I thought I’d be as formal in my post’s title as possible today. As of yesterday, I have an official complaint lodged with NHS England about procedure and process at our local pharmacy. This comes on the back of an error committed last year by the pharmacy I used to use.
I’ve had epilepsy for most of my life, though with a gap of about ten years in my thirties where I didn’t require medication. Last year, a Chester pharmacy dispensed a number of 300 mg Epilim tablets instead of the normal 500 mg I take. The size was very similar; the colour identical; the blister pack had only a slight difference in hue on one side. For a couple of days, I took them without realising – though fortunately no side-effects were felt. I complained to the pharmacy’s head office, received the corresponding apology and on my following visit for my next prescription it was explained to me how procedures were being changed to avoid a repeat of the issue.
Actually, that next prescription also included a pair of 300 mg tablets. I was on holiday by then but on my return, I notified both the pharmacy (they didn’t believe me, I’m afraid) and the manufacturer, with the suggestion that, in the future, the two sizes of tablets be differentiated better physically. The manufacturer took down all kinds of personal details over the phone (all the medication I took; all my conditions; name, address, telephone etc.), and I’ve heard absolutely nothing from them since then.
Meanwhile, as a result of what had happened – and after a long prescription issued by the surgery due to computer problems last summer – I decided to change the pharmacy I went to.
Surprise, surprise – for the first time in my life, I was given a generic sodium valproate, stomach-resistant I think it was called (or maybe gastro-resistant – I can’t remember exactly); clearly, however, not the controlled-release branded Epilim I was accustomed to. I thought nothing more of this as I assumed it was part of a drive to reduce costs by using generic equivalents.
Last week, a member of my family was issued with a double prescription to cover the summer holidays they were shortly going away on. Only three of the four bottles were available; the young woman at the pharmacy said she’d order a fourth and it’d be ready at the beginning of this week. We both went in on Tuesday to pick up our prescriptions, in my case me having phoned first to doublecheck that everything was ready.
Sadly, it wasn’t – and so this is my anecdotal evidence accumulating that not all is right in English pharmacies. From one big national chain to another, problems with procedures and process have arisen again: this time, only half my prescription was ready, and when I got home, I realised only about ninety percent of that half. In my relative’s case, the fourth bottle hadn’t been ordered; there was no record of anyone having requested such an order; and neither was there any record of any prescription having being issued since April.
We agreed to return yesterday, which we did – only to find, after phoning once more in the morning to doublecheck everything would be ready (they said it would be), that whilst the second half of my prescription had been readied, the first half’s missing component hadn’t arrived (or hadn’t been ordered) (or had been lost) (and we’re talking only twelve tablets here – twelve damn tablets!). The manager wasn’t there that day, so in the end to calm the justifiably rising hackles of my relative, I asked for a contact number to complain and then phoned NHS England and registered my dissatisfaction. (Amongst other things in this complaint, I mentioned the fact that on no occasion had either myself or my relative been given an IOU receipt for part-prescriptions not dispensed. In our experience, this is what other pharmacies do everywhere. On reflection, we found it most surprising. One more procedural issue to add to the weary mix.)
Let it be clear, and just to reiterate: my NHS England complaint was all couched in terms of procedures and process, of course; all the time saying I understood the pressures the people in question were currently working under – especially with the backdrop of a savage cutting behind the scenes by this Coalition government of frontline NHS services.
Anyhow. Today, Thursday, we went back to the same pharmacy. I entered alone, and spoke to the congenial young manager. He was honest, took ownership and explained a dire financial background. I said I appreciated the situation – and accepted his apologies. I did query one thing: the previous day, to a person who said he was filling in, I had seen the generic sodium valproate I had been given for my previous prescription, and I’d asked him why I couldn’t just have twelve tablets of generic equivalent to complete what was missing. He went and had a look, came back shortly and said abruptly: “There are no generic equivalents.”
I mentioned this incident today to the manager, who took the information onboard but was unable to explain anything further at the time. When we got back home, there was a voicemail waiting for me on the landline. It asked me to phone him about the “generic sodium valproate”, and so I did immediately.
It then transpired that I’d actually been on the wrong epilepsy medication for two months. The doses had been correct but the delivery technology was different: ie the generic wasn’t given in a controlled-release way. The manager was most apologetic and didn’t minimise how serious the consequences could’ve been. I began to feel sorry for him. I didn’t want to pile further misery onto the original circumstances – especially as I knew an official complaint was already being processed with NHS England. But I did suggest that perhaps it wasn’t now just a question of procedures and process: that the person who made the mistake needed urgent feedback and coaching at the very minimum.
I have to say, however, I shall have no compunctions about being more assertive about my medication in the future. If anything changes, I shall question it most firmly. And I shall check every blister pack I used to blithely take – but, blithely anyway, will do so no more.
A couple of final thoughts: firstly, to err is human, and errors happen. But the reason we have national corporate chains is so they can learn from mistakes and transmit organically-acquired knowhow – in a timely, accurate and lifesaving fashion – to all their staff and employees, through appropriate induction training, as well as on-the-job and continuous learning programmes. (That’s the value they’re supposed to add. That’s the reason we tolerate such huge profit margins.)
I’m not sure that this has been the case here, though – nor on the previous occasion I experienced either.
Secondly, in times of radical change – and whether you agree with the motives behind a particular change or not – everyone can surely agree to accept that managing such flux is a paramount responsibility, especially when we’re dealing with the lives of people who depend on medication to keep chronic illness at bay and ensure that they remain safe, happy, independent and productive.
And again, the anecdotal evidence I lay before you today doesn’t really convince me that this has necessarily happened.
Finally, my relative didn’t get the fourth bottle they were looking for. Not the make in question. They had, instead, to settle for something else. The reason for the preference? Once more, a method of delivery: a translucent bottle makes controlling how much is left much easier, as does a dropper which allows for better control of the medication.
So. Unnecessarily unhappy patients, staff, companies and institutions. A sad – and potentially dangerous – set of situations all around.
At least in these anecdotal cases I put before you this evening. At least in my own personal experience.
Anyone else – maybe who works on the coalface – who knows whether this is either par for an increasingly depressing course or, alternatively, exceptions which unfairly disprove a rule?