Share your thoughts on a consultation for the Department of Health and Social Care regarding drug tariffs

[Josh DUK]

Hello Everyone,

The government are holding a consultation on some proposals to change the way the drug tariff in England operates, with plans to improve the way it works and create a more up-to-date and accessible system that can help the health system.

The drug tariff is the list of medical treatments and devices which are available for prescription on the NHS through a pharmacy and this consultation is focused on the Part IX section for medical devices. This includes blood glucose monitors, lancets, test strips, insulin pens and some continuous glucose monitors like the Freestyle Libre 2 and Dexcom One.

As part of this consultation, they have asked for evidence on additional areas the department are interested in – including waste – and it would be very helpful to hear of your experiences so we can add them to our submission.

Please see a summary of the call for evidence questions on waste below/in the poll with some prompts as a guide. We are also happy to answer additional questions you may have.

The consultation ends on 1st December 2023 and we will be compiling responses on Wednesday 29th November for our submission. Please share your thoughts in the poll listed and in the thread.

Josh DUK
Online Community and Learning Manager

 

[pistolpete]

No waste here, I dont stockpile either, I only order what I need. It would be nice if we were better informed of the current medicine shortages, I can see why people over order you never really know if your going to end up with the medicine you ordered or a generic copy that might not be as expected.

 

[grovesy]

I order when I need, and don't have surplus.

 

[rebrascora]

The system at my GP practice is pretty good in that I can just order what I need each month from my list, so no stock piling and they are pretty good about custom requests if something isn't on the list that I need. So if I needed a new NovoPen Echo which isn't on repeat, I would just make a custom request via the System Online, specifying what I needed and why and the request is put through to a GP to authorise it.
The system would allow people to stock pile if they ordered everything on the list every time, but I would hope that people would not do that and if they did that it would be highlighted and reviewed. So for example, I can get 3 pots of test strips every month which I might need if I have a break from using Libre but most of the time 3 pots will last me 3-4 months.

The poll doesn't include an option for "I have not experienced incidents of waste within my GP practice" which I think is an unbalanced omission.

 

[Robin]

Our system is also flexible, and I can order the items I need when I need them, without having to order everything on the list.
The only time there has been waste, is when I first started getting the Libre prescribed, and the hospital wrote to my GP asking her to prescribe test strips to fit the Libre reader, and they issued the wrong sort. (I wasn’t sure what I was expecting, so didn’t check the bag before I left the pharmacy.)

 

[trophywench]

Well yes - took me ages to get the GP surgery to NOT expect me to order the whole lot every 28 days exactly, then just delete whatever if I don't order em for 12 months.

No pen needles on my scrip whatsoever - disappeared some years ago even though both Novrapid AND Levemir Flexpens still there 'for emergency use' as and when still there - hence why I'm still using the last box I ordered in 2019! Don't think Novofine needles are even available these days - cracking fine needles but shortest were 6mm, never allowed 4mm ever.

 

[Satan’s little helper]

Order what I need. But a week in advance allowing for any possible issues with either admin or aquirment?
Usually a two day turn over. So I can keep on top of things if they arise.
My surgery has a flexible set up. As & when.

 

[TheClockworkDodo]

The poll doesn't include an option for "I have not experienced incidents of waste within my GP practice" which I think is an unbalanced omission.

I agree, I spent some time re-reading it to make sure I hadn't misunderstood one of the answers, but I couldn't select any except possibly "other" as I've had issues with the pharmacy making errors, but not with the prescribing process, and the options are all to do with prescribing. It makes the survey look like an excuse for reducing our prescription options, frankly, not having the chance to say that we have no problems with prescription waste.

Diabetes nurse did once accidentally issue me with several things I hadn't requested when I asked her to review one item, but it didn't matter because there was nothing which wouldn't keep and they were all things I'd use eventually, so no waste.

Pharmacy errors, however, include (among others I've probably forgotten):
* issuing alternative items and alternative brands to which I'm allergic, even though they are supposed to have my allergies on record - the orange glucose gels went to IDDT but the other items weren't diabetes-related and had to go back to pharmacy to be destroyed and replaced.
* issuing items with dates so short they were unuseable so I had to request another (they don't seem to issue older items first, so dates are always very random) - these went to IDDT for emergency appeal which could use them more quickly so weren't wasted.
* claiming they didn't receive the prescription (even though the surgery had a record of its having been sent) - no waste here except of the time of the receptionist and doctor who re-issued it for us. This has happened several times.

 

[Eternal422]

I now order what I need about a week in advance using the NHS app and this is working well for me. Before, when the pharmacy handled my repeats they either asked me what I would need for the following month when I picked up this month’s order which was invariably more than I needed, or they just put in a repeat for everything. Result was a lot of waste and stockpiling. Now that I manage it myself I only have enough that I need and use with a little spare to cover any unforeseen delays. Thankfully my GP health centre haven’t removed anything from my repeat if I don’t order it every month, so far it is all working well.

 

[wantonnoodle]

My GP practice use electronic repeat dispensing which is an absolute pain in the backside. They put me on it a couple of years ago without consulting me first. The problem with this is that the issuing of medicines seems to be driven by the whim of the doctor. Previously, all my medicines were all aligned so they would come due for request at the same time. Now, the script sits on the NHS spine where the pharmacy can retrieve items for a given period that the GP has pre-approved. While this is fine in that I should only need to contact the pharmacy when I need medication, the GP seems to randomly push medications to the pharmacy, which means I have a surplus of some medications, while I then have others that I only get when I speak to the pharmacy, and sometimes they've needed to chase the GP to renew the approval, meaning I can sometimes be cutting it fine getting medication.

I'd be much happier if I could just request from the GP when I need, as I did in the past, but I doubt that I'd be able to get this, as this means more work for the GP, despite being more cost effective in reducing over prescribing.

 

[helli]

Like others, I order what I need when I need it through the NHS App.
Many years ago (before it was done through an app or online), my surgery would order everything on the script regardless whether I had ticked the boxes but that has not happened for a long time.
I do find it frustrating that pump supplies have to be ordered separately direct from the pump manufacturer.
And rather than "over prescribing", I feel the quantities I order could be more so I can order less often when my requirements have not changed for years (and don't need to).

 

[TheClockworkDodo]

And rather than "over prescribing", I feel the quantities I order could be more so I can order less often when my requirements have not changed for years (and don't need to).

Same here, @helli - and I think that's true for a lot of people who are housebound because of disability or age too. It's very difficult for my Mum, who is 95 and relies on a neighbour to collect her prescriptions, that she can get so little at a time of some of her (regular and permanent) meds, as it's not always convenient for the neighbour to be going to the pharmacy every couple of weeks.

It's not quite so bad for me, but I can get 6 months' worth of some of my meds, and 2 months' worth of most of them, and only 28 days' worth of others, and it would save my partner a lot of trips to the pharmacy if the surgery were a bit more organised and ensured that I got at least 60 days' worth of everything - it's not like I'm going to stop needing any of them.