Repeat Prescribing Policy
The purpose of this policy is to set out the methods by which a repeat prescription will be issued and the roles and responsibilities within the practice.
There are Four Stages:
- Initiation/ Request
- Production/ Authorisation
- Clinical control/ Review
- Management control
The decision to initiate or transfer a drug from an acute prescription to a repeat prescription must always be made by the Prescriber (Doctor, Practice Pharmacist or Nurse Practitioner), after careful consideration of whether the drug has been effective, well tolerated and is required long-term. The patient should be seen, or at least spoken to, at this stage to ascertain this and check compliance. It is the duty of the Prescriber to ensure the patient understands the repeat prescribing process and what is required of them.
Care should be taken to ensure the repeat record is accurate, quantities for each drug are synchronised where possible and review dates are entered.
Drugs should be linked to medical conditions within the clinical system as appropriate.
Consideration should be given to alternative drugs and / or generic prescribing where appropriate.
The Prescriber should retain an active involvement throughout the repeat prescribing process and should not delegate any entire part of the process to Administration/Reception staff.
This will largely be the responsibility of the patient, or their nominated representative.
The patient should be given a list of drugs they are currently taking on repeat prescription, forming the right hand side of the prescription slip. The patient or their representative must have an active role in requesting a repeat prescription.
The patient should be encouraged to indicate on the repeat request slip which drugs they require when a request is made. If they have left the form blank and it is not obvious from their computer record which medication is needed, then the patient should be contacted, rather than all the medication given in order to avoid wastage.
Only very urgent telephone requests or telephone requests from elderly and housebound patients can be taken. Patients should allow 48 hours for requests to be dealt with. This allows adequate time for a good quality repeat prescribing system to operate. For postal requests, to be returned via an SAE, patients should allow one week.
Patients are encouraged to tell their GP’s if they are no longer taking a repeat medication. The appropriateness of this can then be assessed and the clinical system updated to reflect the change.
It is becoming more common for chemists to request repeat medication on behalf of patients. Spot checks with patients and chemists are advisable to ensure the correct dosage and issue of medication is being made to those patients.
Production will usually be the responsibility of the Receptionist. A compliance check is preferable at this stage and the system should normally alert the user if medication appears to be over or under used. Particular attention should be paid to ‘as required’ drugs and if problems are suspected the doctor should be alerted, preferably before the prescription is produced.
The Practice should not supply further repeat prescriptions at shorter time intervals than have been authorised without agreeing the reason for the early request, e.g. holiday.
Provided there appears to be no problem, a prescription can be generated and left for the Prescribers to authorise and sign, unless:
- The request slip indicates that a review is necessary
- Any drug requested by the patient is not on their repeat record
- Where the item requested has been issued less than one month previously.
- Any request about which the practice staff are concerned or uncertain.
- If any of the following drugs are requested (unless they are already on an authorised repeat):
- Diazepam (Valium )
- Paracetamol and codeine 500/30 preparations, e.g. Solpadol, Tylex
- All controlled drugs
Where additions or corrections are made the Prescriber signing the prescription should initial or countersign against them. A record should be made of any subsequent handwritten alterations to computer-generated prescriptions.
Blank prescriptions should never be signed for later completion by him/herself or a delegate. Unused space should be cancelled out under the last drug by a computerised mechanism or by the doctor deleting the space manually.
All repeat prescriptions issued are recorded on the clinical system so that there is an audit trail.
The Practice stores prescriptions awaiting collection in a secure way and have a four week limit for collection of repeat prescriptions, after which those not collected will be investigated, e.g. no longer required or medication underused and the patients computer records should be updated to reflect this.
It may be that patients need their medication to be placed in blister packs of 7 days. This is usually appropriate for elderly patients and those that have serious difficulties managing their medication. A request should be put in to the surgery by either the chemist, district nurse or support worker and this should be passed to a Prescriber for approval. It is then usual to produce these prescriptions in 7 day dosages and the issuing of them is overseen by the Reception Manager. Care must be given if a medication is switched part way through a prescription, that the dossette boxes are also changed.
Clinical Control/ Review
This is the responsibility of the Prescribing practitioner (as long as it is within their scope of practice). The practice nurse can review certain patients on behalf of the doctor, e.g. contraception and asthma although patients may not necessarily have to be seen by the doctor. The review date is set on the computer for every 6 -12 months. For those patients who need annual review, e.g. chronic stable conditions, reviewing them in their birthday month may serve to remind patients of their obligation to attend for review.
A 28-day supply of 28 days will be given. A few patients being given three month’s supply, e.g. Oral contraceptives, HRT.
When patients are on several regular long-term medications, quantities should be prescribed to synchronise repeat intervals. In the UK patient packs are moving towards multiples of 28 days (rather than 30)
When patients are discharged from hospital, their regular medication may have changed. This is a particularly vulnerable time for errors to occur and ideally the doctor or practice pharmacist should amend the repeat record personally. A check of prescriptions not yet collected should also be made to ensure that it contains the correct medication.
The following considerations should be kept in mind by the Prescriber when carrying out medication review consultations:
- Control of the condition – is this optimal?
- Unnecessary medication – can anything be stopped?
- Compliance -Is the patient taking the medication properly?
- Could the regimen be simplified?
- Is there a problem with unwanted adverse effects?
- Check understanding of medication?
- Monitoring – is this required, e.g. phenytoin levels, INR, TFTs, LFTs, U&Es
- Cost Consideration – change to generics if appropriate, or consider changing to a more cost-effective treatment (use local formulary)
The NO TEARS tools is also a useful tool during medication reviews:
Need and indication
Tests and monitoring
Evidence and guidelines
Risk reduction or prevention
Simplification and switches
This would largely be the responsibility of the Lead Prescriber (Senior Partner) and the Reception Manager with significant support from the Senior Receptionists and Reception Team.
The practice staff are all responsible for the day-to-day running of the system and includes an appointed member of staff being given responsibility for the daily collection and processing of all repeat prescription requests.
Practice staff that are involved in the preparation of, repeat prescriptions are appropriately trained in the practice protocols for repeat prescribing and their personal responsibilities.