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Monitored Dosage Systems

Dear Malcolm

A well managed residential home has been receiving dispensed drugs from us for many years. The matron has sent her staff away on medicine management courses and they put the pills in dosette boxes from our dispensed packages. A recent authority inspection came down hard on them about 'secondary dispensing' and gave them two weeks to change to a high street chemist Nomad system. This is not a statutory regulation but open to local interpretation by an inspector who undermined our dispensing at a now closed nursing home a couple of years ago. Do other members have any experience of this and any ideas about how to counter this threat to dispensing?

Interestingly the home prefers to continue to receive medications from us but know that this would put their approval at risk.


Henry Smithson
Escrick N. Yorks

Dr Malcolm Ward responds

Dear Henry

The best strategy is to set up and provide your own Nomad MD system. We did when our local residential home came under social services attack and we never looked back. There is some capital outlay and increased dispensing staff costs re the time involved. However, if you dispense weekly cassettes as in the Nomad system the extra income generated through dispensing fees more than covers the costs.

The Nomad system is produced by Surgichem Limited
Surgichem House
Milton Court
Horsfield Way
Bredbury Park Industrial Estate


Malcolm Ward

Dr Allan Tennant responds

Dear Henry

There is no evidence that MDS provide safer dispensing to patient.

Homes will reduce costs by using MDS. This is not a good reason for patients to have to pay the chemist fees or the NHS to pay extra dispensing fees.

Inspectorates have taken MDS as good practice but their is no evidence to show it is.

Many drugs cannot go into a MDS, it is difficult to deal with PRN drugs and homes have to devise new strategies to overcome this problem, which end up being the old strategies.

It is likely that the people who most need MDS are frail, elderly, disabled people where MDS may help to keep them independent in their own home rather than be moved to an institution.

Neither the home nor the inspectorate can make you stop dispensing to your patients.

I have always found saying no and outlining some of the implications if a chemist MDS system is used always helps.

Best wishes

Allan Tennant

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