All dispensed medicines should have displayed on them a batch number and an expiry date and be accompanied by an explanatory leaflet that the patient can understand. Now who could argue with that?
It would appear from recent columns in The Pharmaceutical Journal that pharmacists can and do argue with that.
Before we explore the objections let us dwell on the benefits of the aim.
Batch numbers are vital for investigation of anything that might go wrong after dispensing. All supplies to pharmacies have batch numbers. Why should this aspect of quality control be lost in the dispensing process?
Expiry dates are also identified on supplies to pharmacies so why should these too be lost in the dispensing process? Included here are "hidden" expiry dates that are triggered after preparation (for example, antibiotic mixtures) or opening (for example, eye-drops, or something like Persantin Retard capsules).
Patients frequently ask for leaflets when receiving supplies from bulk packs. They have a right to these even though reading them can add to their anxiety. That may say as much about the content of the leaflet as the frame of mind of the patient, but that is another story.
Current regulations already allow pharmacists to achieve the above objective in certain circumstances by dispensing in manufacturers' original packs.
While pharmacists would currently have a problem with supply from bulk packs, the biggest problem lies with the failure of the pharmaceutical industry to standardise on 28- or 30-day packs. Currently, a pharmacist will be paid for the prescribed quantity or the nearest calendar pack. Pharmacists must supply the quantity prescribed if the pack is not a calendar pack even though it may involve the splitting of a patient pack. What happens then to the patient information leaflet?
Doctors have available to them similar technology to pharmacists, and their computer systems can identify patient packs to prescribe. Some doctors choose to write prescriptions by hand and all doctors write prescriptions by hand when their computers are not available to them, eg, on home visits and emergencies, and therefore original pack quantities may not be prescribed.
The result is that the pharmacist's scissors have to go snipping and the patient finishes up with part packs, occasionally a lot of little bits and no doubt mixed batches of tablets in some cases. None of this helps with patient compliance and must seem odd and unprofessional to the consumer. With reduced revenues to pharmacists it is unreal that the pharmacist should be expected to pick up the cost for the destruction of the "off-cuts".
One solution would be for the pharmacist to be able to dispense (and to be paid for) the nearest patient pack and for the FP10 to be designed so that the doctor could specify five, seven, 10, 14, or 28 days' supply in the case of unit dosages. The quantity to be supplied would be calculated by the pharmacist from the dose and number of days. The pharmacist would also consider calendar packs, special containers and broken bulk.
As now, the Prescription Pricing Authority would accept the pharmacist's endorsement on quantity supplied provided that this was consistent with the body of the prescription.
No doubt there are difficulties to overcome. Pharmacists will buy and, therefore, supply the least expensive brand of the prescribed item whether this is a patient pack or a bulk pack. Bulk packs are progressively being phased out and this phasing out needs to be accelerated.
Parallel imports are another complication with some strange pack sizes and attractive prices. However PIs typically represent less than 0.4 per cent of total dispensing supplies to pharmacies. Providing any medicine to a patient in packaging with information written in a foreign language must be questionable, at least professionally if not commercially.
Half tablet doses, "as required" treatment, weekly dosage and others situations will require imaginative solutions. There will be many more objections to the principle and some will be impossible to overcome other than by the expiry date and batch number being added to the label in the pharmacy. The daily supply of reducing doses of methadone mixture is an example that springs to mind.
This whole issue recently had a new twist added to it. In a Statutory Committee report published in the PJ of December 4, 1999 (p896), the following appeared: "The committee said that its concern about the dispensing of fluoxetine instead of paroxetine was hugely increased by the fact that the capsules were in four separate cut strips each missing a batch number and/or an expiry date." We have been alerted now that such practice could militate against a pharmacist in future.
It is time for action. This issue of appropriate supply to patients needs to be grasped by our profession; it needs to be grasped by the Royal Pharmaceutical Society, by our negotiators and by individual pharmacists. After all, the pharmaceutical industry has had one attempt to standardise on patient packs, and look what happened.
The principle bears repeating: all dispensed medicines should have displayed on them a batch number and an expiry date and be accompanied by an explanatory leaflet that the patient can understand.
David Hignett is a pharmacist in Kegworth, Derbyshire