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Record learning outcomes

by Alexander Humphries*

Taking holidays can often be worse than not taking them. As I write this, the last week has been utter hell as I prepare for my first week off in two years...

The lead-up to a break can often be fraught if, like me, you don't like leaving the locum up to their neck in it on day one. There is one particular job which drives everyone up the wall, including me, and that is the age-old problem of MDS.

Whenever I go away, one of my dispensers insists that we get all of the packs ready before I go, her argument being that, €it's hard work doing these with locums€. So we have trudged through pack after pack, getting ahead in order for the team to survive the next fortnight.

Controversial

MDS can be a hugely controversial area, particularly with CCG and area team pharmacists, but having seen the huge difference they can make to helping people lead independent lives, I'm inclined to disagree with almost everything that is said about MDS by people who haven't seen a patient in years. The first and biggest issue that most NHS organisations have with MDS is the cost. It scares them.

Many areas have blanket bans on the use of seven-day prescriptions as a means of controlling costs, citing the misguided belief that we are paid to provide MDS in the contract. We are paid a fee of 6.6p per item to provide 'reasonable adjustments', but in nobody's definition can MDS ever be classified as a reasonable adjustment. For the average pharmacy dispensing 7,000 items per month, the Equality Act payment is worth around £450 a month.

If you do not provide MDS, this is just a top-up payment for doing nothing. For anyone with more than a handful of MDS patients a month, this figure is nowhere near where it needs to be. Take, for example, a patient with a 28-day prescription for five items: consumable costs account for around £2/month; it probably takes a competent dispenser five minutes to check the prescription (to see what the surgery has missed off this month) and label the items; probably another 10-15 minutes to identify and record the descriptions of each medicine and to prepare the pack ready for checking.

It then probably takes a further 10 minutes of pharmacist time to check it. Call it £3 for the dispenser's time, and another £5 for the pharmacist's time, so probably around £10 per month for this one patient. If the patient is on a much less manageable 10 items, the costs can easily triple. A quick search of my records shows that we currently have 75 active MDS patients, so the costs of MDS for me are certainly double, if not three or four times, what we are currently paid.

Generating demand

There is a school of thought that pharmacies themselves are responsible for generating the demand for MDS. It is true that one multiple has built a successful and very aggressive business off the back of this but the reality for other contractors is stark: do it or lose the patient. The notion that we want more of these things is ludicrous.

The real driver behind the explosion of MDS has been the domiciliary care industry, which often demands that patients with just one item are put onto MDS. It is my belief that local authorities should pay for MDS where a domiciliary care arrangement is in place.

Lack of evidence

Health service commissioners have quoted a lack of evidence for MDS as a reason for not commissioning MDS services. Yet every front-line pharmacist will have examples of patients who were so chaotic pre-MDS that they ended up in hospital regularly, or experienced medicines-related harm from missing or messing up their medication. They will also have plenty of anecdotal evidence of how these patients were stabilised post-MDS.

We regularly get asked by our community matron or the local hospital about starting patients on MDS. Apart from anything else, patients like it and probably think it is part of the standard NHS service. There is clearly a demand, but because this is a noncommissioned service there are huge variations between the standard of care offered by different providers, which is where I suspect the lack of evidence stems from.

A standardised definition, including a proper service level agreement and funding to do this properly, including domiciliary visits, would provide all of the evidence required. As already mentioned, patients like this service. However, the NHS seems perfectly happy with the status quo, so I don't think anything will be happening any time soon...

* Pen name of a practising community pharmacist. Alexander Humphries' views are not necessarily those of Pharmacy Magazine. What has your experience been of providing MDS? Email pm@1530.com

The notion that we want more of these things - ludicrous...