This week 2942 trainee pharmacists qualified in the UK.
The pass rate was 72% this year, down from previous years. Qualified pharmacists have intensive training and testing because a pharmacist’s role in the community has never been more important.
Looking at reasons why pharmacists dispense more and more medical items, our expert pharmacist wrote on how an ageing population may be causing more prescriptions in June. In part 2 we try to understand how the rise in obesity and type 2 diabetes might contribute to over-medication. We also look at the ways in which community pharmacists are coping and how people can play their part.
- Diabetes is a quick onset disease in terms of increased prescribing
- Unless a person who has been diagnosed with diabetes makes successful lifestyle and dietary changes, medication fixes their symptoms.
- Medication does not fix the diabetes.
Unfixed, a diabetic’s problems increase, resulting in more prescriptions. Doctors frequently add statins and blood pressure tablets to diabetes prescriptions because cardiovascular and hypertension are known risk factors.
A pill to fix me
Lifestyle and dietary changes can change the prognosis of type 2 diabetes which is the most common diabetes but in general terms ‘a pill that fixes me, to carry on my lifestyle’ is the choice people are making. NICE guidelines describe 6-10 medicines, common complications and pathways.
- If the diabetes problem is uncontrolled more blood pressure and more diabetes tablets follows quite quickly.
- If the patient is also overweight, prescriptions to control neuropathic pain indicate an extra two medications. If the patient’s diabetes doesn’t improve, the patient will fall into the next stage of treatment adding more anti-diabetic drugs or insulin.
Diabetes UK is a great resource, they say number of people living with diabetes in the UK is over 4 million.
50 million related diabetes medicines by 2025.
That’s a lot of prescriptions to be processing!
How are pharmacists coping?
Most pharmacies consider prescription items and available hours and they drive pharmacy staff to be efficient.
Trained pharmacists come with high training costs and government has cut pharmacy funding, so there’s an ever-widening gap to close in order to make pharmacy efficient. The one-minute-per-prescription is commonplace and the majority of pharmacies are understaffed .
Staff are stressed because they are asked to deliver more volume and although most pharmacies look as though they are ‘managing their workload’, can they really be said to be safe? Headlines and law suits say maybe not.
Pharmacies have two strategies for delivering more prescriptions in time. Dispensing robots and the ‘hub and spoke’ dispensing model.
Dispensing robots are expensive and not fit for general purpose. The hub and spoke model saves 62% of the workload and has government backing.
How hub and spoke works
Dispensing is outsourced to a pharmacy hub, where the process is completed and the fulfilled prescription is sent to the local pharmacy to be given out.
Most patients don’t want to wait two days for hub and spoke to provide their outsourced medication.
Patients going elsewhere to fulfil their prescriptions results in loss of business to pharmacists. Since patients represent well documented future profits for pharmacies, patients are precious and pharmacies don’t want to lose them.
Several of the large multiple pharmacists have tried the hub and spoke process and have not been able to make it work, so the pressure comes back into the branches fulfilling more prescriptions individually in the shortest time.
As a trained pharmacist and manager, our expert advisor feels the Hub and Spoke will be made more efficient and pharmacies will take the opportunity to reduce staff for profit. We always warn against anything that results in less client contact because
- Patient education is key.
- By the time patients get to the stage of receiving their prescriptions, they have been through a lot of and the priority at the pharmacyis more likely to be grab and run, rather than more information.
- The situation gets worse when people have waited a long time to see their GP.
- Good information is key, people need to know what the medication is for and how to take it and this information may need repeating over and over.
- If people don’t know why or how to take it, the medication will end up in a risky stockpile in the patient’s home.
Addressing symptoms with lifestyle and dietary changes will help. Optimising medicines at the outset is the best use of a pharmacist’s time and offers the best outcomes for patients.
We hope the 2942 newly qualified pharmacists get to use what they learned about patient liaison and medication reviews because in our opinion, a pharmacist’s patient facing time is vital.
All our franchised offices recommend their clients review meds with their GP and pharmacist regularly. Seniors Helping Seniors prompts clients to take their medicine, so we rely on the best of the best. Worryingly, we see many of our clients trying to deal with lots of unused medication in their homes. We always focus family decision makers to take unused medication out of harm’s way. Taking medicine back to the pharmacist is a great chance to book a professional review of the medicines you are taking.