# Why do medical card patients have to bring their hospital prescription to their GP?



## Complainer (4 Apr 2009)

I heard today about a medical card holder who left hospital recently with a prescription from the hospital doc for some follow-up medication. However, he had to visit his GP with this prescription, who then wrote out exactly the same prescription on the medical card form, which my friend then brought to the pharmacy. 

I really didn't believe this story, but from checking a couple of hospital websites, it seems that this is the standard process;

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This can't be a medical issue, as it only applies to medical card holders. Can anyone throw any light on why GP surgeries are getting clogged up copying out prescriptions for recent hospital patients?


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## Towger (4 Apr 2009)

*Re: Why do medical card patients have to bring their hospital prescription to their G*

Jobs for the boys... As I have told you before our health service is far from efficient and the same goes for   large sections of the public sector. Apart from where you work of course. BTW The complaints stand in Superquinn was overflowing with forms last week.


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## Complainer (4 Apr 2009)

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Towger said:


> Jobs for the boys...


Not really. This was the angle that the person telling me the story was taking, but the GP is on a flat annual fee per patient, so he does not earn anything more from this patient's visit. It must be a real PITA for the GP to deal with these patients, not be adding any value to the medical treatment, and not be adding any value to their bank account.



Towger said:


> BTW The complaints stand in Superquinn was overflowing with forms last week.


Last time I was there, it was overflowing with envelopes for applications for the loyalty cards, which is a different yoke all together.


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## Padraigb (4 Apr 2009)

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I can see a point in it: the GP is a person's main point of contact with all medical services, and should have knowledge of what is prescribed for a patient. This protocol ensures that the GP gets that information.

It is particularly relevant for long-term medication for chronic conditions where the GP might then be asked to provide repeat prescriptions.


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## gipimann (4 Apr 2009)

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If I recall, hospitals don't have the facility to write medical card prescriptions (which are written/printed on specific forms), so the patient takes a plain-paper prescription to his/her GP to have it rewritten.


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## Fatphrog (4 Apr 2009)

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The hospital prescriptions may be taken to any pharmacy and 7 days medication dispensed. The patient has that week to bring the prescription, or a copy, to the GP for repeats if necessary.


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## Complainer (5 Apr 2009)

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Padraigb said:


> I can see a point in it: the GP is a person's main point of contact with all medical services, and should have knowledge of what is prescribed for a patient. This protocol ensures that the GP gets that information.
> 
> It is particularly relevant for long-term medication for chronic conditions where the GP might then be asked to provide repeat prescriptions.


I was thinking the same thing at first too, but it would not make sense to apply this to medical card holders only. If there was a medical reason, it would apply to all patients.


gipimann said:


> If I recall, hospitals don't have the facility to write medical card prescriptions (which are written/printed on specific forms), so the patient takes a plain-paper prescription to his/her GP to have it rewritten.


Now we're getting places. But still, the question is why foot the hospital docs have the right forms? Surely this is not a stationery issue?


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## Padraigb (5 Apr 2009)

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Complainer said:


> I was thinking the same thing at first too, but it would not make sense to apply this to medical card holders only. If there was a medical reason, it would apply to all patients.



I agree. I'm on long-term medication, and don't have a medical card. The hospital changed my prescription, and I took it to my pharmacist and had it filled. I then spoke to my GP, told him of the change, and asked him if the hospital would notify him. He said that they were supposed to, but that the service was slow and not 100% reliable because of staff shortages (it seems that even if the HSE is heavily staffed in its administrative offices, the same might not apply to hospital offices). He was satisfied to accept my report on the altered prescription because (a) he knows that I am not stupid about such things and (b) it made medical sense to him.


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## Complainer (5 Apr 2009)

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Fatphrog said:


> The hospital prescriptions may be taken to any pharmacy and 7 days medication dispensed. The patient has that week to bring the prescription, or a copy, to the GP for repeats if necessary.


Those hospital websites don't refer to the GP perscription as a 'repeat' or to the hospital prescription as a 7-day prescription. It is the difference in treatment of medical card patients and non-medical card patients that I can't comprehend here.


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## dubliner56 (5 Apr 2009)

*Re: Why do medical card patients have to bring their hospital prescription to their G*

A prescription that a patient will get from its consultant is classed as a 'private prescription' and when brought to a pharmacy for dispensing they are charged the relevant cost, however, if the pateint has a medical card, then this person has to take it to their GP for the prescriped medication to be transferred on to a GMS prescription form, this is then taken to the pharmacy and dispensed to the patient free of charge.


