Dot is a former nurse. She has vascular dementia and is dependent on codeine. We weren’t invited to a recent team meeting to discuss Dot’s care because the PCN pharmacists, who don’t have anything to do with her, apparently know more about her care than we do...

As you might have guessed, I’m fairly fed up with where our pharmacy finds itself in relation to Dot’s ongoing care. We get all the hassle — but nobody listens. 

Dot phones the pharmacy in a state of rage virtually every day. We play our part fully in the struggle to get her to take her essential medicines and get no thanks for it, let alone funding to support the constant resource sapping effort in dealing with her complex problems.

A while ago I rang the local practice to report a safeguarding concern about Dot. I got a call back from the GP some four weeks later. The carers don’t want to visit Dot because they get nothing but abuse. Her medicines, dispensed in a weekly compliance aid (but not by us) are all over the place. She refuses to let the carers take responsibility for them because she “knows what she is doing because she’s an ex-nurse”. 

I don’t understand how this can be considered safe as she has a history of abusing her co-codamol. We’ve reported our concerns for years. Nothing ever happens.

Crisis in care

You don’t have to be an expert to see that social care is in crisis. I feel for the carers who have to do such a difficult job, often dealing with abuse from their clients alongside the contempt of the public who think they are minimum wage lackeys.

(As it happens, the carers in our area are on better money than most of our staff because the council had to top up their pay to attract and retain people in the role after experiencing an exodus of excellent carers since it took control
a few years back.)

Carers clearly need much more support in dealing with medicines-related issues. They need training and there must be better communication between pharmacy and care services in general. 

When Dot eventually ends up as a case in the coroner’s court, as she inevitably will, how will the coroner react when I tell them we had been raising these issues for more than seven years? How will they respond to the systemic failures which have brought us there? A GP overworked and burnt out, a social care system that is chronically underfunded and pharmacies which hand vulnerable patients the equivalent of a loaded gun every week or month? 

There needs to be a formal system for flagging concerns about patients’ use of medicines and a stepwise escalation to help keep patients safe. Simply starting someone on a MDS because the community mental health team think on a whim it would possibly be safer just isn’t good enough. 

Nobody cares that pharmacies like mine might have valuable information that could help to protect the patient. Four weeks in this case is unacceptable for a response to an urgent safeguarding issue. 

Sadly, this isn’t my first ‘Dot’. A few years back one of our patients in a similar situation walked off into the woods at night and died of exposure. There were the same sort of issues around medicines safety. No lessons were learnt. 

Worrying

It worries me that our PCN pharmacists are directing prescriptions to an online MDS provider because they can’t be bothered or don’t want to speak to local pharmacies about starting new patients on these compliance aids. 

More pertinently, I can’t see how an online provider has any hope of keeping the Dots of this world safe. We are struggling to do what we can to keep patients safe ourselves, so how on earth would a remote provider, who doesn’t know Dot and has hundreds of Dots on their books, manage to properly safeguard vulnerable people like her? 

How would you describe your relationship with your PCN pharmacists? Email pm@1530.com

*Alexander Humphries is the pen name of a practising community pharmacist. The views in this article are not necessarily those of Pharmacy Magazine.