# Pharmacy service could save NHS £517.6m, finds study



## Northerner (Aug 8, 2017)

A scheme launched by the Department of Health in 2011 to help patients stick to their drug regimens has been so successful, that in its first five years, it will save NHS England £517.6m in the long-term, a team of health economists has found.

Lead researcher Professor Rachel Elliott from The University of Manchester says the New Medicine Service (NMS) -- a free scheme where community pharmacists help patients take new medicines -- has improved medicines adherence by 10%.

The study was conducted by experts at The Universities of Manchester, Nottingham and a Patient and Public Representative.

Even in the short term, say the team, the scheme -where pharmacists are paid £24.60 each time they look after a patient as part of NMS has saved the NHS £75.4m.

https://www.sciencedaily.com/releases/2017/08/170807104038.htm


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## mikeyB (Aug 8, 2017)

That is an interesting statistic, which doesn't actually surprise me. It rather undermines the argument that supplying strips to Type 2s as a general policy will reduce complications. Equally, it demonstrates that those T2s who want strips will benefit. 

There is a sub group of these non compliers who are happy to get complications to increase their benefits. I know that sounds difficult to believe, but I've seen it.


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## Northerner (Aug 8, 2017)

mikeyB said:


> There is a sub group of these non compliers who are happy to get complications to increase their benefits. I know that sounds difficult to believe, but I've seen it.


I've known people who are very fatalistic about their diabetes, and just expect the worst will take them eventually, so they carry on as though they didn't have it  Also known people who see it as a matter of pride that 'they'll never get me on insulin', as though it's some sort of punishment they can heroically resist  Very hard for me to understand.


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## mikeyB (Aug 8, 2017)

I should say at this point that I don't think anyone on the forum who has complications is caused by anything other than bad luck, and it isn't a thing of their own deliberate making. 

But diabetes affects folk indiscriminately, those with and without common sense, and it is a disease that almost uniquely requires common sense to deal with. You can't wing it.


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## Bubbsie (Aug 8, 2017)

mikeyB said:


> That is an interesting statistic, which doesn't actually surprise me. It rather undermines the argument that supplying strips to Type 2s as a general policy will reduce complications. Equally, it demonstrates that those T2s who want strips will benefit.
> 
> There is a sub group of these non compliers who are happy to get complications to increase their benefits. I know that sounds difficult to believe, but I've seen it.


How on earth have you linked this policy to the provision of testing strips for type 2 diabetics?...the whole aim of this incentive is to ensure that patients adhere to the introduction of new *medications*...to check for side effects...confirm the medication is doing the job intended...patients are happy/able to continue using the new drugs prescribed...completely distinct from the provision/use of testing strips... there is simply no comparison...I have benefitted from this scheme...calls...interviews with the local pharmacist when collecting a new prescription  drug which could have severe... adverse side effects...it would have no application to the practice of checking/confirming whether diabetics are/are not using their testing strips..


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## Vicsetter (Aug 8, 2017)

Not my experience, Bubbsie, my surgeries withdrawal of test strips was blamed on a pharmacist review of my medication without consultatation with me.  The move to extract the pharmacy from our surgery and run it by a local firm was the worst move ever.  The advice I have had from the local pharmacist wouldn't inspire me with confidence on advice over medications. When I enquired about the eating of grapefruit with Amlodopine (advised against in the patient leaflet), the pharamacist merely followed suit, research on-line indicated it would be fine and my GP agreed.


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## mikeyB (Aug 8, 2017)

Bubbsie said:


> How on earth have you linked this policy to the provision of testing strips for type 2 diabetics?...the whole aim of this incentive is to ensure that patients adhere to the introduction of new *medications*...to check for side effects...confirm the medication is doing the job intended...patients are happy/able to continue using the new drugs prescribed...completely distinct from the provision/use of testing strips... there is simply no comparison...I have benefitted from this scheme...calls...interviews with the local pharmacist when collecting a new prescription  drug which could have severe... adverse side effects...it would have no application to the practice of checking/confirming whether diabetics are/are not using their testing strips..


I assume you didn't read the attached article, which contains the data that informed my comment. 

