Taking back waste medication is part of the essential services that community pharmacy must do...
 
Imagine my surprise, then, when I was approached by a carer recently who was having great difficulty returning unwanted medication.
 
She had a huge "black sack" of waste and couldn't get rid of it. The pharmacy that supplies her "home" had refused, as had a another she had approached. In desperation she rang me...and we sorted it out.
 
The excuse they had allegedly given her was " we didn't dispense it, so we cannot take it back" 
that's rubbish literally!

On the note of wast medication do I wonder how many contractors know about their obligation to produce a pre acceptance waste audit.  For more deatils see our news story on the home page.

I had an interesting conversation with a member of staff from the Prescription Pricing Department this morning...
Basically she informed me that it was against my terms of service to put NCSO items between the red separators in our bundle... I explained that I did this to ensure that a "human" priced them correctly as I was worried that CIP would just price them at DT prices.
She said that NCSO was a real hassle for them (!) and that they had to feed all NCSO Rxs in red separators back from the red separators into the main bundle by hand - then the program picks them out again for manual pricing !!!

She wouldn't give me her name or a telephone number. She warned me that if contractors submit large numbers of NCSO items in red separators then she may take the red separators off - whatever that means...

Colleagues on the LPC have informed me that they also put all NCSO into the red separators along with any other prescription that could be priced incorrectly...Does anybody else put NCSO into the red separators?

Drug and alcohol prescribers often prescribe Subutex or generic buprenorphine for substance misuse.
 
Traditionally the drug tariff cost of buprenorphine has been based on the subutex price, so it wasn't uncommon for pharmacy contractors to give the brand to the patient if requested, in the past, on a generic prescription...and historically many substance misusers for a variety of reasons preferred the brand, asked for the brand - and got it. 
 
There is a problem now, however, due to the fact that buprenorphine is now in the Drug Tariff - as a category M product - and is significantly cheaper than the brand. Prescribers are reluctant to prescribe the brand due to the cost implications for the NHS and pharmacists must dispense the generic when ordered, or make a huge loss on the transaction.
 
It's sometimes hard to explain such switches to this vulnerable, and often aggressive, group of patients - therefore it's so important that we all work together on this - prescriber, keyworker and pharmacist - to ensure a smooth transition.

One of the really important things about supervised methadone schemes is that pharmacists are ideally placed to notice changes in physical or mental health of a client - and this ensures that the patient can be "picked up" before potentially serious harm occurs.
 
Pharmacists, historically, have always informed the prescriber if the patient has missed 3 doses - as the client will need to be seen and re-titrated by a prescriber; but Debbi Forsythe, Head of Service - Substance Misuse for First Contact Clinical in South Tyneside has asked pharmacies to let the service know on 0191 4274505 (single point of contact number) if the client has missed 2 days. This will ensure that as much can be done as possible to prevent the missing of the 3rd day...and the need for subsequent re-titration.
 
So in summary, If a client misses 2 days of prescribed medication, or you feel that the physical or mental wellbeing of the client is compromised then contact First Contact Clinical on 0191 4274505.
 
Pharmacists can and do make a difference in the care of these very vulnerable people...