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The importance of stock control

Overstock and you waste money, understock and you compromise practice efficiency ­ Dr Melanie Wynne-Jones shows how to get the balance right

Overstock and you waste money, understock and you compromise practice efficiency ­ Dr Melanie Wynne-Jones shows how to get the balance right

All practices have to carry a certain amount of stock. But drugs and other consumables can be a drain on finances unless carefully managed. Bad stock control can result in money being wasted and efficiency being compromised.

Some of the problems that can arise are:

  • overstocking ­ carrying excessive quantities or unnecessary items ties up working capital, creates clutter and requires storage. It also demands additional or individual ordering procedures and risks expensive drugs running past their expiry dates
  • understocking ­ finding you are out of stock because there is no system to track usage, quantities and dates reduces efficiency and can be life-threatening (ie what if there is no adrenaline available)
  • laying yourself open to litigation ­ eg, if batch numbers aren't meticulously recorded·Fraud/theft.

Practices often surprise themselves at exactly how much stock they keep. Think of the following:

  • drugs ­ emergency and day-to-day (for example, vaccines)
  • treatment room consumables ­ dressings, equipment and so on
  • consulting room consumables ­ urine testing sticks, tongue depressors, paper towels, couch rolls·stationery ­ paper, printer refills, stamps·housekeeping items ­ staff refreshments, cloakroom supplies, light bulbs, etc.

Doctors' bags

Doctors must be able to administer drugs in an emergency. This used to mean carrying a selection of drugs to keep patients going until the pharmacy opened. Drugs were sometimes out of date.

The out-of-hours opt-out, changes in pharmacy opening hours and clinical policies (for example calling 999 instead of visiting people with chest pain) mean that a far smaller range of drugs is needed now, and these are more likely to expire before they are used. But GPs in surgery or visiting in-hours may still face emergencies. A shared bag is the cheapest option, but handovers are inconvenient and may be risky. Someone also needs to take responsibility for replenishing used items and checking expiry dates.

Our practice has drawn up a list of emergencies, generating a tightly restricted list of essential medication and equipment to be kept in the treatment room and in each doctor's emergency bag. Minimum order quantities mean it is cheaper and more efficient to ensure everyone's stock expires/is replaced simultaneously. The initial restocking process resulted in clearance of unwanted and unnecessary drugs, creating space and order but also some wastage. Discarded stock was listed, costed and notified to the practice accountant for the tax return.

The stocklist will be reviewed and if necessary adjusted annually.Practices that decide to stop carrying opiates as a result of the Shipman Inquiry must keep them until they can be destroyed in the presence of the PCT pharmaceutical adviser, and the controlled drugs register can be signed off. Our practice nurses are now responsible for keeping track of expiry dates and supplying items that need replacing. Actual usage is low. Doctors using any particular item inform the nurses so that it can be immediately replaced.

The concise stock list makes ordering drugs ­ and the annual accounting stocktake ­ simple and quick.The nurses carried out a similar clutter-clearing exercise and produced their own inventory for approval. As with the doctors' bags, each item had to justify its cost and its place on the shelf. And each item has to be clearly labelled so that expensive alternatives were not grabbed in a hurry by mistake.

We decided to abandon instrument sterilising and switch to disposable instruments. This has saved nursing time as well as steriliser maintenance and insurance costs, and has satisfied the infection control team.We ensure the practice is not paying for items that can justifiably be put on prescription. Patients are also encouraged to use the community nurses' treatment room service wherever appropriate, thus reducing consumables and nursing costs.

Processes

The simplest way to maintain stock control is a stock book or card index. But this is time-consuming and provides less information than a computerised system.

Specialised software tends to be complex and expensive because it is for businesses that supply or manufacture goods, so practices should try to improvise using spreadsheet or database software. A budget should be set for drugs, vaccines, treatment room stock, stationery and housekeeping consumables, with responsibility for shopping around, monitoring and containing costs devolved to the practice manager and/or nurses. Bulk-buying may pay off, if you have the storage space.

It is also worth considering LMC-led purchasing consortia or a private arrangement with other practices in order to obtain discounts. Piecemeal and last-minute ordering should be avoided as they incur unnecessary organisational and delivery costs.Many injectables are expensive, and misplaced or expired items mean money wasted.

Batch numbers and expiry dates should be recorded by the stock control system as well as on the patient's medical record. The system should ensure prescriptions are generated for personally administered items and submitted promptly to the Prescription Pricing Authority for payment. The practice manager should oversee this, together with the annual stocktake.

Regular reports should be prepared for the partners to consider. These should compare actual spend against the budget, and should track individual items. This is important for all sorts of reasons. It identifies what unit costs are high (for example Zoladex injections), it checks that the service is profitable (for example when planning next year's order for flu vaccines) and it pinpoints any other concerns. However, the operation must be cost-effective. Remember that staff time is valuable.

Keep a lid on expensive items

It's also worth tracking the use of expensive items such as printer refills, and encouraging everyone to use e-mail instead of printing multiple copies of in-house documents.

Checks and balances should be set up to prevent theft. These also protect individual members of staff from suspicion if discrepancies arise. All requisitions, such as injections, printer refills and so on, should be signed for by the person who ordered them.Invoices should be signed off by the person who receives the goods. The same individual should not do both. Invoices should not be paid until authorised by the practice manager and a partner should also scrutinise them on a regular basis.Finally, theft by patients and passers-by is a constant threat, so money spent on physical security measures is money well spent.

Melanie Wynne-Jones is a GP in Marple, Cheshire

Suggestions to Consider

  • Stock the treatment room and partners' bags efficiently and economically
  • Switch to disposable instruments and specula
  • Clearly label all drugs
  • Have a computerised stock control system
  • Set a budget for drugs and all surgery supplies
  • Try to bulk-buy wherever possible
  • Avoid piecemeal and last-minute ordering of stock
  • Take precautions against theft

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