The Pharmaceutical Journal
Vol 269 No 7215 p358-361
14 September 2002

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Letters to the Editor

Patient packs

£500 will not go far towards our stationery bill

From Ms D. V. Taylor, MRPharmS

I can only add my voice to your recent editorial (PJ, 10 August, p180), Alan Rogers and Joy Wingfield (PJ, 17 August, p216) in support of patient packs. I am entirely at a loss to know why "... the UK is unique in that sometimes medicines packs have to be split or bulk supply has to be used to meet a clinical need. ... Therefore this problem is not an issue in other member states" to quote consultation letter MLX285. I was not aware that UK patients have substantially different medical needs from patients in other European countries.

Additionally, it would appear that the Department of Health will require us to supply a separate patient information leaflet with every compliance aid we dispense, every time we dispense one — in other words, weekly to the more confused among our patients, to say nothing of our daily supervised methadone patients. At this rate £500 will not go far towards our stationery bill.

How long will it be before somebody takes legal action for being supplied with either an incorrect or out of date PIL?

This must be one of the worst considered directives from the DoH for some time.

Now is surely the time for us to move to patient packs. The pharmaceutical industry must oblige other governments in this way. Why not ours?

Diana Taylor
Retford, Nottinghamshire

Time, effort, work and money wasted

From Mr J. E. Holmes, MRPharmS

Why is it that with the amount of work and money that is being devoted to medicines management programmes, the Government is unable to come up with an industry standard that will save time and money?

There can be nothing more infuriating for patients and pharmacists than for a patient to "have their medicines managed" and their repeat quantities equalised, and then for a pharmacy to unequalise the quantities legitimately under current legislation.

For example, consider a prescription for:

(a) Fluoxetine capsules 20mg; dose one daily; quantity 56

(b) Danazol capsules 200mg; dose two daily; quantity 112

(c) Lansoprazole capsules 15mg; dose one daily; quantity 56

A pharmacy can quite legitimately dispense 60 for (a), 112 for (b) and 56 for (c).

Immediately the work involved in equalising quantities on the prescription has been wasted, and once again patients will receive different quantities of medicines, and will have to order different items at different times.

It is about time the Government insisted that all repeat prescribing must be in multiples of 28 days, and all manufacturers' packs (including calendar packs) used for repeat prescribing must be in multiples of 28 days.

This anomaly, that pharmacies can fulfil a quantity prescribed with a greater quantity due to the nature of the calendar pack, must be removed from current legislation.

The National Service Framework for Older People states: "Inequivalence in quantities on repeat prescriptions means that patients have to order different items at separate times. The wastage that results from this inequivalence has been estimated to account for 6–10 per cent of total prescribing costs." Yet by not insisting on 28-day packs and 28-day repeat cycles, the Government itself is causing this to occur.

Without an industry standard of 28-day packs, and 28-day repeat cycles, a great deal of time, effort, work and money will be wasted in the process of medicines management.

John Holmes
Prescribing Adviser
Charnwood and North West Leicestershire PCT,
Leicestershire

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