GPs spending 10% of their Medicine Budget on Diabetes

MikeTurin said:

If you pay fully fror the prescription, and the box is clearly not tampered the phamacy here could take it back, except for things like vaccines that must be kept in a cool place, If the prescription is paid by the SSN is forbidden because that was used to make a big tax scam. Once you have made an inventory unbalance, you can easily cook the books for you and friends...

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Yes, but it's the NHS rule book that also says they can't accept used crutches for H&S reasons - madness. One day the idiots who run the NHS will wake up but I'm not hopeful.

MikeTurin said:

I think the best thing to do is to explain the GP that are some unwanted items and why.
If the doctors still insist on the prescription I think it's better to find another one because if one does not trust his toctor the problem are way higher than wasted prescriptions.

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You do know that in the UK it is very hard to change surgery in some places? we cant pick and choose our doctors and have to use the ones available in the geographical location nearest to where we live, unless we are very lucky.

DavidGrahamJones said:

Unfortunately part of the problem is waste. There are many people who pickup their prescriptions and then put them in the bin. Hopefully your FIL won't collect another prescription. My MIL throws her statins in the bin every 2 months, she's 90 and there's a part of my head that says if you can reach 90 with your cholesterol the way it is, why try and change it. What I have tried to tell her is that she should tell her GP that she doesn't want or need them at her age, but she doesn't want him to give her a lecture and so throws them away.

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My husband didn't bother to order anymore 20mg statins and his doctor gave him a prescription for 10mg in the hope that he would take them! Unfortunately every couple of months the doctor tries to persuade him to take them

This is BBC's reality check on who should be taking statins.

http://www.bbc.co.uk/news/uk-40790148

serenity648 said:

My friend is a pharmacist. She says that once the prescription is made up and labelled, it has to be binned, even if the customer hasnt opened the paper bag containing the prescription items.

The best thing to do to stop waste is cross out the items you dont want before handing the prescription to the pharmacist.

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It's about controlling the chain of custody. Until it leaves the pharmacists hands, every single person involved in producing that drug has been logged and tagged so if there's an issue with the medicine it can be thoroughly investigated. When it comes to prescription meds - even things like test strips - risk of tampering is taken incredibly seriously. While that seems like a huge waste of drugs, as other people have noted in this thread already, the way to prevent it is to not fill the prescription in the first place. Wasted medication is the shining example of a "First World Problem".

We tend to think of the NHS and GP surgeries, hospitals, pharmacies as single, enormous organisation. But it's not. It's lots of little organisations that operate under specific rules (NICE guidelines for medicine and clinical stuff) and Public Health England (for things like reportable diseases and ensuring that the public are getting good-quality advice). The picture is further complicated by the creation of Clinical Commissioning Groups (CCGs which have replaced the old PCTs) and Hospital Trusts. GP surgeries can be informed and advised by their CCG, but they are not controlled by them. And then there's Health and Wellbeing Boards which introduces a whole political aspect to the picture...

It's also worth noting that GPs are just that - general practitioners. Nowadays you have "champion" GPs who will specialise in specific things like exercise, obesity, elderly care and whatnot, but that doesn't mean that they're carrying out research or have the expertise of a consultant. It just means that they're prepared to delve deeper into whatever they've specialised in, and that other GPs are able to approach them for advice.

These days we have increasing speciality in the form of Nurse Specialists - a diabetes nurse is one example. But even these people are bound by their practice policy, informed by NICE, PHE and their CCG. Depending on how progressive various areas are, some practise nurse specialists are able to be more patient-led in their approach, but medicine as a tradition has always been very top-down (i.e. they tell us what to do, instead of us telling them what we want) and I've got numerous examples (too boring to note) where an entire new approach or way of thinking has failed because no-one thought to tell the GPs what was going on.

