Prescription writing vs dispensing

Re: Prescription writing vs dispensing

Michael Woodhouse — Thu, 14 Oct 2010 17:40:31 GMT

[quote user="Michael Woodhouse"]You gentlemen need to be careful, there was a disciplinary case not so long ago where a vet was ordering his wife's prescription medication via a wholesaler and a sacked nurse reported him. I forget the outcome but went through to a hearing.[/quote]

Was longer ago than I thought

Linky

Re: Prescription writing vs dispensing

Michael Woodhouse — Thu, 14 Oct 2010 17:32:40 GMT

[quote user="Clive Ansell"]and just ordered the meds I needed for travelling through a veterinary supplier at a total cost of less than £10. [/quote]

[quote user="Bob Russell"]I had to order some medication for me through good old Dunlops because it was out of stock with 'human' wholesalers!!!![/quote]

You gentlemen need to be careful, there was a disciplinary case not so long ago where a vet was ordering his wife's prescription medication via a wholesaler and a sacked nurse reported him. I forget the outcome but went through to a hearing.

Re: Prescription writing vs dispensing

Bob Russell — Thu, 14 Oct 2010 13:16:54 GMT

I had to order some medication for me through good old Dunlops because it was out of stock with 'human' wholesalers!!!!

The pharmacist was not impressed!!!!

Re: Prescription writing vs dispensing

J G Wray — Thu, 14 Oct 2010 11:31:52 GMT

[quote user="Martin Jones"]Est utique profunda ignorantia nescire quod pecces?[/quote]

Not quite sure who this is referring to, so slightly lost on me

Never mind, pachydermus sum

As in large, slow, thick skinned and in possession of a long memory

JGW

Re: Prescription writing vs dispensing

Clive Ansell — Thu, 14 Oct 2010 11:20:08 GMT

I don't think we can compete with internet pharmacies on price, so why do we not charge a realistic fee on a par with the medical profession for providing written prescriptions. My GP earlier this year wanted to charge me £36 for a private prescription, I declined and just ordered the meds I needed for travelling through a veterinary supplier at a total cost of less than £10.

Re: Prescription writing vs dispensing

J G Wray — Thu, 14 Oct 2010 11:10:22 GMT

[quote user="Vikki Halliday"]quod vobis optimus pro nos es totus idem eadem idem[/quote]

Did I offer an alternative? You are blessed with certainty. I was querying the logic.

JGW

Re: Prescription writing vs dispensing

Martin Jones — Thu, 14 Oct 2010 01:19:54 GMT

[quote user="Jonathan Wray"]

post hoc ergo propter hoc

Hmmmm.

JGW

[/quote]

Est utique profunda ignorantia nescire quod pecces?

Martin

Re: Prescription writing vs dispensing

Vikki Halliday LLB — Wed, 13 Oct 2010 22:18:55 GMT

[quote user="Jonathan Wray"]post hoc ergo propter hoc[/quote]

quod vobis optimus pro nos es totus idem eadem idem

Vik

Re: Prescription writing vs dispensing

J G Wray — Wed, 13 Oct 2010 22:15:09 GMT

[quote user="Vikki Halliday"]It's a no brainer. 10 minutes of your time, in exchange for a bonded client who will spend an average of £5000 per dog and £2000 per cat in their pet's lifetime?[/quote]

post hoc ergo propter hoc

Hmmmm.

JGW

Re: Prescription writing vs dispensing

Vikki Halliday LLB — Wed, 13 Oct 2010 21:47:22 GMT

[quote user="Bob Russell"]

Wow! There a lot of charitable practices out there! No charge for consultations! If you are doing work, it costs and someone has to pay for it.

[/quote]

Valid point, however something which is effectively free to the practice as they are paying for it anyway is ten minutes of a vet's time, to chat to a client and make them feel welcomed and wanted. If all a repeat consultation consists of is " and how is Max/Buddy/Molly doing on the Rimadyl/Meloxidyl/delete as appropriate, any problems? I see you have had a recent blood test/urine sample/booster vaccination and health check, so I'll happily dispense/prescribe 1/2/3/6 months of medication, and by the way how are the family/rest of the animals?" , then why not offer it free?

