Unsecure chicken perches

[Tiggy]

we are being asked to save money, Im regularly asked by patients to prescribe items such as paracetamol & ibuprofen which cost pennies over the counter, suncream shampoo etc, what do you all think, I want to provide the best service I can but where is the limit? I dont want to make the service in GP practice worse, infact I think we do a pretty good job, biased I know What do you all think?

 

OK an Omlet challenge for you, if you were in charge of the nhs prescription budget what would you do to make it fair and cost effective?

let me start

 

- take all over the counter medications costing under £5 off prescription for everyone of working age even if they are on benefits.

 

+ treatment for long term conditions should be free for everyone who needs them not just for a handful of conditions

eg asthma hypertension currently you have to pay diabetes hypothyroid you get everything free

Edited February 17, 2011 by Guest

[Snowy]

I do feel it's wrong to be asked to prescribe the cheap OTC meds Tiggy. I'm afraid I would stick my neck out and refuse (unless the patient was entitled to free prescriptions or had a pre pay certificate ) It's a bit naughty of the practice to ask you to do this (but then I don't know if there is a standard policy on this sort of thing) I did used to find that, when I worked in a pharmacy, we would advise the patient to buy it rather than pay the prescription charge, but not sure how many pharmacies will still do this either

[The Dogmother]

Our local pharmacy used to do that too - I'm not surprised that you're not happy Tiggy - that is poor practice.

[bluekarin]

Our Boots chemist will say if there is something cheaper OTC than the prescription charge.

[Snowy]

Also Tiggy, you ask about providing a good service - is that based on a good service to your employer or to your patients? My priority would always be the patient, if your employer doesn't respect that, I would be questionning their policies

[Leicester_H]

I agree - money isn't limitless.

Since eg. painkillers cost 30/40p I don't think you should prescribe these (even to those entitled to free prescriptions since I'm sure there are greater overheads and free simply means the rest of us pay more). If people have pre-paid then maybe consider it as it doesn't seem fair to make them pay twice.

[quickcluck]

I think I would encourage them to buy them, unless they are after a dose that is not available OTC.... we have to take responsibility for our own health too.

 

I dont think it hurts to question ourselves either as patients or Health Care Professionals, things get taken for granted that way which could be why they ask for a prescription

[kerryegg]

I agree but in my case the doctor suggested I take 8 paracetamol a day..........I don't ....... but if I did I would have to keep driving at least 5 miles every couple of days to buy them. I don't know if you can get anything to let you buy more than 16, that would make sense and save money.

[Tiggy]

Also Tiggy, you ask about providing a good service - is that based on a good service to your employer or to your patients? My priority would always be the patient, if your employer doesn't respect that, I would be questionning their policies

 

good service to the patient every time, my Drs are very good they are not looking to make more money for the practice just spend more where its needed & cut down where its reasonable to do so to re allocate those funds.

 

Most of my patients are on benefits of some sort so the demand for cheap OTC meds on prescription is high, driven by patients not Drs who dispair at the amount of scripts we all write, so are trying to find reasonable ways to stop it without compromising care.

 

with GP commissioning looming our local GPs want to try to improve lots of services but the money simply isnt there, we need more health visitors better services for disabled/elderly people at home lots of really important things.

[Griffin]

I think I would encourage them to buy them, unless they are after a dose that is not available OTC.... we have to take responsibility for our own health too.

I agree with that but then I started to feel hypocritical. My youngest daughter has really bad eczema, has done from the day she was born, and last year we finally found a cream that suits her and makes her condition bearable. It can be bought OTC. She gets through shed loads of it, I carry some everywhere with me, she has some at school, she uses it everytime she washes her hands too. I simply could not afford to pay for the amount she uses and am grateful she can have it on prescription. How can I say her cream is more important than painkillers for someone who needs them?

 

I guess the answer is that if the painkillers are not needed daily then the patient should pay for them themselves.

[Tiggy]

I think I would encourage them to buy them, unless they are after a dose that is not available OTC.... we have to take responsibility for our own health too.

I agree with that but then I started to feel hypocritical. My youngest daughter has really bad eczema, has done from the day she was born, and last year we finally found a cream that suits her and makes her condition bearable. It can be bought OTC. She gets through shed loads of it, I carry some everywhere with me, she has some at school, she uses it everytime she washes her hands too. I simply could not afford to pay for the amount she uses and am grateful she can have it on prescription. How can I say her cream is more important than painkillers for someone who needs them?

