Diabetics – Blight of GPs, milk cows of Pharmacists

By | 7 December, 2009

Or  Brutal truths shouted from the Dispensary

Drugs, yesterday

In a guest post, my pharmacist gives the view from the other side of counter; take it away Simon -Tim

Right, time to let you bunch know the grim truth about how NHS payment works and your place in the grand scheme of things.

Here it is: every GP surgery in the land is – a business. One that deals in healthcare and in a very professional and dedicated manner, but a business none the less that has to deliver a year-end profit (where did you think the big houses and fancy cars came from? Do you think that Doctors started off as rich people and went into medicine because they wanted to give something back to the people?) And every Pharmacy – exactly the same – is a business (the front shop with the cash registers probably makes this slightly more obvious: the cars and houses are somewhat further down the scale).

Now, the day to day financing of the medication that keeps you lot alive is one that you fortunately don’t have to dwell on too much – be glad that you were born in the UK after the creation of the NHS (apologies to all the non-UK based readers; our climate may be soggy, our cuisine second rate, but we do have the NHS). So you do at least receive your medications free of charge. But of course it is being paid for behind the scenes – the prescription forms you present to your friendly Pharmacist not only represent the instructions regarding what insulin, etc., you are to receive but are also a form of currency.

After passing through our greasy palms, we submit them to the payment bureau, who eventually reimburse us for the medications (plus a small fee for actually doing the work). But where did that money get drawn from, I hear you ask? Why from the budget of the GP surgery that prescribed the medications of course – money which was originally provided to the surgery, from the NHS budget, on the basis that they have a certain number of patients on their books.

So basically, every GP surgery receives a certain amount of money from the NHS for every patient to finance their healthcare. But of course some patients are more expensive to look after than others. I, for example, in a personal capacity represent the perfect patient from a GP’s financial point of view; I am registered with the surgery, so they receive payment for my care. But I have no conditions requiring treatment, and in fact never darken their doorstep. Hence I represent pure profit to them.

But frankly, you lot are a bit more expensive to keep healthy. Lantus 3ml cartridges – £39.00 for a box of five. Humalog – £28.31. One Touch Ultra test strips – £14.64 a box.  All this coming out of your surgery’s budget and hence reducing their profit. And to make matters worse, it’s not even as though you lot  were healthy for seventy years then deteriorated in the last five years of your lives, nor are you likely to quietly die off in the next few years – you are going to keep draining those budgets for many years to come. In summary, from the financial point of view, you are amongst the worst patients out there – a blight on the budget. Shame on you all.

But before your collective guilt drives you all to overdose on Novorapid, take heart. Your GPs may despise you for the drain you place on their “another week in Dubai” fund, but you are still loved. By whom? Why by your friendly local Pharmacist of course. And we love you for exactly the same reasons your GPs hate you. Those endless prescriptions represent a constant income stream for us. And of course, you have no chance of ever being cured of your woes (Note to self – remember to sabotage new research at Islet isolation laboratory), so of course we will be happily deriving income from you for many years to come. What wonderful milk cows you make.

Right, so now you are aware of your place in the financial pecking order. But what use is this to you?

Well dear diabetics, it really is very simple – you may be milk cows, but that doesn’t mean you have to act like cattle. Each and every one of you is a valuable asset to your Pharmacy. So get out and there and sell yourselves. You should be demanding a high level of service from your Pharmacy for your valuable custom.

Is your GP surgery yanking your chain by continuing to prescribe those test strips you stopped using six months ago, but not prescribing the ones that go with your new meter? Are you tired of trying to get them to sort it out? Well for heavens sake, get your pharmacist to sort it out for you – okay, it is your GP’s job to get these things right, but in their defence its not that easy when you aren’t the one who actually gets to see the things in the real world, that’s what we Pharmacists do.

More drugs, the day before yesterday

More drugs, the day before yesterday

As an example of what you can demand, I shall tell you of a patient of mine. In the interest of patient confidentiality, we shall call him “Tim Brown”. Okay, I confess – to my shame I have known Tim for many years, back to the days when he had no grey hair and a fully functioning pancreas [a long, long time ago -Tim]. But these days I am also his Pharmacist.

