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Monitored Dosage Equipment

Equity of access

Writing to the DoH, David Black and Gill Turner express concern over the lack of standard guidance for the use of monitored dosage equipment/devices.

There are many facets to the support of older people at home, wrote Drs Black and Turner, not least of all the management of medication both to improve compliance and to reduce adverse drug reactions. We have been concerned however, to realise that there is no standard guidance for the use of monitored dosage equipment or devices. Prof Philp’s reply:

“You may know that the Department [of Health] is currently discussing with the Pharmaceutical Services Negotiating Committee and the NHS Confederation, a new contractual framework for NHS Community pharmacy services. The Department issued a progress report on 17 July, which is available at This Link .As part of these discussions, a sub-group will take account of models of provision already in operation by a number of PCTs. You may like to contact Theresa Predergast in the Pharmacy and Prescriptions branch for further details.

Whilst recognising the choice of equipment or device type may be a market decision, the real concern is the inequity of the availability of these devices. For example, in some districts they are provided to patients free because of particular arrangements made by the local primary care organisation (PCO); in others GPs agree to write weekly prescriptions to allow chemists to recoup some of the additional costs. In this situation the cost is borne in part therefore, by the GP and in part by the PCO through prescribing budgets. We understand however, that some national pharmacy chains charge patients individually, a fixed charge per week which of course over a year could represent a significant cost to the patient.

Vital element to community care
We would like to emphasise the value of these devices in enabling older people to manage at home. Most domiciliary care providers will not allow their staff to administer medication to clients from bottles and packets – they are simply allowed to monitor and supervise, usually using a monitored dosage device. This means that monitored dosage systems become a vital part of the care package for many older people. It is also a very valuable element of the overall package which facilitates community care, which in turn reduces admission to emergency units.

There thus seems to be an inequity in the current arrangements whereby some older people have the service provided free while others pay for it.

The cost to the state of reimbursing monitored dosage devices will be significantly lower than the cost of acute, emergency hospital care. It would therefore benefit both the state and the patient to have a uniform system for the reimbursement of the device.

I am writing to draw your attention to the problem and to ask what plans are in place to address the issue.

Gill Turner
Chairman : Policy Committee

David Black
Chairman : BGS England Council