# Prescriptions



## Baldhead (19 Jul 2013)

I take a cocktail of (at the minute) 24 tablets/day for pain relief. My new GP will only give me a prescription for one months supply althought the pain managemen consultant has said I will be on these tablets for the foreseeable future. I asked for more from the GP but he mumbled something about the type of drugs they are he didn't want to increase the prescription, although my last GP was more than happy to give me 3 months supply.

Has anyone else found this? 

Is it to save the NHS money?

Do GP's have a 'quota' for tablets they prescribe?

I don't claim benefits as I have a private pension, I have been told I would qualify for benefits which would mean free presciptions but I don't want handouts.

That's my rant over.

BH


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## Random Orbital Bob (19 Jul 2013)

It is entirely about money. The way NHS trusts work (GP practices) is they get paid by the NHS for each and every prescription they write. One scrip is for 1 months worth of meds regardless of their use.

So if the practice wants to maximise it's profits, it makes each patient pay the maximum possible. You can apply for the equivalent of a "season ticket" for your scrip and you get a discount.

I had a similer battle with my GP years ago when I was diagnosed with a hiatus hernia...I was hacked of having to get to the surgery to manually walk the repeat scrip through the system...over to the pharmacy...wait half an hour...aaaggggghhhhh Grown a beard by this time.

In the end he kindly agreed to 2 months supply per visit..but it's entirely discretionary and if they're feeling skint...they force the month rule


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## monkeybiter (19 Jul 2013)

My wife's on a few meds and has a prepayment card, quite a saving in the long run.


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## Phil Pascoe (19 Jul 2013)

I'm on nine permanent ones, and mine have two monthly for years. I'm exempt on two counts - maybe they'll pay me when I get exempt by age as well.


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## whiskywill (19 Jul 2013)

Us lucky people in Wales get free prescriptions and my local pharmacy operates a system where they organise the repeat prescription and..........deliver it to my door, all free of charge. 
We do have to pay for supermarket carrier bags though.


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## dc_ni (19 Jul 2013)

I'm lucky here in northern ireland, my script is free and the doc does me one for two months at a time.

When I need a new script I just have to ring the surgery to order it and its sent through to the chemist of my choice.

Dave


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## Baldhead (19 Jul 2013)

Bob

I too have a hiatus hernia, been on meds for it for about 12 years, I asked my old GP if he could give me a 3 month prescription, he agreed reluctantly, told me the only thing they can prescribe for more than 3 months is the contraceptive pill!

Going slightly off my original post, my new GP doesn't want to prescribe more than one months supply of Codiene Phosphate because its addictive, the pain consultant I saw increased my Codiene prescription and assured me it is not addictive if taken for pain relief, now who do I believe? 

The consultant also doubled my Gabapentin and reintroduced Amatripylene, the GP wants to me to go from one Amatripylene to four over a period of 3-4 weeks. What Bob has just told me about how GP practices are funded by the prescriptions they write worries me a little.

BH


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## Flynnwood (19 Jul 2013)

I used to think that GP's (in England at least) were PAYE employees of the NHS.

They are not.

There is a yearly option for prescriptions, which could work out cheaper. 

£104 for 14 (or more) items in a 12 month period.

http://www.nhs.uk/NHSEngland/Healthcost ... costs.aspx


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## monkeybiter (19 Jul 2013)

My wife was taking 8 Codiene Phosphate per day for pain, they are addictive, they are metabolised into morphine, and codeine commonly causes headaches. She has since swapped over to Tramadol, which is also addictive. The swap should have been managed over several weeks, but the GP didn't mention that. The hours of vomiting in the car were traumatic.

She also was prescribed two Amatriptylene a night to help sleeping [one total hip replacement at 35 and one deteriorating hip] but realised she was groggy all the time and has weaned herself off them and feels better for it.


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## Eric The Viking (19 Jul 2013)

Random Orbital Bob":1clrusrd said:


> It is entirely about money. The way NHS trusts work (GP practices) is they get paid by the NHS for each and every prescription they write.



I think it's exactly the other way round: every prescription is charged to the individual GP's drug budget. They are responsible for minimizing the cost to the NHS of the drugs concerned.

I'm pretty certain there is no connection at all between prescription charges and GP practices.



> So if the practice wants to maximise it's profits, it makes each patient pay the maximum possible. You can apply for the equivalent of a "season ticket" for your scrip and you get a discount.