It's a no brainer. 10 minutes of your time, in exchange for a bonded client who will spend an average of £5000 per dog and £2000 per cat in their pet's lifetime?

Re: Prescription writing vs dispensing

Bob Russell — Mon, 11 Oct 2010 09:48:26 GMT

[quote user="robloxley"]

[quote user="Bob Russell"]Been looking on-line today - there is a website (requiring prescription) selling Propalin cheaper than we can buy it!!![/quote]

And frontline and drontal and...

They're working on high volumes, low markups (they get below list price by getting and rebating good manufacturer and wholesaler discounts) and low overheads.

[/quote]

I realise this but the price offered on-line inclusive of VAT is less than we are charged exclusive of VAT so that is 17.5% to start with. All products seem to be at similar levels so the discounts they are being offered must be pretty impressive.

Are any veterinary practices (especially the very big ones) able to negotiate similar discounts? If so that's life and we have to live with it.

Are the on-line pharmacies being 'supported' by the pharmaceutical companies or is that hype? If so what do they hope to gain?

We are not likely to prescribe more Propalin/Incurin to patients just because it is half price!!!

Re: Prescription writing vs dispensing

Bob Russell — Mon, 11 Oct 2010 09:38:01 GMT

Wow! There a lot of charitable practices out there! No charge for consultations! If you are doing work, it costs and someone has to pay for it.

This profession still has a lot to learn and the internet pharmacies must be laughing at us!!!

If you phone your solicitor you will be charged for it! Whilst not recommending going that far may I remind people that there is no NHS for pets!

If a consultation is really necessary for the well-being of a pet then it should be appropriate to charge for it. If it is not necessary should it be done at all?

We try to balance the pets requirements with the severity of the medical problem but charge when they are seen. The only legal requirement is that they should be genuinely under our care and no strict intervals are dictated.

Re: Prescription writing vs dispensing

Kate Richardson — Sun, 10 Oct 2010 14:24:15 GMT

That's a good point! I'll have to ask the boss! Free health checks for repeat medications was in place when I started here, as a goodwill gesture for the clients loyalty to the practice; since written prescriptions started being used with a bit more frequency, it was decided not to charge for the prescription, but a charge to be made for the check ups. I suppose in theory we are essentially charging for writing the prescription.

Re: Prescription writing vs dispensing

Rob Loxley — Sun, 10 Oct 2010 12:59:49 GMT

[quote user="Kate Richardson"]We also don't charge a consultation fee for medication checks, to encourage our owners to come in regularly (usually every 3-4months) for a check up. However if the owner requests a prescription rather than buy the medications from us, we do charge a consultation fee for these check ups[/quote]

How does this square with the GTPC that states "a veterinary surgeon must not discriminate between clients who are supplied with a prescription and those who are not in relation to fees charged for other goods or services"?

Re: Prescription writing vs dispensing

Kate Richardson — Sun, 10 Oct 2010 11:56:33 GMT

We don't charge for prescriptions either, and currently it is only a very small minority of people who request them. We also don't charge a consultation fee for medication checks, to encourage our owners to come in regularly (usually every 3-4months) for a check up. However if the owner requests a prescription rather than buy the medications from us, we do charge a consultation fee for these check ups and this is explained to them when they first request a written prescription that they will not receive free health checks. In occasional cases however, where costs are a significant factor for the owner, and the animal will require long term treatment, I will actually advise them that they may be able to get their medications cheaper via a pharmacy, if on balance it is going to be more cost effective long term and they are generally grateful that I am considering their wallet! I am also happy to provide a prescription for 3 months of medication (or 6-12months for flea treatments/wormers) if I feel it is appropriate. My written prescriptions reflect exactly what I would be happy to dispense to the owner.

[quote]

It's called customer service.

Its not rocket science.

[/quote]

Re: Prescription writing vs dispensing

Gillian Mostyn — Wed, 06 Oct 2010 20:41:02 GMT

[quote user="robloxley"]And frontline and drontal and...[/quote]

anything at all really.

