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Gold, incentives and meh

Ben Merriman

  • Gabapentinoids - the new diazepam?

    Ben Merriman's comment 10 Sep 2016 2:55pm

    Expect gabapentin and pregabalin to be winging their way in to schedule three soon

    i.e. no emergency supply, except maybe for epilepsy like with phenobarbital, Rx to hqve a specific dosage on it, Rx lasting only 28 days, supplies limited to 30 days (unless significant clinical need), quantity on Rx in words and figures.

  • GP surgery numbers to be cut as part of major plans around sustainability

    Ben Merriman's comment 31 Aug 2016 1:00pm

    DH are doing this to pharmacy as well. Plan is to close up to a quarter of English pharmacies as there are too many, too close together. Despite pharmacy being the only healthcare profession that contradicts the inverse care law - areas with lots of pharmacies are the most deprived ones.

    I suspect this has nothing to do with DH but that they've been told by the Treasury that they must save 'x' amount and they've always seen pharmacy as an easy target.

    What they didn't expect was over 2m people signing the PSNC/NPA petition backing the services their local pharmacies deliver. Usual short term (i.e. no longer than five years) thinking by government. Something like "Let's save money now and worry about any fallout later. When we're hopefully not in power..."

  • GPs to make 'nearly all' prescriptions electronically under NHS plans

    Ben Merriman's comment 05 Aug 2016 11:24am

    Anyone using a computer connected to the spine will be able to access any EPSR2 prescription via the tracker ( Strictly speaking the patient doesn't even need the token, only the patient's NHS number.

    Good tool to use even in general practice - surgery can see where a missing Rx is, common when patients use multiple pharmacies. When all Rx go electronic, no more reprints due to missing Rx! You'll just see where it is and the patient can either go to that pharmacy or ask the pharmacy to return it to the spine for a different pharmacy to dispense.

    Given the size of the NHS and the number of variables in primary care, these things do need to be implemented slowly. Eventually, no token at all will be needed. Slowly slowly catchy monkey...

  • GPC passes vote of no confidence in Capita after 'months of failures'

    Ben Merriman's comment 22 Jul 2016 11:28am

    Try updating Internet Explorer to the latest version (version 11 -

    Regrettably, a lot of NHS services requiring a smart card don't like browsers such as Firefox or Chrome or older versions of IE. Which is a shame as IE is known to have lots of security concerns.

    The same can be said for Windows 10. Microsoft have been really quite aggressive with promotion of their latest OS. Several of our pharmacies have inadvertently updated to Windows 10 because of these tactics. In fact, I believe an American business settled out of court due to problems caused by this. GemAuthenticate (the smart card authentication software) hasn't been tested with W10 and, as far as I'm aware, no GP or pharmacy software has been tested either (why bother if you can't use anything needing a smart card). Thankfully, their promotion of the super duper fantabidosie (I think that's how it's spelled - I don't suppose any of the Krankies will look on Pulse...) free upgrade finishes at the end of this month so that should reduce the number of early morning panic phone calls made to me...

  • Do we really need pharmacies?

    Ben Merriman's comment 11 May 2016 1:59pm

    GPs are experts in diagnosis. I am not a GP so I am not, nor do I claim or pretend to be. As a pharmacist, I am an expert in medicines and their use. How about we start working together for the benefit of patients? As such I'd propose this to be a long term plan...

    GPs remain the first port of call for all long term conditions (with referrals from pharmacy as part of a national minor ailments service where appropriate). Once the patient has a diagnosis, the GP writes a clinical management plan (CMP; I am sure templates would cover 95% of the population so minimal additional work needed) and the patient goes to that pharmacy of their choice.

    The pharmacist (as a supplementary prescriber) would then take charge of that patient’s care, working within that CMP, only referring back to the GP should there be any issues. Simple hypertension, the CMP could specify that the pharmacist could supply anything from ACEIs/AT2RAs, statins, diuretics, dihydropyridine calcium channel antagonists, antiplatelets. Anything outside of this would involve referral back to the GP; likewise, should the BP not be adequately controlled, the patient would be referred back. Pharmacies would be able to either take bloods themselves or have some sort of appointment system with the surgery.

    Warfarin, asthma, COPD, type 2 diabetes, for example could all be managed in a community pharmacy. No more hours of signing off repeat prescriptions. More time to see patients.

    Pharmacists benefit as their skills are better used. GPs benefit as they see more patients. Patients benefit as they can get to see a GP in a more timely fashion.


  • Government told to restrict gabapentin and pregabalin availability

    Ben Merriman's comment 27 Jan 2016 10:00am

    Pharmacists do get a dispensing fee for a repeat dispensing prescription and monitoring is done at the point of every supply. But legally, a schedule 2 or 3 CD can't be done by repeat dispensing.

  • GPs face tighter prescribing rules on tramadol and temazepam

    Ben Merriman's comment 26 Jan 2016 4:48pm

    I'm commenting after ACMD has recommended that pregabalin and gabapentin should be reclassified as aschedule 3 CDs, in the same way tramadol was in the summer of 2014.

    My suspicion is that this has been done not to generate extra workload on any part of the NHS or even to reduce accidental overdoses from patients who have been genuinely prescribed the drugs. If a drug is only classed as a POM, it is not a criminal offence to possess; someone with a box of pregabalin in their pocket may as well be someone with a box of atenolol in their pocket, as far as the law goes.

    Drugs cannot be classed as schedule 5 drugs unless they're already in another schedule (e.g. codeine is schedule 2 unless it's not a parenteral and in a dosage unit of less than 100mg when it becomes a schedule 5) and it can't be a schedule 4 as it's not a benzodiazepine/benzo type drug or an anabolic steroid. So it has to be a schedule 3, with all the hassle that comes with. Pharmacies everywhere were hugely relieved that they decided to exempt it from safe custody requirements and pray that they do the same for pregabalin and gabapentin as/when this happens.

  • Government told to restrict gabapentin and pregabalin availability

    Ben Merriman's comment 26 Jan 2016 4:36pm

    I suspect the author means that they cannot be done using the NHS repeat dispensing protocol (i.e. top copy of a batch signed, authorising "x" number of supplies) or the old fashioned "repeat "x" times" on a private prescription, rather than authorising a repeat prescription to be generated then individually signed on each occasion, as is done now.

    If any change happens before surgery IT suppliers finally implement CD prescribing with EPS2 (made legal in July '15), they'll have to be done on green forms too.