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## Fatphrog (5 Apr 2009)

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The difference is that the non-medical card patient is paying for their own medication.


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## Complainer (5 Apr 2009)

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dubliner56 said:


> A prescription that a patient will get from its consultant is classed as a 'private prescription' and when brought to a pharmacy for dispensing they are charged the relevant cost, however, if the patient has a medical card, then this person has to take it to their GP for the prescribed medication to be transferred on to a GMS prescription form, this is then taken to the pharmacy and dispensed to the patient free of charge.


Thanks - this is starting to make sense. Do you know why can't the consultant issue a GMS perscription directly?


Fatphrog said:


> The difference is that the non-medical card patient is paying for their own medication.


So is this intended to be some kind of punishment for having the medical card?


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## Fatphrog (5 Apr 2009)

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The medical card patient has a week to obtain another prescription, hardly a punishment.

The greater convenience for the private patient reflect them paying their own way and that they probably have better things to do with their time, such as engaging in the gainful employment that pays for medical card prescriptions.


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## Complainer (5 Apr 2009)

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Fatphrog said:


> The medical card patient has a week to obtain another prescription, hardly a punishment.
> 
> The greater convenience for the private patient reflect them paying their own way and that they probably have better things to do with their time, such as engaging in the gainful employment that pays for medical card prescriptions.


Maybe I'm missing something, but I still don't get it. What is the benefit to anyone (doctor, hospital, patient, pharmacist, anyone) of making the medical card patient go back to their GP?


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## Bronte (6 Apr 2009)

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Complainer said:


> Maybe I'm missing something, but I still don't get it. What is the benefit to anyone (doctor, hospital, patient, pharmacist, anyone) of making the medical card patient go back to their GP?


 Really simply really it's to avoid efficiency.


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## gipimann (6 Apr 2009)

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The division between hospital and GP is because of the funding of the services from HSE.

HSE funding is divided between Primary Care and Hospitals.

The GMS (General Medical Service), now called the PCRS (Primary Care Reimbursement Service) is the scheme which pays GPs who treat medical card & GP Visit card patients and pharmacies for supplying medication under the medical card or Drugs Payment Scheme, as well as other services.

Hospitals aren't funded from this scheme, so they can't be allocated a PCRS number so they can't use the PCRS prescription stationery.


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## Complainer (6 Apr 2009)

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gipimann said:


> The division between hospital and GP is because of the funding of the services from HSE.
> 
> HSE funding is divided between Primary Care and Hospitals.
> 
> ...


 Many thanks, gipimann, now we're really getting places!

Are you aware of any reason why the hospital could not get a PCRS number? As far as I can see, there would be no budget impact, as the hospital would just be perscribing the same drugs to be later perscribed by the GP.


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## Towger (6 Apr 2009)

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Complainer said:


> Are you aware of any reason why the hospital could not get a PCRS number? As far as I can see, there would be no budget impact, as the hospital would just be perscribing the same drugs to be later perscribed by the GP.


 
It would be simpler yet again to have a 'Full Medical Card' flag against the person on the Drugs Payment Scheme system. Then again why was millions wasted 5-6+ years ago installing a central patent database for the country, which AFAIK is still not being used.


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## mathepac (6 Apr 2009)

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Complainer said:


> ... This can't be a medical issue, as it only applies to medical card holders. Can anyone throw any light on why GP surgeries are getting clogged up copying out prescriptions for recent hospital patients


No - it applies to holders of long-term illness cards as well.


Padraigb said:


> I agree. I'm on long-term medication, and don't have a medical card...


Ditto, but I do have a long-term illness card.

I am not being treated by my GP, nor does he prescribe for me for this illness - this is all taken care of at the consultant's centralised clinic.

At least it was until I was switched from quarterly clinic appointments to annual clinic appointments. When my prescription runs out (after three months) my GP has to renew it by copying a list of meds from one page to the next, signing, stamping and dating the new page. I pay him €10 for this.

