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Letters to the Editor
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Metered dosage systems
Contract confusion compounded
From Mr P. Williams, MRPharmS
I have read with interest the points raised in recent editions of the
PJ regarding compliance packaging systems and the new
pharmacy contract.
The points raised have confirmed my views that there is still a lack of
clarity surrounding funding the provision of concordance support services
for patients with or without an “official” disability. As Stephen
Lutener recently pointed out (PJ, 20 August, p224), many patients who could
benefit from additional pharmacy support fall out of the definition of
disabled and are therefore not entitled to the facilities within the new
contract.
It is clear to me, and also to many colleagues and customers, that, although
the proportion of our patients requiring concordance support incorporating
a compliance aid represents a small percentage of the total, these people
are among the most vulnerable who engage with their local pharmacy. The
true cost, in every sense, of failure to support their needs properly,
is disproportionately high. My question is what now happens to these patients?
If locally agreed funding is inappropriately stopped or frozen, then a
highly visible and costly void will emerge in caring for one of the groups
who need our support most. I also fear it is actually the case that some “able-bodied” patients
could be even less able to take their medicines than some patients who
are classed as disabled under the Disability
Discrimination Act (DDA).
We keep hearing how we should make “reasonable judgements” and
references are made to “assessment toolkits” but in reality
how will this work? It is an unrealistic burden to place on pharmacists,
making us decide who is entitled to these services, in addition to designing
the most appropriate nature of support to provide.
I also regularly struggle and debate the application of the DDA definition
of “disabled”, with respect to the use of medicines: the “inability
to remember and relay a simple message correctly” and impaired “memory,
or inability to concentrate, learn and understand”. This suggests
patients unable to remember to take their medicines are disabled. Or does
it? And if we do suggest they are disabled, what will the repercussions
be? To use Bob Gartside’s words, who raised
this debate (PJ, 13 August,
p192), this generates another “practical and ethical dilemma for
pharmacists”.
In his response to this article, Glyn
Ratcliffe requested the views of
other pharmacists on the demand for the provision of monitored dosage systems
(PJ, 20 August, p224). I strongly agree with Mr Ratcliffe. The demand for
systems will undoubtedly go beyond the funding that has been made available
to date. We must press for funding to support all patients whom pharmacists
judge would benefit from concordance support, with or without a compliance
aid. Whether or not the patient is disabled, if they need help, they should
get it.
Mr Gartside may have rightly said there is a lack of “official” research
to support the efficacy of monitored dosage systems. However, I cannot
ignore the truly compelling anecdotal evidence of major improvements in
a patients’ life I see so regularly in my pharmacy — anecdotal
evidence I suspect B.
Shetewi has also seen from comments he made in the
PJ (20 August, p224) and anecdotal evidence we frequently hear in our office,
from pharmacists, patients and their families.
It is this evidence that led me to develop the distribution of “PlusPaks” through
the MTS business. The huge growth of the business illustrates just how
crucial these packaging systems are to thousands of patients in the UK.
The improvement I have seen in patients’ health after receiving concordance
support also means that, in order to satisfy my own morals and commitment
to patients, it is incumbent upon me in my pharmacy business to continue
providing this service to my existing patients. They are certainly not
all disabled. I remain in a quandary as to how to handle the commercial
implications of expanding the service to any new patients, as my new “allowance” has
all been used for existing patients: I cannot charge if they are disabled.
I cannot provide the service “free of charge”, as the nature
of concordance support can be particularly demanding. I say “no” to
a vulnerable and needy patient? Being put in this position is not what
I was expecting from the new pharmacy contract.
Peter Williams
Pharmacy Proprietor and Managing Director of MTS Medication Technologies
Blackburn |
The
Pharmaceutical Journal