Digital-only prescription requests: An elderly woman sent round the houses

Summary

This blog is part of a series written by Dr Charlie*, taking a closer look at some of the patient safety issues affecting people lives today. In this blog Dr Charlie tells us how their elderly mother was met with multiple digital barriers when trying to access her medications.

Describing the situation as a frustrating goose-chase, Dr Charlie summarises the blog by questioning what measures are put in place to safeguard patients during digital transformations. 

*not the authors real name

Content

My elderly parents have always embraced technology, even if it has not always been with enthusiasm. But after my father died, my mother has had to do this on her own.

She has been with the same GP practice for years and has found the changes challenging. However, she learnt that she could no longer phone for a repeat prescription and had to do it all by email. She was always told this was for ‘patient safety’.

Attempting to order online

In March, she sent her usual email request for her two drugs Levothyroxine – a hormone treatment for underactive thyroid and tamoxifen to keep her breast cancer at bay.

She waited a week and then walked 10 minutes to the GP surgery which is where her usual pharmacy is now based. She was shocked when the pharmacist told her that they had not received a request for her repeat prescription. They told her that the system had changed and she needed to go home and request the repeat on the website.

I received a phone call, and was equally shocked that no offer was made to supply the drugs to her then and there, or at least to make up the prescription and deliver it to her.

I called the GP practice and asked for help.

The receptionist informed me that they had had her email request, but the system had changed and repeat prescriptions had to be requested on the practice website for ‘patient safety’ reasons. I explained that it did not seem reasonable for a 96 year old lady, to be expected to do this, plus the fact that walking to the GP practice was not easy for her. I asked if there were any alternatives.

Wild goose-chase or a serious patient risk?

What followed was at best an unnecessary wild goose-chase and at worst, a dangerous series of barriers preventing my mother accessing her essential medications.

• The receptionist gave me an email to contact their in-house pharmacy and she asked me to explain what had happened.
• The email bounced back; there was a message that repeat prescriptions must come through the website.
• I called the GP again and once again was put in a call queue.
• I spoke to the receptionist – a different one this time. She told me all that I already knew. I went through the story once again. I was told that this email address was not the right one and she gave me a different one, assuring me that a pharmacist would reply directly.
• I sent the email.
• It was answered promptly by the pharmacist saying the same thing…all repeat prescriptions must come through the website.
• I called the GP again and once again was put in a call queue; I was told that she could also request her medication on the NHS app. My mother had actually tried this already, but she cannot remember her password for the app and she cannot get into it as a result. I asked the GP to please, please sort this out. I live an hour away. My mother needed her medication, and this was not helpful. They assured me that they would phone my mother and sort it out.
• My mother reported to me that she did indeed get a call and had to explain the situation again and tell them that she cannot access her NHS app because she’s forgotten her password. ‘Just this once’ the GP receptionist had asked the pharmacy to take her repeat prescription request. She reiterated that she needed both levothyroxine and tamoxifen.
• In the meantime, I tried to find out how I could request prescriptions on my mother’s behalf and found that I will be able to do this in future using her GP website. But was still concerned that this is reliant on me.  
• My mother walks to the GP practice a week later and she is handed levothyroxine only. She explains that she also needs tamoxifen. They tell her that she didn’t ask for this, and she told them that she definitely did ask for tamoxifen.  
• Then she is told that tamoxifen is out of stock, so she will have to wait.
• My mother goes for 10 days without tamoxifen.
• Every time, I call her or visit, I ask if she needs her repeat prescription. I also have asked her to ask them to do automatic repeats and even to deliver her medication. It is very hard for her to be expected to walk in the rain to go and get this. Every time I ask, she says that by the time she has walked over to the pharmacy to collect her prescription, she has actually forgotten to ask them to do this.

We can do better than this

When I relayed what had happened to her granddaughter, I was amazed to hear a very different story. When she forgot to order a repeat, her local pharmacist told her ‘not to worry’, contacted the GP and got a repeat prescription done for her immediately.

I remember my own experience of forgetting to order a repeat prescription, where the pharmacist gave me a three-day supply to tide me over just until the full prescription came in. Likewise, another family member has had nothing but good experiences when they need a repeat prescription.

Final thoughts

My mother needed her medication. They have digital access to her previous requests. Why would they not show initiative and offer to help? Why is this couched in the language of ‘patient safety’? Why would you expect a 96-year-old to overcome such obstacles without having any plans to ensure that she doesn’t slip through the net?

She is of an age and generation who does not want to make a fuss; like many she is also worried that her care will suffer if she complains.

What about the people who do not have relatives able to step in and help? How many more elderly people or those who are unable to access the internet or use apps, are caught in similar situations?

When systems are changed how do they mitigate against these problems and how much time do they give to the cross-over? Shouldn’t the GP practices pay special attention to the needs of these patients during that time?

This is too important to shrug off as just one of those things. Digital prescribing can be used for our good, but without a safety net, patients will continue to have the supply of their vital medications interrupted. In my mother’s case, the change that was made for patient safety reasons, became an example of unsafe practice.  

Related reading: Robbie: A homeless patient’s struggles with the system

About the Author

Dr Charlie is an Emergency Physician with many years of experience working in A&Es in the UK. Dr Charlie also has a family with children and identifies as someone with extensive lived experience as a patient. Knowing what is possible and what is achievable even within imperfect systems, Dr Charlie has a passion to improve patient care.