Friday, May 23, 2008

Prescription for Vulnerability

a selection of pillsThis is a revised post as a result of feedback from Judith, see comments.

I have just been to get a prescription from the chemist. You hand over the piece of paper that the doctor or dentist gave you, sign it, pay for it [or not] and wait for 5 minutes or so. When it’s ready the assistant calls your name, but before they hand it over they ask you to confirm your address. I thought that this was some kind of [silly?] ID check, but it’s not.

The Chemist will quite happily hand over prescribed medication to a person whom it is obviously not intended for, for example they may be a different sex. It is not uncommon for a relative, friend or neighbour to collect medication on the patient's behalf.

Judith summizes that it is a check to ensure that they [the Chemist] have not mixed up the medication for say, two "John Smiths". I have now asked twice in two different Chemists and neither of them could explain this to me. It is the nature of our species that we all implement rules without asking why we do it! Anyway, it does seem to me that there are better ways of achieving this end. A tear off counterfoil on the prescription that the customer keeps and then hands over on receipt of the medication, for example. For repeat prescriptions where they are sent automatically to the Chemist, a medication card could be issued by the Doctor. This would seem far more robust. And perhaps those on repeat medication should have some form of medication card for emergencies?

Anyhow, the point of my original post still stands.

Most prescriptions are dished out to the elderly and it is the elderly who are the most vulnerable to conmen, tricksters, bogus callers and the like. The check as it is, and bear in mind that I thought it was an ID check, is not exactly setting a good example to these people. The state should, through example, take every opportunity to demonstrate good security practice to those who are the most vulnerable.

This is not an argument for ID cards, heaven forbid. There is no foolproof method of establishing a person’s identity. As I said
here, "Do you know what a Policeman’s Warrant Card looks like? Would you be able to tell if it is genuine or a fake? I thought not."

I was invited to the London Election Count at the Excel Centre. I was told that I needed a photo ID to gain entry. But supposing I do not have a passport or a photo driving licence? In the event I didn’t go but the letter I received advised that I could have used the alternative of two documentary pieces of evidence like an ordinary driving licence, a pension book or a utility bill. Just the same as is needed to open a bank account. It’s not perfect, no system is, but at least it does have some value.

But perhaps we need not fear. Jim Jay discusses the new "Trust Drug" as reported by the BBC here.


  1. Sorry you missed the count - 14 hours wandering around the hall before the result was declared...

    There's another prescriptions wheeze in town: Instead of two monthly or longer prescriptions, our doctors have been ordered to issue monthlys only. The justification is something about preventing overdoses, in much the same way as asprins are only sold in small packets. Coincidentally it also means that you get to pay for the prescription every month too - effectively doubling my own prescription charge. Perhaps they think people are too stupid to notice...

  2. Yes, Roger, but surely it's worth it to get your Viagra???

    A further irritating habit comes from my doctor. I take regularly 4 paracetamol a day, and I have other prescribed medication on a dose of one per day. Of the latter I can order 56 a time (8 weeks supply) but have to make very special pleading for the occasional prescription of more than 200 paracetamol (only 50 days). 300 are prescribed very grudgingly, and sometimes only after I request the intervention of the practice manager.

    My mother also has some medication on the basis of one per day and is also prescribed 56 of them. One of her tablets, however, is only taken on alternate days so, for the same period she only requires 28. I order 28 and, when I collect the package, find that the doctor has increased that one to 56!

    In both our cases there are no charges, but I am unhappy about the cost to the NHS of this example of excessive prescription. How many more are there out there? I do rectify the situation by missing out that one on alternate repeat prescriptions.

  3. So, why is it that those who pay [I do too] only get 30 days supply and those who don't pay get 56 days supply?

    Another stealth tax perhaps?

    I am expecting the age limit for free prescriptions to be raised to 65, and the freedon pass to be scrapped, some time between now and next February.

  4. I wonder if you may have misinterpreted the pharmacist's explanation?

    Consider: the assistant calls out "John Smith", and there are two John Smith's in the shop - one is a bit hard of hearing, or talking on his mobile, or has bent down behind a display to get something from a low shelf, so without confirmation, the right drugs could go to the wrong patient; ascertaining the address confirms delivery of the right bag to the right person.

    The issue of the amount of tablets allowed per scrip is, I think, once again down to EU regulations - in theory, it should stop overprescription and wastage by GPs, but as already noted here, it boosts State income by increasing the number of scrips; this is counterbalanced by the cost of administering the system.

    Truly, almost everything run by the State ends up being muddled, costly and an invitation to fraud.

  5. Excellent piece of thought Judith, and an angle I had not considered. Just goes to show the value of discussion. However, I’m still not sure I buy it.