My point was made because if 78% of diabetic patients do not comply with prescribed medication, then they are hardly likely to comply with blood testing. If you think that all these people don't comply with medication because they take a reasoned view on side effects, then you are mistaken. That may be your way if doing things, but you've taken that decision after perfectly valid reasoning. That is as rare as hens teeth in the general population, half of whom are of below average intelligence. And diabetes care is an intimate link between treatment and blood testing. If these folk abandon medication, they abandon testing as well. I know they do. I've seen it in every branch of medicine I've worked in.

No one else seems to have picked up on your points, so I assume they read the attachment. I certainly didn't intend to provoke, just to make people think. Sorry if you have a problem with that.


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## Ljc (Aug 8, 2017)

Personally I think part of the problem with some people who are not complying , is lack of proper/accurate  info as happens with many of us on here. I read a post only yesterday from someone who'd been repeatedly told her Hb1ac was fine at her practice , eventually she was referred to the hospital for another reason and was informed her control wasn't ok at all. 
Imo people who come to forums like this one, be they members or just regular browsers are motivated and want to take control of their diabetes.


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## mikeyB (Aug 8, 2017)

Yes Lin, I was going to make the same point. It's all about motivation and effort.

By the way, that case you referred to is interesting. I said this on the thread, that her control may well  have been fine until the development of coeliac disease, so there may be no fault at  all with her previous care. It shouldn't be used as an example of poor care.


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## Northerner (Aug 8, 2017)

Ljc said:


> Imo people who come to forums like this one, be they members or just regular browsers are motivated and want to take control of their diabetes.


Quite. No motivated person should be refused a prescription for strips. People who aren't motivated need support and education to help them understand the benefits of testing - this is the element that is often lacking, either due to misplaced 'cost savings' or lack of motivation/availability of healthcare professionals to monitor progress. Without that, simply prescribing strips and perhaps a leaflet will result in many people just taking the strips and putting them in a cupboard, as currently happens with many of the medications prescribed to people for whatever their problem is.


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## mikeyB (Aug 8, 2017)

I don't think it's really lack of motivation in health professionals, at least in hospital clinics, but sometimes it's like banging your head against a brick wall. But certainly GPs need to up their game, where care at times borders on the casual, to say the least. More training needed.


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## Ljc (Aug 8, 2017)

mikeyB said:


> Yes Lin, I was going to make the same point. It's all about motivation and effort.
> 
> By the way, that case you referred to is interesting. I said this on the thread, that her control may well  have been fine until the development of coeliac disease, so there may be no fault at  all with her previous care. It shouldn't be used as an example of poor care.


That's true.


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## Vicsetter (Aug 8, 2017)

Northerner said:


> Quite. No motivated person should be refused a prescription for strips. People who aren't motivated need support and education to help them understand the benefits of testing - this is the element that is often lacking, either due to misplaced 'cost savings' or lack of motivation/availability of healthcare professionals to monitor progress. Without that, simply prescribing strips and perhaps a leaflet will result in many people just taking the strips and putting them in a cupboard, as currently happens with many of the medications prescribed to people for whatever their problem is.


Or flogging them on ebay, perish the thought.


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## Bubbsie (Aug 8, 2017)

mikeyB said:


> I assume you didn't read the attached article, which contains the data that informed my comment.
> 
> My point was made because if 78% of diabetic patients do not comply with prescribed medication, then they are hardly likely to comply with blood testing. If you think that all these people don't comply with medication because they take a reasoned view on side effects, then you are mistaken. That may be your way if doing things, but you've taken that decision after perfectly valid reasoning. That is as rare as hens teeth in the general population, half of whom are of below average intelligence. And diabetes care is an intimate link between treatment and blood testing. If these folk abandon medication, they abandon testing as well. I know they do. I've seen it in every branch of medicine I've worked in.
> 
> No one else seems to have picked up on your points, so I assume they read the attachment. I certainly didn't intend to provoke, just to make people think. Sorry if you have a problem with that.


