The Pharmaceutical Journal Vol 264 No 7084 p296
February 19, Letters

Unwanted medicines

How to reduce waste

From Mr A. C. Hind, MRPharmS

SIR,—If I was the Prime Minister for a day I would reduce the wastage that occurs in National Health Service dispensing. The value of returned medicines is beyond comprehension. I believe most of this can be avoided and the whole dispensing system simplified at the same time. Reduced NHS costs with no loss of service would be in everyone's interest.
My proposal is as follows:

• Create a white list of drugs allowed on the NHS with a suitable pack size, eg, amoxycillin in 21s, ie, a recommended course. All other pack sizes would be blacklisted for NHS dispensing
• Require regular medication to be in one month packs at British National Formulary recommended doses
• Require "when required" medication to be in a suitable pack size, eg, paracetamol in 100s
• Instruct pharmacists to dispense NHS prescriptions in the nearest number of complete packs, irrespective of the quantity ordered
• Charge patients a small dispensing fee for each patient pack. There would be no exemptions at all. The fee would go directly to the pharmacy for services rendered. The fee, eg, 50p, would be enough to make patients who are exempt at present decide whether they actually need the pack but not too much for patients who, under the current system, cannot afford their prescribed medication. We have probably all seen the asthma patient who says, "I'll just have the blue one and not the brown one"

"Horror", I hear readers cry, all those exempt patients having to pay. But with the money saved on wasted drugs the Government could afford to increase pensions and Social Service benefits to accommodate this.
It also puts a stop to the inequality of payment to pharmacies where the doctors prescribe supplies of up to 300 days. This week's highlight for me was a prescription for 300 bendrofluazide 2.5mg tablets, one each day.
My plan would simplify the pricing of prescriptions. There would be only one bundle. The Prescription Pricing Authority would need only to price the items, add on any special fees and reimburse the pharmacy.
Of course, the payments to pharmacies needs some careful consideration but with the fees from above and a professional allowance I am sure something suitable to both parties could be arranged.
This, of course, would also eliminate patient fraud overnight. If a pharmacy does not collect the fees from the patient then the pharmacy receives no dispensing fee.

A. C. Hind
Derby