Monday, 21 May 2012

The increasing cost of ageing.

For centuries crude indicators such as infant mortality and life expectancy have been used to define how "healthy" a country is. Although life expectancy in the UK has increased life quality has not.

We are living longer but not enjoying doing so. As life expectancy increases so does health need and as birth rates drop the income and personnel needed to service this increased demand become inversely proportional.

For simple grunts on the ground nowhere has this become more apparent than when signing repeat prescriptions. You can spend an hour or more some days checking and signing the repeat prescriptions for most of the practice sometimes 250 - 600 (depending on the time of year) for the bulk of patients who are on monthly prescriptions and then spend another hour or more of your time checking and signing what are known in these parts of the Northernshire as the "weeklies".

What are "weeklies" you may ask? Well they are not part timers like a certain Professor they are people who because they are old and gradually losing it receive their medication in little boxes which have a variety of names to ensure that they are prompted to take their medication. Seemingly a good idea but this is but the start of an increasingly steep slippery slope which goes one way only.

Often it is a carer or relative that suggests this because Mabel or George are becoming a bit forgetful. It is but a sticking plaster on the decline of people living too long as "winners" of the war of increasing longevity but living as victims of the peace that increased morbidity has secured for them (and us) . The victory has merely been on the numbers front only for the defeat suffered by us all is the decreased quality of life this increased survival has given us all.

Now most drugs come in packs of a month's supply usually defined as a 28 day or a 30 day month by the drugs' industry. When drugs have to be prescribed on a weekly basis with a daily defined dosage schedule and placed into a little box with different compartments then this causes the average retail chemist a problem.

Pull a pack of old age prolongation medicine off the shelf and dispense it the chemist will get a dispensing fee plus any profit over the cost they purchased the drug from a wholesaler that is reimbursed by the drug tariff price that the NHS pays for that particular drug.

However if a slowly dementing patient requires weeklies then this starts to cost the chemist time and money and as a result costs the NHS and GPs more. For instead of just asking for a once a month prescription the chemist insists on 4 prescriptions per month = 4 dispensing fees per prescription dispensed instead of 1 hence the "weeklies".

If you have ever watched a dispensary do "weeklies" for a pensioner on 14 drugs a month some of which are taken sometimes 4 or more times a day it is an incredibly time and labour consuming exercise as relatively inexperienced personnel suddenly have to take the responsibility of what a patient or a relative should do namely look after an elderly relative and their medication. Do the maths 14 drugs X one month drug supply = 14 boxes of drugs.

14 drugs X 4 weeks supply = 64 separately packaged drugs per month and then add in the number of times a day each of the 14 drugs needs to be administered and you can see the costs escalate to ensure that relatives are relieved of the responsibility of checking up on elderly relatives or that slowly declining patients can stand a chance of administering the drugs themselves with reduced risk of overdose or omission.

Heaven forbid that a paid carer could be allowed to administer a drug from such a weeklies box health and safety would ensure that a carer capable of taking paracetamol 4 times a day themselves would be incapable of administering a drug from a weeklies box they can only "prompt" the patient to do so.

So GPs and their staff have to evolve systems to cope with the fact that a small number of patients can generate more "prescriptions" per month than the rest of their entire practice population on repeat prescriptions. Now we will not say that this gives chemists opportunities for fraud.

However, when you as a GP are asked, by a large pharmaceutical company, to replace every prescription for a patient on a "weeklie" in a large secure institution, you do start to wonder if the "weeklies" are a bit of a con that needs addressing?

This minor concern follows a surprise "inspection", by a large pharmaceutical company's pharmacist, who just happened to be the same large pharmaceutical company's pharmacist who dispensed all of the weeklies and this "inspection" reveals that all of the weeklies so dispensed are out of date. And the large pharmaceutical company via the same pharmacist then asks the GP to replace every patients' weeklies as a result?

It is a huge waste of GP time, a hugely expensive exercise for chemists and ultimately a complete waste of time for the patients concerned as they nearly always land up going into residential or other care. Usually because of drug or other cock-ups.

Praise be to the Party for ensuring that its provision of care for the elderly is still as crap as ever. Work all your life, pay your taxes and then get bugger all as a result other than a little tablet box. Surely such august bodies as the future forum, the RCGP et al will be on this case?

This must be costing a fortune and the numbers go up every year that we have been in practice.

1 comment:

Can't think of a name said...

No, it's not a waste of time for the patients. Taking the right medication can keep someone in the community, in their own home, near to their friends and neighbours for much longer.

As for relatives, not everyone is blessed with children, not everyone's children live nearby and not all children are capable of looking after their relatives all the time.

I have a relative with dementia and I visit him every single day come rain or shine, and more than once if need be, even if the second time is in the middle of the night.

I'm already on the edge of a complete breakdown, but without the weeklies, I would get very little sleep going round to see him at both ends of the day.

As for the cost to the taxpayer, I bet weeklies are cheaper than residential care. But no, I forgot, they have to use up their savings for residential care whereas weeklies are on the NHS. If you really resent weeklies, campaign for them to be treated as social care and charged as such. I'm sure my relative would rather use his savings for weeklies than to be removed from his home and community and stuck in a 'home'.