I have read the article several times...like you...that's how I formed my opinion ..to which I am entitled...as are you & the other 13.000+ members of this forum...I stand by that opinion...as for my valid reasoning...that's very much a subjective matter for individual assessment...I wouldn't consider myself any more intelligent...articulate/informative than others on this forum... my opinion is no more valid than any others here...as for fifty per cent of the population being below 'average intelligence'...who is really in a position to judge that...anyone whatever level of intelligence/experience has something to contribute to healthy...rational...reasoned discussion...I certainly wouldn't seek to exclude approximately 317.671.96 of my fellow countrymen (approximately half the total population of the UK) from the 'mix' based on that premise......as for no one else picking up on my points...I welcome that...indicates we are all individuals...thinking for ourselves...with a diversity of opinion...surely that should be applauded...welcomed...whether you intended to provoke or not...I have no idea...never gave that any thought at all...obviously only you can answer that...as for having a problem...with what...who?.. you lost me there...I enjoy discussion...exchanging ideas...agreeing/disagreeing...how we learn... progress...surely that's the primary objective of this & other forums.


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## Robin (Aug 8, 2017)

Bubbsie said:


> as for fifty per cent of the population being below 'average intelligence'...who is really in a position to judge that


Maths again! Fifty percent are below average, and fifty percent are above, that's why the average is the average. 
That's not to say that people below the average aren't capable of rational thought. But I do think we get a skewed idea on this forum of how people regard their diabetes, because all of us have been motivated enough to tackle the problem. I think a lot of people just file it in the 'too difficult' part of their brain and hope it'll go away. 
I'm all for offering test strips to people who will use them wisely, but worry about the cost to the NHS of the ones that get shoved in the cupboard. Maybe if the patient doesnt provide a chart with meaningful readings, (after the appropriate support and encouragement to use them) they shouldnt just be left on a repeat.


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## Bubbsie (Aug 8, 2017)

Vicsetter said:


> Or flogging them on ebay, perish the thought.


I find the suggestion that any diabetic would acquire testing strips to sell on ebay extremely offensive...whether you thought this was funny or humorous I have no idea...it has no place here.


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## Bubbsie (Aug 8, 2017)

Robin said:


> Maths again! Fifty percent are below average, and fifty percent are above, that's why the average is the average.
> That's not to say that people below the average aren't capable of rational thought. But I do think we get a skewed idea on this forum of how people regard their diabetes, because all of us have been motivated enough to tackle the problem. I think a lot of people just file it in the 'too difficult' part of their brain and hope it'll go away.
> I'm all for offering test strips to people who will use them wisely, but worry about the cost to the NHS of the ones that get shoved in the cupboard. Maybe if the patient doesnt provide a chart with meaningful readings, (after the appropriate support and encouragement to use them) they shouldnt just be left on a repeat.


Robin...this thread was never about testing strips at all...suddenly we are on the testing strip debate...there is nothing analogous to the testing strip debate and the practice of paying pharmacists to manage  patients use of newly prescribed drugs in the published link...nothing at all...some of the comments above are offensive...judgemental...not appropriate...yet...here we are again having to defend ourselves as type 2 diabetics...in a thread that bears no relation to our particular issues in that respect.


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## Robin (Aug 8, 2017)

Bubbsie said:


> Robin...this thread was never about testing strips at all...suddenly we are on the testing strip debate...there is nothing analogous to the testing strip debate and the practice of paying pharmacists to manage  patients use of newly prescribed drugs in the published link...nothing at all...some of the comments above are offensive...judgemental...not appropriate...yet...here we are again having to defend ourselves as type 2 diabetics...in a thread that bears no relation to our particular issues in that respect.


Well, maybe there has been 'topic drift' as often happens, but it's all linked, surely. Where pharmacies are undertaking medication  education, I would hope they wouldn't refuse advice because something is a management tool not something you actually swallow. I've certainly had medication reviews at my pharmacy that have embraced all my prescription items, insulin, test strips, lancets, etc.
I know you feel passionately about restrictions on testing for Type 2s, and quite rightly, and you want to think the best of people, but I'm afraid the number of private adverts on eBay for odd packets of test strips does lead me to believe that some people who don't get round to using their prescribed ones may be tempted to dispose of them that way.


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## mikeyB (Aug 8, 2017)

Well, I can't see any offensive or judgemental comments. If you remember, alI I said originally was that if 78% of diabetics don't comply or adhere to their medication, it undermines the argument that all diabetics should be given a testing kit - in those cases it would be a waste of money. I also added that it fortified the argument that in motivated folk they should get kits. There isn't really any argument with  you there, Bubbsie, so I don't see how you could possibly get offended.