Don't get me wrong - I don't begrudge him the tenner, but why can't I have a prescription that lasts me from one clinic appointment to the next? Surely he has more important medical work that needs doing rather him being a clerk for the HSE? My GP does not examine me, but has me in his waiting-room taking up space, wasting my time and his time all because of some stupid admin rule, created by the old health boards and being perpetuated by Drumm & Co.

There is no facility for me to attend the clinic for prescription renewal unless I am sent an appointment.


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## Complainer (14 May 2009)

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I arranged to get a PQ submitted on this matter, so you can see the Minister of Health's response at http://www.kildarestreet.com/wrans/?id=2009-05-12.879.0&s=prescription#g882.0.r

Looks like a big missed opportunity to improve effeciency, but I wouldn't hold my breath somehow.


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## locum-motion (25 Jun 2009)

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mathepac said:


> At least it was until I was switched from quarterly clinic appointments to annual clinic appointments. When my prescription runs out (after three months) my GP has to renew it by copying a list of meds from one page to the next, signing, stamping and dating the new page. I pay him €10 for this.
> 
> Don't get me wrong - I don't begrudge him the tenner, but why can't I have a prescription that lasts me from one clinic appointment to the next? Surely he has more important medical work that needs doing rather him being a clerk for the HSE? My GP does not examine me, but has me in his waiting-room taking up space, wasting my time and his time all because of some stupid admin rule, created by the old health boards and being perpetuated by Drumm & Co.


 
This and the original question are two examples of lack of "joined-up-thinking" in our Health Services. First off, in Irish law, *no *prescription is valid longer than 6 months after it was written, even if the Dr writes 'Repeat for one year' or 'Repeat for life' or some such on it. The doctors know (or should know) this. Any of you on regular medication should be familiar with this as the pharmacy should be sending you back to your Dr after each prescription runs out. This is as it should be, as otherwise the pharmacist has no way of knowing if the doctor is keeping an eye on your condition.

However, in Mathepac's case, the consultant obviously feels that a once-yearly check-up is sufficient, since annual appointments are being made.
In that case, why is the consultant issuing 3 month prescriptions? You'd need to ask the consultant that, but it doesn't make sense to me.

2 possible solutions:
1. Always ask for 6 month's worth of repeats, not 3. Then you only have to see the consultant and the GP once each per year.
2. Ask the consultant to write two prescriptions, each for 6 months but with the 2nd one pre-dated for 6 months later. Then you don't need to see GP at all.

As another poster has said, GP should always be informed of decisions/changes made by other Drs. Nevertheless, it isn't the patient's job to do that. The hospital _should_, but system falls down ocasionally.

Re the original question: yes, it really is a matter of stationery and databases. Hospital Drs do not have access to GMS prescription forms, and even if they did, they would have no access to any way of checking who's entitled to get their meds for free. So they just write private (ie plain paper) prescriptions for everybody. When a GMS patient brings that to the pharmacy, they are supposed to bring their medical card with them to prove their entitlement. In actuality, we pharmacists usually are familiar enough with the patient and have filed away their number in the past, so we know if they're entitled`or not.

2 points to note:
a. The scheme that allows you to get 7 days' supply only applies if you present the prescription in the pharmacy within 24hrs. If you wait 2-3 days, I think the logic is that it's not really urgent and you should have gone to the GP!
b. It does *not* apply to private hospitals eg Beacon, Blackrock, Galway, Hermitage Clinics. I think the logic there is that if you can afford to go there, you can afford your medicines. There is a flaw in that logic, though: what if the patient has a Medical Card and was sent to a private clinic under the National Treatment Purchase Fund? (I can't answer that one)


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## Complainer (26 Jun 2009)

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locum-motion said:


> Re the original question: yes, it really is a matter of stationery and databases. Hospital Drs do not have access to GMS prescription forms, and even if they did, they would have no access to any way of checking who's entitled to get their meds for free. So they just write private (ie plain paper) prescriptions for everybody. When a GMS patient brings that to the pharmacy, they are supposed to bring their medical card with them to prove their entitlement. In actuality, we pharmacists usually are familiar enough with the patient and have filed away their number in the past, so we know if they're entitled`or not.


Thanks for the update. Can you clarify if in practice, you find that GMS patients are bringing the 'private' prescription directly to the pharmacist, and not going to their GP first as per the official procedure?

Also, is there any reason why this could not or should not be the official procedure - bypass the GP, and bring the private prescription to the pharmacist. Once the pharmacist knows (and/or can verify that) this patient is GMS, the meds can be issued on the GMS account.


