You know that horrible feeling when you’ve just been taken in by an April Fool and you realise, too late, that firing off a ‘Has the world gone mad?’ email about the RCGP opening a branch office in Australia is going to be something you’re going to have to live with forever?
There’s one thing worse than that. And that’s being nearly taken in by an April’s Fool, seeing through it and wanting to share the joke with others, and then finding out, in mid ‘You-nearly-had-me-there’ rictus that it isn’t an April Fool after all. It’s real.
This has just happened to me. Bang in the middle of a busy April 1st morning day duty stint, our reception walks in waving a prescription and says, ‘There’s a manufacturing problem with erythromycin. The pharmacist says, can you prescribe something else?’
Ha ha ha ha ha ha ha!!!!!!!!!!! Ha ha ha ha!!! Ha ha ha!! Ha! Ha!? Ha ha??! Ha ha ha???! Ha ha huh??????! Ha huh?! Huh????????????????
I ask her to repeat what she has just said, and it comes out the same. There is a manufacturing problem with erythromycin. Can I prescribe something else?
Look. Seriously. How can there be a manufacturing problem with erythromycin? It’s my post-amoxicillin go-to antibiotic. I prescribe it all the time. How can it not be available? It’s like saying there’s no more air. It’ll create complete and utter chaos. It’s mad.
But I shouldn’t really be surprised. This prescribing weirdness has been happening to you, too. So you’re probably aware that there are no longer any creams in the UK. No creams or ointments. None whatsoever. There are manufacturing problems affecting them all. I know this because only a day or so before the April 1st incident I received this message from the local pharmacy: ‘Betamethasone valerate 0.1% is not available. Manufacturing problem. There is no alternative’.
I shouldn’t have been surprised. This is the natural development of whatever dysfunction is currently gripping the pharmaceutical industry/pharmacy profession. We’ve got by for so long prescribing the alternatives we have trained the pharmacists to suggest. Now even they’re exhausted.
So there are no creams or ointments for my patient’s eczema. He’ll just have to rub his skin with a stick or throw rocks at himself or something.
And soon this will reach its natural conclusion. Pulse will run a headline, ‘No drugs left’. Manufacturing problems will mean there are no treatments available anywhere to treat anyone for anything.
And still our receptionists will be standing there with pointless prescriptions and agitated patients in the waiting room asking us to sort it out.
Now, I don’t know who’s responsible for this and I don’t know who can fix it. But whoever you are, I hope you’re both reading this. Because general practice is a really tough job. It’s hard taking histories, performing examinations, arranging investigations and making diagnoses. Prescribing something at the end of that process was the easy bit, usually fixed the problem and at the very least got the patient off our back for a while.
Not any more. For as long as there remain ‘manufacturing problems’ it would seem that we’re supposed to man the frontline without any sodding bullets. This is becoming a monumental pain in the arse. For ferk’s sake sort it out, and sort it out ASAP.
As the pharmacist says, ‘There is no alternative’.
Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.