Re: Prescription writing vs dispensing

Rob Loxley — Wed, 06 Oct 2010 19:26:56 GMT

[quote user="Bob Russell"]Been looking on-line today - there is a website (requiring prescription) selling Propalin cheaper than we can buy it!!![/quote]

And frontline and drontal and...

They're working on high volumes, low markups (they get below list price by getting and rebating good manufacturer and wholesaler discounts) and low overheads.

Re: Prescription writing vs dispensing

Bob Russell — Wed, 06 Oct 2010 18:15:03 GMT

[quote user="Vikki Halliday"]

[quote user="Bob Russell"]

Been looking on-line today - there is a website (requiring prescription) selling Propalin cheaper than we can buy it!!!

Even including P&P we cannot even start to match that and our prices look embarassing so maybe it is time for us to move across to holding only emergency supplies.

Has anyone done this already?

[/quote]

I would love to, but I think you are then going to fall foul of the equally wooly guidance from the RCVS on being able to treat any animal in an emergency, and that could include a series of animals with a series of problems for a number of days until they can get their cheap and cheerful internet prescription posted to, dispensed by and returned to them.

The answer is to ensure that professional fees are charged appropriately, stop charging £40 for cat speys, but not make the cost of veterinary treatment so prohibitive that we either prevent pet ownership or perpetuate suffering by encouraging owners not to ask for our professional services.

How do we do this?

I have a lady who came in recently after transferring from another practice, for a repeat prescription for an NSAID. After consultation, I dispensed a cheaper brand of the same pharmaceutical product, which was not a million miles away from the internet pharmacy price, and she had the benefit of a chat about how the dog was doing, the benefit of me finding that it was on a totally inadequate dose, she got the product there and then, and when she had a problem a few days later, I was there to answer her query in person.

And we don't charge for prescriptions. Yet she still came back to buy from us, a more expensive product that she could have had a free prescription for.

It's called customer service.

Its not rocket science.

[/quote]

At the moment we do not write more than a handful of prescriptions a year and rely on customer service for our survival as the competition grows but it seems crazy that a client can buy medication cheaper than we can!!!

Re: Prescription writing vs dispensing

Vikki Halliday LLB — Wed, 06 Oct 2010 17:21:36 GMT

[quote user="Bob Russell"]

Been looking on-line today - there is a website (requiring prescription) selling Propalin cheaper than we can buy it!!!

Even including P&P we cannot even start to match that and our prices look embarassing so maybe it is time for us to move across to holding only emergency supplies.

Has anyone done this already?

[/quote]

How do we do this?

And we don't charge for prescriptions. Yet she still came back to buy from us, a more expensive product that she could have had a free prescription for.

It's called customer service.

Its not rocket science.

Re: Prescription writing vs dispensing

Bob Russell — Wed, 06 Oct 2010 14:06:55 GMT

Been looking on-line today - there is a website (requiring prescription) selling Propalin cheaper than we can buy it!!!

Even including P&P we cannot even start to match that and our prices look embarassing so maybe it is time for us to move across to holding only emergency supplies.

Has anyone done this already?

Re: Prescription writing vs dispensing

Bob Russell — Tue, 05 Oct 2010 14:21:12 GMT

[quote user="Andre Escudeiro-Vieites"]

Another point: There are great number of sites and products being sold ilegally on the intenet. I proved you can buy optimune, or opticare, an indian licenced product, without authorization in the EU WITHOUT a prescription at all from an UK website. The cost to the customer half that of the wholesaler price to us.

If you have the patience you can have all sorts of things shipped to you, mainly from Asia. This affects us in many ways.It really makes us look like we are trying to rip customers off, and puts us on a very weak competittion position because of the lack of policing and enforcing in the web. Besides, in principle, if a medicine doesn't have a EU/UK authorization we have to asume that it may put the animal(the UK pet population) at risk.

If the prices of veterinary services have to go up to mantain profiatbility we are again going to be in the receiving end (media...). A lot of education will be needed for the public to understand that we cannot longer spay cats for £40, etc.

Maybe the BVA media people could do something about it.

I am not quite sure that the percentage of sales is only going to reach a 20% and maybe the Small Animal Surgery business model based on signifficant turnover derived from drug sales is going to have to adapt a lot.

