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Insight: When is a script dispensed?

By Alexander Humphries*

We were recently sent a prescription that wasn’t meant for us. It was for an old patient who had moved away but we dispensed it in good faith thinking he was back in the area...

This particular morning I had received a phone call from a former patient of ours for whom we had received a prescription out of the blue. The patient had moved away to another part of the country, so it was nice to hear from him again and not all that unexpected because we have seen lots of people who find themselves in our neck of the woods due to the lockdowns.

We ordered the plethora of items on this prescription, including fridge lines. The patient asked if we had received the prescription. Yes, we replied, although we were surprised to see it. Was it meant for us? The patient replied,“umm, erm, no, the surgery sent it to you by mistake. I’ll get the surgery to do another prescription”. 

A couple of hours later I received a phone call from a pharmacy near to the patient. The surgery had refused to issue a new prescription and the pharmacy wanted the prescription to be released from the spine.

I spoke to the pharmacist and explained that I wanted to take advice from PSNC before I released the prescription because we had ordered a lot of expensive medicines to meet it, which we could not use for other patients.

The pharmacist at this point started to become quite rude and wasn’t listening to a word I was saying. While I had sympathy with him in that he had the patient in front of him, we had fulfilled this prescription in good faith and I wanted to be sure of our rights and obligations. Somehow our phone got disconnected...

Differing advice 

After checking with both PSNC and the NPA the situation was even more confused, with each organisation giving slightly different advice and interpretations. The bottom line is that there is no fixed definition as to when a script is ‘dispensed’.

NHS England thinks that dispensing is the point of handing out to the patient – but how is this fair when contractors have incurred costs to procure medicines on behalf of the patient, let alone the costs and workload associated with assembly and checking the script? 

Doctors get very upset about patients who do not turn up to their appointments and cry foul at the waste of resources that this represents. This situation is no different for pharmacy contractors. Costs are incurred due to the action of others.

I decided that I was not going to return the script to the spine because we would not be able to reuse the medicines that we had ordered in. The root cause of the problem here was a surgery sending a prescription to the wrong pharmacy.

Anyone who has ever given the wrong script to the wrong patient will tell you that this is probably one of the most frustrating errors because it doesn’t matter how much good work you have done up to that point, it all gets nullified in 10 seconds of madness.

Getting back to my patient, I decided that the best thing to do would be to contact the practice and explain the situation, and try to get them to issue a new prescription. After 15 minutes on hold eventually I got to speak to a receptionist. It turns out that they had already issued another script – problem sorted. 

I think this was the right outcome for everyone involved, but getting there had been a frustrating and painful experience for the patient, both pharmacies and the surgery. 

Some of you may think that I should have released the script, but to me this is missing the point. The current NHS England definition of when dispensing occurs is not fit for purpose and is not a fair one for the modern world. 

How is this fair?

Take the coming advent of hub and spoke dispensing. The spoke pharmacy will incur the cost of the hub providing its service at the moment that the prescription is labelled. This will crystallise the cost of dispensing and the cost of the drug.

If surgeries believe that they have the right of recall up until the moment the patient can collect the prescription, then potentially pharmacies will be left out of pocket.

How is this fair? If a patient does not collect their prescription, again how is this fair when the pharmacy has acted in good faith? It is time we started to put some of these things right or they will become bigger problems down the line.

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine. What would you have done in Alexander Humphries’ position? Email pm@1530.com

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