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## locum-motion (27 Jun 2009)

*Re: Why do medical card patients have to bring their hospital prescription to their G*



Complainer said:


> Thanks for the update. Can you clarify if in practice, you find that GMS patients are bringing the 'private' prescription directly to the pharmacist, and not going to their GP first as per the official procedure?
> 
> Also, is there any reason why this could not or should not be the official procedure - bypass the GP, and bring the private prescription to the pharmacist. Once the pharmacist knows (and/or can verify that) this patient is GMS, the meds can be issued on the GMS account.


 
Sorry, I think you may have misunderstood me. The closest thing to an 'official procedure' that exists is:
1. Take script to pharmacy, along with proof of GMS entitlement, within 24hrs of leaving the hospital, and you will be given 7 days' supply (or 'one pack' for something like a tube of ointment.)
2. Make an appointment to see GP.
3. See GP before your 7 days' supply has run out, and get an ongoing script from him/her.
4. Take that to the pharmacy to get your ongoing meds.

At the end of the day, your GP is the person with primary responsibility for your general care. Any consultant you see is only responsible for their part of you! So it is very important that your GP still gets to see you despite the fact that the hospital doctor has written your prescription.
If someone sees a consultant for a condition such as epilepsy, for example, but yet also suffers from high blood pressure, diabetes and dermatitis, then the epilepsy consultant may not have really considered those. That's why it is still important to have a GP responsible for overall care, and also why it's a good idea to have a medicines specialist (ie a pharmacist) involved in your care too.

Hope this helps.


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## Complainer (27 Jun 2009)

*Re: Why do medical card patients have to bring their hospital prescription to their G*



locum-motion said:


> Sorry, I think you may have misunderstood me. The closest thing to an 'official procedure' that exists is:
> 1. Take script to pharmacy, along with proof of GMS entitlement, within 24hrs of leaving the hospital, and you will be given 7 days' supply (or 'one pack' for something like a tube of ointment.)
> 2. Make an appointment to see GP.
> 3. See GP before your 7 days' supply has run out, and get an ongoing script from him/her.
> ...


Thanks for the clarification. From my inexpert and amatuer opinion, I have to disagree that there is a 'medical care' reason for getting the patient to attend the GP, for the following reasons;

1) This requirement only applies to GMS patients. There is no suggestion/recommendation/best practice of getting other patients to attend their GP after discharge. If there is a medical reason for this practice, why does it not apply to non-GMS patients?
2) I really can't accept that the consultant (earning €250k per annum) doesn't check the patient's medical history/chart before making his recommendations.

This is just a paperwork issue, and there is an opportunity here for the pharmacists to add value to the process by eliminating the need for the GP visit.


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## locum-motion (27 Jun 2009)

*Re: Why do medical card patients have to bring their hospital prescription to their G*



Complainer said:


> 1) This requirement only applies to GMS patients. There is no suggestion/recommendation/best practice of getting other patients to attend their GP after discharge. If there is a medical reason for this practice, why does it not apply to non-GMS patients?


 
As I said above, it's really down to the availability if stationary. Private patients don't have to get a GMS Prescription Form, so they don't have to visit the GP! The GP will recieve a letter from the consultant re: whatever adjustments s/he has made, and the GP is still responsible overall, but the patient doesn't _have to_ go to the GP to pick up the script.



Complainer said:


> 2) I really can't accept that the consultant (earning €250k per annum) doesn't check the patient's medical history/chart before making his recommendations.


 
(Crass generalisation approaching!) You'd be surprised!!

Apologies to any conscientious consultants that are reading. The vast majority are very good. Some aren't. Same goes for GPs, and for pharmacists too. Most very good, some not. However, having the 3 sets of eyes looking over your care is a good thing, reduces the risk of some major drug interaction making it through.



Complainer said:


> This is just a paperwork issue, and there is an opportunity here for the pharmacists to add value to the process by eliminating the need for the GP visit.


 
This goes back to what I said at the beginning; lack of joined-up thinking! Why not have GMS Prescription Forms in the hospitals? Or why have a separate form for GMS patients at all?
The answer is that because any change would be down to the HSE and the DOHC. And they are 2 bodies who will never settle for one layer of beaurocracy when 5 layers will do the job!


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