Patient Education

Patients will be informed of the minimum period for collecting repeat prescriptions (allow 7 working days for the repeat prescription to be processed, but no less than 3 working days) Requests can also be received via System One Online once the patient has registered for this service. (System One Online requests are managed by the Clinical Pharmacists).

If there are medication related queries on the repeat prescription request, then these may take longer than the minimum 3 working days to process the repeat prescription request.

System for Repeat Prescribing

• Requests for repeat prescriptions will only be accepted in writing. These include the repeat prescription request counterfoil that is attached to prescription. Email requests are accepted, along with System One Online requests.
• Telephone requests will be only be allowed in exceptional circumstances and clear computerised records of the conversations should be kept. Examples are: unexpectedly run out of medication; new medication recommended by specialist (although specialists are normally expected to issue scripts for the first 14 days of treatment).
• Patients who make repeated telephone requests will be noted by the Clinician and these patients will receive a letter detailing the correct way to request repeat prescriptions.
• The patient can nominate a named pharmacy for their repeat prescriptions.
• Patients will be notified of the notice period (excluding weekends and bank holidays) that is required to produce their repeat prescription.
• If patients fail to comply with the above process they will have this recorded in their medical records.

Duration of Repeat prescriptions

• Repeat prescriptions will be issued for multiples of 28 days supply. This provides safe prescribing of medication, safe drug monitoring, accurate and up to date medication reviews. There are some exceptions to this ie longer supplies of certain pills ie HRT and contraceptive pills.
• Contraceptive pills are normally given for 3 months duration, and are not issued on repeat prescriptions. If a patient runs out completely and cannot see a doctor an emergency supply is given, and an appointment arranged at the same time (if possible). Review for Contraceptive Prescribing should be at every 3 months.
• Antibiotics are usually unsuitable for repeat prescriptions. Exceptions are: COPD/Asthma excerbations, UTI prophylaxis in children and adults, sickle cell anaemia, acne, splenectomy/ some leukaemia patients. Patient’s clinical notes should show that the prescriptions for antibiotics are on repeat, or have a read code – carries emergency treatment.

Patients that are going for extended visits abroad

• There is no specific NHS Bedfordshire policy on how much GPs can issue on prescription and this comes down to what is reasonable and safe for the patient and their condition. Although we encourage 28-day issues, there is a maximum of 3 month supply limit which can be prescribed, however this is at the discretion of the individual clinician what they choose to issue on prescription. The reasons for encouraging a 28-day issue is to help minimise medication waste and allow for monitoring to ensure patients remain adherent to therapy (not over-ordering or under-ordering medication).
• With regards to this patient collecting a 4 month supply, the question of who is taking clinical responsibility for them and their condition while they are out of the country remains an issue. There is some information on NHS Choices website for those wishing to travel abroad for more than 3 months (http://www.nhs.uk/chq/pages/1755.aspx?categoryid=73&subcategoryid=105).
• The advice given is as follows and there is more information for the patient to refer to if they would like:
• If you need regular medication for a stable long-term health condition, your GP can prescribe a maximum supply of three months.
• If you’re taking a course of medication that will finish during your holiday, then get advice from your GP. They may be able to give you a repeat prescription.
• However, this will depend on, for example:
  • how long your GP thinks you’ll continue to need your medication
  • how often your treatment needs to be reviewed

New Patients

• Doctors will add the medication of new patients.
• All new patients will be asked to bring the repeat half of any prescriptions issued by previous doctor’s surgery (if they have been previously registered in the UK). Or empty packets of medication.  Any information will be photocopied for future reference.
• If new patients have a current problem or complicated medication the registering nurse should ask the patient to make a GPs appointment

Repeat Prescription Review

• Repeat prescriptions will be regularly reviewed.
• All Repeat prescriptions for new medication will be reviewed by the doctors on a regular basis until the patient is stabilised on the medication, once stabilised, patients should be seen for review after a period of time that has been agreed by the surgery.
• Repeats that will last a duration 1, 3 or 6 months (repeats by number of items not date) will be issued before a review is necessary. The period depends on the patient’s problems and necessary monitoring. The repeats will be done by the number of issues rather than setting an expiry date.
• Patients can be identified as not picking up enough/ too much medication by this method.
• Patients identified as picking up too much medication or losing medication/scripts on a regular basis will be identified by this method especially opiates and controlled drugs and will be put on a monitoring programme, they will be required to attend for a monthly review and nominate a pharmacy for the collection of the prescription. The doctor will decide whether to issue weekly prescriptions.  (See appendix 5).