    What is the point of asking when there is only one patient on the premises? Different if the prescription has been forwarded automatically and the medication is bagged up and waiting on the shelf. But….

    Consider this: when I pick up my repeat prescription from the doctor’s surgery I ask for it by my name [which I may share with another] and they read out the address and ask me to confirm it.

    There is a subtle difference here.

  6. Let us get quite forensic here:

    a. how do you know you are the only patient waiting for drugs? What looks like an ordinary shopper to you may also be in the queue for the dispensary. If you were truly the only person on the premises, I'd suggest that the pharmacist and the assistants have been well-trained and automatically ask for address verification regardless.

    b. your doctor's receptionist isn't thinking, or is too trusting, and needs retraining; there will be patients who can't hear or understand what is being said, but will nevertheless nod happily to whatever is said to them.

  7. No need, I've been thinking, OW!

    The chemist will quite happily hand over prescribed medication to a person whom it is obviously not intended for, for example they may be a different sex. It is not uncommon for a relative, friend or neighbour to collect medication on the patient's behalf. So, it can't be a form of ID check.

    I will have to re-write the post.

  8. I am sorry I have to disagree with 'the powers that be so often'!
    Roger, you pointed to another problem that can only be described as "A bloomin good little earner", prescriptions.
    My, condition (not connected to nagging officials) requires that i have intake of regular medication, otherwise I may well deteriorate rapidly.
    Therefore, I am forced to take medication as a life-giving remedy.
    Yet!!! my prescription used to be three-monthly, then two-monthly, and now perhaps each month.
    One month (of prescription is usually 28 days - which is four times seven, easy machine packaging.
    But this also fits in with the little boxes we Oldies use to put our daily pill intake into.
    Over 60's are different, maybe? But the prescription payment is not?
    Therefore - prescription payment is still - is it not - one item one payment three items three payments etc.
    before the government (because I am over 60) paid once only for each item on my three months prescription. Lets say £6. per item? so every three months the cost to NHS was £24. That was £96 per year.
    When I was changed to one prescription every two months - this increased to: £24 x 6 = £144.
    So, if this now goes to a one-month whack - my four necessary 9non-overdose items - will cost someone (probably the NHS) £288.
    But do not forget all those extra days per month (over 28 dyas) when I am in catch-up.
    No Roger, we are not stupid - we, regrettably, are becoming more and more insignificant regarding noticable varietal input.
    We all know the banker (or anyone really) who retired, but took up a hobby not related to banking!
    And how often that hobbyist became so engrossed, that they became exceedingly proficient in that subject (I omitted the word 'expert' for there is no such thing if we take into account the constant changes in all subjects) and the hobbyist grew to know more on the entire subject than the many 'fragmented' consultants which specialise in only part of the subject matter.
    In its most simple form, Kingsmill bread - local store = 2 loaves for £1.60p.
    Kingmill bread (crust removed) - local store - 2 loaves (less their crusts) for £2.
    The extra cost in preparation of the loaves is minimal.
    Anyone like to take over this conversation - I wouldn't like to be appear to be too knowledgeable?
    Looking down the page here sometimes - one price that never alters is of course - the cheap remark.
    To some the spice of life no doubt.

  9. Oops - looked down the page re remark 30's etc. - my various prescriptions only come in pop-strips mon, tue, wed etc., not loose.
    This also thankfully, helps us oldies to keep track of when we took the last dose.

  10. Richard, I'm not sure I can quite understand what you are getting at:

    what a patient pays for his prescription bears little connection to the actual cost of the drugs+cost of dispensing, so adding up notional figures is neither here nor there.

    Have you tried insisting to your GP that you get 3mths of drugs at a time for YOUR convenience? If he refuses, you could always ask your Primary Care Trust GP adviser for assistance.

  11. Judith - Hi - I gave this example to show how the cost per item is apparently about to increase to each person who has no box to tick on the prescription eg. under 60 (so called normal person).
    And why measured amounts of medication are necessary rather than addictive.
    A do appreciate the cost of the various drugs may not be the same as the prescription charge.
    Thus if you are on low income - whoops - surely this means extra payment for NHS via benefits I presume.
    Regarding the doseage on the prescription - the Order came from the local health trust, it seems the Dr (he or she) has no say in the matter.
    Another thing is, that if you need some dressings to go with medical creams etc. The NHS allows the cream but NOT the dressings that are special to that treatment.
    With such large patient lists - we on the NHS are reluctant to "Insist" - for that can easily be turned on its head if the practice is pushed.
    However, I do converse with my medical team on all matters medical pertaining to my condition and I am pleased to say they do above their best for me.
    Any good numbers for the lottery draw so I can join BUPA please.