The discount is true. Prescription charges are per-item, irrespective of the cost of each item. If you regularly have more than two items/month it's cost-effective to have a discount card (the "pre-payment certificate"). I couldn't afford my own drugs without one.



> I had a similer battle with my GP years ago when I was diagnosed with a hiatus hernia...I was hacked of having to get to the surgery to manually walk the repeat scrip through the system...over to the pharmacy...wait half an hour...aaaggggghhhhh Grown a beard by this time.
> 
> In the end he kindly agreed to 2 months supply per visit..but it's entirely discretionary and if they're feeling skint...they force the month rule



They're not supposed to supply more than a month at a time for various reasons: 

1. Meds can't be returned for re-distribution. If your meds change or you come off something, any left over are wasted, sometimes expensively.

2. Some categories of medication, e.g. many classes of painkillers, are both dangerous and addictive. You're not supposed to be able to stockpile in case you sell them, get high on them, or whatever. Takes all the fun out of it, IMHO, but hey...

3. The prescription fee *is* income to the NHS. Cutting the number of scrips does cut down the income the NHS gets back in, increasing the overall cost of running the scheme.

I presently have 7 items on regular prescription. Having a pre-payment card saves a fortune. I also have an accommodating GP, who does 2-monthly scrips for some things, because it's easier to manage (some drugs suppliers' 'months' are 28 days, some 30 and so on - it's infuriating to try to keep track of everything). 

Most practices now use EMIS Web as their patient management system (not great, but hey, that's NHS politics for you). EMIS have a national portal for appointment and repeat prescription booking. You need to set up access with your practice (paper form!), but it does save time and stress. Part of the GP contract and the GPSoC software provision framework (just expired) was a commitment to make sure that every practice has a web site with a defined information set on it and on-line booking capability (repeat scrips and other routine stuff) by April 2015 (IIRC). If your practice hasn't got that yet, ask them when they're implementing it!

E.


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## AndyT (19 Jul 2013)

Ask your pharmacist for a review of all the medication you are on. A 'medicines use review' is a formally defined service that a Pharmacist is paid to provide. Also ask them about the Electronic Prescriptions Service. This is gradually being rolled out across the country and is the way that the sequence of having your GP prescribe something and then having a pharmacy dispense it can be made much more efficient and convenient for you.


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## RogerS (19 Jul 2013)

Our surgery has been on the electronic system for well over a year. I simply login, ask for the repeat then pop down to the pharmacy attached to the doctors surgery a couple of days later. Works really well. Dead easy to get doctor's appointments as well within a short timeframe. Brilliant GP surgery. Can't fault them.


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## MARK.B. (20 Jul 2013)

Even here in the sticks our surgery uses a electronic system,it works very well and saves a lot of time and costs.
If you have a friendly doctor try asking him to let you see the price list for the drugs that they prescribe to you, i was amazed at how much the NHS pays for some of even the most common drugs,the cost for new or experimental drugs would make your eyes water, what you pay in subscription charges wont even come close to covering the cost that is charged to the NHS.


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## Dodge (21 Jul 2013)

On this subject there is another factor that naffs me off big time - as previously said a script or prescription allows you to get a months supply of your medication - so why when I get my tablets month on month are there 28 tablets in the box??? Excuse me but only one month is the year has 28 days in it!!! :evil: :evil: 

Basically my monthly prescription means that I actually need 13 prescriptions a year.

Sorry my little rant of the morning over (hammer) (hammer)


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## Jacob (21 Jul 2013)

Dodge":2yd2emyw said:


> On this subject there is another factor that naffs me off big time - as previously said a script or prescription allows you to get a months supply of your medication - so why when I get my tablets month on month are there 28 tablets in the box??? Excuse me but only one month is the year has 28 days in it!!! :evil: :evil:
> 
> Basically my monthly prescription means that I actually need 13 prescriptions a year.
> 
> Sorry my little rant of the morning over (hammer) (hammer)


Dear oh dear that's terrible - no wonder you are so upset! :roll:


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## Eric The Viking (21 Jul 2013)

Dodge":dbhetovh said:


> On this subject there is another factor that naffs me off big time - as previously said a script or prescription allows you to get a months supply of your medication - so why when I get my tablets month on month are there 28 tablets in the box??? Excuse me but only one month is the year has 28 days in it!!! :evil: :evil:
> 
> Basically my monthly prescription means that I actually need 13 prescriptions a year.
> 
> Sorry my little rant of the morning over (hammer) (hammer)



Yup, me too. As mentioned, I currently have seven or eight items on prescription, plus one bi-monthly injection. They vary from 28-days, to rolling weeks (days named on the blister-packs), to 30-days. 

