Chris Lancelot: Starter scrips would save time and money

The more I see of the DoH, the more it seems out of touch with basic psychology. Take new drugs: the department recommends that any initial prescription should be limited to a week, to avoid wasting the whole month's supply if the patient proves intolerant to the first few doses.

Although this idea at first seems sensible, it flies in the face of practical psychology. Which patient wants to pay a full prescription charge for only seven days of medication when almost certainly they will need it for longer? If the patient is relatively poor, will the GP force them to pay two prescription charges for each new long-term drug? Patients will be unhappy with doctors who always cost them double for any new prescription.

So in the real world the DoH's method is totally unrealistic.

There is a practical alternative: create a system for starter prescriptions. Add a box labelled 'Initial supply' to the blank prescriptions. If the GP enters a number here, the pharmacist dispenses only that number of days' medication, while still collecting the full prescription fee. If the drug is well tolerated, the patient returns to the chemist to collect the remainder of the prescription, without further charge. If not, the waste is minimal, and no one pays twice.

This system could also massively reduce the cost of acute prescribing. GPs often prescribe more painkillers or anti-inflammatories than are strictly necessary, to avoid the patient paying for a further prescription if recovery takes longer.

A 'starter prescription' to cover the first 10 days of a three-week scrip would mean that, if the patient recovers quickly, the remaining medication will not need to be dispensed. (How about that? 50 per cent drug savings.)

Clearly starter prescriptions would cause more work for the pharmacist, and this should attract extra remuneration. Even so, it would be cost-effective. The savings could be enormous, although exemptions might be needed in rural areas, to avoid patients making two long journeys to the pharmacy.

Millions of pounds of drugs are wasted each year because the first few doses cause problems. A starter prescription system would cut wastage and reduce costs - without penalising patients financially.

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