Changes to Immunosuppression Medication Prescription

Some of you may have read a recent warning from the National Kidney Federation regarding changes to the method of prescribing immunosuppression drugs for transplant patients. Immunosuppression drugs will now be prescribed and dispensed from the patient’s renal centre. I had expected to hear more about this significant change but have heard nothing. Then again, I’m only the patient.

I decided to investigate by speaking to my local pharmacist, the transplant nursing team and NHS England. NHS England kindly and quickly sent me a copy of the 2013/14 NHS Standard Contract for Renal Transplantation (Adult) which contains notification of the change but sadly not the reasoning behind it. Speculation isn’t my forte so the only sensible reason I could come up with was that of responsibility – the patient’s renal centre currently determines which immunosuppression drugs and dosage a transplant patient is to receive so it should be responsible for the prescription and dispensing of those drugs and not my GP. Fair enough, I can understand that.

My next conversation was with the transplant nursing team and while they’re aware of the changes they have yet to decide how they would implement them. However, as they only write prescriptions for fulfilment at the hospital outpatient pharmacy, patients would have to come to hospital to collect their, and let’s not forget this, life saving drugs. In my case this would entail a round trip of over 50 miles, car parking fees and a prolonged wait in the woefully inadequate, Lloyds run, outpatient pharmacy at Salford Royal. It is only fair that I emphasise that no decisions have been made by the renal department on how they will implement the changes to immunosuppression drug prescription but it is equally fair to report that the method I’ve outlined is the only one they could implement without major changes to existing systems and processes.

The next port of call in my investigation was my ever helpful pharmacist at the small, local branch of Boots a mere 10 minutes walk away from where I live. He was unaware of the proposed changes but pointed out that he could already receive electronic prescriptions and perhaps that would be a sensible method to investigate and potentially implement as a solution to this problem.

Jeremy Hunt, Secretary of State for Health, has proposed that the NHS be “paperless” by 2018. Now I’m aware that, in the immortal words of Sir Robin Day, Mr Hunt is a here today, gone tomorrow politician but problems such as prescriptions to out-of-area patients should be easy to implement electronically given that most of the technology and infrastructure already exists. As the NHS has created, out of economic and practical neccessity, medical centres of excellence covering patients in a radius of 30 to 40 miles then it must also acknowledge the cost and stress of travelling to these centres. There are already reports of outpatient appointments being missed simply because patients can’t afford the cost of travelling.

My aim in writing ths blog is to raise awareness of the issue of changes to the prescription of immunosuppression medication and hopefully stimulate a debate between patients and their renal centres regarding the introduction of a sensible, cost-effective and practical solution to this problem. You may be able to tell that I’m rather angry at the implications of the proposed changes but I get even more angry when I consider that on top of the disruption and cost of these changes I have to pay for my life saving immunosuppression drugs too!


8 thoughts on “Changes to Immunosuppression Medication Prescription

  • I can well understand your frustration as I have already pointed out on Facebook that my pharmacist can only issue Prograf one box of 50 at a time although my monthly script from my GP is for 100. Now while I haven’t progressed my investigations further as you have, my pharmacist sends out one of their staff in all weathers to retrieve patients scripts from my GP Surgery. I believe that the pharmacy is set up for electronic script transfer, but my GP Surgery as good as it is is not there as yet.

    I would also have to make a 50 mile round trip to the hospital to collect my scripts unless of course the Lloyds pharmacy followed in the tyre tracks of my local pharmacy and did home deliveries. Now there is something to ponder.

    My wife has just cheered me up by saying that they are only supplying 50 at a time in case I pop my clogs and they save the money on one pack by not having to write it off.

  • My husband is a transplant patient and has been changed to the new system. His prescription is dispensed by Evolution Healthcare and delivered either to is or our local phamacy. I am a pharmacist and I was initially concerned about this, but so far the system has been OK and we received our 3 month supply , 200 tabs instead of 180 that pharmacy has to supply . The only problem is making sure your supply is on the way from Evolution before the GP stops supplying.

    • Thanks for the comment Lily, I’m reassured to hear that there are sensible solutions available and working. If you don’t mind me asking, which renal centre does your husband attend?

      • Good reading,my son has had home delivery since transplanted 4 years ago by Healthcare at Home….fantastic service and all doses changes etc I can leave to his Consultant and HAH to sort between them. All I am responsible for is a stock check once a month before delivery and to make sure I am in for delivery as the drugs need to be signed for. Just hoping this remains the same when he reaches 18 , adult renal.

        • Thanks Sarah, considering the comments you and Lily have made I obviously live in an unenlightened backwater. 🙂 It’s great to hear that these services are available and making, what is already a difficult life, a little easier.

  • Hi Rob the system your pharmacist refers to EPS2 (Electronic Prescription Service 2)
    This is being implemented across G.B. and is up and running well in some areas. If
    you are on repeat prescription your G.P. can send it electronically to your designated
    Pharmacy. Trouble is will Renal Centres have this software. I know from local involvement
    that some G.Ps have not yet invested in the required software so I could imagine Renal
    Centres being reluctant till it has been established will NHS pay for it.
    EPS2 does away with paper scripts and automatically sends details to the Prescription
    Pricing Authority for payment back to the pharmacist. TONY .’.

    • Thanks Tony, I’m aware of EPS2 and my GP has yet to implement it although I think it is planned for next year’s budget. The problem, as you say, is will renal centres implement. I’m planning to have a meeting at Salford Royal next week when I hope to discover more. Watch this space!

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