With the less important (and safe) stuff, I keep a Kilner jar on the worktop labelled "Poison - not sweets" and have blister-pack emptying sessions periodically. The blister packs take up a stupid amount of room though, compared to pills in bottles.

It's a right PITA keeping track of everything, but it does keep me alive.

E.


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## Harbo (21 Jul 2013)

So you want to go back to the days of a Pharmacist or Dispenser counting out pills and putting them in tiny bottles so you can have 28, 29, 30 or 31 pills depending on the time of year ??
Much safer to have them in 2 weekly blister strips x 2, with the day marked on them - that way you can keep track on them?

Our rural GP Surgery dispenses prescriptions, which can be ordered electronically and collected from the Practice or delivered to our village shop. It sends out 4 weekly electronic remainders and when annual reviews are required. It works really well.

Rod


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## Reggie (21 Jul 2013)

They have to dispense and count the pills in one form or another, I've had plenty of prescriptions where my tablets have been made up of broken up blister packs to make up the numbers. mine come in boxes of 56, my prescription is 84, someone has to break those up and count them. Mine does email based repeat prescriptions, supposed to give them 2 days to fill it and send it to the pharmacy across the road, invariably after 3-4 days it still isn't across at the pharmacy, this isn't part of a blame culture, this about them doing the job and providing the service they say they will provide.


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## Mark Hancock (21 Jul 2013)

_If you have a friendly doctor try asking him to let you see the price list for the drugs that they prescribe to you, i was amazed at how much the NHS pays for some of even the most common drugs, the cost for new or experimental drugs would make your eyes water, what you pay in subscription charges wont even come close to covering the cost that is charged to the NHS._




Next time ask how much he makes on the drugs he buys in. Surgeries buy in drugs from a number of wholesalers having signed up for contracts giving them discounts on volume usage and the use of generics where possible. They are then reimbursed by the NHS at fixed rates which makes the surgery a nice profit


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## Reggie (21 Jul 2013)

Any unnecessary visits to a doctors to pick up prescriptions for ill people doesn't help them to get better, it's not about blaming, it's about wishing the system were better and wanting to know what's wrong with it.


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## Jacob (21 Jul 2013)

Reggie":3i0219jm said:


> Any unnecessary visits to a doctors to pick up prescriptions for ill people doesn't help them to get better, it's not about blaming, it's about wishing the system were better and wanting to know what's wrong with it.


This is a good example of what I mean. Complaining about having to pick up a prescription fer gawd's sake! Get a life! Do you have everything else in your life delivered? If absolutely necessary there are ways and means - health visitors etc, who will take care of these things for us. What's wrong with the system? - hardly anything at all to judge by this thread - just this weird background moaning by brainwashed people! Wittering about getting 28 pills instead of 31!!! Er - if you haven't got your head around this one just re-order EVERY 4 WEEKS rather than once a calendar month. Would a diagram help?

PS 28 divided by 7 is 4. There are exactly 4 weeks in 28 days. Easy peasy!!


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## JakeS (21 Jul 2013)

monkeybiter":2skyx2f9 said:


> The swap should have been managed over several weeks, but the GP didn't mention that. The hours of vomiting in the car were traumatic.



My experience has consistently been - regardless of how excellent the doctors I've seen in my life have otherwise been - that the doctor tends to assume that the pharmacist will inform you of these things, and the pharmacist assumes that the doctor's already told you.

If you get any new drugs from your doctor, ask them on the spot: is there anything special I have to do with these? I'm already taking X, should I keep doing that or swap over to the Y you've just prescribed me?

Then do the same with the pharmacist. They don't like it half the time 'cause it means that the actual pharmacist has to come out from the back and talk to you instead of leaving the shop staff to deal with the customer-facing stuff, but it _is_ their job.




I've twice now found out important information about medication I'm on well after the point I started taking it. In one case I thought that the medicine was doing absolutely nothing; turns out that nobody had thought to mention that I have to take it on an empty stomach. Once I started doing that the difference was like night and day, but I was all ready to go and bother my GP about it another time. Neither the doctor nor the pharmacist mentioned this, and it wasn't even on the included sheet, I happened to read it on Wikipedia while looking up how the drug was spelled!


