Fleegle's Blog. Feel free to add YOUR opinion.

[Twinkle]

One day in a month? How are you coping? This blog of mine is what this is all about. Apparently HSE are intent on reducing the number of Community Pharmacies in Ireland to 1,000 in order to save money, yet they're perfectly happy to still pay some 'happy as I am, who needs professional development' GPs half a million each to prescribe out-of-date drugs (most of which are so antiquated they're unavailable) to a 'grateful' population. ALL WRONG....

...when I worked in the UK it was as a Prescribing Advisor (following years in hospital and community) extolling the virtues of evidence-based-medicine and cost-effective prescribing (when GP fundholding came in) to GP practices.

As a locum in Ireland, despite limited work, the irrational prescribing patterns just blow me away... Tons of expensive antibiotics, tons of Crestor in patients who've not been tried on simvastatin..wrecks my head.


...and I'm coping because I kept on my cleaning and gardening jobs - school toilets still need scrubbing, and no sign of Mary Harney there !!!

[hibernia]

...
As a locum in Ireland, despite limited work, the irrational prescribing patterns just blow me away... Tons of expensive antibiotics, tons of Crestor in patients who've not been tried on simvastatin..wrecks my head.

!

Most important thing is not to let them mess with your head. If you let it get to you you will go mad.

This is how I cope.
Doctors prescribe that way here, not because they are stupid but because they simply don't know any better. Accept that. If they ask for your advice give it, if they don't then don't offer it unless of course a patient may be at risk.
If they want me to help rationalise prescribing and so save tons of money I'm happy to do so WHEN they pay me. At the moment they don't even pay me for what I do so I won't be offering any unpaid expertise.

Sorry if I sound cynical. I have a very good relationship with my local prescribers who do respect my knowledge but it is frustrating to see so many simple changes you could make to help patients and save money and to see things getting worse instead of improving.

[Twinkle]

not cynical at all Hibernia - sums up how I feel too...

in other news - today I became a proper culchie...I've bought a muddy-looking pony !!!
(now I need some more locums to keep him in hay)

[Fleegle]

The Budget

Here are the main points which affect us as pharmacists...what are your views lads?


Reduction in payments to Pharmaceutical suppliers
Reductions on the overall reimbursement cost to the State of drugs and medicines provided through the GMS and community drugs schemes are estimated based on discussions under way with pharmaceutical manufacturers.

Note from Fleeg.. this reduction sought by the HSE is reputed to be 40% . Whilst this is still notional, Ms Harney can still employ the FEMPI legislation which is still in force. She appears to be trying to introduce this for all off-patent medicines, including PIs on Jan 1st 2010. This means our current stock holding will automatically devalue by 40% in three weeks time. Our only option is therefore to buy only what is desperately needed, and reduce our stocks to an absolute minimum until the position is clarified. What price healthcare now?


Increase in DPS Threshold of €20
The monthly threshold for the Drugs Payment Scheme is being increased from €100 to €120.

Prescription charge of 50c per item
The number of prescriptions under the GMS has increased in recent years from 12.79m in 2004 to 15.65 m in 2008. The number of items dispensed in the GMS has increased from 35m to 48.21m in the same period. To address the associated rising costs a 50 cent charge per item subject to a monthly ceiling of €10 per family is being introduced for the GMS and LTI scheme.

Private income collection
There are significant sums outstanding in respect of the treatment of private and semi private patients by the HSE and its funded hospitals. Measures are being undertaken to speed up the billing and payment process in order to reduce outstanding amounts which will result in an increased level of income to the hospitals.

Revision to DTSS Scheme
Under the Dental Treatment Services Scheme, adult medical card holders may obtain dental services from dentists in private practice under contract to the HSE. Expenditure in the Dental Treatment Services Scheme has risen by 60% over the past five years. In order to achieve the savings outlined in Budget 2010, the HSE will put measures in place to contain DTSS expenditure at 2008 levels.

[Fleegle]

Meltdown

I received an e-mail today from my local HSE pharmacist. It contained an attachment, which was a letter written to them by a hospital pharmacist in the province. I will not paste it here, but the general point was that the hospital pharmacy is receiving frequent phone calls from community pharmacies with particular regard to the unavailability of items being prescribed by consultants, interns etc. on discharge prescriptions.