[/quote]

Opticare (cyclosporin) sent from 'Canada' for £10.93 per tube plus free viagra!!!!

I would like to see UK internet pharmacies match that one!!!!!

Re: Prescription writing vs dispensing

Bob Russell — Mon, 04 Oct 2010 11:21:42 GMT

[quote user="bob lehner"]

[quote user="Andre Escudeiro-Vieites"] Besides in principle, if a medicine doesn't have a EU/UK authorization we have to asume that it may put the animal(the UK pet population) at risk. [/quote]

I believe there is a massive industry in China and other Far Eastern countries producing counterfeit human (and probably veterinary) pharmaceuticals - beautifully packaged and very dificult to distinguish from the real thing, but of little or no therapeutic value.

Apparently anti-malarials are one of the biggest items and are causing major concern due to non-efficacy and those containing sub-therapeutic levels of the drug contributing to the development of resistant strains.

I think we should make every effort to impress on our clients the foolishness of getting drugs from foreign sources via the internet.

[/quote]

They will generally not let you know even if questioned. I have a cat on medication for hyperthyroidism that has been getting one tablet daily for a year although we have only supplied 60 tablets!

Funnily enough the cat is a walking skeleton, heart rate way over 200bpm. I strongly suspect this is a medication - no prescription required job rather than not giving the tablets!!! It is back on 'proper' medication and it will be interesting to see if things improve.

Re: Prescription writing vs dispensing

bob lehner — Sun, 03 Oct 2010 10:10:52 GMT

[quote user="Andre Escudeiro-Vieites"] Besides in principle, if a medicine doesn't have a EU/UK authorization we have to asume that it may put the animal(the UK pet population) at risk. [/quote]

I think we should make every effort to impress on our clients the foolishness of getting drugs from foreign sources via the internet.

Re: Prescription writing vs dispensing

Andre Escudeiro-Vieites — Sat, 02 Oct 2010 19:53:48 GMT

The whole thing was supposed to come about in order to artificially modify the market position of Vets in this country, so with very active politics the market was shifted to "fairer" competition status between vets and other suppliers of animal medicines.The policy actually created a whole business field. As it was pointed before, now more companies are having to feed shareholders. Isn't the free market perfect?.

We have now a big percentage of animals on chronic expenive medication having written prescription(It looks like it is not that much in other practices according to previous comments)

My nurses and often myself spend time(therefore you can apply the whole cost analysis thing) giving advise to the customers about medication,etc. Obviously the service provided is the same as when we were having all that revenue from the medicince sales and it applies equally to the customers that buy from us or from the internet. The internet sites only sell. Try to phone them at 7.pm to ask what to do if your dog had a whole packet of Vetoryl!! I will still answer that call, effectively a phone consultation that won't be charged.

Maybe the BVA media people could do something about it.

Re: Prescription writing vs dispensing

Anthony Todd — Sat, 02 Oct 2010 12:27:18 GMT

[quote user="Bob Russell"]No objection at all to writing prescriptions as long as the time spent doing it is properly charged for.[/quote]

IMHO you're totally missing the point and no wonder the clients get disgruntled or worse.

The fee is not for the time spent but for the consideration we should give to the patient, the drug, the drug interaction, the weight, the dose and the compliance.

And, of course, our subsequent liability for the consequences of our prescription.

I well remember intervening in the good ol' days when a repeat for [typically phenobarb.] was, on discovery, at the wrong dose, the dog was either asleep all the time or fitting exactly as it had been forever, and the dose was either "as directed" or "as before" and the owner had forgotten what that was.

Adjustments in a repeat script are the rule rather than the exception in most "drug" scripts.

Three examples will give the idea:

Suggest a repeat prescription interval for the following:

Digoxin, 12yo KCS, heart failure

Phenobarb, 6yo fitting alsation

Advantage, 3yo normal cat

Pred 7yo atopic Westie.

I'll bet the intervals are all different!

There can't be a "rule" nor better "guidance", apart from the sensible guidance now in place, but this does involve the vet's thinking a bit, making a decision and taking full responsibility for the repeat prescription.