Equality Act – Reasonable Adjustments & MDS

Updated 01/06/2023

Recommendations to support review of MDS (Dossetts)

That there is patient assessment to identify the most appropriate intervention to help people use their medicines effectively and safely
Existing patients should not be stopped without warning
That original packs of medicines are preferred in the absence of specific need for an MCA
That carers have appropriate training to administer medicines from original packaging
Best practice is followed where an MCA is assessed as the most appropriate intervention for a patient
That policies and processes are reviewed or created that ensure they are patient-centred
Are the risks associated with dossett trays eg: risk of no available PIL, risk for incorrect filling outweighed by the benefit to the patient?
Has a review of ongoing need been performed in the last 12 months?
Is the patient stable? Dossett trays should not be amended but where changes are required recalled, and re-issued with full new prescription for all items. Patients where changes are occurring are unlikely to be suitable for MDS or will require weekly prescriptions

Dossetts are to assist the patient, not to assist 3^rd parties and it is prudent to review dossett provision where it is not the patient who is the primary beneficiary of the tray

Community Pharmacy England Guidance

An extract from PSNC (now known as Community Pharmacy England) Guidance PSNC Briefing 060/17 Equality Act 2010 a quick reference guide (updated September 2017) can be found below

What is a “reasonable adjustment”?

There is no definition in the Act, but contractors should consider what would be reasonable in the circumstances, taking into account the following (non-exhaustive) list of factors:

the effect of the disability on the individual person with disabilities;
whether taking any particular steps would be effective in overcoming the substantial disadvantage that people with disabilities face in accessing the services in question;
the extent to which it is practicable for the community pharmacy to take the steps;
the financial and other costs of making the adjustment;
the extent of any disruption which taking the steps would cause;
the extent of the community pharmacy’s financial and other resources;
the amount of any resources already spent on making adjustments;
the availability of financial or other assistance; and
health and safety matters.

A “reasonable adjustment” does not necessarily mean that every adjustment that is possible, should be made or is a reasonable one. The duty is to make reasonable adjustments.

Further context and information:

MDS supply is not recommended as best practice by the Royal Pharmaceutical Society (RPS) and other organisations and different pharmacies will decide when it is best utilised, if at all. The current RPS Guidance is that the use of original packs, supported by appropriate pharmaceutical care is the gold standard for medicines supply. Pharmacies may consider supporting this with charts and reminders, which can help carers and patients to administer medicines from their original packs.

Under the Equality Act 2010, the requirement has always been to ”make reasonable adjustments” for individuals with disabilities, and the provision of unlicensed medicines (removal and supply of the significant majority of medicines outside of their original container is outside of their marketing authorisation and so medicines become unlicensed), additional labour and costly equipment required for monitored dosage systems may, by an individual contractor, be seen as beyond reasonable. Pharmacies may therefore seek to offer alternative mechanisms to support patients, such as reminder charts, large print labels etc. It is also important to note that the Equality Act 2010 would apply only to the patient; pharmacies have frequent requests for MDS to support carers, and as such the act of having a carer could be considered the appropriate adjustment to support the patient to take their medicines – MDS is not a substitute for lack of training by paid-for carers.

The limited evidence available to date indicates a lack of patient benefit outcomes with the use of MDS, and this has meant a change in viewpoint for most pharmacy providers. Following best practice guidelines, many pharmacies are now assessing or reviewing patients using their detailed knowledge of the medicines being prescribed to understand the best options to support the patient. Whenever a medicine is placed in a multicompartmental aid, the medicine is then being used outside of its marketing authorisation and becomes unlicensed, and the responsible pharmacist takes accountability and the associated risks that this carries on each occasion that an MDS pack is supplied. Detailed stability data for medicines outside of their original packaging is sadly lacking, and the limitations of MDS systems mean that things such as timing of doses, for example before or after meals becomes very difficult to manage. With MDS, compromises have to be made, and this has the potential to significantly affect the care the patient receives. This may mean prescribers have to make adjustments to prescribing in order to minimise the overall risk to patients.