It appears many more unlicensed (eg timodine, doxepin, scopoderm etc) or out-of-stock products, (eg aldomet, mogadon etc etc), products which are not ordinarily held by the pharmacy's first-line wholesaler (so attracting ZERO discount), or otherwise almost- impossible to obtain medicines are being prescribed, therefore putting community pharmacies in the position that they cannot source the drugs immediately, and must often also go through the ridiculous 'hardship' or 'LTI' 'authorisation' process before they can be sourced or supplied at all, which, allowing for current backlog, is taking weeks if not months before a medicine can be supplied, usually at vastly-inflated cost, and with carriage fee to boot. This whole process also involves the massive time-consuming process of looking out for invoices as they arrive, photocopying them, and attaching them to your paper claim just so you get paid. Most often you aren't paid on first submission, and have to re-claim anyway..usually two or three times. The best bit is that most of these products have never been assigned a GMS code, so they're automatically bumped back as unpaid, month after month, invoice submitted or not. Have you checked your LTI submission payments lately?

The hospital pharmacist finds this unacceptable, and feels community pharmacies must take responsibility for prompt supply of all medicines prescribed by the hospital, often at a financial loss, and an unacceptable delay to the patient, whilst waiting for confirmation that the supply will be re-imbursed.

My own opinion..the beginning of the end. Prescribing is no longer in tune with supply, and when the proposed 40% cut on off-patents kicks in in February, it will be the end. Simplified, pharmacies can no longer afford to stock medicines. Compounding the situation is the imminent €120 DPS threshold for private patients. They won't be able to access many newly-prescribed medicines either, despite this ridiculous MONTHLY fee they are being charged for medicine, over and above the private-patient GP consultancy fees, currently set at €50 to €60 per visit, over-and- above the average payment they each receive from the HSE for GMS sevices of around €200,000 per annum each....some are on upwards of €500,000.. (plus pension entitlement, paid locum fees and holiday pay)

Healthcare no more. game over within 6 months. Watch this space.

Fleegle.

[lamzee]

Is timodine unlicenced now as well ?? Whatever next !!! Is the pharmacy you work in still processing hardship scheme?

[hibernia]

[B

The hospital pharmacist finds this unacceptable, and feels community pharmacies must take responsibility for prompt supply of all medicines prescribed by the hospital, often at a financial loss, and an unacceptable delay to the patient, whilst waiting for confirmation that the supply will be re-imbursed.

I now operate under a "temporary administrative arrangement" so vague that I doubt anybody knows what my responsibilities are but in the days when I had a contract I understood that the requirement to supply "with reasonable promptness" only applied to drugs that were re-imburseable.

Everybody has to look at their own responsibilities. We continue to get prescriptions for Timodine long after it was discontinued because prescribers don't know this. Other products are usually suitable so it just takes a bit of re-education.
Stock shortages are down to the manufacturers who should sort the problem. If specialist supply companies can get hold of the stuff (at vastly inflated prices) how come the people who make it can't? The IPHA agreement has a whole section on shortages and continuity of supply that never seems to have been enforced.
Unlicenced products are necessary in some cases, e.g. paeds and pallitive care but again there are often licenced alternatives and pharmacists (both hospital and community) can help prescribers in this area. Everybody needs to put pressure on suppliers to provide a licenced source of commonly used products like amitryptyline 10mg.

Finally we all need to work together, not snipe at one another about whose responsibility this is.

[Fleegle]

OK lads.....things are changing. I like my Irish blog, so it will remain as it stands. I will update it accordingly, as before. In tandem, I will also blog on 'Fleegle's Other Blog' on my 'blogsite' Let's see how it goes.

Fleegle.

I have chosen to link them this way...Jack Jarvis and Victor McDaid...Still Game...the weather says it all.....

http://www.youtube.com/watch?v=aLxl3lClb1I

Talk soon..

[Fleegle]

Dublin barmen.............aren't they great!

My brother was in Mulligans pub on Poolbeg street having a pint at the bar when a yank came up and said to the barman "Excuse me sir, where is your bathroom?". So the barman gave him directions and off went the yank. A few minutes later the yank returns and says to the barman "Excuse me sir, there's no lock on the door". The barman replied without looking up from the pint of Guinness he was pulling "As long as I've been here, no-one ever tried to rob a shite."

Post robbed by me from...

Overheard in Dublin

Worth a look in your spare time...some of it's hilarious....

Happy New Year tae ane an a'

Fleeg.

[Twinkle]

Definition of optimism in Ireland.......


...ironing 5 work shirts on a Sunday night !!