It's not a failing on their part. They're under enough pressure and they hate things like 8 minute appointments and "1 problem per appointment" as much as we do. But if you have 100 patients for whom statins could be appropriate and you give them to only 70 of them, there's nothing stopping the Emergency Consultant demanding why #71, who just got wheeled in with a cardiac event wasn't on statins. "Trying to cut our prescriptions bill," doesn't quite read so fabulously in that report, no matter how noble the intention.

But there ARE innovators, like the lovely Dr Unwin who - as @Brunneria noted, reduced his surgery's prescription bill... by a whopping £45, 000 / year - and won a prize for innovation:

http://www.norwoodsurgerysouthport....s_release_low_Carb_GP_wins_National_Award.pdf

My issue with "big pharma" is not, actually, the cost or the availability or even the pushing of the big drugs. It's that they're following the cash and not the need. If drug research was need-led, we'd have significant leaps forward in new antibiotics - a field which is desperately underfunded and yet presents problems that see us as a species teetering on the edge of disaster. Big investment is required, but it's not "sexy" enough and will initially prove incredibly expensive. So why would a cash-chaser bother when you can invent 3 more ways to sustain an erection or yet another antihistamine tablet and flood an already crowded market?*

Our NHS is a complex beast and GPs fight for funding and sustainability the same way any other business does. Sometimes they look for ways to innovate. Sometimes they focus on patient outcomes or being excellent at supporting carers or whatever else they've been asked to do by their local CCG's.

And, similarly, drug companies research in the direction their shareholders point them in, and they research what's going to sell super-well. This is the world we live in. It's less awful in the UK because companies can't advertise their specific drugs directly to patients and because GPs will often substitute for a generic form to save money, but we will never see big results in big problems unless the big companies are prepared to make big investments.

Sorry. Ranting a bit.

*I'm not saying these drugs don't help people. I'm saying compared to not receiving effective antibiotics when you've had an operation, are undergoing cancer treatment and a million other uses, these types of drugs pale into insignificance. And it IS a crisis. It's not happening tomorrow, it's happening right now:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/

(Sorry for the double post)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1395800/

People are trying to think of ways to "recycle" unwanted medication. But the packaging has to be so safe and tamper-proof that it's proving very hard to do.

Flip the issue over and imagine that you're the person who ticks the box to say you're happy to accept recycled medication (because you can't afford the prescription costs or whatever) or, worse maybe, you're working for an NGO and sourcing meds for some urgent humanitarian crisis and recycled meds are the cheapest, best option.

It takes just one lunatic, and there aren't many, but there are enough to make the security of those medications a serious issue. And maybe they didn't do it on purpose and just left that bottle on the window sill in the sun for a week. Or maybe they are dangerously crazy and found some tiny needle and compromised the tablets with something or other.

Do you really want to be the person playing those odds? Or the pharmacist who supplied them?

Or should the drugs being recycled have to be tested? That's a whole new industry and would completely destroy the point of recycling in the first place - it would increase the cost of recycling meds.

Also, it's worth noting, that unwanted medications should be returned to your pharmacist because they have the specific equipment to dispose of them appropriately (cremation with heavy air filters, it turns out). If you bin them, they'll go into landfill and potentially enter our / our agriculture's foodchain. If you flush them, they'll definitely enter our food chain.

It's a ball ache and it's far less private, but take them back to where you got them.

JohnEGreen said:

This is BBC's reality check on who should be taking statins.

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I notice that the most recent guidelines suggest that an additional 12 million people should be taking them. At least we can go back to the NICE guidelines which make it quite clear that prescriptions should only be handed out with agreement of the patient, if the patient doesn't want them, the patient doesn't have to have them. Maybe I read it wrong.

ringi said:

one of the targets is that statins are prescribed to defined groups of people, including most people with Type2.

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I'm still intrigued as to how the NHS can fine GPs not prescribing them, especially as the patient effectively has the "power of veto". Was that the Daily Express?

serenity648 said:

You do know that in the UK it is very hard to change surgery in some places? we cant pick and choose our doctors and have to use the ones available in the geographical location nearest to where we live, unless we are very lucky.