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## Dodge (21 Jul 2013)

Jacob":mi7lwnw2 said:


> Reggie":mi7lwnw2 said:
> 
> 
> > Any unnecessary visits to a doctors to pick up prescriptions for ill people doesn't help them to get better, it's not about blaming, it's about wishing the system were better and wanting to know what's wrong with it.
> ...





Lets start the quote/requote/requote/requote should we Jacob. I see you are back to your antagonistic opinionated attitude again. Didn't take long did it!! 

You never did answer the question raised by another as to why you were banned from another forum did you! 

#-o #-o


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## Reggie (21 Jul 2013)

Jacob":hlpro3jl said:


> Reggie":hlpro3jl said:
> 
> 
> > Any unnecessary visits to a doctors to pick up prescriptions for ill people doesn't help them to get better, it's not about blaming, it's about wishing the system were better and wanting to know what's wrong with it.
> ...


 That's also another part of the problem, people just dismissing others because it doesn't fit their view of the world. Why bother telling people to collect their prescriptions after 48 hours if you're not going to have it ready? Why offer a service to place it across at the pharmacy if you're not going to bother doing it? Why override the prescription your specialist has written out, does the GP all of a sudden know more about the condition than the specialist? My GP has zero involvement in my medical condition and the care provided for it apart from filling out a prescription.

Why should you need anyone else to arrange these things when all it takes is for the people that offer the service to actually do the job properly in the first place. They won't need a diagram, they already have it on posters so they know what they're supposed to do.


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## Jacob (21 Jul 2013)

Dodge":5yyvcuwl said:


> .....
> You never did answer the question raised by another as to why you were banned from another forum did you! ....


You tell me!
Personally I thought it was because they were a gang of prats. Could be another reason but I can't say I'm bothered. :lol: :lol:


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## Dodge (21 Jul 2013)

Jacob":3f6u3yic said:


> Dodge":3f6u3yic said:
> 
> 
> > .....
> ...



Pot/Kettle!! :lol: :lol: :lol:


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## Harbo (21 Jul 2013)

Oh I thought they were your friends - I thought they started that Forum 'cause you had been banned from here and felt sorry for you?


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## Jacob (21 Jul 2013)

Reggie":y91l42vy said:


> Jacob":y91l42vy said:
> 
> 
> > Reggie":y91l42vy said:
> ...


Why not be grateful for the fairly excellent service we all get instead of finding fault in tiny details as thought the whole system has failed? Do you really imagine it will work better when it has been fragmented and privatised? We are going to miss it when it's gone.


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## Phil Pascoe (21 Jul 2013)

fairly excellent?


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## Jacob (21 Jul 2013)

phil.p":3ky8v3be said:


> fairly excellent?


Utterly excellent compared to the equivalents around the world. Is there a better free NHS anywhere else? If so what are they doing which we don't? Genuine question here, not rhetorical - I don't know the answer.


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## Phil Pascoe (21 Jul 2013)

That wasn't what I meant - "fairly excellent" is a bit like "a bit pregnant" it's either excellent or not. But as to your point, other countries have systems that work, and NONE of them have ever seen the need to copy ours.


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## Reggie (21 Jul 2013)

Jacob,I'm grateful for the stuff they do well, I'm not grateful for stuff that they don't do that they're apparently paid for, who would be?


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## Eric The Viking (21 Jul 2013)

Jacob,

They've nearly killed me twice. In both cases the failures were process related. 

There's no point in making a fuss, although I probably could have, but they were things that might have been completely avoided, and I'd like others not to be in the same situation.

There's also the not-so-small issue of how efficiently public funds are spent.

E.


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## Flynnwood (21 Jul 2013)

Eric The Viking":24q1rykm said:


> Jacob,
> 
> They've nearly killed me twice. In both cases the failures were process related.
> 
> ...



Improvement / higher quality is a 'change for the better'.

You can't have improvement without change.

You really should 'make a fuss', and draw their attention (at the highest level you can push to/access) in the shortcomings in the process that is operational at the local postcode level.

Start with the CEO office and push hard.


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## Eric The Viking (21 Jul 2013)

In both cases the (different) people that made the mistakes know and are chastened and highly unlikely to do it again. Processes have been changed, but there was no animosity - it wasn't necessary. 

If I thought there were management issues, I'd have made a very big fuss indeed. I wasn't a hospital in-patient in either case. 

E.


