I noticed that the Prime Minister has recently announced a scheme that will enable pharmacy contractors to receive earlier payment for prescriptions dispensed...so far so good, because it currently takes us 2 months to be completely paid for our dispensing (not a good state of affairs for cash flow!).

The problem is that this new scheme, which will enable contractors to receive advance payments for prescriptions dispensed on day 7 or 8 of the month following that in which the items were dispensed - i.e. a few days after submission of their prescription bundle, will be subject to a charge! 

For example, for prescriptions dispensed in January, contractors - for a fee - would be able to access the NHS Business Services Authority (NHS BSA) advance payment on the 7th or 8th of February. The full and final payment would still be received on April 1st.

The aims of the scheme are to help contractors better manage cash flow and to enable  them to settle their accounts more quickly - which is to be welcomed, but surely now is the time to bring pharmacy contractors in line with other commercial transactions and pay in 30 days, not 60 and then we wouldn't need this scheme!

I came across a situation involving substance misuse the other day that got me thinking...
 
If you have a client getting regular daily methadone, but they never attend at all on Sat (for Sat/Sun), is it better to suggest that they pick up the Saturday/Sunday doses on Friday? 

On one hand, collecting on Friday may suggest that the product will be consumed appropriately; on the other hand, is this playing into the hands of somebody who will abuse the weekend supplies? For some patients, clearly they will benefit clinically; but for others the risk of diversion will be large...

 

Let me know whether you feel...

I had a request the other day from a patient wanting Miconazole cream to treat athletes foot...but she is a breastfeeding mother.
 
When I examined the literature, the advice is to consult the GP; but for detailed information, and because the patient was in a hurry, I contacted the Regional Drug Information Unit in Newcastle to see exactly what the issue/problem is.
 
As usual and within a few minutes, I received an excellent response!
 
Basically, I was told that Miconazole is very poorly absorbed and so a small amount between the toes of a breastfeeding mother will lead to negligible absorption; and therefore there is only a very small risk indeed to the baby.
 
Armed with this information, the lady bought the product - and agreed to speak to the GP before using.
 
The Newcastle based Information Service is a really useful resource to use!

I had an interesting conversation with a company representative recently.
 
It turns out that the product "Dovobet ointment" will be available only in the 120g pack size in the near future as the 60g pack size will be discontinued.
 
The "gel form" will be available in both sizes.
 
The problem here is that if pharmacies receive prescriptions for 60g of the ointment, once it's gone, they will be able to properly supply the 120g and be paid for it...but the clinical indication for this product is clear - it shouldn't be used in a casual manner. Indeed the BNF states "apply once a day to a maximum of 30% of the body surface for 4 weeks (max of 15g daily); If necessary treatment may be continued beyond the 4 weeks or repeated on the advice of a specialist.
 
Now, we don't know what areas of skin are being treated -and treatment may rotate around the body as different body parts need to be treated - but by giving a larger pack, the temptation to overuse might be great...
 
Perhaps, we should provide patients with a MUR when supplying Dovobet to ensure appropriate use; and more importantly prevent inappropriate excessive application?

Our communications officer, Sami, who has been instrumental in pulling together the services, was present at the beginning of the live training to explain the differences in the two SLAs and PGDs and told us all to go forth and vaccinate! 
 
Very good words indeed, and I urge you all to vaccinate as many "at risk" patients as you can...
 
The NHS service offers the opportunity to inoculate "at risk" people under 65 free of charge; and in previous years this cohort of patients have been shown to be very difficult to reach - indeed only about 50% were vaccinated.
 
This is a great opportunity for community pharmacy to step up to the plate, and work with GP colleagues to find, offer and deliver a service that will provide real value to these patients in the missing "at risk" group - protecting them from potentially life threatening illness. Also, large numbers vaccinated will strengthen the arm of the LPC in future negotiations.
 
So please, using the words of my colleague, if you've trained up and signed the relevant paperwork - go forth and vaccinate!

I did an interesting MUR the other day on a gentleman who takes blood pressure tablets and uses inhalers for asthma.
 
During the MUR it became apparent to me that he was in denial regarding his medication and really wished to be free of all of it. He had started jogging to improve his health and lose weight - which is admirable and I applauded this; but as he was now feeling fitter, he decided that he would stop his steroid inhaler and only use his blue inhaler when necessary. As he told me this I could hear his chest wheezing...
 
I explained the importance of regular steroid inhaler use to alleviate, and treat, his condition - and we discussed the idea of stepping down (and up) as conditions change; but in a sensible way - preferably with GP approval. He told me that the GP had previously given him similar advice - which he had ignored; but agreed to use the inhaler as prescribed in future after our discussions. 
 
It's easy to be in denial; and in most cases probably occurs because people are ignorant of the consequences of benefit versus risk - good communication is so important.
 
Once a patient understands about the medication, patients are so much more compliant - and MURs are a great tool to get this information across and reinforce good messages!