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## Northerner (Aug 8, 2017)

Bubbsie said:


> I find the suggestion that any diabetic would acquire testing strips to sell on ebay extremely offensive...whether you thought this was funny or humorous I have no idea...it has no place here.


It does happen, Bubbsie, or certainly has in the past to my knowledge, particularly when cheaper alternatives like Codefree weren't available and they could command a good price. It's not offensive to suggest that some people do this.


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## Bubbsie (Aug 8, 2017)

Robin said:


> Well, maybe there has been 'topic drift' as often happens, but it's all linked, surely. Where pharmacies are undertaking medication  education, I would hope they wouldn't refuse advice because something is a management tool not something you actually swallow. I've certainly had medication reviews at my pharmacy that have embraced all my prescription items, insulin, test strips, lancets, etc.
> I know you feel passionately about restrictions on testing for Type 2s, and quite rightly, and you want to think the best of people, but I'm afraid the number of private adverts on eBay for odd packets of test strips does lead me to believe that some people who don't get round to using their prescribed ones may be tempted to dispose of them that way.


Again...I find that comment unacceptable...it has no place here.


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## Bubbsie (Aug 8, 2017)

mikeyB said:


> Well, I can't see any offensive or judgemental comments. If you remember, alI I said originally was that if 78% of diabetics don't comply or adhere to their medication, it undermines the argument that all diabetics should be given a testing kit - in those cases it would be a waste of money. I also added that it fortified the argument that in motivated folk they should get kits. There isn't really any argument with  you there, Bubbsie, so I don't see how you could possibly get offended.


Mike I've given you my  response...if you want any further comment...I suggest you reread it.


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## Bubbsie (Aug 8, 2017)

Northerner said:


> It does happen, Bubbsie, or certainly has in the past to my knowledge, particularly when cheaper alternatives like Codefree weren't available and they could command a good price. It's not offensive to suggest that some people do this.


I have made a complaint about  this...and other comments I find offensive...the fact that you as a moderator are supporting that view is astounding....let wait for that to be considered.


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## Robin (Aug 8, 2017)

Bubbsie said:


> Again...I find that comment unacceptable...it has no place here.


I've just stated what I believe may be happening, you don't have to agree with me, but I defend my right to have raised the question.


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## Northerner (Aug 8, 2017)

I actually found the statement about non-compliance a bit ambiguous and not sure whether it means 78% are non-compliant after 10 weeks or the other way around 



> Non-adherence is common in diseases such as chronic obstructive pulmonary disease where only 33% of patients continue their drugs after 10 weeks. In schizophrenia the figure is 52%, asthma: 67%; and diabetes 78%.



Does this mean 78% are non-compliant or 78% continue their meds after 10 weeks?


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## Bubbsie (Aug 8, 2017)

Robin said:


> I've just stated what I believe may be happening, you don't have to agree with me, but I defend my right to have raised the question.


I have not found your comments offensive Robin...take no issue with you.


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## Northerner (Aug 8, 2017)

Bubbsie said:


> I have made a complaint about  this...and other comments I find offensive...the fact that you as a moderator are supporting that view is astounding....let wait for that to be considered.


You may find the practice offensive, as I do, but the statement that it happens isn't.


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## mikeyB (Aug 8, 2017)

Bubbsie said:


> I have not found your comments offensive Robin...take no issue with you.



That rings  a little hollow Bubbsie when you said Robins comments were 'unacceptable' and 'had no place here'. Sounds like an issue to me


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## Bubbsie (Aug 8, 2017)

Northerner said:


> You may find the practice offensive, as I do, but the statement that it happens isn't.


Alan..let me clarify my position...the suggestion that type 2 diabetics acquire medication...then sell  it on ebay is offensive to me...possibly others here...the level of derision in this thread...the way this issue is trivialised time & time again...in my opinion would not encourage others with a similar point of view making that known...you as a moderator supporting that assertion...really does astound me!


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## everydayupsanddowns (Aug 8, 2017)

Thread closed after moderator discussion.


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