 

I guess the answer is that if the painkillers are not needed daily then the patient should pay for them themselves.

 

I dont think anyone would want you to pay for your daughters cream, its a long term condition and needs treatment, all I would take off prescription are treatment for coughs & colds minor sore throats that sort of thing. One chap wanted his free paracetamol because he had a hangover thats the sort of thing Im talking about, GP soon told him where to get off

[Snowy]

Ah forgive me Tiggy, I read it as the practice wanting you to prescribe more, not the patient! Sorry!

[Leicester_H]

I agree but in my case the doctor suggested I take 8 paracetamol a day..........I don't ....... but if I did I would have to keep driving at least 5 miles every couple of days to buy them. I don't know if you can get anything to let you buy more than 16, that would make sense and save money.

 

Sainsbury's allow customers to buy 2 packs of 16. If you need more , you have to ask the Pharmacist. The one time I needed to, it wasn't a problem.

 

H

[Tiggy]

I agree but in my case the doctor suggested I take 8 paracetamol a day..........I don't ....... but if I did I would have to keep driving at least 5 miles every couple of days to buy them. I don't know if you can get anything to let you buy more than 16, that would make sense and save money.

 

Sainsbury's allow customers to buy 2 packs of 16. If you need more , you have to ask the Pharmacist. The one time I needed to, it wasn't a problem.

 

H

 

thats worth knowing H,

[TheFeatheredFiend]

My DH has an underactive thyroid which means he gets precriptions for his thyroid meds (Levothyroxine) free. Thing is, he gets ALL precriptions for free too, even if it's for an entirely unrelated condition.

Much as we like not having to pay for prescriptions for anyting, the NHS could save a boatload if only the prescriptions for the lifetime illness were free and we had to pay for everything else like 'normal' people.

[Leicester_H]

the NHS could save a boatload if only the prescriptions for the lifetime illness were free and we had to pay for everything else like 'normal' people.

 

Well said - not many people are as fair-minded as you.

 

I think free prescriptions should be means tested. My OH gets them free but could easiliy afford to pay. In times of short supply, money should be channelled FIRST to those that need it most. (Ideally, I think all medicines should be free - as people don't choose to be ill. Also, Dentists - who would frivolously go to the dentist! - but thats a different argument!!)

[Angie]

interesting topic...on a low income and only able to purchase 16 paracetamol at a time, when your not well and needing them for longer than two days, i would be tempted to ask for more on prescription.( could be 5 days before i was well enough to get out to get any.)

when i worked my scripts cost me £777.60 a year, the drugs actually cost £476.40 a year...but you can purchase a prepayment prescription card at £104 a yr. Now my benefits cover the costs for me and i am very grateful.

Not all can afford the cost of drugs and if it meant children in a low income family did without food i would give the prescription.

[Tiggy]

My DH has an underactive thyroid which means he gets precriptions for his thyroid meds (Levothyroxine) free. Thing is, he gets ALL precriptions for free too, even if it's for an entirely unrelated condition.

Much as we like not having to pay for prescriptions for anyting, the NHS could save a boatload if only the prescriptions for the lifetime illness were free and we had to pay for everything else like 'normal' people.

 

totally agree its bonkers, same goes for epilepsy, then its so unfair that asthmatic like me have to pay for all my inhalers & people with high blood pressure who often have 3 or 4 different tablets a day have to pay too

[Tiggy]

interesting topic...on a low income and only able to purchase 16 paracetamol at a time, when your not well and needing them for longer than two days, i would be tempted to ask for more on prescription.( could be 5 days before i was well enough to get out to get any.)

when i worked my scripts cost me £777.60 a year, the drugs actually cost £476.40 a year...but you can purchase a prepayment prescription card at £104 a yr. Now my benefits cover the costs for me and i am very grateful.

Not all can afford the cost of drugs and if it meant children in a low income family did without food i would give the prescription.

 

I presume you have a repeat prescription for a long term condition in which case your treatment ought to be free, as for the cost of paracetamol I checked in our local chemist today their own brand is 16p for 16 tabs and they will let you have 2 packs if you ask at the counter, at that sort of price I dont think a prescription can be justified.

