| · Department of Health
· Work pressures (2)
· Homoeopathy (2)
· Controlled drugs
· Safety
· Oxygen service
· Compliance aids
· Needle exchange
· Paracetamol
· Smoking cessation
· The profession (2)
· Retention fees (4)
· The Society (2)
· Public image
Letters to the Editor
|
Compliance aids
MDS fee needs review
From Ms P. Grant, MRPharmS
I would like to comment on two connected letters published in the PJ of
29 July. The first is from Paul
Kirby (p132) about the practice of requesting
seven-day prescriptions as a method of payment for compliance aids supplied
under the Disability Discrimination Act. The second is from Helen
Badham (ibid) suggesting that medicines use review has a greater contribution
to make if it is carried out in a patient’s home or care home.
The repackaging of medicines into compliance aids or monitored dosage systems
(MDSs) is a time-consuming and labour-intensive exercise. I am aware that
six minutes per item is the average time allowed by some retail pharmacy
chains for MDS dispensing, compared with one minute per item for dispensing
of original packs. Although most pharmacies have been happily performing
this service for care homes for many years, without expecting additional
payment, when asked to provide the service for an individual patient in
their own home, they require additional funding. Presumably this is because
the labour cost of supplying to care homes is offset by the profit on purchasing
gained through a large prescription volume. However, it is not so easy
to make a profit when supplying this service for an individual patient.
In Poole, we moved away from supplying seven-day prescriptions several
years ago for three reasons. First, it is tedious and time-consuming to
generate and dispense these weekly prescriptions. Secondly, as the volume
of patients requiring MDSs grows, the demand on the fixed global pharmacy
sum will become unsustainable. Third, it provides a valuable service to
a vulnerable group of patients who have cognitive loss, visual impairment
or loss of manual dexterity which prevents them from self-medicating in
any other way. We recognise the value of this service by paying a monthly
fee to pharmacies that are willing to support patients in this way. We
should be calling on the Pharmaceutical Services Negotiating Committee
to negotiate a nationally agreed payment for this service to patients and
seek a revision of the ridiculously small addition to the dispensing fee.
The fee for provision of a compliance aid could be an item prescribed on
FP10: a medicines management prescription analogous to an exercise prescription.
It seems ludicrous to prescribe medicines that can cost hundreds of pounds
without a comparatively small additional payment to help the patient to
be able to take those medicines correctly.
Miss Badham identifies patients in the community, living on their own,
who would never be able to medicate themselves safely with or without a
compliance aid unless they receive additional support. This support often
comes from social service care workers. However, before medicines can be
built in to any care plan, these patients need to have an MUR and a therapeutic
review provided by a qualified pharmacist. These patients are usually on
complex medical therapies, struggling to manage their own chronic diseases
and are candidates for case management to prevent unnecessary hospital
admissions. This role is increasingly being taken on by community nurses
who quickly begin to realise that they need to help these patients to self-medicate.
One way to do this is to have medicines in a repackaged form so that the
nurses can monitor the patients’ compliance and therapeutic decisions
can be based on what the patient is actually taking as opposed to what
has been prescribed. Nurses will need to turn more to community pharmacists
to provide this highly individualised service for patients. Pharmacies
need to be demanding adequate payment for providing advice in the form
of therapeutic reviews and MURs, and for the time-consuming task of repackaging
the medicines, so that the patient can be medicated safely.
The combined message that I see coming from the letters written by Mr Kirby
and Miss Badham is a timely one. GP commissioners will soon be looking
for services to help patients with long-term chronic diseases manage their
medicines. The pharmacy profession should be providing these medicines
management services and calling on its national negotiating bodies to obtain
a proper fee for any such services from the Department of Health. This
fee should be commensurate with the professional nature of the service
and the value to the health economy in terms of prevention of hospital
admission and improved health status for patients.
Pam Grant
Wimborne, Dorset |
The
Pharmaceutical Journal