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Here, especially if one lives in the contry side could be difficult to change GP too, especially for people without a car. You have a couple of GP in the town, and if the other one is full you can't change easily.

From what I've heard when in a small town nearby there was a problem because the GP died in a car crash an the other doctor was full, people had to get the doctor in a nearby town. For people without a car the problem was solved because a bus company was offering a Dial-a-Ride Transit.

Anyway I think that having a GP that is writing prescriprion without listening to the patient is a big problem for the patient that will also mirror on the sanitary service and to the general population.

SockFiddler said:

People are trying to think of ways to "recycle" unwanted medication. But the packaging has to be so safe and tamper-proof that it's proving very hard to do.

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The first step would be when someone declines to collect the medication from the chemist (so it has not left the chemist) - as most repeat prescriptions are send directly to the chemist it is hard to just cross out the items you don't want.

DavidGrahamJones said:

At least we can go back to the NICE guidelines which make it quite clear that prescriptions should only be handed out with agreement of the patient, if the patient doesn't want them, the patient doesn't have to have them. Maybe I read it wrong.

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But lots of patient will never say anything to a doctor they think the doctor does not want to be told, after all a doctor must be shown respect even if you are going to ignore the doctor as you made need the doctor on your side for something else.

There is also the problem that doctors prescribe drugs without giving the patient a chance to first go away and do their own research etc. Hence the patient may have been willing to take the satins at the time they were added to the repeat prescription list and hence from then on automatically gets issued by the chemist.

Given how hard it is to get a GP appointment and not wanting to waist the GP's time and get told off, lots of people will take the easy option and just bin the unwanted drugs.

DavidGrahamJones said:

I'm still intrigued as to how the NHS can fine GPs not prescribing them

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see http://www.pulsetoday.co.uk/your-pr...-statin-threshold-in-the-qof/20010096.article

It is one of the stats used to decide on the "quality of care payments".

I have to select the items I want repeated so surely just leave unticked the ones unrequired?????

ringi said:

There is also the problem that doctors prescribe drugs without giving the patient a chance to first go away and do their own research etc. Hence the patient may have been willing to take the satins at the time they were added to the repeat prescription list and hence from then on automatically gets issued by the chemist.

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@ringi you're so fab, I absolutely think you're ace. And I wish this was the situation. But we're in a peculiar place with a disease that is pretty much unique and that colours our perception of other people's behaviour.

This is a forum for people who want to challenge the status quo. This is a place for people who want to do that research and have those conversations and find a different way forward. In this, we are peculiar.

Similarly, diabetes is a disease that can be almost entirely self-managed. Barring asthma (which, to my knowledge, cannot be managed into remission) this makes what we have somewhat unique; we can proactively improve our outcomes ourselves, even. While diet and exercise regimes will certainly be a part of managing a great number of other conditions, diabetes is unique in that the more engaged we are, the better our outcomes will be.

So, essentially, we're a group of maverick patients doing things our own way. We have learned self-awareness and researching skills and to learn from the experience of others and to try to work in partnership with our medical teams (instead of in obedience). And because that is our experience here, it's coloured how we think of other people's experiences.

The truth is, medicine is incredibly paternalistic: they tell us, we do it. People don't research or engage with their health. They're told they have a thing, that there is a pill for that thing and how often to take it, and off they go and do it. I've had friends - incredibly smart, otherwise proactive friends - tell me that they could "never do what you're doing", and when I asked for clarification, they said "Research, learn, challenge what you're told. It just wouldn't ever have occurred to me that it was something I could do."

People aren't lazy or stupid for the most part. But they want to stay healthy and they don't understand that they can (and arguably should) actively participate in their own healthcare. They do what they're told because that's what they're told to do, and it took all of us a serious shaking of the apple tree for our particular reasoning to change.

If doctors waited for people to get some research done, hardly anyone would ever get cured of anything. My friends already thought me mad because I insist on reading the paper information sheets for new medicines (even new formulations of old medicines). Some of us are cast this way; most of us are not.

