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Not a dry eye in the house

‘Ah, Dr Copperfield. Sorry to telephone during your coffee break. Can I have a word about this new patient’s lubricant eye drops?’ I don’t know what pharmacists do for kicks, but if worrying about two-pounds’ worth of hypromellose is what passes for excitement in their humdrum, packet-lifting and labelling lives, bring it on.

‘Okay’, I reply, balancing a coffee and Hob Nob on one knee and a telephone handset on the opposing shoulder. ‘Enthrall me.’

‘This bloke must be drinking them, judging by the amount that are on his monthly prescription.’

‘Good luck to him – hopefully they’ll have laxative qualities. How much can a couple of dozen bottles of lube cost?’

‘The thing is that he’s using those unit dose thingies and he’s getting 900 a month. That’s 30 doses a day. And he’s not getting the Pound Shop product either.’ ‘Must be a misprint, it should be 90, not 900,’ I said.

‘No, I checked with his previous pharmacy, he’s had a repeat prescription for 900 units per month for at least the last year.’

So what? My coffee’s getting cold and my interest in this guy’s xeropthalmia is pretty close to, well, zero. But he continued: ‘A box of 30 runs to £17, so...’ he did the maths quicker than I did, ‘...that’s 510 quid.’

‘Per month?’

‘Per month. So that’s £6,120 per year, which assuming it was supposed to be 90, is an estimated wastage of £5,508.’

‘Ah, you’re on fire now! You’re hotter than my Aunt Jaymini’s homemade lamb jalfrezi, and that’s famous throughout the suburbs of North and East London.’

But yes, I get the idea. These drops cost a small fortune because they have magical sticky qualities and only have to be used two or three times a day. Not 20 or 30.

I foresee a difficult consultation coming up about using them appropriately or switching to a cheaper and shorter-acting product. A perfect opportunity for one of our young, keen and caring registrars to learn the dark art of telling a punter how we do things downtown.

Can’t really blame the patient, though. He probably went off to St Elsewhere’s, had a quick once-over from a geezer in a bow tie and was told to pick up a (mis-typed) prescription from his GP the following week.

I muse on this when the phone rings again. District nurse dressing stuff. Could Mrs Bloggs have 30 sacrum-shaped adhesive border dressings, two bottles of skin cleaner, two saline aerosols and a few rolls of hypoallergenic tape?

Why the hell not? Then again, she had a prescription issued for 30 virtually identical dressings chosen by another district nurse yesterday, which cost a bomb because each one has magical sticky qualities and should stay in place for a whole week.

‘Can I run a question past you? Why are you after 60 mega-expensive bits of plasticy-gauzey stuff in 48 hours? That would amount to a year’s supply.’

‘Actually, Dr Copperfield, you should know that we are required to take down and change the dressings if they become soiled.’ ‘And how often does that happen in Mrs Bloggs’s case?’ ‘Twice a day. She’s been doubly incontinent for months.’

Forehead slap. So that’s dry eyes and wet bottoms blowing a supermassive black hole in prescribing costs. Multiply that by a few other examples, and all the practices in the land, and you have the answer to the budget deficit. Not the NHS’s, the country’s. All we have to do is open our eyes when signing repeat scripts. Preferably, without the help of drops.

Dr Tony Copperfield is a GP in Essex