 

We only have 1 pot of money and if everyone who is entitled to free prescriptions continues to demand everything free then we are looking at important services being underfunded. Cuts will be made & I rather it be done in a more sensible manner, I have been on a low income in the past just enough to keep me off benefits so had to pay for prescriptions. Ive been tempted to cross off my preventer inhaler & just get the blue one, thats what happens people who really need medication to control serious diseases are penalised whilst those who for whatever reason get free scripts get everything no matter how trivial free

 

Come on omleteers lets have some ideas that we could put to the DOH after all its our NHS - and if I have to choose between writing yet another script for a perfectly healthy but unemployed person with a cold and getting another health visitor on our patch I know which Id choose

Edited February 17, 2011 by Guest

[Snowy]

Very true Tiggy! I was diagnosed as hypertensive last year and have discovered the joys of having to get two different meds, every month (because they can't prescribe more than a month at a time) but I am on them for life! Thank goodness for the pre-payment card! Now, do I continue to buy expensive herbal remedies to supplement the regular meds, or do I accept an additional 'prescribed' medication that would be paid for under my pre-paymenbt cert?

[Alis girls]

Its a gimme gimme gimme world out there. Some patients won't buy anything even Calpol for their kids - they would sooner them suffer or risk very high temperatures. There are plenty of generic cheaper versions. I had to ask for a presc of Paracetamol syrup for youngest son as school won't give it unless its prescribed. So if they go back to school and need pain relief they wont get it unless bottle as their name on. As you can see I am fed up with the NHS, the abuse of it shocks me. I have nothing else to say otherwise I will be sent to stand in the corner

[Bramble]

This is a tough one, isn't it? I suspect that the minority who abuse the system are in danger of stopping those in genuine need from getting things they need for free?

This is an incredibly dim question, but would it be cheaper (for the nhs) if your surgery could actually give e.g. paracetomol or other OTC meds directly to patients rather than having to issue a script which the patient then takes to the chemist? I'm not talking about for people with a hangover though!

I'm not sure where the limit should be, but I think probably OTC stuff that costs less than say £2 shouldn't be available on script (I think £5 is too high, that's a big chunk out of someone's weekly benefit?)

Alternatively, what if everyone had to pay say £1 when they get a script for OTC meds, regardless of means? That would stop people asking for a script for a 16p box of asprin?

[Olly]

My sister is a chronic asthmatic, has arthritis and has needed regular supplies of inhalers and other drugs for years - all payable, although she used to buy a pre-payment certificate. She too was diagnosed with hypothyroidism and suddenly it's all free. As she says, she would have cost the NHS a lot more if she didn't take her inhalers etc! I also get free prescriptions for the same reason, I could well afford to pay for them and it seems daft to me that everything is free, not just the lifesaving drug you need.

 

Surely prescription should be on the basis of medical need ... a hangover is not a medical need. My late father was prescribed paracetamol, as others on here have said, he needed large amounts and most pharmacists will not sell more than two packets - that was a justifiable prescription in my view. Before we got them on prescription I used to have to drive round town buying two packets in each pharmacy, to make sure he got enough! Unless there is a genuine medical reason however, they shouldn't be provided - even someone on benefits can afford 16p, and most of us take painkillers too frequently anyway.

[Redwing]

I used to work in a chemist and the abuse of the system is sickening, one lady used to admit to scratching her kids heads gently to make the skin flake just to get free shampoo!

 

he problem is that its not those who pay for their prescriptions that abuse the system so its not necessarily that things are cheaper off prescription its that things are cheap off prescription but those who dont pay would much rather not and I think thats what Tiggy is saying

[keyhole kate]

Dont get me started 11 years ago I suffered a unexplained mysenteric thrombosis which should have killed me the consequence of has left me within total 120cm of bowel ( Tiggy & other medics will understand ) as a consequence I have shipping order amount of meds all on script one of which is warfarin If I dont take it I could suffer another thrombosis which would without a doubt kill me as OH keeps me and I dont claim a penny I have to pay for all my meds I therefore buy a annual prepayment certificate. When a warfarin home testing machine became available to buy at a cost of £300 which I was prepared to pay for myself my GP surgery refused to supply the testing strips on prescription as they get a payment for testing me at the surgery which in my case due to malapsorbtion is weekly so instead I take up an appointment and nurses time every single week. The thought that patients can have prescriptions for cheap over the counter meds other than for long term health conditions and as for shampoo it makes my blood boil.