The process goes something like this: I will be busy at my place of work, when I receive a message from Tim, demanding further supplies of insulin, needles and test strips – normally accompanied with a threat of hideous violence that will be inflicted upon my person if I do not comply with his demands. I immediately spring into action – forwarding a request for a new prescription to his GP surgery, while at the same time ordering in the stock I will need to fill the prescription.

A few days later, the prescription form will arrive (Tim’s surgery is not one of the local ones we send a driver to, hence it arrives by post in one of the stamped addressed envelopes previously provided to the surgery for this very purpose).  The prescription is dispensed (all the stock previously ordered will have already arrived by this point). Tim receives the message that his gear is ready. We have been known to deliver it to his place of work, but mostly these days we presents himself at my pharmacy to collect it and deliver insulting remarks.

Now of course this example is an easier process because I know Tim personally, the message normally being communicated by text message straight to my mobile. But he has also been known to harass me by email. No reason whatsoever why your local Pharmacist should not be able to do the same for yourself. Please note – if your Pharmacist tells you they don’t have an email address you can use, please point out the following; THIS IS THE YEAR 2009. Every Pharmacy in the land is connected to a perfectly good broadband connection, courtesy of the NHS. If they cannot be contacted by Email, it is either because they can’t be bothered, or because they are part of a large chain of Pharmacies that will get around to sorting this out sometime in the next decade or so.

So in summary, remember that your condition makes you very valuable to those of us who feed off the sick. Get into your Pharmacy and demand:

“I’m a valuable income stream – what are you going to do for me?”

Simon Wilson insists that he is a real Pharmacist, working in a real Pharmacy. On particularly challenging days, he does suspect he may be a fictional character of his own imagination.

13 thoughts on “Diabetics – Blight of GPs, milk cows of Pharmacists

  1. Alison

    Excellent post Simon. It’s great to know that I am a terrible drain on GP resources but a key provider when it comes to financing pharmacists holidays!

  2. Phyl

    Besides being hysterically funny, as an American I find this still really valuable. Regardless of the fact that the revenue streams differently here, my son’s diabetes does make him an important customer at our local pharmacy and I should expect good service. It’s a good reminder that we need to stand up for ourselves (or our children).

    You guys are such comics. I wish I could come to the UK and meet you all.

  3. Tim

    @Phyl Indeed – we’re customers too and we can move to other pharmacists and health care providers if they don’t serve us well (even with the limitations imposed by the NHS / health care insurers).

  4. Simon

    Other patients with Diabetes are free to change Pharmacy at will. Tim however is not – he is locked in as my patient for the rest of his artificially prolonged life 🙂

  5. Samantha

    I always remember one time just after I was first diagnosed, I ran out of test strips – those ones that came in a huuuuuuuuge cardboard box and were wrapped in silver foil. My nan had to buy me some, and back then I *think* it cost her about £30

    Gosh we are an expensive bunch aren’t we?!

    Unfortunately I find that many pharmacies aren’t so brilliant as Simon’s!!! The amount of times I’ve had insulin given to me off a SHELF, or been refused something or just dealt with some form of…ejit, who has no clue what to do with diabetes stuff is just unbelievable. The one I use at the mo though seems ok, its a er…larger company lets say but so far so good, the pharmacist is a good bloke!!!

  6. Caroline

    Fascinating stuff! I’m not going to add up how much it costs to treat me, as I probably would feel bad (but shouldn’t). Love the Simon/Tim double act!

  7. Ckoei

    Re: “a small fee for actually doing the work”

    In South Africa, commercial pharmacists are entitled to a set dispensing fee for deciphering prescriptions. I was wondering what unit of medicine merits such a fee (e.g. does the same fee apply to a 5pack and a single cartridge of Lantus?)
    Otherwise you can milk Tim’s surgery for every test strip, needle, lancet & cartridge consumed and you’ll be oil-bathing in Dubai in the blink/wink of an eye 😉

  8. Simon

    Ckoei, tragically we are paid a a fairly pitiful fee per item, set by the NHS. The cost of the item is irrelevant, I get paid the same for dispensing a 18p packet of Diazepam as I do fora £39.00 box of Lantus. We get paid this for time we dispense the item, so it is in our interests for the patient to receive a smaller supply each time, so they have to come back more often. And Tim wonders why his surgery only supplies him one pack of Freestyle test strips at a time 🙂

  9. Tim

    I just re-read this article six months after it was originally published – and it’s bloody good!


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