hope better understanding might promote more sensible behaviour.

[Leicesterbaggie]

A question for you WCV. Is there no way that those with more serious illnesses can have their prescriptions prioritised. I obviously know nothing of the system and that's why I'm asking. Personally I'm on one blood pressure tablet and one statin a day as probably 50% of the country are. If ours were delayed a little it probably wouldn't have the same dramatic effect as someone with a series condition. Is this too simple a suggestion?

[9goals2hattricks3pen]

I was out out the country for 10 weeks at the end of last year and in preparation I over ordered my pills. It was immediately refused by the doctor until I contacted the pharmacy and explained why. Before they went ahead they had to go back to the doctor. So I guess it is controllable.

Broadly correct WCV or not?

[westcountryvillain]

Thanks everyone for all your comments and support (923 - brilliant you shared this on FB locally, there's quite a bit of that going up and down the nation which I am sure is helping get folk to think before jumping to conclusions that their local chemist is shyte. One stumbling block though is a lot of the older generation don't access social media - my Dad being one, so all of you good people on here please do take 5 mins to ask for patience and order their prescription a week before they need to start taking their medication).

923 - glad the surgery refused, means they are doing their job properly, pharmacies get bin-bags full of unwanted medicines returned to them and they cannot be re-used so 28-day prescribing is strongly advised within the NHS (with a few exceptions such as HRT and the contraceptive pill - both of which usually are manufactured in 3-month packs). If going away for an extended period then you can of course have arrangements made for you, as you managed to do through your pharmacy - we are here to help and by talking to your surgery should the need arise again you should be able to get sorted. Obviously in the current climate there is less time available to tend to such situations but then again not many folk are travelling abroad!

Leicesterbaggie - good thought, the seriousness of a condition is not well defined, take blood pressure in your case - it is a silent killer in that it tends to be symptomless. Going a few days without a statin isn't going to be a huge problem but then again if your arteries are well furred up you wouldn't want to be taking risks.

For all of you on repeat medication - (Mick this would help you) - there is a system called Repeat Dispensing (RD) where a batch of prescriptions for 6 or 12 months is sent to your pharmacy (either electronically or a paper version). The electronic system is clever enough to make the next month's prescription available to the pharmacy 21 days after the current one has been processed (which means the pharmacy has produced the white labels). Most pharmacies should be able to organise this work so that you collect on (not before) a specific date, suffice to say though that if a pharmacy is struggling due to perhaps staff sickness or job vacancies then they will fall behind on the work so if that's the case typically for you then phone a day or two before you're due to collect. Speak to your surgery about moving to RD.

Mick - obvs your choice to buy Nexium but you have paid into the system mate and are using it for your Amitriptyline so try to get these synced by your GP or surgery pharmacist.

Q - Phenobarbital is very rarely prescribed these days and I suspect is probably expensive so I can understand why they would not want to keep in stock. If other more routine items (message me if you don't want to share on here) are frequently needing to be ordered for you then generally that's a poor service. In my original post I referenced the 75%:25% split of repeat meds vs more acute situations and if a business operates on a label today, stock tomorrow model then in theory it only needs to keep stock for the 25% but run it too fine then you disappoint patients & make more work for yourself having to serve them again when they come back for owed items.

Q - on shortages in general, it's a complex situation and is a market driven. The Govt. in its funding model allows for a certain amount of purchasing profit and for each drug the number of suppliers tends to determine market pricing, it is highly competitive. Prices can get driven down to a point where suppliers exit the market to the point where only one is left and if they run into production problems then that's an out of stock situation. GP's then prescribe an alternative creating a spike in demand and production needs to catch up. In addition suppliers can manipulate the market by exporting to countries paying a higher price and a number of raw materials are sourced from China so any disruption at the ports will affect production. To be honest - the system has been plagued with shortages for years causing a colossal amount of work for pharmacies sourcing stock and for surgeries to change folk to a different drug.

Mick - a pharmacy supplying monthly instead of 2-monthly makes more money but as I said the taxpayer gets a cracking deal, it couldn't be done cheaper without introducing additional risks to patient safety. It's also far better to have it than have so much wastage - people still order even though they don't take medication because it's free and I think they are afraid they'll get into trouble with their GP. They are so misguided it's unbelievable, especially with the shortages issue!

Hope this helps and stay safe (whatever that means - just how does one stay safe?). Time for a beer now.

WCV