A Glimpse of the Future?

Hanna’s daughter dropped her off outside the surgery, early as always. The main entrance was blocked by a large dark blue van marked in bold white lettering: NAS. Hanna adjusted her glasses but couldn’t make out what the letters stood for. She hurried round to a side entrance that few patients seemed to know about.

Once inside it was chaos. The receptionists were not sitting in their usual places. Instead, they were moving quickly around the waiting area, wearing headsets over their ears and signing people in for appointments using clipboards and pens. They chatted with the patients, just like they usually did, but Hanna could sense change in the air. One of them took Hanna’s scribbled note - her request for her regular medication. “Just this once” the receptionist said. The letter box that she usually dropped it into had vanished.

There were some other people – a whole army of them – whom Hanna did not recognise. Men and women dressed in dark blue boilersuits with white caps pulled low over their faces. She saw the same logo – NAS – on their backs. The boilersuit people were dragging heavy boxes to and from their van. They moved quickly and silently, not a word spoken. Some were ripping name plates off the consulting room doors, throwing them into black sacks, and replacing them with blue and white numbers instead. Tatty cardboard boxes stuffed with old wires, computer keyboards and screens were moving out. Sealed, shiny blue and white plastic crates were moving in.

Ah, finally the surgery is getting a new computer system thought Hanna. Thank goodness for that. The receptionists were always grumbling about the old system. It was slow. It crashed. It failed. And ever since paper prescriptions were banned, it had developed a mysterious habit of sending the electronic versions to the wrong pharmacy. Hanna had been caught out by this more than once. It was very easy to be caught out by some of the changes that were happening at the surgery. She used to find it so reassuring to leave the building clutching her paper prescription in her hand. But maybe these invisible prescriptions are better overall? Perhaps someone is keeping an eye on what the doctors are prescribing to patients and making sure they do the right thing?

When she got home again, Hanna inspected the contents of her medicines tin, her usual routine. She lifted them out, one by one: pills; sprays; creams and eye drops. She had eleven different pills to swallow now. Hanna was sure it was too many, so sometimes she missed doses. For some years she had followed her ‘one in, one out’ policy on pills. Each time a doctor prescribed her a new one she rejigged things, cutting down here and there to make space for it. It was becoming quite a juggling act. Hanna didn’t want to tell Dr Parr about this. Dr Parr is always so understanding of my funny ways, thought Hanna. But she had decided that this might be a step too far, even for Dr Parr. She would think I’d gone mad!

Hanna said her afternoon prayers, then lay down to have a short nap. The surgery visit had been quite enough for one day. It was not long before Hanna fell into a long, deep sleep…

A brown envelope landed on Hanna’s door mat with a thud. Ahmed, her grandson, rushed to pick it up for her. Inside it, a blue and white letter from NAS with details of an appointment booked for later the same day at her GP surgery. As she unfolded it these words leapt up from the page: DEMAND TO PROVIDE STATEMENT REGARDING UNUSED MEDICINES. Hanna’s heart jumped. She threw on her headscarf and hurried outside, clutching the letter in her hand, feeling very confused.

By the time she got to the surgery she was quite out of breath. Her heart was pounding quickly. The next thing she knew she was being led inside a huge room which she didn’t recognise. The back wall was made of a large computer screen, bigger than any screen she had seen before. It displayed what looked like medical records and Hanna could see her name shining in large letters at the top. There were dazzling rows of flashing red and green lights. Hanna blinked at the screen, feeling even more confused. Between Hanna and the screen was a long desk, where three people sat, wearing dark blue boilersuits and white caps. She turned to her left and to her great relief she saw Dr Parr. A familiar face at last! Hanna was about to wave but stopped herself when she saw the solemn look on Dr Parr’s face. She quickly returned her hand to her side. What on earth is going on? thought Hanna. Is this really happening to me, or is my imagination going wild?

The boilersuit person in the middle wore the letters MDO across his chest in bold white letters. He introduced himself as the Medicines Duty Officer. He said he was part of the National Adherence Service, tasked with making sure people take their medicines. The MDO explained that the National Adherence Service had been tracking Hanna’s medicines and the data showed she hadn’t been using them as prescribed. He paced slowly towards Hanna, holding out his hand. In his palm was one of the pills Dr Parr had prescribed for her. The MDO paused and broke it in two: "Our technology is now so advanced that a dissolvable chip lets those of us working at the NAS know whether people are taking their medicines or not. We’re linked to the computer systems in every GP surgery in the country. We know exactly what doctors are prescribing and what their patients are taking.” Hanna gulped and tried to catch her breath as she glanced over again to Dr Parr, eager for some reassurance.

“Thanks to our sophisticated, state-of-the-art technology” the MDO continued “it has come to our attention that you are not taking all of the medicines you have been prescribed, Hanna.” He turned to point at the screen. “In fact, we notice a worrying pattern in our historical data. We can see that every time Dr Parr prescribes a new item of medication, you stop taking an existing item. This pattern seems to go back several years.” Hanna’s heart jumped again as she tried to take in what she had just heard. Is this some kind of bad dream? She paused a while, gathering her thoughts. “I was just…I was trying to…I was really worried that I may be taking too many medicines.”

The MDO shook his head.

He turned to Dr Parr next, “Dr Parr, you surprise me. We’ve always received such good reports about your prescribing. Surely you agree there is a problem here?” Dr Parr said nothing. The MDO sat down again, poured himself a glass of water, and joined his colleagues in shuffling papers on the desk whilst Hanna and Dr Parr exchanged nervous glances. Leaning forwards on his elbows, with his hands clasped in front of him, he gave Hanna and Dr Parr a long, cold stare. “I insist you both do a mandatory Medicines Awareness Course. The NAS runs a weekly course at our digital laboratory only two miles from here, and we will be delighted to provide free transport. It is time you both learned to appreciate the value of medicines.”

Hanna lowered her gaze and looked sideways again to Dr Parr. Dr Parr was slumped forward in her chair, holding her head in her hands. A few minutes passed. Silence. Then Dr Parr rose slowly to her feet and walked over to Hanna, placing her hand gently on Hanna’s shoulder. “Don’t worry Hanna” she whispered “We all know that patients who are prescribed lots of medicines find ways of organising them into their lives. Let’s talk about this.” Raising her voice, so that the MDO could hear her clearly, she continued “Hanna, it’s for you and me to decide together what is in your best interests, not some stranger from the NAS with a fancy computer. He doesn’t even know us! Hanna, we can work this out together. Let’s talk about it.”