But I love your optimism all the same. <3

Diakat said:

I have to select the items I want repeated so surely just leave unticked the ones unrequired?????

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I do as well, now that I have on line access after changing GP and have told the chemist not to order repeats for me. But every time I go into a chemist they try to get me to sign up to their repeat ordering system.

Don't you have annual reviews with your GP? I book mine when I get my flu jab. We look at what meds I've had on repeat and whether I still need them, we look at what's changed with my health, what my caring needs involve now...

Maybe that's it. It's not a general annual review, but a carer's review. Still, might be worth looking into to see if it's an annual habit you can adopt.

Thinks are changing with satins as even the news papers now have articles about too many people taking them, therefore “normal” people are starting to question them. A drug that someone is told they must take for life as it may stop them getting ill, is very different from a drug that is prescribed because of a medical problem the person went to the GP with.

I hardly ever research any drug my GP prescribes for short term usage.

ringi said:

I do as well, now that I have on line access after changing GP and have told the chemist not to order repeats for me. But every time I go into a chemist they try to get me to sign up to their repeat ordering system.

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I use a chemist to get repeats - I ring them up, tell them which items I need, they then get the presciption from the gp and I pick my items up a couple of days later - simples
I picked some up yesterday and the pharmacist did an annual review of meds ( to check im using them correctly apparently!) and there's one item I never order any more but is still on the repeat list which he queried - I told him I dont use the 50:50 cream prescribed by the gp (to mouisturise my feet ) as its basically useless and instead buy flexitol myself - the pharmacist agreed my choice was better but too expensive fo gps to prescribe

badcat said:

I use a chemist to get repeats - I ring them up, tell them which items I need, they then get the presciption from the gp and I pick my items up a couple of days later - simples
I picked some up yesterday and the pharmacist did an annual review of meds ( to check im using them correctly apparently!) and there's one item I never order any more but is still on the repeat list which he queried - I told him I dont use the 50:50 cream prescribed by the gp (to mouisturise my feet ) as its basically useless and instead buy flexitol myself - the pharmacist agreed my choice was better but too expensive fo gps to prescribe

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And the pharmacist can claim 28 quid for doing that review

Money, money, money somethings funny in a medics world (apologies to Abba)
Having spent my working life in the NHS i can confirm its getting funnier ( in a bad way) day by day

ringi said:

It is one of the stats used to decide on the "quality of care payments".

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Not so much a fine then, just not getting an incentive payment, they're different.

If my memory serves me well and there's no guarantee of that (thanks to statins, LOL), the incentive payment is made if 50% of patients are within the range being advised by NICE. It's a one off payment rather than something extra per person.

That article seems to indicate that "GP leaders and leading clinicians" are not happy with the move to lower the threshold.

I think SockFiddler has it about right, most people will just do as they're told and so long as they don't feel the effects of whatever is prescribed they're happy. If not, and I'm one of those unfortunates, then we will look into what the problem is, especially as I was just fobbed off with lies by my previous GP.

Apologies to Art of Flowers for going off topic.

Salvia said:

And the pharmacist can claim 28 quid for doing that review

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Worth every penny. LOL

http://www.pharmaceutical-journal.c...ing-an-annual-medication-review/20200770.blog

Salvia said:

And the pharmacist can claim 28 quid for doing that review

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Interesting, just not the whole story, the pharmacy makes the claim rather than the pharmacist and there's a limit to how many can be claimed in a year. If every review took as long as the person in my previous message, definitely worth every penny. I've had one review in the 28 years that I have been using the local pharmacy. Perhaps I should ask for more, but then if they are limited to 400 (see below) maybe that's all I can expect.

"The fee for provision of an MUR is £28. Pharmacies that make arrangements to provide Advanced services before 1 October in any financial year are able to conduct and be paid for a maximum of 400 reviews in the financial year (1st April - 31st March). The limit for pharmacies that enter arrangements on or after 1 October in any financial year is 200 for the financial year."