August 2007: a questionnaire - designed by researchers at Newcastle University in collaboration with BTF - was distributed along with BTF News to explore the perceptions of the 28-day prescribing recommendation to GPs amongst patients receiving thyroid hormone replacement. There were 2,551 responses.
July 2008: preliminary results were published (BTF News issue 65, Summer 2008). Nearly 40% of patients were being prescribed levothyroxine for just 28 days. Of those who had asked their GPs, approximately half of practitioners declined to prescribe a longer amount. Seventeen percent of the respondents admitted to having missed taking their tablets owing to a lack of dispensed medication. Overall, 59% of respondents expressed themselves dissatisfied.
September 2008: BTF Director Janis Hickey wrote to the Department of Health (DoH) enclosing the results and requesting a review of short-term prescribing policies, which meant that in practice many GPs were prescribing levothyroxine for only 28 days. She pointed out that patients with a life-long dependency on medication such as levothyroxine are in a different category from patients receiving short-term care, and that the vast majority of hypoythyroid patients have an annual blood test and remain on a fixed dose from one year to the next. She also pointed out that increasing a one- or two-month supply to three months could save an estimated £6.5 million a year in dispensing fees as well as saving doctors' and pharmacists' time. The DoH declined to take up the issue, stating that there had been no government directive on prescription lengths.
December 2008: the Medicines, Industry and Pharmacy Group of the DoH updated its statement on prescribing policies, emphasising that: ‘...where patients have stable long-term conditions, and can manage their stocks of medicines effectively, prescriptions for longer periods may be more suitable and more convenient for patients’ (Connect, December 2008).
January 2009: Janis Hickey and Dr Peter Hammond, BTF Trustee met with Phil Willis, MP for Harrogate and Knaresborough who pledged his support and wrote to the Secretary of State for Health and the local Primary Care Trust. The replies again declined to take up the issue.
March 2009: the results of the survey were presented at the Society for Endocrinology BES meeting in Harrogate. Phil Willis, MP for Harrogate and Knaresborough, visited the meeting to show his support for the campaign to amend short-term prescribing (BTF News number 68 Spring 2009). The campaign attracted coverage by the BBC which published an article 'Short term prescriptions attacked' on its website (http://news.bbc.co.uk/2/hi/health/7941889.stm).
May 2009: the survey results were published, following peer review, in the journal BMC Public Health. The article, entitled "Trends in thyroid hormone prescribing and consumption in the UK" by Anna L Mitchell, Bryan Hickey, Janis L Hickey, and Simon HS Pearce, went on line on 11 May 2009. Anyone wishing to download it can freely do so at www.biomedcentral.com/1471-2458/9/132.
December 2009: On 1 December 2009 the British Thyroid Foundation and British Thyroid Association wrote a joint letter to the Secretary of State for Health to voice repeated concerns about the practice of prescribing medicines for only 28 days and to request that clear guidance be communicated by Primary Care Trusts to GPs. The MP for Harrogate and Knaresborough, Phil Willis, followed this letter up with a letter of his own in January. Neither letter has received a response.
January 2010: Although National Prescribing Centre (NPC) guidance was updated in December 2008, stating that 'where patients have stable long-term condition, and can manage their stocks of medicines effectively, prescriptions for longer periods may be more suitable and more convenient for patients' (Connect, Issue 55, December 2008), some members continue to have difficulty obtaining levothyroxine prescriptions for longer than 28 days.
December 2010: Janis Hickey, BTF Director, and Dr Peter Hammond met with Andrew Jones, MP for Harrogate and Knaresborough, concerning 28-Day Repeat Prescribing. Mr Jones is keen to take up the cause and is penning a letter to Andrew Lansley, Secretary of State for Health.
In addition, the Addison's Disease Self Help Group (ADSHG) has been working on this issue. The British Medical Journal has published a Rapid Response concerning 28-Day Prescribing as a commentary of the new Waste Medicines report released by the Department of Health on 23 November, 2010. You can read ADSHG's full coverage on 28-Day Repeat Prescribing and the New Waste Management report at www.addisons.org.uk/topics/2010/06/0021.html.
Two great steps in the right direction for longer prescription lengths for those with long-term health conditions.