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The way that some pharmacies run their repeat script reordering systems sends out the wrong message, says PM's anonymous columnist Alexander Humphries

If you have been anywhere near one of the large pharmacy multiples in the last couple of years, you won't have escaped their focus group-tested sales patter, the gist of which is: €Would you like us to re-order your medicines?€.

Repeat reordering systems are nothing new, nor particularly revolutionary, but what is new is the pushiness with which some pharmacies promote these schemes to patients.

Financial rewards

Staff are given financial rewards for the number of sign-ups they get; performance is monitored, assessed and enforced. You can't blame the employees €“ they are only doing what they've been told to do by head office and their area managers.

To be clear, I'm not talking about pharmacies collecting prescriptions from a GP practice on behalf of patients €“ that is just common sense process management. I'm specifically talking about the pharmacy initiating or managing a patient's repeat prescription.

Is it too much to ask patients to re-order their own medicines?

The commonest example of this would be the pharmacy that asks patients when they collect, say, July's prescription, what they want in August. Sure, you'd hope they'd want their antihypertensives or diabetes treatments next month as well, but what about painkillers, needles, insulin or inhalers, where use varies from day to day or month to month?

How realistic is it to expect the patient to see into the future to predict what they'll want in four, eight or 12 weeks?

Head office supremos have already thought of this and refer to Stock Answer Number 1: €We have a process and a procedure to make sure that we don't oversupply medicines unnecessarily.€

I'm sorry, I just don't buy it €“ especially when you consider that performance-related bonuses might give staff a perverse incentive to oversupply to meet their targets. Senior management within one large multiple organisation claim that they are not responsible for over-ordering a patient's medicines €“ it can't happen, there is a procedure. Well, I had one of that same company's managed repeat patients bring back to me (see picture):

• 86 x 28 codeine phosphate 30mg (nearly 2,500 tablets!) 
• 21 x 28 naproxen 500mg tabs
• 43 x 32 paracetamol capsules
• 10 x 30 meloxicam 7.5mg tabs
• 5 x 8 Estraderm patches.

So how could this happen? They've got both a process and a procedure after all. Cue Stock Answer Number 2: blame the patient. €They keep ordering out of fear that they will need the medicine at some point in the future€. Clearly the patient I saw who brought all those medicines back for destruction thought the same...

Convenient

Patients go along with these wasteful systems because they see them as convenient. Even the parents of one of my employees use a rival pharmacy's repeat reordering system because they say it is easier than doing it themselves.

Unfortunately, with the overwhelming majority of NHS prescriptions free of charge to patients, there is no cost or disincentive to the individual. So what can be done to prevent 'pharmageddon'?

Well, the Scottish Government has effectively outlawed the practice, saying that €patients should be encouraged to take responsibility for ordering their own repeat prescriptions€.

Practices have a huge role to play in tackling this problem because the downside of managed repeats is increased waste, disempowered patients and unnecessary work for GPs and staff unless the public begins to understand that the right to free NHS care comes with a responsibility to do what they can to look after themselves. Is it too much to ask them to reorder their own medicines a week or so before they run out?

At the very least all local stakeholders should hold regular dialogue to raise concerns and give feedback, with GP surgeries ideally placed to host an open and honest debate about where managed repeats can be useful or when they are simply commercialising laziness.

At best I believe that managed repeats are unhelpful. At worst, at times, they are extremely wasteful. They also, perhaps, say something about the culture of the companies that promote them so enthusiastically...