Issuing emergency repeat prescriptions for patients who miss reviews to ensure they are not without medication, will take place at the repeat prescription doctor’s

• THIS MUST BE MARKED IN THE COMPUTER RECORD (use code .66R REPEAT PRESCRIPTION MONITORING or entered as an Admin Note on patient records) SO AS TO AVOID REPEATING NEXT MONTH.
• Re-authorisation can also take place after eg Diabetes review or Asthma Review for a further 12 months

Medication Review for Older People and Vulnerable Patients

For Older people or vulnerable patients, a medication review should take place at least every 12 months (Patients over 75 years taking 4 or more medications will have their medication reviewed at least every 12 months and ideally every 6 months.)   (NSF for older people). Pharmacists serving some Care homes (Complex Care Team BCCG) are currently providing a medication review service for the patients in that home.

• Doctors will ensure that ALL changes in medication are authorised for change by the pharmacist or nurse practitioner and the dose are entered in the patient records and the authorisation for repeat prescription for the old medication or dose is removed whilst instigating the new authorisation. All discharge letters and clinic letter medication changes should be actioned by the doctor receiving the letter. IF THERE IS ANY DOUBT ABOUT WHAT IS PRESCRIBED THE Doctor or Pharmacist attached with the GP surgery SHOULD CONTACT THE PATIENT AND/OR THE HOSPITAL.
• Reviews carried out by pharmacists will be recorded in the computer records and any vital advice actioned. This will prevent any repetition in work.
• Complex Care Team may be involved with this group of patients

Care Homes

• Doctors will adopt the following principles of good practice when managing repeat prescriptions request from care homes:
• Requests should come from carers NOT pharmacists although situations may arise when a pharmacist may need to address a particular problem
• Do not repeat directions “as directed” as this cannot be administered by carers. Refer to GP for dose to be advised
• Watch for regular requests for prn medication which seems inappropriate
• Watch for use of large quantities of creams, dressings, appliances etc.
• 28 day prescribing for patients
• Homes may be using compliance aids, which operate a 28-day cycle. Patients may come into the home mid-cycle. Requests may therefore be for odd quantities to set patient into system. This will mean less long-term work for the practice as all patients in the home will then send in requests for repeat prescriptions at the same time.
• Patients with learning disabilities sometimes spit out medication, which therefore needs replacing. Pharmacists may have request prescriptions for small quantities, e.g. 1 or 2 tablets. WE have agreed with our local home (Valley House) – if patient’s spit out – mark as missed dose, and if 3 consecutive doses are marked as missed then the Home and Carers are to inform Pharmacist (Jenny) or GP or Social Worker or Consultant for Learning Disabilities for further advise and action

Staff

• All Repeat prescriptions of medication will be produced by trained members of the Pharmacist team,  reception team and/or doctor/nurse in response to patient/carer request. The doctor is responsible for checking and authorising before signing.
• The practice has identified named staff (appendix 2) who are be responsible for managing and running the repeat prescribing system. This involve reviewing requests, issuing repeat prescriptions, notifying the pharmacist or doctor when a medication review is due and to avoid delays in the issue of the repeat prescription, reception staff will create a paper trail of those needing a medication review and provide to the clinical pharmacist.
• Staff should have adequate training to be able to manage these systems. This should be part of their job description and they should have protected time for this work. New staff should be trained before taking on this duty.  All staff should be kept informed of new developments in the systems.
• A checklist is given with this pack to aid staff when reviewing repeat prescriptions. (Appendix 3)
• No routine prescription requests are to be issued by the trainees at the practice (i.e. FY2, ST2 and ST3 doctors) prescriptions will only be issued during consultations or home visits.
• Extra care should be taken when issue ‘special’ medication or liquids that do not automatically appear on the picking list in System One, there is a cost implication as well as a safety issue if details are entered incorrectly.
• Handwritten prescriptions must have the details of the medication entered onto System One for future reference.

 Issuing Controlled Drugs to Patient

To form a Controlled Drug (CD) register for collection of all CD prescriptions.

• Patients must show form of identity when collecting prescriptions from the surgery.
• If a representative is collecting on behalf of patient, they must have a signed letter of authority from the patient which scanned into the patients notes for future reference.
• Patient/ representative to sign the register to confirm they have collected the prescription.
• There must be no changes made to entries without an explanation (if an error is made for example)

Repeat Medication Reviews and Drug Monitoring

• For the purpose of safe prescribing of medication, in most cases, a blood test, blood pressure readings and weight are required. Patients will be given advance notice of these required checks before any further medication will be prescribed.
• Patients will be advised that failure to engage in the required monitoring, the Practice has the right to stop all medication being prescribed until patient engagement has taken place.