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## Lons (21 Jul 2013)

Jacob":2b5co1aj said:


> Utterly excellent compared to the equivalents around the world. Is there a better free NHS anywhere else? If so what are they doing which we don't? Genuine question here, not rhetorical - I don't know the answer.



It isn't FREE. Every working person (and a lot of pensioners) have paid and are still paying for it.

It's a sick service now (no pun intended) with huge amounts of waste, massive inefficiencies and very top heavy management to front line staff bias. With no less than 7 of my immediate family directly involved with the NHS as well as a number of very close friends and apart from the usual patient experiences, I see and hear about a lot of the problems.

When it's good it can be very good indeed but the direct opposite is also the case and I'm not sure that the private route is the answer either. What is certain is that it can't be sustained and it's only frightened politicians that keep it alive in its current format.

Bob


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## AndyT (21 Jul 2013)

Where the Electronic Prescription Service is available (most places now but not all) one of the extra benefits it brings is that people with long term conditions and many drugs can have the dispensing quantities and dates harmonised. This avoids problems of different pills running out at different times. It can save a lot of time for the patient especially if they are in a rural area and have to travel to the pharmacy. 
So if you want that, ask your pharmacist. If they don't understand, nominate a different pharmacy where they do understand it. They are private businesses supposedly competing for an income from the public purse. Some are much less efficient than they should be.


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## Reggie (22 Jul 2013)

About that EPS, they say it's a 48hr turn around, I left mine 96hrs because I know they never meet that target, I put it in on the monday, it still hadn't even been signed by the doctor by Friday afternoon, I always put my repeat prescription request in with a weeks worth of tablets left because it is crucial that I don't miss any of my tablets. These services aren't run as a convenience, they are for helping patients to get better, yes, there are services where you can have your tablets delivered, some of us with chronic illnesses don't need to pass that burden onto another service, we just need the EPS service to work more efficiently and not take 5 days to fail to get a signature.


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## Harbo (22 Jul 2013)

Sounds like you have a local problem - complain to your Primary Care Organisation.

Rod


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## Eric The Viking (22 Jul 2013)

Harbo":16d74o2n said:


> Sounds like you have a local problem - complain to your Primary Care Organisation.



Primary Care Trusts are defunct now, thanks to yet another re-org. I've looked quickly, and it's not clear to me who now has oversight of primary care, except in a general sense at a national level. 

Royal College of GPs? If so it'll be interesting, as not all GPs are members. I believe it's now mandatory, but it wasn't when my wife qualified, so she didn't join (it's cheaper to just do the exams, which she does occasionally, as an external candidate).

I expect someone who knows will be along in a minute...

E.


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## AndyT (22 Jul 2013)

I'm only on a mobile at the mo so can't check easily but GP services are commissioned by NHS England. I can't remember if it's at Area Team or Regional Team. Your local Health and Wellbeing Board sounds as if it might be the place to go but I think they have a different function. I think the Care Quality Commission does not cover GPs. 
It's all been changed so much that I really don't think many people know how it ought to work. How it actually works is something we must wait to find out.


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## Jacob (22 Jul 2013)

AndyT":1nahc84o said:


> .......
> It's all been changed so much that I really don't think many people know how it ought to work. How it actually works is something we must wait to find out.


It's being fragmented quite deliberately. Run it into the ground and sell it off bit by bit, the most profitable bits first.


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## Cheshirechappie (22 Jul 2013)

Jacob":2qk4359y said:


> AndyT":2qk4359y said:
> 
> 
> > .......
> ...



Jacob, the government can't sell off GP practices. They are already private enterprises that contract to do NHS work, and that's always been the case, so far as I know (somebody will correct me if I've got that wrong).


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## AndyT (22 Jul 2013)

CC you are correct that GP practices are essentially small businesses. That was the compromise to get them onside when the NHS was formed, 65 years ago. 


What has changed this time round (ie since April this year) is that the new Clinical Commissioning Groups (CCGs) which buy services from hospitals etc are obliged to offer the work to "any qualified provider" which can mean a private sector company such as Virgin Healthcare etc. 


I don't want to take this thread off into a discussion of whether the intention of our MPs is to make things better or worse. This forum has a 'no politics' rule and I've been careful to keep to matters of fact, not opinion.


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## finneyb (24 Jul 2013)

Thought this was relevant 
http://www.bbc.co.uk/news/health-23374000

'Doctors have been urged to change how they prescribe medicines to stop £300m of drugs being thrown away each year.'

Brian


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