Policies promoting 28-day prescribing by GPs ‘are likely to be a false economy as they cost at least as much as they are projected to save’. So said Pulse magazine (in October 2012).

What they didn’t say is that from a patient’s point of view – particularly if you have long-term conditions (LTCs) – the policy also drives you to distraction.

Minding the engine

There’s a certain amount of stuff I need, just to keep me ticking over. I’ve had a Whipple’s procedure, so my re-built upper GI tract resembles the air filter that the lads at Houston jury-rigged for the beleaguered crew of the Apollo 13 team; that is to say, it looks like something you’ve made out of the extra tools you get with a vacuum cleaner. As a result:

• I need to take omeprazole and a low dose of aspirin every day.
• The diabetes that you get thrown in free with a Whipple’s means I also need insulin, and the gear that goes with blood-glucose testing several times a day.
• And the lack of pancreas (that rather zippily puts the pancreatico in ‘pancreaticoduodenectomy’) requires that, whenever I eat, I replace my absent digestive enzymes with Creon (used widely by people with cystic fibrosis).

I mostly only see the doctor, every three months, to get my prescription reviewed and signed off again.

So, what’s my beef?

I can only get 28 days supply. This is rubbish on a number of counts.

First, I’m not going to use any more drugs or paraphernalia, just for fun, just because it’s there. The arguments about wastage – that people throw away or stop taking their antibiotics because their cough has gone – don’t apply here. I’m not going to stop taking Creon with everything I eat (really). I’m not going to leave the insulin in the cabinet because I think the diabetes has cleared up. And you don’t finger-prick for fun. If you do, go to a more appropriate website. So giving me three month’s supply won’t lead to wastage, and that’s clear if you just look at what I’m taking.

Second, the article above makes it perfectly clear that surgery staff – GPs, receptionists, dispensers and clerical staff, as well as pharmacists – are spending an inordinate amount of time, doing an inordinate amount of paperwork reviewing and signing off regular prescriptions. I appreciate that it is important to review meds, for many reasons. But in my case, and I’m sure in that of many others, the requirement for this stuff is absolutely not going to go away. Not until, ahem, you know… This is stuff that we’re stuck with. So reviewing it monthly is pointless as well as expensive.

The third thing that bothers me is the sheer tedium of the process. It’s bad enough, as you may know yourself, taking drugs everyday. It’s even more tedious managing diabetes, every single time you eat or drink, and often in between. (Yes, yes, it’s the price of the life-preserving cancer surgery. I’m fine with that, and grateful, and happy to be alive. Sorry. I just dropped my zen there for a minute.) So it’d be a boon to me, it’d actually be a small glory, not to have to worry about my prescription quite so regularly. Not to have to calculate how soon to re-order. Are we running into a Bank Holiday? Can I get down there on Friday? Better explain that I’m going away, so ordering early. Having an LTC is inconvenient, but mainly it’s tedious. It is absolutely not fascinating, so try not to say that next time you’re tempted to pore over my gear. It’d be just a bit less tedious to be able to go three months instead of 28 days. It’d be, yer know, nice.

Now, to understand the fourth whinge, there’s a thing you have to get about rural practices*. What happens is that when I get a prescription – a regular one or one written during a consultation – it’s dispensed in-house. There is a policy that if you live in an outlying village your stuff is dispensed at the surgery. Mostly this is seen as a benefit but, honestly, I think it’s a bit weird and I’ve never really got it. The pharmacy is only a very short walk from from the GP surgery, and if you’ve made the trip from home (3 miles or so for me), whether it’s by car, bus-what-bus, or Shanks’s pony, going to the pharmacy as well is barely a hardship. But there you go. (There’s a downside to this, mind, because if, like today, I see a GP and they give me the script for my regular drugs, there won’t be any Creon in. They never have the Creon in because ‘it isn’t prescribed regularly’. You think? So I have to make a return trip anyway, always, thus negating any possible benefit of dispensing in-house.)  (* Don’t be grubby.)

Anyway, my fourth point is that, because of the above, I have to go to the surgery, every 28 days, to pick up my prescription and, in all likelihood, sit there and wait while it’s dispensed. It’s lovely, and the staff are nice. But just going, just parking there, just being there, with the institutional chairs, with the coughers and the dribbly, fevered children, every 28 days, make you feel… well…  like a patient. I know. I know, I am. But most of the time I’m not ill, I’m just managing my LTCs, with all the other bloody ‘expert patients’, and getting on with my life, which I happen to like and enjoy. And it always just makes me a bit miserable and to be honest a bit resentful, to be reeled in again to the bleeding surgery. If I had a 3-month prescription I’d honestly feel better, freer, less tethered to the service. Yes, less tethered.

Patient-centredness

Funny, isn’t it, how patient-centredness keeps coming up? Where is the patient-centredness in this unthinking blanket approach? Where is the self-management? The trust in ‘lived experience’? My message to the Royal College of General Practitioners would be short and sweet:

• Don’t assume wastage. Look at what I’m actually taking and question whether it’s likely that I’ll leave it in the cabinet.
• Don’t review stuff on a 28-day basis that I’m definitely going to need for ever.
• Give me a break from the relentlessness. I’ve got so many better things to do.
• Release me from this pointless umbilical cord and trust me.

Come on, guys. You were the bright ones in your class. Use some discretion.

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Patient-centredness is close to my heart. If it’s close to yours, you might want to take a look at the Coalition for Collaborative Care, which is working to put patients front and centre of their own care.

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