According to the campaign Medicines Waste UK, unused prescriptions cost the NHS an estimated £300m every year. Translate that to the frontline, and it could pay for 80,906 more hip replacements or 11,778 more nurses. What can GP surgeries do to help cut down on wastage? Dr Ray Vella, a GP at The Surgery in Beckenham shares some basic tips
Check your re-ordering system
Check your system for ordering repeat medication. Ideally, the patient, not the pharmacist, should send repeat medication requests to the surgery. If the pharmacy is doing this, ensure that they have a system in place for checking with the patient first about which meds are needed, rather than automatically ordering everything on the list. All practices will soon have to offer an online repeat medication system, which puts the patient in charge.
Check the drug history tab
The drug history tab on your clinical record system will show you the patient’s repeats ordering pattern, and whether they are ordering a prescription that is not due. This may occur when the patient has forgotten to go and pick up the rest of some medication that the pharmacist did not have enough of in stock. The pharmacist still gets paid for the full prescription, so it is important to monitor this. This is your dispensing clerk’s job.
Check adherence before issuing a repeat prescription
Apart from asking the patient when they come to see you for a meds review, check their medical record for clues, eg diabetic patients’ cholesterol and HbA1cresults. It is amazing how many patients think they are keeping the doctor happy by continuing to reorder drugs that they are clearly not taking.
Consider prescribing for only two months at a time
Prescribing two months’ supply at a time reduces the chances of patients losing track of supplies, or wasting medication that the GP stops prescribing. For example, we usually prescribe six months’ supply of the contraceptive pill, and considered extending it to a year. We decided not to, because of the potential for wastage of a drug that comes free of charge to the patient. Checking what drugs your patients are on and their adherence should be a routine part of every consultation.
Review prescribing of dressings and appliances
There is a lot of waste with non-drug items such as dressings and stoma bags, because GPs do not know enough about them to prescribe economically. In my practice we have had instances where the supplier has tried to reorder them for patients who have died. Non-drug items are a big issue, as they are expensive. This type of wastage should be addressed at CCG level. Perhaps the solution is to take the prescribing of these items out of GPs’ hands entirely and have a central system managed by district and specialist nurses.
Set up a prescribing incentive scheme
Our local CGG has instigated an incentive payment scheme for practices to take action to reduce drug costs. One method is regular meetings with one or two pharmacists and an ‘expert’ patient representative to discuss and resolve issues.